standard 9: teaching, supervision, assessment, and student ... · pdf filecacms dci (november...

CACMS DCI (November 2014) – Standard 9

STANDARD 9: TEACHING, SUPERVISION, ASSESSMENT, AND STUDENT AND PATIENT SAFETY

A medical school ensures that its medical education program includes a comprehensive, fair, and uniform system of formative and

summative medical student assessment and protects medical students’ and patients’ safety by ensuring that all persons who teach,

supervise, and/or assess medical students are adequately prepared for those responsibilities.

9.1 PREPARATION OF RESIDENT AND NON-FACULTY INSTRUCTORS

In a medical school, residents, graduate students, postdoctoral fellows, and other non-faculty instructors who supervise, teach or assess medical students

are familiar with the learning objectives of the required learning experience in which they participate and are prepared for their roles in teaching and

assessment. The medical school provides resources to enhance and improve residents’ teaching and assessment skills, with central monitoring of their

participation in those opportunities provided.

SUPPORTING DATA

Table 9.1-1 | Provision of Objectives and Orientation Source: School-reported

List each required learning experience where residents, graduate students, postdoctoral fellows, and other non-faculty instructors supervise, teach, or assess medical

students. Add rows as needed for each campus.

Campus

Required learning experience

Types of trainees who provide

supervision/teaching/assessment

How objectives provided and teachers

oriented

Table 9.1-2 | Resident Preparation to Teach Source: School-reported

Briefly summarize the program(s) available to residents to prepare for their roles in supervising, teaching and assessing medical students in required clinical learning

experiences. For each program, note whether it is sponsored by the department or the medical school, whether the program is required or optional (R/O), and whether

resident participation is centrally monitored (Y/N), and if so, by whom. Add rows as needed for each campus.

Campus

Program Name/Brief Summary

Medical

school (M)

or

Department

(D)

Required/

Optional

R/O

Central

monitoring

of

attendance?

Y/N

By Whom?

Emergency Medicine

Family medicine

Internal medicine

Obstetrics Gynecology

Pediatrics


Psychiatry

Surgery

Longitudinal Integrated

Clerkship

Other (list):

NARRATIVE RESPONSE

a. Describe any medical school policies that require residents and non-faculty instructors to be prepared for their role in supervising, teaching or assessing

medical students.

b. Describe how the relevant department or the medical school’s administration ensures that residents and non-faculty instructors are oriented to the learning

objectives and to the methods of assessment for the required learning experiences in which they participate.

c. Describe how data provided by medical students or faculty members on the quality of resident teaching are used to improve the quality of resident teaching

and/or supervision.

d. Describe any medical school or relevant department programs that prepare graduate students or post-doctoral fellows to teach or assess medical students.


9.2 FACULTY APPOINTMENTS

A medical school ensures that supervision of medical students is provided throughout required clinical learning experiences by members of the medical

school’s faculty.

NARRATIVE RESPONSE

a. Describe the steps taken to provide faculty appointment to physicians who will supervise, teach and assess medical students in required clinical learning

experiences.

b. Describe how, by whom, and how often the faculty appointment status of physicians who supervise, teach and assess medical students in required clinical

experiences is monitored.

c. List any required clinical learning experiences where students are being supervised, and assessed by physicians who are not medical school faculty members

(do not include residents/fellows). Describe the steps being taken to provide faculty appointments to these physicians.

d. Where teaching and assessment of students in required clinical learning experiences is carried out by individuals who do not hold faculty appointments at the

medical school, describe how the teaching and assessment activities of these individuals are supervised by medical school faculty members to ensure that the

teaching is aligned with the learning objectives, is of good quality and that the learning environment is appropriate.

SUPPORTING DOCUMENTATION

a. Copy of the formal policy requiring physicians who supervise medical students in required clinical learning experiences to hold faculty appointments in the

medical school. (Appendix ZZ)


9.3 CLINICAL SUPERVISION OF MEDICAL STUDENTS

A medical school ensures that medical students in clinical learning situations involving patient care are appropriately supervised at all times in order to

ensure patient and student safety, that the level of responsibility delegated to the student is appropriate to his or her level of training, and that the

delegated activities supervised by the health professional are within his or her scope of practice.

