Welcome to Clerkship Curriculum and Evaluation Issues Dr. Joyce Pickering July, 2007 Clerkship is the most fun part of the curriculum! Also has the steepest learning curve Also can be quite stressful Thousands of med students have done it successfully (and enjoyed it) before you. Understanding how things work can be helpful in coping. During each of your rotations, you will be working with a team consisting (usually) of other students, residents at various levels, and attending staff. This team work can be one of the best parts of clerkship. Don’t hesitate to ask them when you don’t know something. Don’t forget that you are there to learn, and you are not there (primarily) to impress them. Get off on the right foot . . . Each clerkship rotation usually starts with an orientation session. It is very important to show up on time to this session. Your clerkship manual has the time and location for the orientation session for each rotation for each hospital. Often you will only find out your call schedule once you arrive. Expect to be on call your first night (just in case.) You can give “call requests” but there is no guarantee that they will be granted. Call requests are normally submitted about a month before the rotation, and usually are submitted to the chief resident (check with the teaching office). As a general rule, the same call rules that apply to residents are applied to students. Current contract allows Maximum 6 in house calls in 28 day period Two weekends off per month Each rotation has slightly different expectations for call. ASK when you start. In general, you can “trade” calls with another student on your service. Make sure your senior resident is aware and approves, and that hospital locating knows. Please note: no call past 20:00 hrs on Sunday before a new rotation, or before a whole class teaching day. Whole class teaching days Wed. Sept. 5th, 8 – 12 a.m. ACLS preparatory lectures Thursday, Jan. 31, 2008 8:30 – 4:30 Clinical Application of the Healer Role Thursday, April 24th, 2008 8:30 – 4:30 Palliative Care Day If you are out of town on those days, you will be notified about any material to be covered. Religious holidays Generally can be accommodated if the teaching office has enough notice. Patient care will always take precedence Please note that more than 5 days missed (for any reason) means an automatic repeat rotation. Most services expect students to have their own pagers. Purchase or rent one now, and let “locating” at the hospital know the number. Wear your name tag. Most hospitals require that you get a hospital name tag. (The MUHC one works at all MUHC sites.) Ask at your orientation. Identify yourself to patients as “My name is John Doe. I’m a 3rd year McGill medical student and I’m part of the team that will be taking care of you.” Remember the dress code . . Page 38, Red Book Generally, the “Mother rule” works well. Most common complaints I get: Showing the abdomen Torn jeans Short shorts GOOD NOT GOOD GOOD NOT GOOD GOOD NOT GOOD With special thanks to Drs. Jeff Segal, Keith Richardson, and Vi Nguyen (class of 2007) for being good sports! Transportation We advise the BMW (bus, metro, walk) Parking is your own responsibility, and relatively expensive. Each hospital has a list of which students will be rotating and when, but some will not issue monthly permits to students. Punctuality and conscientiousness are very much noted during clerkship. Woody Allen: “Eighty per cent of success is showing up.” Remember to be careful about elevator/cafeteria/corridor conversations about patients – respect confidentiality. Respect confidentiality when looking at patient information on the computer – don’t look at results that don’t concern you. Evaluations At the end of each clerkship rotation (usually 8 weeks), the clerkship rotation director submits an evaluation form to my office. This evaluation is filled in by the clerkship director, and compiles data from various sources. Typical sources are the evaluation of your clinical supervisors, a written exam, possibly a Objective Standardized Clinical Exam (OSCE) etc. Your clinical supervisors will usually ask for the input of your senior residents as part of the clinical evaluation. ROTATION WEIGHTING PASS REQUIREMENTS REMEDIAL OF MARKS Medicine Clinical : 60% Global - 60% and Failure on Global mark requires 8 week remedial. Written: 30% Clinical - 60% and Failure on Clinical mark requires 8 week remedial. Oral: 10% Oral/Written Exams - 60% each * Failure on the written or