What do grades in clinical subjects depend on? Case study of the Zagreb University School of Medicine.

Aim: To investigate the influence of clinical site, student's and preceptor's sex, and preceptor's academic rank on grading in eight clinical subjects at the Zagreb University School of Medicine between 1999 and 2002.

Methods: We analyzed oral exam grades from five fourth-year clinical courses (radiology, oncology, nuclear medicine, internal medicine, and psychiatry) and three fifth-year clinical courses (surgery; ear, nose and throat diseases (ENT); and pediatrics). Internal medicine course also had a written test, common for all students. We recorded the clinical site where the exams were taken, clinical subjects, grades, number of attempts at passing the exams, student and preceptor gender, and preceptor academic rank. Chi-square test was used for data analysis.

Results: Grades from all clinical subjects but internal medicine course significantly differed, depending on clinical site where the exam was taken. There was a significant difference in grades from the internal medicine written exam among teaching sites. Preceptors with higher academic ranks awarded better grades. Male and female students performed equally well. Female preceptors gave significantly lower grades, regardless of the student gender and created a higher failure rate.

Conclusion: Oral exams are a subjective method of evaluating students' knowledge of clinical subjects and depend on the site of teaching and examination. Written exams and structured clinical skills examinations should be implemented for objective student assessment.