Career Choice Disclosure and Clerkship Grades Among Orthopaedic Residency Applicants

Objective Medical student clerkship evaluations are susceptible to preceptor bias. Students interested in orthopaedics may choose not to disclose their career path during clerkships to avoid bias. The purpose of this study was to identify factors that may lead to grading bias, including career choice disclosure, among medical students interested in a career in orthopaedic surgery. Design A cross-sectional survey was performed by distributing an anonymous electronic survey. Respondents were asked if they disclosed an interest in orthopaedic surgery during core clerkships and whether or not they believed it impacted their grade. The relationship between demographic variables including age, gender, race, ethnicity, and geographical location were also collected and compared. Setting Multiple institutions in different geographic locations in the US. Participants Medical students in orthopaedic interest groups or those who completed an orthopaedic surgery rotation. Results Of 149 responses, 90 (60.1%) of students chose to disclose an interest in orthopaedics during all clerkships. Over 50% of students were able to achieve honors in core clerkships except for OB/Gyn (41/112, 36.6% honors) and emergency medicine (17/59, 28.8% honors). On average, 7.9% of students believed disclosure had a negative impact on their grade, but in internal medicine and OB/Gyn, those that disclosed were able to achieve honors more often than those that did not. Males (38/50, 76%) were given honors more often than females (11/24, 45.8%) in their surgery clerkship and those that identified as “other” race (1/6, 16.7%) achieved fewer honors in surgery and pediatrics compared to White, Black, Asian, Indian, and Hispanic students (48/68, 70.6%). Conclusion Some students believe disclosing an interest in orthopaedics may negatively impact their grade, but the opposite may be true. Other potential areas of bias include gender and race. More research is needed to improve the clerkship evaluation process given an increasingly competitive application process.