SCHOOL OF MEDICINE STUDENT HANDBOOK

EVALUATION OF STUDENT PERFORMANCE
CLASS OF 2010 AND SUBSEQUENT YEARS

Examination Policy

Foundations of Medicine and Health Curriculum

Summative Portfolios

Core Clinical Rotations

Advanced Core Rotations

Research and Scholarship

Flexible Program

Promotion Guidelines

Remediation

Students must satisfactorily complete all components of the educational program in a timely fashion to be eligible for promotion and graduation. In keeping with the goal of a balanced and coherent educational program, the School of Medicine seeks to identify potential academic problems early, and provide non-prejudicial intervention as necessary to assist all students in meeting academic standards.

Foundations of Medicine and Health SSEQs are administered in proctored classrooms and are expected to represent each student’s own work.  All National Board of Medical Examiners (NBME) Tests are administered following NBME guidelines.  Students are required to sign an Examinee Acknowledgement Form before the first examination is administered.  This form is reproduced in Appendix II.

All students must take the examinations in the assigned facility on the scheduled examination date and time.   Students who are not able to take a Foundations of Medicine and Health Curriculum examination at the scheduled date and time because of illness or emergency must contact their Society Dean before the examination.  When an acute illness or other emergency arises less than 24 hours before an examination, students should contact their Society Dean to report the situation.  When deemed appropriate, the student will be granted official approval to defer the examination and personnel will be notified.  The student will be expected to take the exam on the official scheduled date, and is bound by his/her honor not to look at or review published ideal answers.

Disabilities and Accommodations
The School makes accommodations available to those students who, because of a documented disability, require accommodations.  Students with disabilities who request accommodations must provide written documentation to his/her Society Dean who will submit the request to the Accommodations Committee.  The specific procedure and forms that must be completed are described in Appendix I and Appendix II.

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Student assessment in the WR2 Curriculum is designed to accomplish three goals:  1) drive the types of learning and inquiry that are goals for the WR2 Curriculum; 2)  ascertain whether students attain the level of mastery set as a goal for graduates of Case; and 3)  prepare students for the Multiple Choice Question (MCQ) USMLE exams.  These three goals are accomplished through multiple different assessment methods.

Student performance is assessed by a variety of methods with special emphasis on scientific reasoning, comprehension, and problem solving, (e.g., synthesis essay questions, multiple-choice, laboratory practical).  Performance is designated as “meets”, “provisionally meets”, or “does not meet criteria.”  Students who do not meet or provisionally meet criteria are identified to the Society Deans and the Block Leader (see the Remediation of Foundations of Medicine and Health Curriculum section).  Information concerning examination performance and class rankings is not part of the student’s permanent record.  However, examination scores are recorded for students participating in the Medical Scientist Training Program. The following assessments are used in the Foundations of Medicine and Health:

1. Assessment of students’ participation in weekly Case Inquiry (IQ) groups by faculty facilitators, utilizing observable behavior anchors and focusing on contributions to the group content, contributions to the group process, and professional behaviors.
   
   

2. Synthesis Essay Questions (SEQs).  Weekly, formative, open book concept reasoning exercises in which students are  given a brief written clinical scenario and asked to explain a clinical phenomenon and its basic science underpinnings.  Throughout a teaching block, students complete SEQs at the end of each week.  They then compare their answers to an ideal answer template as well as get feedback on their reasoning ability from their IQ group facilitator.
   
   

3. Summative Synthesis Essay Questions (SSEQs), or exercises that measure what students know at specific points in their education, are closed book exercises with approximately 5 scenarios that take 3-4 hours to complete.  These SSEQs are based on the synthesis essays students have done in an open book fashion throughout the block.  In the final week of the block SSEQs present concepts from previous exercises in new contexts and require a more sophisticated level of concept integration. These summative exercises are scheduled at the end of each large teaching module (every 3-4 months) and are graded by the faculty who are content specialists.
   
   

4. Structure Practical Exercises.  These assessments will occur in the final week of blocks 2-6 and will integrate anatomy, histo-pathology and radiology through clinical scenarios and questions that ask for anatomic localization and histo-pathologic identification.
   