oral exam requires 8 week *applicable to students with “below remedial if ward evaluation is ‘below expectations’. expectations” clinical evaluation Surgery Clinical : 70% Global - 60% and Failure on Global mark requires 8 week remedial. Written : 25% Clinical - 60% and Failure on Clinical mark requires 4 week remedial. Attendance/ Log 5% OSCE - 60% Failure on OSCE requires a repeat oral examination. Obstetrics & Clinical: 50% Global - 60% and Failure on Global mark requires 8 week remedial. Gynecology Assignment:20 % Clinical - 60% and Failure on Clinical mark requires 4 week remedial. OSCE: 30% Assignment – 60% and Failure on Assignment requires supplemental assignment. OSCE – 60% Failure on OSCE requires a repeat oral or OSCE examination. Pediatrics Clinical(ward): 40% Global - 60% and Failure on Global mark requires 8 week remedial. Ambulatory : 20% Clinical (Ward) - 60% and Failure on Clinical (ward) component requires 8 week Neonatology : 20% Written - 60% remedial. Written : 20% Failure on exam requires remedial oral exam if ward evaluation is ‘meets expectations’ or better Failure on exam requires 8 week remedial if ward evaluation is ‘below expectations’ Psychiatry Clinical : 55% Global - 60% and Failure on Global mark requires 8week remedial. Written : 15% Clinical - 60% and Failure on Clinical mark requires 8week remedial. OSCE: 30% OSCE – 60% Failure on OSCE = Academic incomplete; student requires a repeat OSCE. Student can have 2 chances at passing the OSCE; a 2nd failure constitutes a failure on the unit and would require an 8 week remedial. (Note: a student who passes on the second attempt will pass the unit but cannot be assigned a global grade higher than “meets expectations”) Family Medicine Clinical 80% Pass - 60% overall and Failure on clinical evaluation requires 4 week remedial Assignment 20% 60% on clinical Geriatric Clinical: 60% Global - 60 % and Failure on Global evaluation requires 4 week remedial Medicine WebCT Modules: 5% Clinical - 60% and Failure on clinical evaluation requires 4 week remedial FEAT (portfolio):10% WebCT Modules – Pass / Fail and Failure on assignment requires supplemental assignment Final Exam: 25% FEAT (portfolio) – 60% Final Exam - 60% Elective Clinical 100% Pass - 60% Failure on Global evaluation requires 4 week remedial. STUDENT CLERKSHIP (POM) EVALUATION FORM Student Name: ________________________ Dates of Rotation: _______________ Rotation: ____________________________ Site(s): ________________________ Physicianship Behaviours Consistently Not Consistently listened to the patient demonstrated respect for the patient recognized and met patient needs respected patient confidentiality maintained appropriate boundaries with patients functioned well as a member of a team was on time completed tasks in a reliable fashion maintained appropriate appearance and attire demonstrated awareness of limitations admitted errors/omissions addressed gaps in knowledge and/or skills accepted feedback Narrative Comments: Knowledge and Clinical Method N/A U BE ME EE S knowledge of basic sciences knowledge of clinical sciences communication skills data collection physical examination skills hypothesis generation and Differential Dx. clinical judgment formulation of a treatment plan written skills (medical dossier) organizational skills technical skills skills that are discipline-specific ( ) Narrative Comments: Instructions Physicianship Behaviours: If you observed that a student did not always demonstrate the expected behaviour(s), indicate this by placing a checkmark in the appropriate box and elaborate in the narrative comment section. Please indicate if steps were taken to address areas of concern and/or if the student demonstrated improvement during the rotation. Demonstration of exceptional abilities in professionalism and/or humanism can also be indicated in the narrative. Behaviors are monitored longitudinally throughout clerkships; your assessments in this section do not necessarily appear in the Medical Student Performance Evaluation document (i.e. Dean’s Letter) that is used for residency application. If certain issue(s) appear to be of a serious nature, are repetitive and/or irremediable, your assessment may be included in the Dean’s Letter. Knowledge and Clinical Method: Assess student performance using the following five descriptors: Unsatisfactory (U) (<59) = Not acceptable for a student at this level of training. Below Expectations (BE) (60-69) = Falls short of reasonable expectations but