Course Self-Assessment Form

Course Self-Assessment Form

R.A. Bloodgood revised 9/18/00


Curriculum Committee Self-Assessment Form

(hopefully to be used as a Web template) for use by 1st/2nd year courses:

  1. Introductory Information
a. Name of Course
b. Course Director (co-Directors):
c. Clinical Associate(s):
d. Year and period of time covered by this self-assessment:
e. Purpose, Goals and Objectives for the course
  1. Time assignment/utilization in the course:

    Type of Teaching/Learning

    Total Hours

    Number in Group

    Large Group instruction




    Basic science lecture




    Clinical lectures/ clinical correlations







    Small group instruction




    Laboratory instruction








    Problem sets



    Individualized instruction




    Patient contact




    Self study



    Further Explanation:

  2. Description of course content:

    Append a copy of the course schedule/syllabus
    If course has a web site: list URL: _________________________
    Using the USMLE Content Standards, please mark the individual content standards covered in this course
    For each lecture, provide a single paragraph description
    For each lecture, provide two sample questions
  3. Assessment of Student Performance:

How does this course evaluate student performance?
(Check all that apply)
Exams (Number = )
Quizzes (Number = )
Problem sets (Number = )
Direct observation (Number = )

Student performance on formal course exams:

Does this course give letter grades:  yes  no


Exam 1

Exam 2

Exam 3

Exam 4

Mean %tile





Range of %tiles






Please include a copy of each exam along with an indication of topics covered by that exam and an item analysis of student performance. Identify questions (with subject area) that were missed by 50% of the students.

Did any subject areas in the course stand out in terms of student performance?

Assignment of letter grades for course:


Letter Grade

%tiles falling
within this letter grade

# of students
receiving grade

% of students receiving this letter grade













































N (number of scores) =

Mean score for the course (4.00 scale) =

Ask for break out of grades (average for the group) for:

1) MAAP-II students

2) Medical students repeating the course (with their previous grade)
3) MSTP students
4) Generalist initiative students

If any of these groups of students (ie. MSTP students) took a modified version of this course, please describe.

  1. Student Evaluation (of the course and its faculty):

    Hopefully, these data will be collected on-line using a Web form being developed by the Computers in Medicine committee to replace the current paper form. Hopefully, the programs being written will automatically compile and format the data and insert it into these courses self-evaluation templates.

    First part of data would be a form showing all the quantitative data on the course from the medical student evaluation forms

    Second part of the data would be a histogram(s) showing quantitative data across multiple years. Most important would be overall course score over multiple years but other components of the evaluation data might also be useful viewed across multiple years.

    Third part of the data would be the collated free response comments for each of these questions used on the medical student evaluation form for the particular course

  2. Faculty evaluation of the course (and peer evaluation):

  3. Analysis of new initiatives tried in the course during the year under evaluation

For each new Initiative, have three fields to fill in:
A. Description of the new initiative
B. Outcome information
C. Recommendation for future years regarding this initiative (drop, retain, modify)

  1. Proposed New Initiatives for the next year of the course.

    Describe new initiatives and the implications of these changes (for instance, implementing small group meetings in a course that had not previously had them would have implications on increased staffing needs for the course and needs for small group meeting rooms; for instance, providing a very useful Web site for the course might lead to reduction in lecture attendance; for instance, implementing improved "wet" lab may require investment in costly equipment)

    Describe strategies for addressing concerns raised in current year's evaluation

    Describe ways the course is attempting to identify the information most relevant to clinical practice?

    Describe attempts being made to integrate basic science material across courses

    Describe attempts to integrate basic science material with clinical material