   

5. Self Assessment Multiple Choice Questions (MCQs).   At the beginning of each 12 week teaching block students will have access to 200 MCQs and answers drawn from the School of Medicine’s existing extensive bank of questions which will be mapped to learning objectives for the block. These questions are representative of those given during the USMLE Part I.  Students can use these MCQs through the block as a study aid and method for self-assessment.
   
   

6. Cumulative Achievement Tests (CAT). At the end of each block students will complete a secure formative MCQ achievement test, based on content covered in the current teaching block as well as on content from each previous block.  These exams will be designed, utilizing test question resources available through the NBME.  Tests will become progressively longer throughout the Foundations of Medicine and Health.  The final CAT will reflect material across all curriculum blocks.     These formative tests are for student use only, and enable students to gain perspective on their overall progress and preparedness for the USMLE.
   
   

7. Student progress in Foundations of Clinical Mastery is measured by small group facilitator assessment in the Seminars of Clinical Practice, direct observation of skills, preceptor evaluation of patient-based activities, and OSCE examinations.
   
   

8. Professional Learning Plan.  During the Reflection and Integration Week, students review the learning objectives for the block and reflect on their learning, identifying their strengths and areas for further study.  A reflective essay is completed that links to pieces of evidence, accumulated throughout the block, to support why areas of strength and areas for further growth have been identified.  A plan for further learning is then developed.
   
   

Required Assessment Tools to Measure Achievement of Learning Goals in WR2
                                                                       

Foundations of Clinical Medicine (Foundations) is the first course in the clinical curriculum and continues throughout Medical School.  In years 1 and 2, the guiding principle is that early exposure to patients, with direct observation by experiences faculty physicians, is optimal for both professional development of students as doctors and assessment of their clinical skills.  Foundations has three interrelated components:  clinical skills training, patient care experiences, and Foundations of Clinical Medicine Seminars.
 
Students will be evaluated formatively throughout the year on each aspect of the Foundations course.  Summative evaluations will be employed as well, and will include preceptor evaluations, peer reviews, and objective structured clinical examinations.  At the end of each block of the Foundations of Medicine and Health Curriculum, students will receive a designation of “meets expectations”, “provisionally meets expectations”, or “does not meet expectations”.  These designations will be approached in a manner consistent with assessment in Foundations of Medicine and Health.

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Summative Portfolios

End of Block 4, End of Block 6, and During Year 4

Portfolio:  a purposeful collection of student work that exhibits the student’s efforts and includes self-reflection on strengths and areas for improvement.

Competency:  an outcome that must be met in order to graduate from Case School of Medicine.  The WR2 Curriculum has 9 competencies that must be met in order to receive an MD degree.

Summative Portfolio:  a student’s self-reflection on his/her learning progress and choice of supporting evidence with regard to each competency that is reviewed to determine promotion decisions.

• At three points in time, a summative portfolio will provide an assessment of how a student is progressing with respect to meeting 9 competencies of the WR2 Curriculum required for graduation.  Use “achievement levels” to guide reflection.

Summative Portfolio:  End of Block 4

• Focus on 5 of 9 competencies:  medical knowledge, patient care, interpersonal and communication skills, professionalism, life-long learning, and personal development.

• Assessment of 4 competencies will be postponed until later in the curriculum:  research and scholarship, civic professionalism and leadership, practice-based learning and improvement, and systems-based practice.

Form of the Summative Portfolio

• 5 sections, one for each of the 5 competencies; each section no longer than 1 ½ pages.

• Reflect on your learning and accomplishments this year through the end of the Block 4 in each competency.  Think about each achievement level listed for a given competency.  Discuss your strengths and areas for improvement for each achievement level.  Reference evidence from your ePortfolio and other available evidence to support your reflections.

• Due at end of Block 4.

• In rare circumstances, some students will be granted a portfolio extension until the end of the summer 2007 to complete remediation plans for Blocks in the first year curriculum.  Student must have evidence in their portfolios of successful remediation in order to receive promotion to Year 2.

• Portfolios will be read by a group of portfolio reviewers to determine if you are qualified for promotion to Year 2.

