Preparing Final Clerkship Performance Evaluations

1. Preparing Final Clerkship Performance Evaluations A Guide for Clerkship Directors and Evaluation Teams 2012-13

2. Table of Contents • Evaluation Criteria • Data collection • Interpreting evaluation data: • Patient Care (RIME) • Professionalism and Interpersonal Communication • Final grades • Narrative evaluations • Appeals • Resources and Contacts

3. Evaluation Criteria

4. Grades and MSPE reporting • Students may earn a grade of Pass or Pass with Distinction in each of three domains: • Patient Care • Professionalism and Interpersonal Communication • Final Exam • Grades for each domain are reported separately in the MSPE Updated for 2012-13

5. Criteria for Pass • Patient Care: • Direct observations of clinical skills complete (2 per clerkship) • RIME Interpreter* • Professionalism/Interpersonal Communication: • No significant or consistent concerns • Patient logs, other assignments complete • Exam score above clerkship passing threshold *See the CBEI website for additional details on the RIME framework.

6. Criteria for Pass with Distinction • All Passing criteria must be met AND • Patient Care: • RIME Manager • Professionalism and Interpersonal Communication (IPC): • Multisource feedback requested: 1 non-MD staff member, 1 patient, 1 peer • Consistent evidence of both Exceptional Professionalism and IPC with patients AND members of the medical team • Exam score above clerkship-specific threshold for Pass with Distinction Updated for 2012-13

7. Data Collection

8. Data Collection • Ideally • 100% of potential evaluators • will complete electronic evaluation forms in E*Value. • within a week of an evaluation being assigned.

9. Data collection • In reality • The minimum acceptable return rate is 50%. • Final evaluations must be submitted within 6 weeks of the end of the clerkship. • Some evaluators will not want to use E*Value.

10. Recommendations • Keep an eye on return rates – start reminding and re-requesting early. • Clerkships may need to tailor approaches to data-gathering to suit the needs of different groups, sites, or individual evaluators

11. Recommendations • Avoid going into an evaluation team review or submitting final evaluations with a return rate under 50%. Evaluations based on input from fewer than 50% of potential evaluators are unlikely to stand up in an appeal. • All evaluators who submit information (residents, faculty, fellows, non-MD staff, peers) should be listed as Contributing Evaluators in the final evaluation form.

12. Data Collection • For ideas, resources, and practical support in boosting evaluation return rates, contact • Jen Deitz (jdeitz@stanford.edu) • Gretchen Shawver (gshawver@stanford.edu) or • Elizabeth Stuart (aestuart@stanford.edu)

13. Interpreting Evaluation Data:Patient Care (RIME)

14. Two paths to distinction Performance Threshold for Distinction Time Students may earn Pass with Distinction by meeting criteria throughout the clerkship OR improving to meet criteria by the end of the rotation

15. Expected Transitions MANAGER INTERPRETER REPORTER Core clerkship students are expected to be in the Interpreter stage. POM Core clerkship Sub-I Residency + See the CBEI website for additional details on the RIME framework.

16. Interpreting Data from Patient Care (RIME) forms • For a student in the Interpreter stage: • Nearly all evaluators will select Consistently True for items in the Reporter section. • Data will include a mix of Sometimes and Consistently True for items in the Interpreter section.

17. Reporter Items

18. Interpreter Items

19. Alert • If significant number of evaluators - throughout the rotation - have selected Sometimes or Rarely True on Reporting items – the student has not met expectations for performance in a core clerkship and should receive a non-passing grade. • Clerkship directors should speak directly with individual evaluators to confirm that a student is not consistently demonstrating the skills required in the Reporter stage.

20. Pass with Distinction MANAGER INTERPRETER REPORTER POM Core clerkship Sub-I Residency + Pass with Distinction requires consistently strong Reporting and Interpreting (solid bars) with evidence of being in the transition to the Manager stage.

21. Interpreting Data from Patient Care (RIME) forms • For a student in the Manager stage: • Nearly all evaluators will select Consistently True for items in the Reporter and Interpreter sections. • Data will include a mix of Sometimes and Consistently True for items in the Manager section.

22. Manager/Educator Items

23. Broadly • Students in the Manager stage are functioning above the expected level – at the level of a sub-intern or beyond.