acceptable. Meets Expectations (ME) (70-79) = Equal to the majority of students at this level; 80% of students usually meet expectations. Exceeds Expectations (EE) (80-89) = Unusually strong; often exceeds reasonable expectations; only 5-10% of students exceed expectations. Superior (S) (90-100) = Far exceeds expectations; only occasionally observed in students at this level. This is an exceptional student. The overall Clinical Mark will be a composite of the clinical supervisor(s) assessment(s) of student performance based on all criteria: in behaviours, knowledge and clinical method. Please provide narrative comments. Checkmark in the “BE” or “U” columns must be accompanied by a detailed narrative, based on observations. DERIVATION OF GRADE: % Contribution Numerical Grade CLINICAL MARK ( ) ____________ ORAL EXAM MARK ( ) ____________ WRITTEN MARK ( ) ____________ OSCE MARK ( ) ____________ OTHER: _____________ ( ) ____________ FINAL GRADE 100% ____________ GLOBAL EVALUATION: Unsatisfactory □ Below Expectations □ Meets Expectations □ Exceeds Expectation □ Superior □ Clerkship Coordinator: __________________ Date: _________________ Typically, because this evaluation requires compilation, it is not completed by the time you finish your rotation. However you should endeavor to get both mid way and final evaluations verbally from your direct supervisor and/or the clerkship director. Most evaluations are available on line. For those that are not, you are encouraged to come in and see it. I will ask to see you if any overall evaluation is “fails” or “below expectations”, or any other issue of concern is noted. The Medical Student Performance Record (MSPR), a.k.a. Dean’s letter, is a compilation of all your evaluations during medical school. Although not the only part, clerkship evaluations are an important part of the MSPR. (NB: the MSPR should not be thought of as a reference letter, and does not include reference letters that you may ask people to write for you.) STUDENT CLERKSHIP (POM) EVALUATION FORM Student Name: __John Doe_________________Dates of Rotation:05/11/22 to 06/01/16 Rotation: ________General Surgery______ Site(s): ___RVH__________________ Instructions Physicianship Behaviours Consistently Not Consistently Physicianship Behaviours: listened to the patient X If you observed that a student did not always demonstrate the expected behaviour(s), indicate this by placing a checkmark in the appropriate box and elaborate in the narrative comment section. Please indicate if steps were taken demonstrated respect for the patient X to address areas of concern and/or if the student demonstrated improvement during the rotation. Demonstration of recognized and met patient needs X exceptional abilities in professionalism and/or humanism can also be indicated in the narrative. Behaviors are respected patient confidentiality X monitored longitudinally throughout clerkships; your assessments in this section do not necessarily appear in the maintained appropriate boundaries with patients X Medical Student Performance Evaluation document (i.e. Dean’s Letter) that is used for residency application. If functioned well as a member of a team X certain issue(s) appear to be of a serious nature, are repetitive and/or irremediable, your assessment may be included in the Dean’s Letter. was on time X completed tasks in a reliable fashion X Knowledge and Clinical Method: maintained appropriate appearance and attire X Assess student performance using the following five descriptors: Unsatisfactory (U) (<59) = Not acceptable for a student at this level of training. demonstrated awareness of limitations X Below Expectations (BE) (60-69) = Falls short of reasonable expectations but acceptable. admitted errors/omissions X Meets Expectations (ME) (70-79) = Equal to the majority of students at this level; 80% of students usually meet expectations. Exceeds Expectations (EE) (80-89) = Unusually strong; often exceeds reasonable expectations; only 5-10% of students exceed expectations. addressed gaps in knowledge and/or skills X Superior (S) (90-100) = Far exceeds expectations; only occasionally observed in students at this level. This is an exceptional student. accepted feedback X Narrative Comments: The overall Clinical Mark will be a composite of the clinical supervisor(s) assessment(s) of student performance based on all criteria: in behaviours, knowledge and clinical method. Please provide narrative comments. Late on 2 occasions to rounds, but no further tardiness after