SUPPORTING DATA

Table 9.3-1 | Clinical supervision, level of responsibility and scope of practice Source: AAMC CGQ

Provide data from the AAMC Canadian Graduation Questionnaire (CGQ) on the percentage of respondents that agree/strongly agree (aggregated) that they received

adequate supervision during required clinical learning experiences. Also provide data on the percentage of respondents that agree/strongly agree (aggregated) that they

were given appropriate responsibility for patient care. Add rows as needed for each campus.

Campus


School %

Appropriately supervised Appropriate level of responsibility

2013 2014 2013 2014

Emergency Medicine

Family medicine

Internal medicine


Pediatrics

Psychiatry

Surgery

Longitudinal Integrated Clerkship

Other (list):

Table 9.3-2 | Clinical supervision and level of responsibility Source: AFMC GQ

Provide data from the AFMC Graduation Questionnaire (AFMC GQ) on the percentage of respondents that agree/strongly agree (aggregated) that they are appropriately

supervised during required clinical learning experiences so as to ensure student and patient safety. Also provide data on the percentage of respondents that agree/strongly

agree (aggregated) that the level of responsibility given was appropriate. Add rows as needed for each campus.

Campus


% agree/strongly agree

The level of supervision

ensured my safety

The level of supervision ensured

the safety of the patients

for whom I provided care

I was given appropriate

responsibility

for patient care

Emergency Medicine

Family medicine

Internal medicine



Pediatrics

Psychiatry

Surgery

Longitudinal Integrated Clerkship

Other (list):

NARRATIVE RESPONSE

a. Describe how departments and the medical school central administration ensure that medical students are appropriately supervised during required clinical

learning experiences so as to ensure student and patient safety.

b. What mechanisms exist for medical students to express concern about the adequacy and availability of supervision and how and by whom are these concerns

acted upon?

c. What mechanisms are used during required clinical learning experiences to ensure that the level of responsibility delegated to a medical student is appropriate

to the student’s level of training and experience?

d. Provide examples of how the clerkship director or the student’s preceptor ensures that the activities delegated to medical students while under the supervision

of a health professional who is not a physician are within the scope of practice of that health professional.


a. Copy of any policies or guidelines related to medical student supervision during required clinical learning experiences that ensure student and patient safety.

(Appendix AAA)


9.4 ASSESSMENT SYSTEM

A medical school ensures that, throughout its medical education program, there is a centralized system in place that employs a variety of measures

(including direct observation) for the assessment of student achievement, including students’ acquisition of the knowledge, core clinical skills (e.g.,

medical history-taking, physical examination), behaviors, and attitudes specified in medical education program objectives, and that ensures that all

medical students achieve the same medical education program objectives.

SUPPORTING DATA

Table 9.4-1 | Observation of Clinical Skills Source: AAMC CGQ and AFMC GQ

Provide data from the AAMC Canadian Graduation Questionnaire (CGQ) and the AFMC Graduation Questionnaire (AFMC GQ) on the percentage of respondents that

agree/strongly agree (aggregated) that they were observed by a faculty member or a resident in all required clinical learning experiences. Provide data from other sources

for required clinical learning experiences that are not evaluated in the CGQ or GQ. Add rows as needed for each campus.

Campus

Required clinical learning experiences

School %

History Physical Exam

2013 2014 2015 2013 2014 2015

Emergency Medicine

Family Medicine

Internal Medicine


Pediatrics

Psychiatry

Surgery

Other (list) indicate data source

Table 9.4-2 | Methods of Assessment – Year One Source: School-reported

List all required learning experiences in the first year of the curriculum. Indicate the total number of exams. Indicate items that contribute to a grade and whether narrative

assessment for formative or summative purposes is provided by placing a “Y” in the appropriate column(s). Include evaluations provided by faculty members or residents

in clinical experiences and small group sessions (e.g., a facilitator evaluation in small group, problem-based, case-based teaching). Use the row below the table to provide

specifics for each occurrence of “Other”; number each entry and provide the corresponding number in the table. Add rows as needed for each required clinical learning

experience and for each campus where there are differences across campuses.

Campus (if applicable)

Required

learning

experience

No. of

Exams

Student Performance Assessment

MCQ, Key

features

exam

Short answer,

knowledge

application

exercises

Lab or

Practical

Exam

OSCE/SP

Exam

Small group

assessment

by Faculty/

Resident

Paper or

Oral

Presentation

Other*

(specify

below)

Narrative

Feedback as

part of an

assessment

*Other


Table 9.4-3 | Methods of Assessment – Year 2 Source: School-reported

List all required learning experiences in the second year of the curriculum. Indicate the total number of exams. Indicate items that contribute to a performance

assessment and whether a narrative is provided by placing a “Y” in the appropriate column(s). For faculty/resident ratings, include evaluations provided by faculty

members or residents in clinical experiences and small group sessions (e.g., a tutor, facilitator evaluation in small group, problem-based or case-based teaching). Use the

row below the table to provide specifics for each occurrence of “Other”; number each entry and provide the corresponding number in the table. Add rows as needed for

each required clinical learning experience and for each campus where there are differences across campuses.

