Assessing the Student

• Students, of course, because they rely on your assessments for accurate descriptions and ratings of their behaviors in the clinical setting. The just in time assessments you complete contribute to student understanding of their performance, just as your timely feedback helps students improve their medical skills. Your assessments also impact student grades and promotion in medical school. We have an appropriate process for assistance and remediation for students in need. Student are not going to fail if they don’t get top marks! We recognize that not everyone can or will earn top marks and assign grades appropriately.
• Medical educators because you play the role of providing the student assessment which contributes to promotion in and graduation from medical school.
• Medical school administrators and curriculum developers because they must make decisions about student promotion and the curriculum of the medical school. The assessments you complete let us know if our curriculum at the school is providing a strong enough foundation.
• Hospitals and clinics because our learners will one day work in these settings with continued promotion through medical school.
• Patients because, with continued promotion, our learners will one day care for patients as licensed physicians. We hope they will provide culturally competent, evidence-based care to future patients.

• Students saying they won’t get a good residency if they don’t get the highest rating. This is NOT TRUE.
• Thinking that the amount of time you had with the student wasn’t enough. Anything counts; even spending a half day with a student may offer a prime opportunity to give the student feedback and provide assessment. You can also ask for input from others in the environment, such as staff and patients.
• Thinking that the student will not receive remediation. We have assistance and remediation available for learners.
• Thinking that you haven’t had training on how to best assess the student. We are available to address your concerns and help develop you in assessment.

We’ve designed our assessment forms so that the middle option is where we expect most of our students to be during most of the third year. We expect that at the beginning of the year, some of them may not be able to consistently get a middle mark; at the end of the year most will consistently earn a middle mark and may earn higher marks. Here’s an example a possible question from the ASPC with the middle answer marked with an arrow. We also include unable to determine just in case you are not able to evaluate the student on that area.

Your assessment of our students is not just about a grade. We expect that our students will be in the middle somewhere. If students do earn high and low marks, we expect narrative comments from you so that we can help the student and all necessary stakeholders to understand these ratings. We are not using the items that contribute to professionalism for the student’s grade, such as discernment, conscientiousness and emotional intelligence. You should also know that student assessments contribute to, but are not, the entire clerkship grade. Grades may also come from quizzes, student write-ups or presentations, on campus OSCE simulations, Formal presentation by the student, and an NBME exam (shelf exam) given at the end of each clerkship.

You may be asked to complete just in time assessments or assessments at the midpoint or end of the clerkship. Just in time assessments are based on a defined interaction with the student, such as observing the student obtain and history and perform a physical examination or providing a quick summary of an article. The student will give you a card to complete prior to the just in time assessment. These just in time assessments may have supervisory scales that are a different way of letting us know where you feel the student is at by letting us know how much you had to help them. These supervisory scales will contribute to decisions about where students are in the thirteen EPA’s; EPA stands for Entrustable Professional Activities, sets of behaviors expected of all medical school graduates entering residency. Your assessments, along with assessments from other medical educators, will contribute to decisions about where students are in the EPA’s.

The midpoint and end of clerkship assessments will likely be emailed to you. This end of clerkship assessment is also called the ASPC, or Assessment of Student Performance in a Clinical/Clerkship Setting, assesses student skill in obtaining patient histories and performing physical examinations as well as the student’s ability to present and document the patient interaction. The ASPC asks you to assess the student’s ability to provide an assessment and management plan. Further, the ASPC asks you to assess professional skills such as truthfulness, conscientiousness, accountability and ability to work with others.

• “R-I-M-E” is an elegantly devised and highly practical structure for evaluating student performance in the real clinical setting developed by Dr. Louis Pangaro. The levels of reporter-interpreter-manager-educator correspond to the developmental competencies of clinicians in training.R: A Reporter has the skills to obtain a history and physical examination and communicate that information to colleagues in written and oral forms.
• I: An Interpreter knows how to reason through this information to determine what problems and diagnoses a patient has or might have.
• M: A Manager knows how to take care of the patient and does so, including treating his/her medical problems and conditions.
• E: An Educator is a manager who asks questions about how to improve patient care, seeks the information to answer those questions, and communicates his/her knowledge to others for wider benefit.