being spoken to. Checkmark in the “BE” or “U” columns must be accompanied by a detailed narrative, based on observations. DERIVATION OF GRADE: Knowledge and Clinical Method N/A U BE ME EE S % Contribution Numerical Grade CLINICAL MARK ( 50 ) ___73_______ knowledge of basic sciences x ORAL EXAM MARK ( ) ____________ knowledge of clinical sciences x WRITTEN MARK ( ) ____________ communication skills x OSCE MARK ( 50 ) ___72_______ data collection x OTHER: _____________ ( ) ____________ physical examination skills x FINAL GRADE 100% ___73_______ hypothesis generation and Differential Dx. x clinical judgment x formulation of a treatment plan x GLOBAL EVALUATION: written skills (medical dossier) x organizational skills x Unsatisfactory _ technical skills x Below Expectations _ skills that are discipline-specific ( ) x Meets Expectations X Narrative Comments: Exceeds Expectation _ Satisfactory rotation. Able to function well in team. Would need more initiative, but progressed Superior _ well during the rotation. Knowledge as expected for level. Clerkship Coordinator: __________________ Date: _________________ Academic Progress Core Clinical Clerkships The following evaluations are presented in chronological order. Narrative Comments Surgery – MEETS EXPECTATIONS Satisfactory rotation. Able to function well in team. Would need more initiative, but progressed well during the rotation. Knowledge as expected for level. Psychiatry – MEETS EXPECTATIONS – Student A is a pleasant and motivated student whose interest fluctuated on this rotation. He needs to keep up his psychiatry knowledge. He did improve as the rotation progressed. Medicine – EXCEEDS EXPECTATIONS – Student A has an outstanding ability to manage and communicate with difficult patients and families. He is enthusiastic and keen to look things up. He is resourceful and independent. Student A is good-hearted, ethical, and principled. Student A could improve his knowledge base, but this will likely grow quickly since he is eager to learn. His synthesis is improving, but needs further work. Family Medicine – EXCEEDS EXPECTATIONS – Student A’s notes were very clear and he has good communication skills. He shows a lot of interest in pediatrics. He could demonstrate more initiative toward case management. His written assignment on Infant Support Services – Enfance Famille program was well done. Pediatrics – EXCEEDS EXPECTATIONS – Student A tends to be somewhat quiet in the group setting, but he is one of those students who gets everything done without a lot of fanfare. His histories and physicals were complete and accurate. He was excellent with patients and their families, and it was obvious that they liked and respected him. In addition he interacted very well with all members of the healthcare team, and was a willing worker and a real team player. On his weekends on call, he was able to work independently, showing good judgment and the ability to know when to call for help. His written documentation was well done. Student A’s clinical evaluations were above average and excellent. Obstetrics & Gynecology – EXCEEDS EXPECTATIONS – Student A’s performance exceeds expectations. He is a conscientious student who is hard working and motivated. He functions above the level of most of his peers and was a real pleasure to work with. Physicianship section Physicanship McGill University Faculty of Medicine reports physicianship concerns if serious or repetitive. No physicianship concerns were noted during the clinical rotations of Student A. As a general rule, at the Dean’s office, we do not change the clinical evaluations or final marks that are sent in. Physicianship comments and evaluations may be included. If you are unhappy with your evaluation . . . First, see your immediate supervisor (attending staff). If not satisfied. . . Second, see your site clerkship director. If not satisfied Third, see the Chair of the undergrad education committee of the department involved. If not satisfied. . Fourth, ask to see Dr. Pickering (398-3519) or write a request for an appeal to Dr. Pickering. This must happen within 8 weeks of the receipt of the evaluation. (See page 51 of the Red Book.) In case you’ve forgotten what the Red Book looks like . . . Leaves etc. during clerkship As a general rule, we discourage these unless for medical reasons. Some may be allowed (eg. presentation at a conference) but you need both your clerkship director AND the Dean’s office permission. Any leave of more than 5 days out of 28 (for