Core Competencies – End of Block 4 Achievement Levels
Western Reserve2 Curriculum

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Assessment in Core Clinical Rotations is multidimensional and competency based. Elements of performance that are important are cognitive skills, interpersonal skills, qualities of character, integrity, and work habits.  The procedures used to assign grades will be derived for each discipline (internal medicine, family medicine, surgery, ob/gyn, pediatrics, neurology, psychiatry) from performance on Core Clinical Rotations as outlined below:

An evaluation strategy using a point system has been established to make the evaluation process objective and standardize evaluations across sites. Points are earned by clinical performance in the inpatient and ambulatory settings based on assessments by residents, attending physicians, and preceptors.  In addition, performance on objective examinations also factors into your grades - the NBME Progressive Achievement Test and the Objective Structured Clinical Examination (OSCE). During the Advanced Core, students are able to build on their clinical activity scores and add to those already achieved in the respective disciplines in the Basic Core. Attendance and participation in the Friday afternoon seminar series also are requirements.

Three components are combined as follows to sum to the 500 points overall:
            A. Clinical Activity Score:                                300 points
            B. NBME Progressive Achievement Test:           150 points
            C.  OSCE Performance Score:                           50 points 
            D.  Friday Afternoon Curriculum:                      meets/does not meet expectations

A. Clinical Activity Score -- 300 points

The Clinical Evaluation form contributes to this portion of the evaluation. Seven competencies contribute to the final score: patient care, medical knowledge, communication skills, professionalism, practice-based learning, systems-based practice, and research/scholarship.  Performance is rated for each of the competencies as Outstanding (10 points), Above Expectations (8 points, Meets Expectations (6 points), and Significant Room for Improvement (4 points). 
The maximum score that can be achieved on a single form is 70.  Scores on all forms submitted for a student will be averaged.  The average score will be multiplied by a factor of 4.3 to achieve a final Clinical Activity Score.

B. NBME Progressive Achievement Test--150 points
The highest of the three discipline-specific NBME Progressive Achievement Test scores will be used and weighted in the calculation of the student’s grade in each discipline.  Students who score above the mean (when compared to the criterion referenced group) are eligible for honors or commendable.

Students who score more than two standard deviations below the mean each of three time points must retake the exam. Scores are standardized to a mean=70, stddev=8.   Two digit scores will be multiplied by 1.55 to achieve a final NBME point total.

C. OSCE Performance Score–-50 points
Using the Class of 2007 as the criterion referenced group for this OSCE, students who pass this exam are eligible for honors or commendable.  These scores are standardized to mean=70, stddev=8.   Two digit score will be multiplied by 0.52 to achieve a final OSCE point total.

 

Addendum (effective July 16, 2007):  As part of our continuing review of the grading process, we have decided to make a change in how the end of year OSCE is factored into your discipline-specific grades.  All students must pass the OSCE—either on the first try or on a subsequent attempt.  A passing score on the OSCE will give you all 50 points (out of a possible 50).  In other words, when you pass, you get 100% of the possible points. 

D. Friday Afternoon Curriculum---meets/does not meet expectations

In order to meet expectations for this part of the curriculum, students must attend and participate in all sessions unless excused by the course director as well as satisfactorily complete all assignments.

TOTAL POINT SCORE – clinical evaluations from the inpatient setting, the ambulatory setting, and written and clinical exams are summed to determine the student’s total point score. Cut-off scores are as follows:

• HONORS: A total point score > 450 and a score of at least 70 on the NBME and passing score on the OSCE.
  
  COMMENDABLE: A total point score < 449 points and > 375 and a score of at least 70 on the NBME and a passing score on the OSCE.
  
  SATISFACTORY: A total point score of < 374 and > 300 points and a score of at least 56 on the NBME and a passing score on the OSCE.
  
  INCOMPLETE: Students whose total point scores are below 300, or who score less than 56 on the NBME or who score less than 56 on the OSCE.  These students will be given the opportunity to retake that component of their evaluation on which they scored below established cutoffs.
  
  

Final grades of Honors, Commendable, Satisfactory, Unsatisfactory, or Incomplete will be assigned for each core discipline based on this combination of information.  An Incomplete designation must be replaced by an Honors, Commendable, Satisfactory, or Unsatisfactory evaluation; arrangements must be made with the Clerkship Director and the appropriate Society Dean.  Students who receive an unsatisfactory evaluation or whose behavior has been deemed unprofessional will appear before the Committee on Students for review of their total performance throughout all programs of the curriculum.  Satisfactory completion of all required core clerkships is a requirement for graduation.

