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Rating of clinical performance and examination scores are employed to establish the final grade of students undertaking the surgical clerkship. This retrospective study was undertaken to determine whether there is a correlation between these two grading procedures in evaluating students. Grades for clinical performance and the scores obtained on the written examination-either intramural (IM) or extramural (EM)-by each student for 20 recent consecutive 12-week surgical clerkship rotations were tabulated and the correlation (regression) coefficients of the two grading systems calculated in each rotation. By means of a questionnaire, grading methods employed in 60 randomly selected US medical school surgical departments were requested (55 responded). Correlation coefficients indicate that there is no statistical correlation between the grades of the clinical performance and the written examination in the majority of rotations (80 percent IM and 70 percent EM).GRADING PROCEDURES USED TO DERIVE THE FINAL GRADE AND THE MEANS OF REPORTING IT IN OTHER MEDICAL SCHOOLS ARE AS FOLLOWS: 41 percent (23/55) used the clinical performance and written examination; 38 percent (21/55) used the clinical performance, written examination, and oral examination; and 20 percent (9/55) used the clinical performance only. For the final grade, 91 percent (50/55) subscribed to honors, pass, and fail categories and 9 percent (5/55) preferred a numerical grade.