Purpose. To evaluate a review process for identifying marginal perform
ers among students in a clerkship. Method. To better identify the marg
inal performers among the students participating in the medicine clerk
ship at the University of Minnesota Medical School-Minneapolis, the Me
dicine Clerkship Committee reviewed in 1990-91 and 1991-92 all student
s rated by faculty or housestaff as below expectations for any of nine
areas of clinical performance (27 students of 890, 3%). (In the past,
a student was considered to be a marginal performer only if he or she
was assigned an unsatisfactory numerical grade, calculated from the n
ine ratings, or if written comments by housestaff and faculty and the
opinions of the attending faculty and clerkship site coordinator indic
ated that the student should fail.) Chi-square analysis was used to co
mpare the number of students judged to be marginal performers under th
e review process with the number of marginal performers in 1988-89 and
1989-90. The two groups were also compared based on their preclerkshi
p performances on standardized examinations. Results. Ten of those rev
iewed (37%) were judged to have performed marginally. Although the stu
dy group's performance on standardized examinations was not different
from that of students during the previous two years, significantly few
er students were identified as marginal performers before the review p
rocess began than afterwards (2 of 867, 0.2 %, versus 10 of 890, 1.1 %
, p < .05). Conclusion. Without changing the way in which faculty and
housestaff evaluated students, the review process improved the medicin
e clerkship evaluation system by identifying significantly more studen
ts who were marginal performers.