In addition to the grading process described above, University students will join College students in a parallel end of block assessment process focusing on expectations in relation to core competencies.  At the end of each block, a report for each Discipline will be developed for each student. The report will include a summative assessment for each competency: “Meets all competency standards”, “Meets most competency standards, no remediation required”, “Meets some competency standards, remediation required” or “Not observed/not applicable”.  For “Meets some competency standards, remediation required” a remediation plan will be created. This remediation plan must address all elements that did not meet standards for competency.  This report will be available to the student’s Society Dean.  Students are encouraged to discuss this report with their Society Dean in order to address areas of weakness when planning clinical electives and other learning activities.

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Advanced Core Rotations

The Advanced Core Rotations consist of 4 separate, required 4-week rotations that are completed in any order. The 4 domains for these experiences are: Chronic Illness, Aging in Men and Women, Peri-Operative Care and Pain Management, and Undifferentiated Care. During the Advanced Core, students are able to build on their clinical activity scores and add to those already achieved in the respective disciplines in the Basic Core. Only Advanced Cores that feature 4 weeks of clinical activity in one discipline area will be counted toward a Basic Core Discipline grade. This includes:

• "Aging" for Internal Medicine
• "Chronic Disease" for Internal Medicine or Pediatrics (but not both)
• "Undifferentiated/Emergent Care" for Internal Medicine or Pediatrics (but not both)

The Advanced Core grades will contribute as follows to the FINAL point total (out of 500 possible points) for the Basic Core grades:

• Advanced Core grade of Honors--add 10 points
• Advanced Core grade of Commendable--add 5 points
• Advanced Core grade of Satisfactory--add 0 points

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For the Class of 2010, research and scholarship is a critical component of the curriculum.  The objective is to help students acquire tools and experience in asking questions, critically assess literature, and develop other aspects of the life-long pursuit of learning that is an integral aspect of the career of all physicians and physician/scientists.  The research and scholarship component of the curriculum has four aspects.  First, a seminar course in the foundations of research and scholarship meet once a week during the first 18 months of the curriculum.  Second, the summer following the first year is available for students to engage in elective 8-week, full-time, mentored research experiences with a faculty member here or at another university.  Funding opportunities are described at the website for the Office of Medical Student Research.  Third, each student spends one of three possible 4-month blocks in year 2 (March-June) or year 3 (July-October, November-February) pursuing full-time mentored research.  Prior to starting this block, each student selects a project and an advisor and writes a proposal.  The aim is to provide students with an opportunity to pursue an area of interest in greater depth than can presently be accomplished within the curriculum.  The topic can be as varied as the range of interests of the students and faculty and includes opportunities to pursue basic, translational, clinical, or population-based research.  The goal for each student is to formulate a question in an area of interest, to develop and implement an approach to answering it, to carry out this project, and to arrive at an interpretation of the observations.  Fourth, students may pursue research interests during elective time in the latter part of year 3 and throughout year 4.  The research project pursued during the 4-month block, as well as subsequent elective time if desired or needed, will culminate in an M.D. thesis in the format of a manuscript similar to a leading journal in the particular field.  A complete description of the requirements is found at the website for the Office of Medical Student Research.

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The Flexible Program provides opportunities for students to pursue electives in areas of personal interest.  A description of the elective offerings and expectations for student performance is available in the Flexible Program Catalogs provided by the Registrar.  In order to drop an elective, a student must secure his/her Society Dean’s permission.

Type A Electives
Student performance in Type A offerings is evaluated as credit or no credit.  Instructors are encouraged to provide narrative comments on student performance.

Type B Electives
Student performance in Type B offerings is evaluated as honors, commendable, satisfactory, unsatisfactory, and incomplete. An incomplete designation must be rectified. Instructors are encouraged to provide narrative comments on student performance.

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Academic Expectations for the Foundations of Medicine and Health
Students must achieve passing marks in all components of the Foundations of Medicine and Health curriculum.  If a student does not meet expectations in any block, remediation is required.

