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. 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, exam, evaluations by your team (the questions on the evaluation tool that are most relevant to the competency are in parentheses and in italics below), and submissions to 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. (Roughly 1/3 is medical knowledge, 1/3 is patient care/ PBL, and 1/3 professionalism/communications/SBP)
Professionalism (~10%): This is best assessed by your teams so the ward evaluations are the primary method of assessment (questions 4, 5, 7, & 10). However, the way you interact with staff, your portfolio advisor, and your ability to follow directions are also taken into account.
Patient Care (~20%): This is very much a combination of ward evaluations (questions 12-28) 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 (e.g. mini-CEX, progress notes, write-ups, evaluations of observed physical examinations).
Medical Knowledge (~33%): Fund of knowledge is primarily assessed by the subject exam. The scores correlate to competency level in the following way:
≥ 85% = exemplary
50%-84% = very good
11%- 49%= competent
≤ 10% = needs remediation and will result in an “incomplete” in the clerkship until the exam is passed on a second retake. Failures beyond that will be referred to the Academic Status Committee.
Clinical reasoning ability is also critically assessed through ward evaluations (questions 30-31, 36) and write-ups. Please note patient write-ups are looked at very closely, particularly in terms of how you prioritize and organize problems into a problem representation, develop 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.)
Practiced-based Learning
(~15%): The way you put together your portfolio and specific entries related to PBL like self-assessment, feedback, goals, and developing life-long learning habits generally are weighted more heavily than ward evaluations as we recognize that much of what you do to improve your own practice may go unseen. However, we would expect the team to recognize improvement. ( questions 34-35) Completion of SIMPLE cases and patient logs is also taken into account.
Human Communication (~10%): This relates primarily to your interaction with patients and thus is assessed by your ward teams (question 32-33) though you also have the opportunity to ask patients to directly evaluate you and this can be included in your portfolio. Eight or more patient evaluations will take precedence over team evaluations of your patient communication skills.
System-based Practice (~10%): This is evaluated both by your ward team (questions 6, 33) 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 competencies. 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.
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 raw score.)
B+: This is where most of you will fall as you will earn mostly very good to exemplary ward evaluations (consistently above average), you will follow the directions for your portfolio and submit all the required elements, and will achieve over the 50% 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) but may have had some difficult in specific competencies (not consistently above average).
C+/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.)
