Clinical skills are developmental in nature. These skills must be taught and evaluated at increasing levels of proficiency from the beginning of the medical education process through the residency years and beyond. Competency at basic, intermediate and advanced levels of proficiency in the clinical skills can be defined and criteria for mastery specified. Evaluation of most of the clinical skills requires direct observation of student's performance.
Basic Clinical Skills Series I-IV should be vertically integrated and learner objectives defined in the following skill areas:
Courses other than BCS I-IV should provide opportunities for teaching and assessment of these skills in years 1 and 2:
Performance Based Examinations (PBE) will be used for evaluation of these clinical skills.
PBE I content will focus on:
PBE II content will include:
PBE IV will be a comprehensive evaluation of knowledge, skills and attitudes.
All PBEs will incorporate basic science concepts in interstations or associated exercises.
Promotion to the next year should depend on the student obtaining mastery in all required skills.
1) Predetermined level of performance for mastery in the skill areas at specific points in the curriculum will be established and published to the students and faculty.
2) PBE I and PBE II will test increasing levels of proficiency in the clinical skills.
3) PBE I and II will constitute 50% of the grade in the BCS I-IV series and 15% of the grade in Human Behavior, KFH, and Ethics.
4) PIMS students will participate in the PBE I at the prescribed level of proficiency in all skill areas.
5) Clerkships will provide objective, reliable evaluation documented through observation of students' performances in clinical skills. This can be accomplished with the following evaluation methods:
6) All clerkship forms for global ratings of student performance will have uniform items and rating scales determined by the clerkship directors addressing the following clinical skills:
Additional items related to the specialty area may be included following the required items.
7) Global rating forms can be used only with evidence of direct observation of patient encounters. This method should account for only 20% of the students grade due to reliability issues.
8) Reports of clinical skills performance evaluation will be generated within two weeks of the end of each clerkship and sent to the students, course directors, curriculum committee, academic status committee and administration to follow students' progress in performance of the clinical skills.
9) A mechanism must be created whereby faculty review with students their progress in the clinical skills.
10) The fourth year PBE will expand to 12 stations beginning in 1998. Generalizability scores require adequate sampling of student performance. NBME contributes 6 stations. The remainder of the cases will be institutionally generated. The 4th year clinical skills committee will implement an expedient process for reporting results of the examination to students, academic status committee, curriculum committee and clerkship directors committee with recommendations for remediation of students where required.
11) Students' performance on the fourth year PBE will become part of the Dean's letter of recommendation for residency applications.
The medical education program99 has the responsibility to foster commitment to the values of professionalism by its students. Professional behaviors are definable and can be evaluated using a variety of evaluation strategies including written scenarios, MCQs, and multi-station formats (PBEs). Professional behaviors can be assessed by peers, faculty, residents, health professionals, patients and staff.
1) The curriculum committee must define the components of professionalism required of its graduates for clinical competence.
2) Standards of ideal behavior as well as unprofessional behavior must be specified.
3) Evaluation methods must be designed.
4) Faculty must be instructed in the standards and appropriate methods to assess professional behaviors. (Workshops)
1) A task force must be identified to define the components of professionalism.
2) All courses/clerkships will identify a subset of elements of professional behavior appropriate to the course and the method(s) of evaluation.
3) Each course/clerkship director will submit to the Curriculum Committee for approval a plan identifying the subset of elements of professionalism to be assessed, evaluation strategies to be used and the sources of the evaluation (faculty, peers, residents, etc).
4) All courses/clerkships will utilize a minimum of three sources for evaluation of professionalism. Peers must constitute one of the three sources in all courses. Clerkships and other clinical courses must include patients or standardized patients as one source.
5) A minimum of 10% of the course grade will be attributed to components of professional behavior.