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.

P/RIME. PRIME language is encouraged in assessing students. It is a useful evaluation tool and is the basis for the Workplace Based Assessment (WBA). 

• Professionalism – Timeliness, dress, participation, interactions with patients and staff 
• Reporting – History, physical, oral case presentation (Pass)
  
• Interpretation – Ability to come up with reasonable diagnosis and differential  (High Pass)
• Managing – Efficiency, helpfulness, quality of care, appropriate test ordering and medication use (Honors)
• Enhanced Communicator – Teaching the team or patient.  

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

WBAs will be generated by students for completion by their preceptors on a daily basis. For detailed instructions on how to do this, please see Canvas. Students will be able to track their progress in Elentra. In addition, the WRITE Educational Specialist will monitor student progress in the WBAs and provide written updates via email to students every 2 weeks.

The level of enstrustment 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 did it
2. I talked them through it
3. I directed them from time to time
4. I was available just in case

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

1. pediatrics
2. adults
3. behavioral/mental health
4. women’s health

For MEDLIC 1, students will need to submit WBA for at least 2 of the 4 patient populations.

Upon conclusion of MEDLIC 2, students will need to have submitted WBAs for all 4 patient populations. WBAs are cumulative across MEDLIC 1 and MEDLIC 2.

Ranked grading will be determined by the level of entrustment at student achieves for the patient populations within the RIME framework. Each WRITE EPA maps to a level in the RIME framework. See Canvas for further details about processes and policies for student entrustment.

• Reporter
  • Gather a History and Perform a Physical Examination (EPA1)
  • Document a Clinical Encounter in the Patient Record (EPA5)
  • Provide an Oral Presentation of a Clinical Encounter (EPA6)
• Interpreter
  • Interpret Common Diagnostic and Screening Tests (EPA3a)
  • Prioritize a Differential Diagnosis Following a Clinical Encounter (EPA2)
• Manager
  • Recommend Common Diagnostic and Screening Tests (EPA3b)
  • Enter and Discuss Orders and Prescriptions (EPA4)
• Enhanced Communicator
  • Form Clinical Questions and Retrieve Evidence to Advance Patient Care (EPA7)
  • Collaborate as a Member of an Interprofessional Team (EPA9)
  • Identify System Failures and Contribute to a Culture of Safety and Improvement (EPA13)

This framework tracks student development.

Mid-clerkship Evaluations: These are required and due at week 6 for MEDLIC 1 and week 6 for MEDLIC 2. Due dates are included in the weekly communication email and noted on the WRITE Student Calendar. Evaluation comments will be collected via a form linked on the WRITE Canvas Page.

Final Evaluations: These will be due one week after the end of each quarter. There will be a final evaluation for MEDLIC 1 and a final evaluation for MEDLIC 2. They will be accomplished using the online E*Value evaluation program.

• MEDLIC 1: Final evaluation due week 12 
• MEDLIC 2: Final evaluation due week 9 or week 12 (for sites with Ob/Gyn) 

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.

For issues that come up about the mechanics of accessing or using E-Value, the WRITE educator would be your best resource. Click here for a link for how to access and submit student evaluations (PDF).

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.