Feedback and Evaluations

In order to give effective feedback, a physician needs to develop a sound teacher-student relationship. During the first month, the preceptor should observe the student daily doing interviews and examinations in order to gauge the student’s level of competence and to instruct him/her in areas that need improvement. Evaluation methods and instruments are designed to enhance the student’s learning experience, not just measure performance.

Verbal feedback and evaluations are an integral part of the clerkship experience. A lack of direction and ongoing feedback are the most significant shortcomings identified by students during the clinical portion of their training–hallway discussion and off-handed feedback are not as powerful as sitting down and having a private dialogue with the student.

RIME is a tool that can be used to gauge student development over time; standing for Reporter, Interpreter, Manager, and Enhanced Communicator.

Reporter represents the base level of entrustability – the student can take a H&P and give an OCP

Interpreter is a step above Reporter – the student can give a reasonable diagnosis and differential. Includes “do not miss diagnosis”

Manger is when the student shows a high level of efficiency and can order appropriate tests and medications.

Enhanced Communicator is when the student can teach the team and/or patient.

Workplace-based assessments (WBAs) are brief formative assessments completed by a preceptor after a clinical encounter that rate the student on the level of entrustment for that specific encounter.

WBAs will be generated by students for completion by their preceptors. Students will be able to track their progress on their Qualtrics dashboard.

The level of entrustment is rated on the Modified Ottawa scale which asks the preceptor “In supervising this student, how much did you participate in this task?”

Preceptors respond on a four-point scale:

1. I stepped in and did it, they observed
2. I talked them through it
3. They mostly did it, I directed from time to time
4. I was available just in case and I checked their work

Students will need WBAs and all 11 EPAs (listed below) for each of the 4 patient populations seen in WRITE:  

• Adult medicine
• Obstetrics & Gynecology
• Pediatrics
• Psychiatry

To pass MEDLIC 601, students will need:

• A minimum of two level 3 out of 4 in all four patient populations on the entrustability scale for the following EPAs:
  • Gather a history
  • Perform a physical
  • Document a clinical encounter in the patient record
  • Provide an oral case presentation of a clinical encounter

• A minimum of two level 2 out of 4 in all four patient populations for the following EPAs:
• Prioritize a differential diagnosis following a clinical encounter
• Interpret diagnostic or screening information for common clinical situations

To pass MEDLIC 602, students will need:

• A minimum of two level 3 out of 4 in all four patient populations on the entrustability scale for the following EPAs:

• Prioritize a differential diagnosis following a clinical encounter
  • If student achieved entrustment level 3 during MEDLIC 601, they do not need to resubmit this EPA
• Communicate effectively with patients and their families
  • Students will need a total of four WBAs from at least two different patient populations

• A minimum of two level 2 out of 4 in all four patient populations for the following EPAs:

• Recommend diagnostic or screening plans for common clinical situations
• Enter and discuss orders and prescriptions
• Form clinical questions and retrieve evidence to advance patient care
• Provide continuity of care for a patient with a chronic condition
  • Students will need a total of two WBAs from at least two different patient populations

Mid-Clerkship Evaluations:

These are LCME requirements and are due by week six of MEDLIC 601. For MEDLIC 602, they will be due by week five at sites without OBGYN and by week six at sites with OBGYN

Final Evaluations:

These are due within three weeks after the end of MEDLIC 601 and MEDLIC 602. A MS Form will be shared with the site director and can be submitted by the site director and/or other preceptors who may be able to speak about the student’s progress. The form will include questions about the student’s performance with the four main patient populations, their development using the RIME model (see Using RIME for more details), patient comments, their contribution to your community, and areas of strength and areas for growth.

It is important to do a “good” evaluation: Please be sure that the grading anchors match the comments about student performance AND that the comments are specific, descriptive, and substantive.

Comment Examples: “the Good, the Bad and the Ugly”

• The Ugly: Jenny was a great student.
• The Bad: Jenny was a hard-working student, got along well with others, and was always prepared.
• The Good: Jenny was intellectually curious, thoroughly researched her patient’s diagnosis, and went the extra mile. Staff and patients commented on how much they enjoyed working with her. She developed an outstanding rapport with her patients and took ownership of their care.

Anything having to do with questions about how to evaluate a student would be sent to the WRITE educator.

On the issue of filling out evaluations using E-Value when there is no student ID present (which, if not filled in, evaluators cannot proceed), the evaluator should insert the phrase “please complete” which will alert the WRITE educator to insert the student ID.