COMPASS
Following recommendations made by the Clinical Assessment Workgroup after over three years of work, the University of Washington School of Medicine is transitioning to a competency-based medical education (CBME) model, including pass/fail grading for required Patient Care core clerkships starting in Spring 2026 and pass/fail grading for required Explore & Focus Phase clerkships starting in Spring 2027.
COMPASS
Competency Mapping and Programmatic Assessment System (COMPASS) is UWSOM’s new assessment framework that supports the School’s transition to a CBME model. The new framework is designed to address concerns about the current grading system and to better align educational practices with student competency development, competencies in ongoing medical education, and patient needs.
Look for the compass icon to identify changes associated with this new program of assessment:
Key components include:
- Workplace-based assessments (WBAs)
- Clinical competency coaches
- Clinical competency committees (CCCs)
Clerkship Grading & Assessment
Starting in Spring 2026, all six required Patient Care core clerkships (Family Medicine, Pediatrics, Internal Medicine, Psychiatry, Obstetrics & Gynecology, and Surgery, including WRITE clerkships) will be graded as Pass/Fail. All required Explore & Focus core clerkships (Neurology, Neurological Surgery, and Emergency Medicine) will retain tiered grading as they pilot WBAs in 2026 and will transition to Pass/Fail grading in Spring 2027.
Grading & Assessment Changes by Clerkship
All six required Patient Care core clerkships (Family Medicine, Pediatrics, Internal Medicine, Psychiatry, Obstetrics & Gynecology, and Surgery, including WRITE clerkships) will be graded as Pass/Fail.
Pass/Fail grading encompasses a variety of assessments across four competency domains. Each domain includes competencies that map to the School’s 32 medical education program objectives (MEPOs):
- Patient Care
- Interpersonal & Communication Skills
- Service to Patients & Community (Professionalism)
- Medical Knowledge
Assessments are specific to each clerkship but will include:
- Workplace-based assessments (WBAs)
- Mini-clinical evaluation exercise (mini-CEX)
- Clinical performance rating items
- NBME subject exam
- Other clerkship-specific assessments
| Domain | Assessment | Passing Threshold | Grade if Failed | Remediation |
|---|---|---|---|---|
| Patient Care | Clinical performance rating items | Level 2 or higher on all items | Fail | Repeat clerkship |
| WBAs | At least 1** verified level 2 or higher on all required activities | |||
| Mini-CEX* | Pass | |||
| Interpersonal & Communication Skills | Clinical performance rating items | Level 2 or higher on all items | Fail | Repeat clerkship |
| WBAs | At least 1** verified level 2 or higher on communication WBA |
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| Mini-CEX* | Pass | |||
| Service to Patients & Community (Professionalism) | Clinical performance rating items | “Competent” or “approaching competency”*** on all items | Fail | Repeat clerkship |
| Completion of all clerkship requirements | Completion of all required clinical encounters, at least 3 WBAs/week across all required activities, required mini-CEXs, any additional clerkship-specific assignments | |||
| Medical Knowledge | NBME subject exam | 5th percentile (national) | Pass | Must pass exam prior to Step 2 CK |
| Clinical performance rating items | Level 2 or higher on all items | |||
| * Mini-CEX domain varies by clerkship ** 2 on 12-week IM clerkship *** Students who receive “approaching competency” on any item will be referred to clinical competency coach; patterns will be reviewed by CCC |
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More information about grading in required core clerkships is available in the Assessment Policy and Academic Grading Policy. For specific clerkship grading information, please check the clerkship website.
WRITE clerkships (MEDLIC 601/602) will be graded as Pass/Fail.
MORE DETAILS COMING IN FEBRUARY 2026
All required Explore & Focus core clerkships (Neurology, Neurological Surgery, and Emergency Medicine) will retain tiered grading as they pilot WBAs in 2026 and will transition to Pass/Fail grading in Spring 2027.
Completion of new WBA requirements in required Explore & Focus core clerkships only will add a bonus of up to 2% to the final clinical grade, not to exceed 100%. Students will receive credit for all submitted assessments as a proportion of the total number/type of WBAs required, as follows:
- For each WBA submitted, students will earn 1/8 of 1% (up to a maximum of 2/week).
- For each activity submitted, students will earn 1/8 of 1% (up to a maximum of 1/activity).
