Clerkship/Post Clerkship Committee
December 10, 2012

Members Present: Bray, Cheng, Heald, Keeley, McGahren, Newberry, Potter, Solorzano, Schroen, Jackson, Ham, Lieb, Sudhir, Wispleway, Herrington

McDaniel, N, recorder of minutes

Minutes

1. Technical Standards for LCME: the LCME requires that all SOM have technical standards for admission, promotion and graduation. The UVA SOM adopted the AAMC standards for admission in the late 1970’s. This committee discussed this in October meeting. A sub-group (McGahren, Bray, Schroen, Ham, McDaniel) sent draft document to Leslie Thomas and Dr. Canterbury in November. The SOM has returned a document to this committee asking for links to specific learning objectives.
    

   a.	This committee was requested to review the current Technical Standards document
   b.	This committee is requested to link specific learning objectives to the technical standards (focus on the physical requirement section)

            
2. Proposed evaluation change has been tabled for current time
    

   a.	Technical issues with OASIS
   b.	While the evaluation has been used at SUNY for more than 10 years the tool has not been validated
   c.	It is proposed to pilot the new form alongside of the current form in order to validate the findings
   d.	Elizabeth Bradley will continue to work on this
   e.	Alternate forms which are validated and give more specific behaviors than UVA SOM current form may be proposed

                           
3. Proposed centralization of Clerkship Coordinators: there was extensive discussion of this issue. All of the clerkship directors present (and one by email who could not be present) do not support this proposal. In particular they note that having the coordinator in the department is optimal for communication and clerkship support. They note that the clerkship coordinators provide more than 50% of their effort to the clerkship and at times it is a full time job for many of them. Dr. Sudhir noted that for EM having the coordinator in Anesthesia Department makes her job as director more time consuming because she does more of the direct faculty contact. Concerns expressed:
   
   

   a.	This is not how the majority of SOM nationally interpret the LCME guidelines. It was noted that a survey done by the clerkship coordinators found that the vast majority of medical schools surveyed had a decentralized model.
   b.	This has HR implications
   c.	The directors and chairs do not support this plan.

   
        
4. Clerkship Grading: propose weighting of components across the clerkships was discussed. The goal is consistency across the clerkships so that students know what to expect. The students expect transparency in the grading components.
    

   a.	SHELF or summative examination 25%
   b	Professionalism 5%
   c.	Mid-clerkship evaluations 20% (these must be linked to learning objectives)
   d.	Clinical evaluation 50% (this could include evaluations such as OSCE, presentations or other assessments linked to clinical reasoning and decision making)

                        
   There was extensive discussion related to this topic. The following points were stated:
    

   1.	The scales used to evaluate the students whether 5 or 9 points tend to put students in a very narrow range with very few low scores. Requirements to justify high or low scores make range even smaller.
   2.	The midpoint (expectation for the majority of students) is not a % grade
   3.	Clerkships use similar but not exact same methodology to calculate the clinical grade from the evaluations. Clerkship directors would like input from assessment team on the methodology to use. It was noted that questions 1-16 gives information useful for feedback to the student and possible items for praise or concern. The overall clinical grade was determined using question 17 for most clerkships rather than a composite score using all 17 questions.
   4.	There was a technical error in one student’s grade for a recent neurology rotation. The error was corrected and the grade revised. Communication among the students has resulted in concern about all of the grades. Dr. Solorzano has reviewed all of the grades and no other errors were found. Although there is concern expressed by students, the neurology grades have not changed on review after the new grading scheme and quizzes were added.
   5.	It was noted that the changes in the percentage weighting for clerkship grades will effect each clerkship differently.
   	a.  Several clerkship need to finalize plans for mid-clerkship evaluations linked to the learning objectives
   	b. Overall grades will need to be reviewed relative to historic trends with the new weighing system (eg those with high and low percentages of SHELF)
   6.	Transparency in the methodology used should be a guiding principle for all clerkships.

                                               
5. This committee requests knowledge of curricular items planned for the intersession for August 2013. This committee supports vacation for the students if the curricular items are less than a full 5 days. Suggested items for the intersession from this committee
   
    

   a.	CPD time for mentors to meet with students
   b.	Workshops, skills practice and OSCE

   
   
   
6. There was discussion of how often the SHELF examinations will be give with the new clerkship format
    

   a.	Psych/Neuro/FM SHELF will be given monthly
   b.	Pediatrics and OB will be given every 6 weeks
   c.	Medicine will be given every 12 weeks (the students will also have to take the test for EM at the end of the 12 weeks)
   d.	Surgery will be given every 12 weeks

                           

Action Items for this committee and each clerkship director:

1. Review Technical standards and link learning objective to items. Due by January 4, 2013. Send links to Nancy McDaniel and copy Leslie Thomas please.
2. Clerkship directors to meet with Michelle Yoon to review clerkship learning objectives to be completed by December 15, 2012.
3. Identify materials that support learning objectives also by January 15, 2013.
4. Finalize assessment methods which are linked to learning objectives by January 15, 2013.
5. Each clerkship (director and coordinator) will work with Medical Education Technology to have information/learning materials etc in standard format ( this is ongoing under leadership of John Jackson whose team is working with clerkship coordinators)
6. Align grading scheme as noted to start in March 2013 with class of 2015
7. Request to SOM  for clarification of how to use current evaluations to calculate clinical grade
8. Communication to students about the components of grades should occur

Next Meeting: January 28, 2013 5:00 PM in the Pediatric Conference Room