An Analysis of Obstetrics and Gynecology Medical Student Performance Evaluation Clerkship Narratives: Insights From the PRIME+ Framework

Abstract

Background: Despite existing guidelines for writing clerkship summative assessment narratives, their quality, structure, and utility remain variable. Categorizing Medical Student Performance Evaluation (MSPE) narratives using a framework can reveal patterns and gaps in content, offering actionable insights. Objective: This study aimed to (1) categorize MSPE narrative comments using the PRIME+ framework (professionalism, reporting, interpreting, managing, and educating, and areas for improvement [+]), and (2) examine differences in length and content by gender, race, origin of medical school, and final clerkship grade. Methods: Seven hundred twenty applications to our obstetrics and gynecology (OB/GYN) residency program in 2023 were reviewed, focusing on the OB/GYN core clerkship narrative. Narratives were categorized using the PRIME+ framework, and differences in length and content were assessed by gender, race, origin of medical school, and final grade. Differences between groups were evaluated with nonparametric tests. Results: Six hundred fifty-three narratives from 231 medical schools were included. Fifty-one unique grading systems were reported. PRIME+ domains were represented as follows: professionalism (94.8%, 619 of 653), reporter (71.1%, 464 of 653), interpreter (37.5%, 245 of 653), manager (69.1%, 451 of 653), educator (69.7%, 455 of 653), and areas for improvement (3.7%, 24 of 653). For each domain, <13% of narratives included ≥1 specific example. Median word count differed between US-based (155 words; 95% CI, 148-162) and international (61 words; 95% CI, 51-75) applicants (P=.001). Students earning “honors” had longer narratives (median words 149; 95% CI, 131-164 vs 117; 95% CI, 97-134; P=.001) with more specific examples (1.2 examples; 95% CI, 0.97-1.4 vs 0.88; 95% CI, 0.53-1.2; P=.024) and advanced PRIME+ domains, specifically educator (P=.016). The number of specific examples differed by race (P=.02) but not gender. Conclusions: MSPE narratives for the OB/GYN clerkship demonstrate variability in content and length.