Workplace-Based Assessments (WBAs)
WBAs are brief, formative assessments completed by a preceptor after a clinical encounter that rate a student’s performance and provide feedback for that specific encounter. WBAs are similar to the EPAs widely utilized by residency programs.
WBA Requirements by Clerkship
At least 3 WBAs per week and at least 1 verified* assessment at an entrustment level of 2 or higher for each of the 8 required activities. No more than 6 WBAs per week will count toward the weekly total.
*WBAs are considered verified if they are either:
- Submitted directly by the preceptor, or
- Submitted by a student and confirmed by the preceptor.
Required Activities:
- Gather a history
- Perform a physical examination
- Prioritize a differential diagnosis following a clinical encounter
- Recommend diagnostic or screening plans for common situations
- Interpret diagnostic or screening information for common situations
- Provide an oral presentation of a clinical encounter
- Document a clinical encounter
- Communicate with patients and/or families
An OR-specific activity – Prepare effectively for operative cases – is available only to students taking Ob/Gyn or General Surgery. Completion of this activity counts towards the weekly WBA total but does not count as a required activity.
At least 3 WBAs per week and at least 2 verified* assessments at an entrustment level of 2 or higher for each of the 8 required activities. No more than 6 WBAs per week will count toward the weekly total.
*WBAs are considered verified if they are either:
- Submitted directly by the preceptor, or
- Submitted by a student and confirmed by the preceptor.
Required Activities:
- Gather a history
- Perform a physical examination
- Prioritize a differential diagnosis following a clinical encounter
- Recommend diagnostic or screening plans for common situations
- Interpret diagnostic or screening information for common situations
- Provide an oral presentation of a clinical encounter
- Document a clinical encounter
- Communicate with patients and/or families
MEDLIC 601
Completion of EPAs 1a, 1b, 3a, 5, 6
- Entrustment level of 3 or higher in all four patient populations for EPAs 1a/b, 5, 6
- Entrustment level of 2 or higher in all four patient populations for EPA 3a
MEDLIC 602
Completion of EPAs 2, 3b, 4, 7, 9
- Entrustment level of 3 or higher in all four patient populations for EPAs 2, 9
- Entrustment level of 2 or higher in all four patient populations for EPAs 3b, 4, 7
Required EPAs:
- EPA 1a – Gather a history
- EPA 1b – Perform a physical examination
- EPA 2 – Prioritize a differential diagnosis following a clinical encounter
- EPA 3a – Interpret common diagnostic and screening tests
- EPA 3b – Recommend common diagnostic and screening tests
- EPA 4 – Enter and discuss orders and prescriptions
- EPA 5 – Document a clinical encounter in the patient record
- EPA 6 – Provide an oral case presentation of a clinical encounter
- EPA 7 – Form clinical questions and retrieve evidence to advance patient care
- EPA 9 – Communicate effectively with patients and their families
- EPA 14 – Provide continuity care, conducting interval visits for primary care patients with chronic conditions
At least 2 WBAs per week and at least 1 assessment for each of the 8 required activities over the course of the clerkship.
Required Activities:
- Gather a history
- Perform a physical examination
- Prioritize a differential diagnosis following a clinical encounter
- Recommend diagnostic or screening plans for common situations
- Interpret diagnostic or screening information for common situations
- Provide an oral presentation of a clinical encounter
- Document a clinical encounter
- Communicate with patients and/or families
An OR-specific activity – Prepare effectively for operative cases – is available only to students taking Neurological Surgery. Completion of this activity counts towards the weekly WBA total but does not count as a required activity.
Completing WBAs
To complete a WBA:
- A student requests to be assessed on one of the six required activities for a clinical encounter.
- The preceptor observes the student’s actions, decisions, and interactions.
- The student reflects on their performance and discusses it with the preceptor, who provides feedback and helps set measurable goals for development.
Preceptors will be asked to provide brief feedback (1-2 sentences) on what the student did well and what they can do to improve. They will also provide a rating for the encounter utilizing the following entrustment scale:
- “I stepped in and did it, they observed”
- “I talked them through it”
- “They mostly did it, I directed them from time to time”
- “I was available just in case and I checked their work”
WBAs are submitted though a Qualtrics survey. Each student has a unique form link and QR code that can be used by either the student or a preceptor to submit a WBA. Preceptors will receive copies of the WBAs they have submitted so that comments can be reused when filling out eValue forms.
