II. Template for Clerkship Written Report

 

II.C.  Evaluation Data of the Course or Clerkship (Sample from Pediatrics)

 

1. Final Grade Distribution

Year	A+	A	B+	B	C+	C	D or F
2003		21%	39%	32%	4.4%	3%	.5% incomplete
2002		30%	23%	44%	-	3%
2001		30%	27%	38%	1.5%	2.5%
2000		25%	36%	32%	5.1%	1.0%
1999		30%	35%	31%	1.7%	1.7%

 

2. NBME Exams Performance: NBME scores for past year are equivalent to the national data. Mean is higher than national scores in 5 out of 6 pediatric clerkships. Only three students failed the exam but improved on the retake. One student of the class of 2003 has yet to take the exam (missed due to illness).

 

3. Reference to Clerkship Objectives: A primary goal of the Pediatric Clerkship is to have students demonstrate competency in obtaining history and performing physical exam on pediatric patients which is done in the Harrell Center with tape review. The rest of the competencies are evaluated in the clerkship with evaluation forms by residents and faculty.

 

4. Copy of lecture and online evaluations (attached)

II.D. STUDENT EVALUATION OF THE CLERKSHIP AND THE DIRECTOR (Sample from FM/G)

 

1. Synopsis of student written evaluations of the clerkship. The clerkship received very good overall evaluations. Average numerical rating over the entire year ranged from 4.1 for increasing skills in physical exam to 4.4 for improving interviewing skills. Several categories showed a slight increased from last year. The students gave the course an overall rating of 4.4 for the year (increased from 4.3 last year). Of the individual components, the Family Medicine and Medicine components were rated most highly (4.2 each, essentially unchanged). The rating for the Geriatrics component increased from 3.4 last year to 3.6, demonstrating a modest improvement.

Narrative comments were very consistent with the numerical ratings. Suggestions for change were often conflicting. For instance, one student would want more of one thing while another wanted less. Many comments still focus on the Geriatrics component, with many students favoring deleting Geriatrics entirely. This seems to be largely because it is not a popular topic and because students feel they get exposure to many elderly patients throughout the 3 d year. This is addressed under section F2 below. Several students gave specific suggestions for changes in the Friday sessions. In response to these suggestions comments, two speakers were changed.

2. Synopsis of student debriefings. Debriefing comments closely mirrored the comments described above. Most of the suggestions for change centered around trying to improve the quality of certain sites, suggestions regarding Friday sessions, and suggestions about the Geriatrics component. Changes made in response to student feedback are discussed under section F2 below.

3. Summary of evaluation of Course Director and administrative support. For the year, Dr. Hatch's performance as course director received an average rating of 4.6 (increased from 4.4 the previous year). Written comments were also very positive, with 16 complimenting the clerkship organization and his approach. The previous year, some students had suggested that students should be given a better idea of what to expect on the exam. After trying harder to do this over the last year, no students made that comment this year.

II.E. EVALUATION OF INSTRUCTION (Sample from Medicine)

 

1. Number of hours that students spent learning in various modalities:

 

a. Twenty-two formal lectures by faculty: There are three hours per week of interactive seminars as well as one hour a week of Medical Grand Rounds. Once a month, students attend Morbidity and Mortality conference as well as Chief of Medicine Rounds with Dr. Kitchens.

 

b. Small group discussions: The students spend approximately two hours per day meeting with their attending physician and the rest of the medical team, which consists of one resident and two interns. They also spend four hours per week in a medical subspecialty clinic working one-on-one with an attending physician. The students spend one to two hours each week in groups of approximately four to six with either Dr. Lynch and Dr. Harrell at Shands Hospital or one of the hospitalists at the VA Medical Center. These sessions consist of case presentations and bedside teaching.

 

2. Synopsis of the student evaluation of the overall instruction by faculty and staff. Teaching by attending physicians was rated 4.1 by students during 2001-2002. Teaching by ward residents and interns was rated 4.1. Written comments regarding teaching by faculty and housestaff were, in general, very positive. The separate inpatient and outpatient faculty and housestaff evaluations were very strong particularly at Shands and Jacksonville. These ratings were in the 4*3-4.4 range.  There were only a very few isolated negative comments about faculty or housestaff.