24. Q & A Q: Should core clerkship students really be expected to manage patient care?

25. Q & A: “Manager” A: The term Manager is not meant to imply independent implementation of patient care plans. Students who are Managers demonstrate a sense of personal responsibility for knowing as much as possible about their patients and ensuring that they receive optimal care. Managers see themselves – and are seen by others – as patients’ primary providers and advocates.

26. Q & A: M without I? Q: The evaluators for one of my students marked Consistently True for all of the Manager items, but only Sometimes True in the Interpreter section. Does the student meet criteria for being a RIME Manager?

27. Q &A: M without I? A: No. Pass with Distinction requires consistently strong Reporting and Interpreting skills in addition to the skills and attitudes represented by the Manager items on the evaluation form.

28. Q & A: Outliers Q: What if one evaluator checked Rarely or Sometimes True on an item – when all other evaluators marked Consistently True?

29. Q & A: Outliers A: When reviewing data for both Patient Care and Professionalism/Interpersonal Communication, Evaluation Teams should look for trends and themes - over time and across evaluators.

30. Outliers In sorting through outliers, consider: • Role/identity of the evaluator • Setting • Time the evaluator spent with the student • Timing during the rotation

31. Interpreting Evaluation Data:Professionalism and Interpersonal Communication (IPC)

32. Fundamentals of Professionalism and IPC

33. Interpreting data from the Professionalism/IPC form • To Pass, there should be a consistent trend of meeting expectations, with no significant or consistent concerns.

34. Exceptional Professionalism/IPC

35. Interpreting data from the Professionalism/IPC form • For Pass with Distinction, data from multiple evaluators should show a consistent trend of exceptional Professionalism AND Interpersonal Communication with BOTH patients and members of the medical team: • “Yes” answers to the yes/no question • Narrative examples of exceptional professionalism AND interpersonal communication Updated for 2012-13

36. Multisource Feedback (MSF) • To meet criteria for Pass with Distinction, students must request multisource feedback from • 1 non-MD staff member • 1 patient • 1 peer • A response by peers, non-MD staff, patients is not required. • Clerkships must put systems in place to record students’ MSF requests.

37. Q & A: Multisource Feedback Q: What if a non-MD staff member reports concerns about professionalism? Does that disqualify the student for PWD? Q: What if a patient or non-MD staff member submits a glowing description of a student’s Interpersonal Communication? Shouldn’t that information count toward Pass with Distinction?

38. Q & A: Multisource Feedback A: For the initial phase of CBEI, the content of multisource feedback is not considered in determining whether a student has met criteria for Pass with Distinction Positive comments from MSF content may be used as examples in the final narrative evaluation.

39. Final Grades

40. Final grade options • As of July 2012 clerkships will enter one of the following final grades for each student: • N - Continuing • Fail • Marginal Pass • Pass • Pass with Distinction will be recorded separately for each performance domain Updated for 2012-13

41. N grade • N is for failed exams. • N should not be used routinely for: • Marginal/non-passing performance in the domains of Patient Care or Professionalism/Interpersonal Communication • Missed time from the clerkship • Incomplete assignments • Use Marginal Pass or suspend the evaluation if a student has not completed all clerkship requirements*

42. More on N See MD Program Handbook for additional details.

43. Q & A: N grade Q: I have a student who was admitted to the hospital with appendicitis the night before the shelf exam. Should I wait to submit his evaluation until he takes the exam?

44. Q & A: N grade A: No. The evaluation should be submitted with an N grade within 6 weeks of the end of the clerkship. Evaluations contain important information that should be made available promptly to students. Evaluation submission should not be delayed by failed or missed exams.

45. Marginal Pass vs. Fail See MD Program Handbook for additional details.

46. Q & A: Evaluation Review Shortcuts? Q: Does the full evaluation team need to review files for all students, or just those who seem likely to meet criteria for Pass with Distinction in one or more domains?

47. Q & A: Shortcuts? A: CBEI introduces not only a new grade to recognize exceptional performance, but also a new process to ensure a fair and balanced review for each student. All students should benefit from the process of a full review.

48. Q & A: Evaluator Lists Q: Does the final evaluation in E*Value need to list every individual evaluator by name?

49. Q & A: Evaluator Lists A: It is strongly recommended that all contributors are listed individually, by name.

50. Narratives Guidelines for Narratives Summative vs. Formative