Watch the video below to learn more about WBAs, including guidance on how to complete one:
Clinical Competency Coaches
Clinical Competency Coaches support students’ growth within the COMPASS competency-based assessment framework by helping them make sense of feedback, track progress over time, and plan next steps for development.
Each student will be assigned a Clinical Competency Coach who will serve as a longitudinal advisor across clerkships. Coaches do not directly assess students or determine grades. Instead, they function as a guide and advocate, helping students interpret workplace-based assessments (WBAs) and other performance data and reflect on opportunities for continued growth.
Clinical Competency Coaches:
- Review patterns and trends in WBA feedback with students
- Support goal setting and individualized learning plans
- Help students prepare for Clinical Competency Committee (CCC) reviews
- Encourage reflective practice and professional growth
- Connect students with additional resources when support is needed
Regular coaching meetings are a core feature of COMPASS and are designed to promote transparency, equity, and continuous improvement throughout clinical training.
Clinical Competency Committees (CCCs)
CCCs are faculty committees responsible for reviewing assessment data and making recommendations around promotion from one phase of the curriculum to the next.
CCCs review aggregated evidence of student performance, including WBAs, clerkship rating items, and other relevant data, to determine whether students are meeting expected milestones for their phase of training. Decisions are based on patterns of performance over time rather than single observations.
Clinical Competency Committees:
- Review students’ WBAs and other assessment data holistically
- Determine progress toward competency milestones
- Recommend promotion to the next phase of training
- Identify students who may benefit from additional support or coaching
- Ensure consistent, fair, and equitable decision-making across clerkships
Students do not appear before the committee. Recommendations are communicated through established academic channels and supported by coaching conversations to ensure clarity and next steps.
Get Involved
Your engagement is critical in helping the school transition successfully to this new educational framework. Help us improve clinical assessment by sharing your experiences and suggestions — we want to hear from you!
- Complete a short survey to provide feedback on your experience completing WBAs. You will have the option to submit anonymously or provide your contact information if you would like the team to follow up.
- Get help with a specific issue or ask a question about COMPASS by emailing us.
- Ask questions or share your concerns at an upcoming town hall meeting. Click here to register for the next COMPASS town hall meeting on Wednesday, 4/22/2026 at 5 p.m. PT (4 p.m. AT, 6 p.m. MT).
FAQs
CBME is an approach to preparing physicians for practice that is fundamentally oriented to graduate outcome abilities and organized around competencies derived from an analysis of societal and patient needs. This outcomes-based approach to the design, implementation, assessment, and evaluation of a medical education program is structured around a framework of competencies. Curriculum is organized around the outcomes expected of a medical student and a student’s advancement is dependent on having achieved those expected outcomes.
CBME Core Components:
- An outcomes competency framework
- Progressive sequencing of competencies
- Learning experiences tailored to competencies
- Teaching tailored to competencies
- Programmatic assessment
WBAs are brief, formative assessments completed by a preceptor after a clinical encounter that rate a student’s performance and provide feedback for that specific encounter. Some examples of WBAs include:
• Entrustable professional activities (EPAs)
• Mini-clinical evaluation exercise (mini-CEX)
• Direct observation of procedural skill (DOPS)
• Clinical encounter card (CEC)
• Acute case assessment tool (ACAT)
• Consultation observation tool (COT)
• Observed history & physical (H&P)
• Case-based discussions (e.g., Aquifer cases)
• Direct observation, assessment, and feedback
In practice, a WBA might involve tasks such as conducting a patient interview, performing a physical examination, or managing a specific clinical procedure. For example, a student might be assessed on their ability to conduct a thorough history and physical exam on a patient. The preceptor would observe the student during this process, assessing their communication skills, clinical reasoning, and professionalism. If the student meets the established criteria, the preceptor would then “entrust” them to perform this activity with less supervision in future clinical settings, thereby confirming their competence in that area.
A milestone is an observable marker of an individual’s ability at a stage of expertise. Milestones illustrate the expected progression of competence from novice to mastery associated with each enabling competency.
Milestones:
- Illustrate the developmental nature, features, and progression of the competencies
- Assist learners in monitoring their own developmental progress
- Allow individuals to monitor their own progress
- Support the identification of learners whose progress is not following the typical development sequence to assist in early intervention
- Guide curriculum development
During Transition to Clerkships, you will receive an initial email from the COMPASS team with your unique Qualtrics link. You will receive a second email from the COMPASS team 1-2 business days after your receive the initial email with a easy-to-remember short link and QR code.