 

3. Critique of the overall teaching efforts of faculty and staff with identification of strengths and areas for improvement: The faculty lecture series and the Doc in the Box sessions lead by Dr. Lynch are consistently highly rated. However, the primary strength of teaching on the Internal Medicine Clerkship remains the day-to-day in-depth discussions that occur regarding patient care among the students, faculty and housestaff. Because of the large number of faculty and housestaff in our department, an area for improvement remains the heterogeneity of teaching efforts and abilities among the large group of physicians who teach the students (despite initiatives to improve it). Heterogeneity among teaching efforts by the faculty may need to be addressed by faculty development. Another area in need of improvement is that attending rounds are not always conducted at the level of the student, but rather arc work rounds directed at the housestaff level. This has been an ongoing problem for the past several years, since the Medicare regulations mandated closer involvement of faculty in the day-to-day details of patient care. The new chief residents have made this an area of focus for the 2002-2003 year and are involving the chairman. Finally, replacing the lecturer changed three of the seminars that had low evaluations at the midyear point. All of the evaluations improved and the two renal lectures, given by Dr. Weiner, are now among the highest rated. The lecture series is now even more highly rated.

 

II. F. DIRECTOR'S EVALUATION OF THE CLERKSHIP (Sample from Ob/Gyn)

 

1. The appropriateness of the clerkship to the curriculum's general professional education program:

a. Certainly the Ob/Gyn Clerkship is appropriate to a general professional education. 88% of students felt the clerkship provided them with a very good or excellent experience if they did not plan to specialize in Ob/Gyn and 86% of students felt their clerkship experience was very good or excellent for making a career choice. We are frustrated that women's health does not have a larger part in the curriculum. We are teaching two separate disciplines (Gynecology and Obstetrics) over two sites. Almost 20% of the class felt the clerkship was too short (only four students thought too long). We feel that we teach not just Ob/Gyn but good medical practice with excellent instructors. Six weeks is just not enough time to either cover all the material or get to know the students, as we would like. Psychosocial issues, sexuality, and expansion of oncology, endocrinology, breast disease and preventive care are just some of the topics in the national curriculum we would like to address. There is tremendous opportunity for interdepartmental collaboration, which we do not have time to utilize.

b. On the Class of 2002 AAMC Graduation Questionnaire, Ob/Gyn received the highest ranking of any COM program compared to students from other schools. This is consistent with previous questionnaires and reflects the high regard in which the students hold their Ob/Gyn experience even months after finishing the clerkship.

c. Course content covers the Clinical Presentations specific to Ob/Gyn as well as  much of the national curriculum as time allows. A variety of teaching methods are used. Small group discussions, shadowing, modeling, and constant integration of the students into activities not student specific are all emphasized. Notable are the Case-Based Conferences (CBC) that replaced lectures. For each curriculum topic, students are given at orientation, 3-4 illustrative cases with 3-4 corresponding questions. Students are expected to discuss the cases and questions at the CBC. This was initiated as a modified PBL exercise with more responsibility for information from the student rather than from the faculty. Three other advantages over lectures became clear. (1) Because the students have done the major work ahead of time, missing the CBC (ex. to do a delivery) was not as critical to the students and facilitated them taking advantage of clinical opportunities with less stress. (2) Because the students do the major work, faculty can easily substitute for each other and so it is exceedingly rare for a CBC to be cancelled. (3) Every session is different which keeps faculty enthusiasm high.

2. Strengths and weaknesses of the clerkship and plans for improvement:

a. The primary strength of the clerkship is the commitment of the department and the chairman to student education. Education is the reason the Department of Obstetrics and Gynecology exits at the University of Florida. Faculty and residents are recruited for teaching experience, interest and excellence. The Chairmen at both sites commit a considerable amount of the Directors' time to run the Clerkship. In addition, the Department commits to a full-time clerkship administrator. Student Education is a standing item on the agenda for faculty meetings. The Department fights a continuing battle to keep an adequate call room available. There is no plan to change.

b. Within the limits of six weeks we are able to give students a broad overview of the field with an emphasis on basic generalizable clinical problems. 88% of students felt the clerkship provided a very good or excellent experience if they did not specialize in Ob/Gyn. As explained above we would like more time to expand on and add to the topics we cover. No change in our time allotment is seen in the future.

