The rotation for medical students consists of two 4-week blocks. Students do 4 weeks of Parkland General medicine wards or Parkland Hospitalist and 4 weeks of general medicine wards of either, CUH, Methodist, Presbyterian, or the VA.

GRADED REQUIREMENT

Midpoint and summative feedback

• LCME (Liason Committee on Medical Education) REQUIREMENT:
  • Must provide MID-TERM feedback so students can adjust their behavior
  • Must provide summative feedback at the end
  • Feedback sessions must be done formally 

Written H&P Feedback Form (mobile friendly)

• Complete the MedHub form with link to a checklist tool to give feedback on your student’s first documented H&P in the EMR. 
• This H&P should include a comprehensive HPI, past history and med list without the use of prebuilt EMR templates and A/P emphasizing clinical reasoning for differential diagnosis, diagnostic and therapeutic plan for the patient’s care.
• Must formally document strengths and areas of improvement
• This is not the formal write-up which is no longer a requirement on the clerkship.
• Forms are only reviewed for timely completion, not assessment of performance.  Worth 4% of student’s final grade.

Narrative Evaluations

• Evaluations must be timely!
  • Complete within one week after your rotation
• Document (in the narrative) your OBSERVATIONS across 3 domains of student performance:
  • Professionalism
  • Communication
  • Clinical acumen
• Provide specific examples of each domain!
  • Only with documented observation of a student’s clinical competency can we ensure the grades we assign are based upon our stated rubric.
• Refrain from documenting an intended grade in your comments as your grade designation will be reviewed to ensure it matches with our suggested rubric
• If we are unable to determine by your comments which grade was earned, the IM Clerkship Co-Directors will reach out to you for further information. 
• If you provided robust data but it was determined the grade should have been different we will feed forward that information to you to help standardize the grading process. 
• Comments in the first box, “Descriptive paragraph about student performance:”
  • Included in the Dean's letter and the Departmental letter
  • Professional communication from you to the University and future residency programs
  • Unacceptable to write simple generic statements such as “good student.” Vague statements:
    • do not help students in their residency applications
    • do not provide valuable summative feedback
    • do not provide specific observations of clinical competency to on which to base the grade
  • Refrain from placing overtly negative comments in this box

Example of comments for the “Descriptive paragraph about student performance” box:

STUDENT A was a wonderful student who had several key strengths:

1. Professionalism: She was always punctual, attentive, and actively engaged on rounds and inpatient care. She asked good questions and spent meaningful time at the bedside with patients. She worked hard to establish rapport with her patients and performed invaluable and rigorous medicine reconciliation with a patient for whom a complex medication regimen led to a readmission.
2. Clinical acumen/Potential for growth: STUDENT A takes feedback very well and delivers on specific goals for improvement. Her raw potential as a physician and fund of knowledge is quite vast. She absorbed information readily, read extensively on her patients' medical problems to contextualize her personal studying with ongoing care, and actively sought feedback and guidance from team members. Her presentations, documentation, and logical organization profoundly improved and ultimately excelled during my time with her. In several areas of competence, she began to emerge as a manager. In the realm of inpatient insulin titration, she was actively recommending plans to our team that were regularly incorporated into actual care. This competency was obtained after a single lecture 
   followed by at home study and mentorship with her residents in a few short days. She is a rock-star learner.

• Reserve formative comments for the second box, “Feedback-only comments”
  • Student can read but will not be included in any official letters
  • Completion of this box is required and should include specific feedback on behaviors and skills that need further professional development

Example of feedback only comments:

Student B, I enjoyed working with you and would be happy to work with you again in the future. Areas that you should work on for continued growth:

1. Consistently provide your clinical reasoning in your documentation and be able to share on rounds.
2. Consistently root your clinical reasoning in the evidence and share with the team.
3. Move into the role of manager, and later peer educator.

You have a lot of potential, Student B, and I am excited to see how you develop as a physician.

Grading

Clinical grades for the IM Clerkship are given as Honors/High Pass/Pass/Fail. In an effort to provide a fair and meaningful grading system, clinical grades should be awarded based on the level of clinical competency you observe during your time with a student at the end of your rotation.

Please note that the grades (not your narrative evaluations) will be blinded to the students until the end of the superblock to allow the Clerkship Directors time to review the grades to make sure they are supported by the narrative evaluations as this is a new rubric.

Honors students should be:

1. Able to formulate a diagnostic and therapeutic plan independent of the resident on straightforward patients and with little direction on more complicated cases. 
2. Organized, thorough and able to ask pertinent questions based on the appropriate differential when performing a history and physical. 
3. Utilize a concise SOAP format when making an oral presentation. 
4. Able to manage the most common complaints with the use of evidence-based medicine and use literature to suggest management changes pertinent to their patients’ care and illustrated by their ability to counsel patients appropriately on the plan of care. 
5. Able to prepare written documentation that demonstrates thorough history taking, be absent of copy and paste, and the assessment should continuously be updated to reflect the current clinical status. 
6. Able to present treatment plans prioritized and based on national guidelines and standard of care therapy. 
7. Able to make most patients and families feel comfortable.
8. Professional in all interactions with all team members. 