Students not attending Transition to Clerkships will receive an email containing their unique Qualtrics link at least 4 weeks prior to their first Patient Care rotation start date.
The short link and QR code are also available at any time on your Student Performance Dashboard.
If you cannot locate the email containing your unique link and/or the short link and QR code do not appear on your Student Performance Dashboard, email the COMPASS team.
Email the COMPASS team with a screenshot of the error you are receiving. Please include whether the error is associated with your QR code or with your short link.
The Student Performance Dashboard includes WBA tracking data. If you are concerned about meeting the requirement, email the COMPASS team for a confirmation of received submissions.
WBAs are most effective when focused around a single activity, and WBA requirements have been designed with this in mind. Before requesting multiple WBAs, talk to your preceptor about whether they feel the activities can be adequately assessed in a single encounter.
If you are having difficulty finding opportunities to be assessed for a particular activity or finding preceptors willing to assess you, please contact the Clerkship Director.
For the purposes of WBA requirements, a week is defined as Monday-Sunday.
Forward the confirmation email you received from somdata@uw.edu. The COMPASS team will send your preceptor an email with the link to confirm submission.
WBAs are intended as opportunities for formative assessment. However, preceptors will receive copies of WBAs they submit and may reference them when providing comments to the Clerkship Director about your performance.
Clerkship Toolkits
Patient Care Phase Resources
- WBAs Clerkship Orientation Slide: A PowerPoint slide that highlights key details about WBA requirements for required Patient Care core clerkships starting Spring 2026
- Grading Clerkship Orientation Slide: A customizable PowerPoint slide that highlights key details about the 4-domain grading system for required Patient Care core clerkships starting Spring 2026
- WBA Infographic: A visual guide that that highlights key details about WBAs, including specific requirements.
- WBA Conversation Guide: A quick reference guide for completing WBAs using the Prepare to ADAPT framework for asking for, receiving, and providing feedback in the clinical learning environment.
- Qualtrics User Guide: A job aid for submitting WBA forms in Qualtrics.
- Departmental Email Template: A customizable email template for communicating with site directors about upcoming changes.
- COMPASS Slide Deck (Short Version): A 15-slide PowerPoint presentation for introducing COMPASS. To request full resolution PowerPoint file, email Mary Sargent.
- Who’s Who Guide: A reference guide for students outlining the role of coaches, mentors, clinical skills educators, clinical learning specialists, and academic learning specialists.
- COMING SOON: Entrustment Rubric: A set of shared anchors for the entrustment scale to support consistent decision-making across clinical contexts.
- COMING SOON: COMPASS Slide Deck (Long Version): A longer PowerPoint presentation for introducing COMPASS to site directors and for presentations outside of the UW (includes a video that can be used to submit a practice WBA in real time).
Explore & Focus Phase Resources
- WBA Pilot Clerkship Orientation Slide: A PowerPoint slide that highlights key details about WBA requirements for required Explore & Focus core clerkships starting Spring 2026, including specific requirements and the grading bonus structure.
- WBA Pilot Infographic: A visual guide that that highlights key details about the WBA Pilot, including specific requirements and the grading bonus structure.
- WBA Conversation Guide: A quick reference guide for completing WBAs using the Prepare to ADAPT framework for asking for, receiving, and providing feedback in the clinical learning environment.
- Qualtrics User Guide: A job aid for submitting WBA forms in Qualtrics.
- COMPASS Slide Deck (Short Version): A 15-slide PowerPoint presentation for introducing COMPASS. To request full resolution PowerPoint file, email Mary Sargent.
- Who’s Who Guide: A reference guide for students outlining the role of coaches, mentors, clinical skills educators, clinical learning specialists, and academic learning specialists.
- COMING SOON: Entrustment Rubric: A set of shared anchors for the entrustment scale to support consistent decision-making across clinical contexts.
- COMING SOON: COMPASS Slide Deck (Long Version): A longer PowerPoint presentation for introducing COMPASS to site directors and for presentations outside of the UW (includes a video that can be used to submit a practice WBA in real time).
Additional Resources
- Prepare to ADAPT: GME resources related to the ADAPT framework
- CBME Overview with Jordan Kinder, Curriculum Management System Manager
- Clinical Assessment Workgroup
- Clerkship Directory