c. The department has been innovative in several ways.

vii. For CBC's, both in GNV and JAX, students have large nameplates that they place in front of themselves. This has facilitated the faculty leaning their names, which has improved evaluation.

viii. Although teaching instruction is very good only a small portion is provided in direct Attending - Student sessions. As a relatively small department, faculty must cover several services at several sites and the time for teaching students in the absence of residents just does not exist. Of particular importance is that resident and ARNP Continuity Care Clinics (which is where all the patients are) have a tremendous negative impact on faculty opportunity to interact directly with students in the outpatient setting. This will not change in the foreseeable future.

ix. Although now competency based, most of the student evaluation is still by interaction and observation. Nationally, OSCE and standardized patent examinations have been used in Ob/Gyn clerkships but these clerkships have been eight weeks long and/or have fewer students per class. In view of these limitations for its use here, we must rely on continued faculty and resident development in the area of student evaluation. We eagerly look forward to COM activities in this area.

x.  Numbers of patients is just adequate. For example, although students do an average of 5 deliveries, the range is >15 to 2. Every   student this year but one indicated they could do a delivery on their own if needed but all wanted to have done more. A delivery is not just a mechanical event. It is sharing with a woman and her family one of the most intimate and miraculous moments in life. It teaches respect for the human body as a wonderful work of nature which does just fine without our intervention. No were else is "First do no harm" as evident. No physician ever forgets his or her first delivery. Managed care resulted in a drop in the number of deliveries by our department over several years but we seem to stable at present. Since this is a national trend, as students do fewer deliveries at all medical schools, interns enter with less experience and are less likely to pass down procedures to students. The addition of PA students this past year and more fourth-year students than ever on elective creates competition. The same situation applies to gynecological procedures and surgery. Priority is given to third-year students but we have to fulfill all mandated commitments. No increase in patent volume or decrease in number of students is seen in the near future. We have been able to hold total patent numbers stable over the last several years by matching the decrease in patents seen at the Women's Health Group and outlying prenatal clinics with an increase in the number of patients seen at the Park Avenue Women's Center. The role of students in the care of the latter is being debated within the department.

Director and the Chairman at JAX to improve the rotation. At a meeting of the Ob/Gyn Clerkship Directors, Chairmen and Deans for Education of both sites, student feedback was evaluated and it was hypothesized that the relatively low evaluation of JAX was the result of two factors: The short length of the rotation (2 weeks) did not permit students time to become comfortable with the instruction and instructors at the site, and many students resented being forced to go to JAX without a choice (all student rotated through JAX). It was decided to change the structure of the clerkship for the class of 2004 from three 2 week rotations (2 weeks in OB in GNV, 2 weeks in GYN in GNV and 2 weeks in OB & GYN in JAX) to two 3 week rotations (OB or GYN in GNV and OB or GYN in JAX) with the students having the choice of what to do where. Both sites have jointly analyzed the GYN and OB rotations to be sure that the students will have comparable opportunities and experiences at both sites. Syllabi and rotation modules have been created for the new format. The downside of the new format is that the faculty will interact (and vice versa) with only two-thirds of the students rather than all of them, as is now the case.

3. Long-term goals for development and new directions for the clerkship

a. Overall, we feel we are making the most of the time and clinical material available under the outside constraints under which we must operate. However, strengthening every faculty, resident and staffs ability to teach effectively is an on-going project. Dr. Pat Duff, a founding member of the Society of Teaching Scholars, presents a program, "Leaning to be anEffective Teacher" for our residents. This includes Teaching in Sound Bites, Providing Constructive Feedback and Engaging and Confirming the Student. We also look forward to integrating the program created by Dr. Genuardi in Jacksonville into Gainesville resident education. COM Faculty Development sessions are now also available.

b. The most significant future development is the change in clerkship format for the class of 2004 from three 2-week rotations to two 3-week rotations as described above. Not only will this benefit the JAX experience but will also result in the Gyn and Ob services in GNV interacting with the students for 3 weeks instead of only two. Both departments are very excited about the new format and results of this change will be monitored closely.