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A Guide to Grading
1. Identify student’s current status and prior clinical experience.
2. Review course goals and objectives with student.
3. Establish your expectations early.
4. Provide feedback frequently so there will be no end of rotation surprises
5. Expect improvement. The evaluation is based on the last day of the rotation, not
the first.
6. Our expectations of a student in the first 3-4 rotations will be different than more
advanced expectations in the last 3-4 months.
7. Attitude counts.
A knowledge of prior clinical experience will help you set
expectations. Examples: A student who had completed OB-
GYN should have a good working knowledge and skill level for
that topic but may have to spend more time developing a
knowledge base for chronic disease. Do not, however, assume
a strong skill set just because of the prior experience without
observation.
The table below is a “user’s guide” for the grade sheet. The yellow column would
represent higher level of competency in the beginning clerk.
The grading form
Item analysis
Basic Medical Knowledge: Relative to level of training [Medical knowledge]
The early student who has had minimal clinical experience should, at a minimum, display
a basic knowledge of common problems by the end of the rotation. Better students will
range in the high pass level. Honors is the exceptional student who displays clinical
skills that exceed (not just level of training) expectation.
Fail Low Pass Pass High pass Honors Comments
Poor fund of Limited fund Fund of Solid fund Outstanding Please use
knowledge: of knowledge of fund comment
limited knowledge; consistent knowledge; of section to
ability to can apply with level applies knowledge; provide
apply clinically: has of training. readily to superior, support for
clinically. potential for clinical advanced fail, low
improvement. problems. skills pass or
applying to honors.
complex
problem
Elicits focused histories: Relative to level of training [Patient care]
The average student will need some organization help, especially in the beginning. It is
not uncommon to be over inclusive of data in a “casting the net and hoping to catch a
fish” style. This should show improvement over the course of the rotation. Better
students will be able to focus on the specific problem, organize and prioritize information
during a basic, uncomplicated encounter. Exceptional students will be able to sort
through a patient with multiple problems and prioritize data.
Fail Low Pass Pass High pass Honors Direct
observation
Disorganized, Organized; Organized, Excellent Excellent Yes
incomplete, obtains usually skills; skills;
lacks focus. basic complete thorough thorough yet No
history but including focused succinct and
points pertinent (+) history. focused Did you
often & (-) ROS; history. Able observe the
missed but often to prioritize patient
including with data obtaining a
pertinent extraneous appropriately. history?
(+) & (-) information.
ROS.
Performs focused physical exam relative to level of training [Patient care]
The student will be fulfilling basic expectations with an exam that is focused and competent for
the common problem, more broad for the complex or overall health evaluation visit. Respect of
patient’s privacy and sensitivity is expected at all levels. Better students will be thorough in a
manner that is adequate to the evaluation of the problem/s that need attention and display good
technique. The honors student will have good, organized exam skills, display excellent
technique in a sensitive fashion and be able to identified focused exam needs for focused
problems as well as disease specific exams in chronic problems.
Fail Low Pass Pass High pass Honors Direct observation
Omits Generally Complete; Thorough Thorough Yes
critical complete usually and and
parts of but often recognizes accurate; accurate; No
the exam misses abnormal focused on focused on
and/or significant findings the problem the problem, Did you observe the
deficient abnormal well exam?
exam skills findings. organized,
includes
pertinent
negatives
Diagnostic tests and procedural skills relative to Family Medicine [Patient care]
Students love to observed and be involved in procedures. Procedures in this case, however,
include the selection and use of laboratory tests, imaging studies and referred procedures. The
average student will suggest tests and be able to discuss indications. The better student will
recommend procedures or studies that represent established guidelines when available. Actual
office procedure skills should be commented on as to performance documentation and observed
skill level in the comments section. The honors student selects tests and procedures with an
understanding of efficacy and cost.
Fail Low Pass Pass High pass Honors Direct
Observation
Doesn’t Knows Understands Uses tests Uses Yes
understand indications of indications skillfully and tests/procedures
indications some for recommends skillfully, No
for most procedures tests and procedures aware of cost
procedures and tests procedures appropriately effectiveness,
or lab tests and test
efficacy
Oral presentations [Patient care] [Communication]
The beginning student may ramble and be either excessive in detail or may be too restricted,
report only verbatim history. As the month and student experience progresses the student should
begin to focus and organize data in a more succinct fashion. This may require some coaching at
first…remember, set expectations. You can let the student know what you expect to hear on a
case by case basis. Compare the SOAP based presentation to the presentation on daily rounds
for those who have only inpatient experience. Exceptional students will “get it” and be
organized and succinct. If you feel that your job is easier at the end of the student’s presentation,
you have an exceptional students.