any reason) is an automatic “incomplete” – ie rotation needs to be repeated. You are allowed 5 days off at Christmas OR New Years but there is no guarantee as to which one, so don’t make travel plans. Check about “hospital holidays” when you start a rotation – remember, not all hospitals use the same dates. If you feel that things are not going well FOR WHATEVER REASON, address it first with your clinical supervisor/clerkship director. If you are not satisfied with their response, or you are uncomfortable speaking to them, please see Dr. Tellier or myself. Two tales . . . Tale #1. A student did two days of an elective, then left without telling anyone. When the supervisors went to fill in the evaluation form 4 weeks later, they failed him and wrote that he had unprofessional conduct (because he disappeared without notifying anyone.) When the student was contacted by the Dean’s office to get his side of the story, he said he had been harassed (verbally), and that the elective had been very poorly organized. This was why he had left. Although the student’s allegations were looked into and some changes were made, the fact that these allegations only came up AFTER he was told he had been failed, significantly weakened his case. Tale # 2. Jan 19th: Med student (MS) e-mailed his family med supervisor saying that a female patient of his had called his home and said she’d fallen in love with him. MS says he told her that it was inappropriate for her to call his house, and that it would be impossible to see her. MS was worried that she would continue to harass him and asked for his supervisor’s advice. Supervisor e-mailed back the same day telling MS he did the right thing and if she actually comes to the house, to call the police. With MS’s permission, the supervisor e-mailed Dr. Pickering a copy of the e-mail correspondence. Feb. 4th, Dr. Pickering received a letter from the Director of Professional Services of the hospital. He has been notified by a staff psychiatrist that a patient claims that a medical student (MS) made sexual advances (drove her home, kissed her on the lips.) Patient was not complaining, in fact the patient felt complimented by these advances, but the psychiatrist reported it because it was unprofessional behaviour. The patient told the psychiatrist about it on Jan 26th. The patient was reluctant to have it reported, but finally agreed. Feb. 6th. Dr. Pickering called the psychiatrist. The psychiatrist had meanwhile seen the patient again (Feb. 2nd). The psychiatrist told the patient that he had reported the event. The patient felt “bad” and then retracted almost everything she had said. Because the student notified the supervisor BEFORE the patient mentioned anything, the student’s account was more credible and the case was closed. These sorts of incidents are UNUSUAL but illustrate the point . . . “A ounce of prevention is worth a pound of cure.” For the Introduction to Clerkship course (1 week) : All sessions are mandatory (unless marked otherwise) Please sign in as requested Signing for anyone else or having them sign for you is unprofessional behaviour. If you have reasons to be absent (eg doctor’s appointment etc), please provide documentation to Nicole Guedon (email@example.com). Please . . . Arrive on time Don’t leave in the middle Lecturers in turn have been asked to ensure they finish on time and respect the break times scheduled. Please make all class announcements at 11:50, or at 15:50. All material that you will be tested on will be covered in the lectures Readings are to reinforce lectures, but not to cover any new material. Some lectures will only be posted on line after the session is given. Marking Scheme; 50% attendance 50% MCQ question exam Questions from all sessions, including this one. “Clerkship – the Student’s View” and Senior clerkship information: Monday 15:00 Optional session. Three students (class of 2007) will give you some “student to student” pointers. (30 minutes) This will be followed by an information session given by Dr. Pickering for those who would like to start thinking about senior clerkship rotation sequences (15 minutes) All information will be available on line All information will be repeated at our Senior clerkship information session in October, before you are asked to make any choices. Now onto your favourite director of student affairs Who will talk about personal coping strategies… Career planning . . . And much, much more . ..
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