During this clerkship you will be evaluated in all of the
six core competencies of the college of medicine. Performances can
range from exemplary to needing remediation. Your grade will be
directly based upon the level of competence you demonstrate by the end
of the clerkship. As you know, the competencies are highly
interrelated and therefore the way we divide some of the behaviors is
somewhat arbitrary. But when viewed as a whole, the six competencies
do cover all the major qualities we want to assess in your development
as a physician. There are multiple ways we can assess your competence
on this clerkship no one evaluation is weighted the same for each
competency. In other words, your team evaluations are not simply
turned into a number that falls within a certain grade range. I want
to make the grading process as transparent as possible so will try to
give you the ‘inside scoop’ on how I weight various aspects of your
performance to generate your competency level and your final grade.
On the medicine clerkship we assess you using a standard MCQ
NBME subject exam, evaluations by your team and
content of a learning portfolio that you
will create. Each of these methods of assessment works well for some
competencies and not as well for others. The following is a breakdown
by competency of how the evaluation tools are weighted.
Professionalism (10%): This is
best assessed by your teams so the ward evaluations are the primary
method of assessment. However, the way you interact with staff, your
portfolio advisor, and your ability to follow directions are also
taken into account.
Patient Care (35%): This is very
much a combination of ward evaluations and portfolio submissions.
Students tend to need the most help with physical exam skills, patient
write-ups, and oral presentations. There are ways to provide clear
evidence in the portfolio of your achievement in these areas. Please
note patient write-ups are looked at very closely, particularly in
terms of how you organize a problem list into a differential diagnosis
and subsequent working diagnosis. (Doc-in-the-box sessions can really
help you learn to do this if it is a weak area.)
Medical Knowledge (25%): This
is primarily assessed by the subject exam, though your clinical
reasoning in your write-ups is taken into account. A score of 80 or
better is required to earn an exemplary rating in this competency.
Practiced-based Learning
(15%):
The way you put together your portfolio and specific entries related
to PBL like self-assessment, goals, developing life-long learning
habits are weighted more heavily than ward evaluations.
Human Communication (10%): This relates primarily to your
interaction with patients and thus is assessed by your ward teams
though you also have the opportunity to ask patients to directly
evaluate you and this can be included in your portfolio.
System-based Practice (5%):
This is evaluated both by your ward team as it related to your ability
to function as part of a team but all the other aspects of this
competency can be demonstrated in the portfolio so both assessment
tools are weighted pretty evenly.
The above summarized what we believe are the optimal assessment
tools for each competency. I know you are interested (understandably)
in how this translates into a grade. So I will try to summarize that
as well. One fundamental principle I use is that three of the six
competencies don’t necessarily change much as the year progresses
(professionalism, PBL, and human communications). This doesn’t mean
you can’t improve in these but it means you can theoretically start
the year performing at an exemplary level so my expectations are
higher for these competency. Other competencies (patient care, medical
knowledge, and SBP) are very dependent on experience and practice so I
expect you to perform at a less proficient level earlier in your
training and this is taken into account. Patient care and medical
knowledge are generally weighted more heavily in terms of your overall
performance.
A: This represents an exemplary performance and is not easy
to achieve. You will need to be exemplary in most competencies and
definitely exemplary in professionalism. To achieve overall
exemplaries, you will need to put in extra work to the portfolio
particularly to supplement areas you have identified as weaker points
for you. You are also expected to perform above the mean on the
subject exam. (The mean has traditionally been a 78.)
B+: This is where most of you will fall as you will earn
mostly very good to exemplary ward evaluations, you will follow the
directions for your portfolio and submit all the required elements,
and will achieve at least a B on the subject exam.
B: This is the grade for a student who has performed
competently in all ward evaluations, passed the exam, and the
portfolio (which implies competent write-ups).
C: There is no C+ in this clerkship as I cannot meaningfully
distinguish a C+ from a C. This grade is reserved for students who may
receive a “needs remediation” evaluation on a competency, fail to pass
the exam on the first try, or submit an incomplete portfolio BUT who
are able to demonstrate overall competence by the end of the
clerkship.
I: This is given to students who do not pass the subject
exam and are awaiting the retake or may have an extenuating
circumstance that requires them to complete the clerkship later.
D/F: This is given to students who do not demonstrate basic
competence by the end of the clerkship at the discretion of the
clerkship director. This could result from a range of problems from
unprofessional behavior to failure to submit competent patient
write-ups. (A “D” is given to a student who we believe can be
remediated without having to repeat the entire clerkship, while “F” is
reserved for any student we believe will need to repeat the entire
clerkship.)