Students are required to remediate all basic science subject committees in order to emphasize:

• Mastery of basic science concepts
• Early identification of failure to master basic science material
• Personal responsibility in the remediation process
• Standardized remediation strategy for all basic science subject material

Attendance and Participation Policy:  Case IQ Program
The Western Reserve2 Curriculum and the IQ Program brings students greater freedom in directing their learning and greater responsibility for managing their professional commitment to the learning process.  The IQ Group Program assumes professional behavior among students as a fundamental principle.  Expectations for attendance and participation were developed in the context of student maturity and institutional respect.  Please take a moment to review these policies:

Attendance 
Students must attend 100% of the IQ sessions and show up on time.  The quality of the work in the group depends upon the participant’s presence and preparation.  If students do not attend, prepare, or participate, this will hurt the learning of the group.  We recognize that major life events occur (illnesses, birth of a child, weddings, funerals, etc.) and you may need to miss a session.  Such absences are handled initially in discussion with your IQ Group facilitator and then with your group.

Students are not allowed to extend vacations beyond the periods specified by the official academic calendar.  Leaving early for an official school vacation is a breach of your professional responsibilities to your group and to the policies of our School.  Your professional commitments extend through 12 noon on the final day of classes prior to an official school vacation and resume at 8 am on the first day of classes following a vacation.  IQ Groups that come immediately before and immediately after official school vacations - “bookend” sessions - will take place as scheduled and not be changed.  Your attendance and full participation in IQ Groups is a part of your professional obligation to our School and to the IQ Group Program.

Participation

Students must have high professional standards in an IQ Group.  Since this kind of teaching is more like a clinical experience rather than an anonymous large classroom experience, students must act like professionals.

Students will communicate correct information.

Students will insure the quality of their own learning and the integrity of the process by engaging in truthful reflections and assessments of personal and group performance.

Students will listen to one another and create a safe learning environment that is non-threatening.

Students will help one another by preparing, participating and creating a positive learning environment.

 

WR2 Remediation in Foundations of Medicine and Health (FMH)

The Following components make up the end of block ratings:

            1. SSEQs
            2. Structure Practical Exercise
            3. Cumulative Achievement Test
            4. Final Case Inquiry Faculty Assessment
            5. Medium Group Faculty Assessment
            6. Foundations of Clinical Medicine
            7. Clinical Immersion Exercise
            8. Professional Learning Plan
            9. Society Dean Advising meeting (mid & final)

Definition and consequences of end of block ratings:

Meets criteria; overall satisfactory achievement of criteria: the student has met all expectations for all components of the block.

Does not meet Criteria:  3 possibilities

1) Targeted remediation required-- Students will receive this rating if they do not meet criteria for any of the following:
                       
           Structure Practical Exercise
           Cumulative Achievement Test
           Final Case Inquiry Faculty Assessment
           Medium Group Faculty Assessment
           Foundations of Clinical Medicine
           Clinical Immersion Exercise
           Professional Learning Plan
           Society Dean Advising meeting (mid & final)

The student is required to meet with his/her Society Dean and develop a plan to address specific areas noted and show evidence of successful remediation in his/her portfolio.

Deadlines:  Targeted remediation for blocks 1-4 must be completed prior to submission of the end of block 4 portfolio.  Targeted remediation for blocks 5 and 6 must be completed prior to submission of the end of block 6 portfolio.  Note that the Structure Practical Exercise is a component of each of blocks 1-6.  Exceptions to this timing must be approved by  the student's society dean.

2) SSEQ remediation required--  Students who do not meet criteria for the SSEQ examination are required to remediate.  All students will be required to pass the same remediation assessment that will be designed by block faculty.  Evidence of successful remediation must be provided in the portfolio.

Deadlines:  Block 1 SSEQ remediation must be completed by the end of winter break of the same academic year.  SSEQ remediation for blocks 2-4 must be completed prior to the  initiation of block 5.  SSEQ remediation for blocks 5 and 6 must be completed before the student can continue with any curricular activities beyond the Foundations of Medicine and Health at the end of block 6.

3) Incomplete-- Student is unable to achieve the objectives of the block due to illness or emergency.  The student will work with his/her society dean and corresponding block faculty to develop a suitable schedule for fulfilling block requirements.

Referral to Committee on Students (COS):

A student will be referred to the COS as soon as any of the following criteria are met:

           1.  A student fails one SSEQ exam in blocks 1-6 and fails that block's remediation.
           2.  A student fails two SSEQ exams in blocks 1-6.
           3.  A student fails to meet expectations for one or more targeted remediations.

For complete COS policies see the Committee on Students section in the Student Handbook.

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