Fail Low Pass Pass High pass Honors
Disorganized/ Generally Presentations Presentations Consistently Did not
incomplete; complete; organized and organized, organized, observe
by end, may lack logical with logical; logical,
listeners organization/ assistance. highlights complete;
uncertain of fail to Highlights abnormal highlights
primary highlight pertinent findings; pertinent Presentation
clinical abnormal positives and succinct information; skills
problem or findings; negatives. preparation adversely
recent events. needs much does not impacted by
assistance require anxiety.
assistance.
Succinct
Written notes: Problem oriented SOAP format [Patient care] [Communication]
The student should use the SOAP format for documentation of notes. The average student may
mix components and use the inappropriate A/P technique. Point out that “A” is what you think
and “P” is what you plan to do. The exceptional student will review charts beforehand, update
the medication list, review chronic disease parameters, update prevention data and have an
organized note or notes.
Fail Low Pass Pass High pass Honors Direct
observation
Incomplete or Includes basic Accurate, Pass plus Accurate,
erroneous information; thorough, ongoing thorough, Yes
rarely and succinct. assessments and succinct. No
analyzes new Focuses on of primary Updates
data/ impact presenting problems. chronic You do not
on patient complaint. problems, have to
management. prevention include the
and student’s note
medications. in your chart,
but, please
review their
notes.
Differential diagnosis, application of clinical skills [Patient care] ][Medical knowledge]
Prioritizing problems and establishing a working differential is an advanced skill and may not be
evident initially. We expect growth in this area as the rotation progresses. The student should
become adept at this skill in the more common, simple problems. The student should display a
knowledge of the evaluation and management of common chronic diseases as well by the end of
the rotation. Most will be overwhelmed by the complex, multi-problem patient. Exceptional
students will begin to prioritize their approach and ask guidance when indicated.
Fail Low Pass Pass High pass Honors Direct
observation
Usually Usually Formulates Consistently High pass
unable to handles major assessment able to plus provides Yes
formulate an problem; may of major formulate rationale for No
assessment of not integrate problem; may assessment of decision
basic medical all aspects have trouble basic making.
problems. (H&P, labs, identifying/ problems; Evidence of
rx); suggests prioritizing also can clinical
elemental multiple prioritize guidelines
understanding problems. multiple when
. problems. available.
Management plans and follow-up [Patient care] [Medical knowledge] [System based
practice]
Don’t be surprised if early learners miss the boat on management plans. As the student grows so
should this skill. Plans should include: diagnostic evaluations, medications with dosage, patient
education and follow up. The exceptional student will also review chronic problems and
prevention and document plans for updating in the appropriate section of the record and the note.
This student will be aware of evidence based treatment goals and surveillance intervals. This
information is readily available to all the students. Selection of medications may require your
guidance.
Fail Low Pass Pass High pass Honors Direct
observation
Treatment Plan often Plans are Plans High pass
plans neglects appropriate, excellent plus: Includes Yes
inadequate. important complete and including updates for No
Fails to components, timely education, disease
recognize including follow-up, surveillance
when urgent education and and and self-
treatment follow-up prevention mgmt plan.
indicated
Incorporates health promotion and disease prevention [Medical knowledge] [System based
practice]
Prevention is a major focus of the Family Medicine experience. Students have been instructed to
review this element for all their patients by chart review. The USPSTF is the guide for this task
and they have a Palm based program to assist. The exceptional student will not have to be asked
but will review the record (preferably in preparation for the clinic day) and identify prevention
needs accurately. This student will consider the patient’s characteristics and risk factors in
decision making. Average students will consider this only when it is a “health maintenance” visit.
You can decide how much counseling…beyond the basics…you want to have the student do.
You can evaluate their skills by direct observation or by asking the patient what they understand
from the interaction.
Fail Low pass Pass High pass Honors Comments
Ignores all Rarely includes Appropriately Often includes Always
opportunities preventive includes age prevention; includes
for prevention services; specific identifies prevention;
underestimates preventive patient’s identifies risks
effect patient’s services high risk and readiness
behaviors on behaviors and to change and
risk offers skillful in
counseling counseling
Dependability, motivation, responsibility, initiative [Professionalism] [Communication,
Personal interaction]
This is not training level dependent. The student’s ability to display professional behaviors and
attitudes should start on Day 1.
Fail Low Pass Pass High pass Honors Comments
Unreliable, Sometimes Punctual, Pass plus Dependable;
often absent late, not dependable, Dependable; highly
or late; reliably able accepts highly committed to
commitment to complete responsibility committed to clinical care;
uncertain. assignments and enjoys seeks
or tasks clinical care. opportunities
to help clinic
team
Rapport and relationships with patients [Professionalism] [Communication, Personal interaction]
This is not training level dependent. The student’s ability to display professional behaviors and
attitudes should start on Day 1.