Campus (if applicable)

Name of required

learning experience

No. of

Exams


MCQ, Key

features

exam

Short answer,

knowledge

application

exercises

Lab or

Practical

Exam

OSCE/SP

Exam

Small group

assessment

by Faculty/

Resident

Paper or

Oral

Presentation

Other*

(specify

below)

Narrative

Feedback

*Other

Table 9.4-4 | Methods of Assessment – Year 3 Source: School-reported

List all required clinical learning experiences in the third year of the curriculum, adding rows as needed. Indicate the total number of exams per clinical learning

experience. Indicate items that contribute to a grade and whether narrative assessment for formative or summative purposes is provided by placing a “Y” in the

appropriate column(s). For faculty/resident ratings, include evaluations provided by faculty members or residents in clinical experiences and small group sessions (e.g., a

facilitator evaluation in small group or case-based teaching). Use the row below the table to provide specifics for each occurrence of “Other”; number each entry and

provide the corresponding number in the table. Add rows as needed for each required clinical learning experience and for each campus/instructional site where there are

differences across campuses/instructional sites.

Campus/instructional site

(if applicable)

Required clinical

learning experience

Number

of exams


MCQ, key features

exam, knowledge

application

exercises

Oral

Presentation

Preceptor

Faculty/Resident

assessment

OSCE/SP

Exams

Other*

(specify

below)

*Other:


Table 9.4-5 | Methods of Assessment - Year 4 Source: School-reported

List all required clinical learning experiences in the fourth year of the curriculum, adding rows as needed. Indicate the total number of exams per clinical learning

experiences. Indicate items that contribute to a grade and whether narrative assessment for formative or summative purposes is provided by placing a “Y” in the

appropriate column(s). For faculty/resident ratings, include evaluations provided by faculty members or residents in clinical experiences and small group sessions (e.g., a

facilitator evaluation in small group or case-based teaching). Use the row below the table to provide specifics for each occurrence of “Other”; number each entry and

provide the corresponding number in the table. Add rows as needed for each required clinical learning experience and for each campus/instructional site where there are

differences across campuses/instructional sites.

Campus/Instructional Site

(if applicable)

Name of required

clinical learning

experience

Number

of

exams

Grade

MCQ, key features

exam, knowledge

application exercises

Oral

Presentation

Preceptor

Faculty/Resident

assessment

OSCE/SP

Exams

Other*

(specify

below)

*Other:

NARRATIVE RESPONSE

a. Describe the assessment system of the medical education program that monitors student achievement of the medical education program objectives

throughout the duration of the MD program. Describe the committees or groups involved in the decision-making process for student advancement and the

type of information that is used in the decision-making process. Describe how remediation plans are developed and how remediation is monitored to ensure

that deficiencies are effectively addressed.

b. For each comprehensive clinical assessment (e.g., OSCE or standardized patient assessment) that occurs at the program level i.e. independent of required

learning experiences, describe when in the curriculum it is offered, the general content areas covered by each, and the purpose of the assessment (formative to

provide feedback to the student and/or summative to inform decision-making about student advancement or graduation).

c. Identify the required learning experiences that include a formal assessment (either for formative or summative purposes) of the following areas:

1. History taking


2. Physical examination

3. Communication skills

4. Clinical decision-making


a. Data from internal data sources (administrative data e.g., completion of MiniCEX forms, confirmation by the preceptor or resident, or student perceptions)

regarding observation of history taking and performance of a physician examination. (Appendix BBB)

b. Samples of the specific or standardized forms used in the assessment of the following clinical and cognitive skills. Indicate on a cover page the required

learning experiences where each form is used and whether the results are used for formative (feedback) and/or summative purposes.

1. History taking (Appendix CCC)

2. Physical examination (Appendix DDD)

3. Communication skills (Appendix EEE)

4. Clinical decision-making (Appendix FFF)


9.5 NARRATIVE ASSESSMENT

A medical school ensures that a narrative description of a medical student’s performance, including his or her non-cognitive achievement, is included as

a component of the assessment in each required learning experience in the medical education program whenever teacher-student interaction permits this

form of assessment.