Narrative comment example:

I had the pleasure of working with Student A in her final two weeks of her IM Clerkship the last clerkship of her third year. Student A has developed an organized and thorough approach to history taking. She was still gaining confidence in her physical exam skills but was able to synthesize the available data and prioritize an appropriate differential. At the beginning of the rotation, Student A self-identified a few areas to work on and one was her mastery of the pulmonary exam and in a few short days she was accurately identifying adventitious lung sounds. When delving deeper into her knowledge of common medical management or work-ups, Student A was able to draw upon a firm foundation of medical knowledge. In a team environment, Student A had a quiet reliability and was immensely trusted by her peers. Overall, Student A has done a wonderful job cementing the clinical skills needed for her intern year.

Example feedback-only comments for the same student:

Student A, I am glad I got to know you better over our time together. You are doing very well and operating at the level of an early manager. It was evident that you are dedicated to helping your patients by continually reading on their medical issues. Areas to focus on in your last year of medical school is your physical exam skills - being a colleges peer mentor can help give you more deliberate practice as well as using your Selectives to continue to hone these skills. Also as we discussed, try to slow down and pause when discussing findings and management plans with patients. Watch for body language and when you see a change, take the opportunity to ask your patients what they think or understand. Your approach to learning of purposefully setting small goals each learning period and moving to the next is very smart and is definitely paying off! Keep it going!

In short, you would trust this student to manage straightforward patients without supervision.

High Pass students should be:

1. Able to interpret data collected from the history, physical examination, medical record, laboratory data, and radiologic studies and formulate a well-reasoned and prioritized differential diagnosis on straightforward patients. 
2. Organized, thorough and able to ask pertinent questions based on the appropriate differential when performing a history and physical. 
3. Able to prioritize urgent problems and share literature pertaining to their patients.
4. Utilize a concise SOAP format when making an oral presentation. 
5. Able to provide appropriate clinical reasoning for current treatment plan for their patients.
6. Able to demonstrate empathy for patients and be professional in all interactions.  

Narrative comment example:

I enjoyed working with Student B on his IM clerkship. I was his first attending of the clerkship and Student B showed considerable growth. By the end of the two weeks, Student B was able to take, and document a thorough history and physical exam. He worked on prioritizing his problem lists, developing a relevant differential and explaining his clinical reasoning. He will continue to work to consistently root his clinical reasoning in evidence and to move toward becoming a peer educator. He is very bright and has great potential here. We had a patient with a fever of unknown origin. Considerable testing was ordered to no avail. Student B did his own reading and presented three possible diagnoses the residents and I had not considered. When the Infectious Disease team was consulted, their recommendations were exactly what Student B had suggested.

Feedback-only comments for same student: 

Student B, I enjoyed working with you and would be happy to work with you again in the future. Areas that you should work on for continued growth:

• Consistently provide your clinical reasoning in your documentation and be able to share on rounds.
• Consistently root your clinical reasoning in the evidence and share with the team.
• Move into the role of manager, and later peer educator.

You have a lot of potential, Student B, and I am excited to see how you develop as a physician.

In short, you would trust this student to be able to interpret the data and articulate an appropriate and broad differential diagnosis without supervision.

Pass students should be:

1. Able to obtain information from a history and physical
2. Able to thoroughly review a medical record, rarely missing pertinent details to past medical history or current presentation
3. Able to report findings in an organized and coherent SOAP format. 
4. Consistently reading on their patients’ medical problems and come back to teach the team their findings. 
5. Able to demonstrate empathy for patients and be professional in all interactions. 

Narrative comment example:

I worked with Student C during his first two weeks on clinical clerkships. Student C demonstrated an ability to link clinical situations to pathophysiology during chalk talk teaching topics and discussions during rounds. He eagerly read on medical topics applicable to his patients and was enthusiastic on rounds and clinical discussions surrounding our patients. He was extremely professional in his interactions with the team. Above all, Student C was quick to adapt to feedback.

Feedback-only comments for same student:

Student C, as we discussed at the end of the rotation, you are a dedicated student and a delight to work with! To grow in your clinical skills, gaining knowledge of typical signs and symptoms of common illness scripts will help you ask questions on history in an organized and efficient manner. Currently you are consistently operating at the level of a reporter. You are organized in your delivery of information and to move to the next level you should learn more about common signs and symptoms that are more specific for disease processes and therefore increase your post-test probability. To do this you can use resources such as the JAMA Rational Clinical Exam Series or the book evidence based physical diagnosis. In just two short weeks, I can see great potential in your abilities as a physician. Your heart is in the right place and you have the talent and intelligence to back it up!

In short, you would trust this student to report their findings in a thorough and organized manner.

Fail* should be assigned in the cases of a student who is:

• Repeatedly providing inaccurate data or omitting important details.
• Unable to consistently report findings in an organized manner.
• Unable to document a complete history and physical.
• Not reliably completing clinical care or required tasks.
• Resistant or defensive to constructive feedback.
• Insensitive to needs or feelings of patients or the healthcare team.
• Frequently absent or late.
• Unexcusably absent one or more times. An unexcused absence is any absence not communicated to both the IM Clerkship and the clinical team attending and resident.

*Any student who exhibits any of the above behaviors must be brought to the attention of the Clerkship Co-Directors immediately to ensure we are not missing a potential pattern that indicates an issue with student wellness, personal emergency or a clinical competency issue we can help provide resources to improve. Your communication with us can help us provide a learning environment that prepares our students for continued growth.