Fail Low Pass Pass High pass Honors
Insensitive to Uncomfortable Interacts well Extremely Compassionate, Did not observe
needs, in patient with compassionate respectful,
feelings, interactions patients and and respectful receives
values of families. with patients spontaneous
patients. and families positive
feedback
Broaches
boundaries
Lack of
compassion
Rapport with colleagues, staff and attending [Professionalism] [Communication, Personal
interaction]
This is not training level dependent. The student’s ability to display professional behaviors and
attitudes should start on Day 1.
Fail Low Pass Pass High Pass Honors
Disrespectful, Often fails to Communicates Very strong Strong communication
rude and act well; communication skills, professional
insensitive in collegially; respectful, skills and demeanor, looks for
office or communication cooperative professional opportunities to help
hospital unclear, and demeanor the clinical team.
incomplete, or collegial
disorganized
Intellectual curiosity: Review of medical literature and other resources to advance medical
knowledge base
This is not training level dependent. The student’s ability to display professional behaviors and attitudes should start
on Day 1.
Fail Low Pass Pass High pass Honors
Fails or refuses Misses Looks up Reads more Reads extensively,
to read, study important clinical data broadly than communicates
or investigate clinical or appropriately; patients’ findings, shares
reference reads up on problems; knowledge
information; patients’ actively seeks and actively
reads only problems daily ancillary teaches, enjoys
when asked clinical data learning
and uses
inappropriate
sources
Accepts constructive criticism and feedback [Professionalism]
This is not training level dependent. The student’s ability to display professional behaviors and attitudes should start
on Day 1.
Fail Low Pass Pass Honors
High pass
Actively "Chip on Open to Actively
Actively Did not observe
rebuffs or shoulder" feedback and seeks seeks
avoids slow to constructive feedback;
feedback;
change. change. criticism. grows with
grows with
Doesn't Defensive Willing and each each
recognize able to encounter;
encounter;
own change learns form
learns form
limitations. each each
mistake;
mistake.
provides
feedback as
well
Knowledge of psychosocial and family issues [Patient care] [Interpersonal and
communication skills]
This knowledge and skill set should grow during the rotation. Students will need to be aware of
the psychosocial issues that impact disease management. This component should not
overshadow other aspects of care, but should compliment the patient centered approach. Early
students may get stuck in the dramas of our patients’ lives and may need help with balance. As
the student advances their tendency to “take care” inspite of all odds will be tempered with
reality. The exceptional student will recognize the need to look for an evaluate medical and
psychosocial resources in care plan.
Fail Low Pass Pass High Pass Honors
Ignores Underestimat Considers Considers Always fully Did not
psychosocial es social, psychosocial integrates observe
issues in impact of psychological issues and psychosocial
patient psychosocial , and their impact issues
care and family issues on disease into all
family issues mgmt. aspects of
patient care
Chronic Disease Management (CDM): Using evidence based clinical guidelines (EBG)
The management of chronic health problems and common chronic diseases brings into focus the
Family Medicine concept of continuous, comprehensive care. The chronic disease management
model provides an opportunity for students to learn about the long term management of such
problems as diabetes, hypertension, asthma, COPD, etc. Students will have access to learning
modules about the process as well as receiving a didactic presentation during orientation. The
average student will complete the required disease registries and report what they thought about
management. The exceptional student will be proactive in looking at the chart in advance and
reviewing the target problems. That student will grow in the knowledge of population
management as well as individual care focused on assisting patient with the identification and
attainment of skills to achieve treatment goals. She or he will help with the update of the
documentation of care as well.
Fail Low Pass Pass High Pass Honors
Ignores Addressed Correctly Incorporated Did
chronic health BG addressed review of prospective Instructed
issues or has parameters EBG EBG at every review of student to
no working when parameters encounter EBG and address only
knowledge of prompted do for chronic (with updated items the presenting
EBG so with disease exception of correctly for complaint
assistance or focused visits. urgent each unless visit
incompletely priority) encounter. specific to
Displayed chronic
awareness of disease mgmt.
patient
characteristics
that might
impact goals
and
intervention.
CDM: Patient Self-mgmt skills
Most students will attempt to “educate” patients about their illness or problem in the traditional
didactic fashion. Look for the exceptional approach including motivational interviewing,
identification of patient directed and identified goals that are realistic and manageable in the
short term. The outstanding student will consider barriers, access to care, support resources,
education and the role of the health care team in working toward treatment goals.
Fail Low Pass Pass High pass Honors Comments
Ignored the Provided Provided Pass criteria High pass
patient’s role patient patient plus identified criteria plus
in disease education but education and and addressed demonstrates
management did not assessed self-mgmt. ability to
and include self patient’s needs motivate
prevention management willingness to patients
skills change toward self
behavior management.
when needed. Provides
culturally
aware
intervention
and
sensitivity to
the
psychosocial
factors that
impact care.
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