A Narrative Study of Equity in Clinical Assessment Through the Anti-Deficit Lens

Acad Med. 2020 Sep 1. doi: 10.1097/ACM.0000000000003690. Online ahead of print.


Purpose: Efforts to address inequities in medical education are centered on a dialogue of deficits that highlight negative underrepresented in medicine (UIM) learner experiences and lower performance outcomes. An alternative narrative explores perspectives on achievement and equity in assessment. This study sought to understand UIM learner perceptions of successes and equitable assessment practices.

Method: Using narrative research, investigators selected a purposeful sample of self-identified UIM fourth-year medical students and senior-level residents and conducted semi-structured interviews. Questions elicited personal stories of achievement during clinical training, clinical assessment practices that captured achievement, and equity in clinical assessment. Using re-storying and thematic analysis, investigators coded transcripts and synthesized data into themes and representative stories.

Results: Twenty UIM learners (6 medical students and 14 residents) were interviewed. Learners often thought about equity during clinical training and provided personal definitions of equity in assessment. Learners shared stories that reflected their achievements in patient care, favorable assessment outcomes, and growth throughout clinical training. Sound assessments that captured achievements included frequent observations with real-time feedback on pre-defined expectations by supportive, longitudinal clinical supervisors. Finally, equitable assessment systems were characterized as sound assessment systems that also avoided comparison to peers, used narrative assessment, assessed patient care and growth, trained supervisors to avoid bias, and acknowledged learner identity.

Conclusions: UIM learners characterized equitable and sound assessment systems that captured achievements during clinical training. These findings guide future efforts to create an inclusive, fair, and equitable clinical assessment experience.