NARRATIVE RESPONSE

a. Describe any medical school policies that include the requirement for a narrative description of medical student performance, where feasible.

b. List the required learning experiences in the first two years of the curriculum that include narrative descriptions as part of a medical student’s final assessment

where the narratives are:

1. Provided only to the students as a formative assessment

2. Used as part of the final grade (summative assessment) in the course

c. List the required clinical learning experiences that include a narrative description as part of a medical student’s final assessment where the narratives are:

1. Provided only to students as formative assessment

2. Used as part of the final grade in the clerkship

d. If a narrative assessment is not provided in a required learning experience where teacher-student interaction could permit it to occur (e.g., there is small group

learning), provide the reason(s).


9.6 SETTING STANDARDS OF ACHIEVEMENT

A medical school ensures that faculty members with appropriate knowledge and expertise set standards of achievement in each required learning

experience in the medical education program.

NARRATIVE RESPONSE

a. Describe how and by whom the standards of achievement are set for the following:

1. Required learning experiences

2. The curriculum as a whole (i.e., graduation requirements)

b. Describe how the medical school ensures that faculty members with appropriate knowledge and expertise set the standards of achievement for required

learning experiences and for the curriculum as a whole.


9.7 TIMELY FORMATIVE ASSESSMENT AND FEEDBACK

A medical school ensures that the medical education program provides timely formative assessment consisting of appropriate measures by which a

medical student can measure his or her progress in learning. Each medical student is assessed and provided with formal formative feedback early enough

during each required learning experience four or more weeks in length to allow sufficient time for remediation. Formal feedback typically occurs at least

at the midpoint of the learning experience. In medical education programs with longer educational experiences (e.g., longitudinal integrated clerkship,

year-long courses) formal feedback occurs approximately every six weeks. For required learning experiences less than four weeks in length alternate

means are provided by which a medical student can measure his or her progress in learning.

SUPPORTING DATA

Table 9.7-1 | Formative Assessment years one and two Source: School-reported

For each required learning experience in the first and second year, list the type of formative assessment provided (e.g., quizzes, practice tests, study questions, formative

OSCEs). Add rows as needed for each campus.

Campus

Required Learning Experience

Length of Learning Experience

(in weeks)

Type(s) of Formative Assessment Available

Table 9.7-2 | Mid-point Feedback Source: AAMC CGQ and AFMC GQ

Provide data from the AAMC Canadian Graduation Questionnaire (CGQ) on the percentage of respondents that agree/strongly agree (aggregated) with the following

statement “I received mid-point feedback on my performance” and AFMC Graduation Questionnaire (AFMC GQ) with the following statement: “I received feedback early

enough in this experience to allow me to improve my performance”. Add rows as needed for each campus.

Campus

School %

2013 2014 2015

Family Medicine

Internal Medicine


Pediatrics

Psychiatry

Surgery

Table 9.7-3 | Mid-point Feedback Source: School-reported or ISA

Provide data from required clinical learning experience evaluations for the most recently-completed academic year and/or the independent student analysis (ISA) on the

percentage of respondents that agree/strongly agree (aggregated) that they received mid-point feedback for each listed clinical experience. Specify the data source. Add

rows as needed for each campus.

Campus

Emergency Medicine


Family Medicine

Internal Medicine

Obstetrics/Gynecology

Pediatrics

Psychiatry

Surgery

Other (list)

Data Source:

Table 9.7-4 | Longitudinal Integrated Clerkship Feedback Source: School-reported

Provide data for each longitudinal integrated clerkship (LIC) for the last three academic years from LIC evaluations or administrative data documenting feedback sessions

on the percentage of respondents that agree/strongly agree (aggregated) that they received feedback approximately every 6 weeks. Specify the data source. Add rows as

needed for each campus.

Campus AY 2012-13 AY 2013-14 AY 2014-15

Data Source:

NARRATIVE RESPONSE

a. Describe how and by whom the provision of formative assessment in required learning experiences, including clinical, is monitored.

1. Within each learning experience

2. At the curriculum management level.

b. For required learning experiences of less than four weeks duration, describe how students are provided with timely feedback on their knowledge and skills

related to the required learning experiences objectives.

c. Describe information from the independent student analysis, required learning experience evaluations, or other measures regarding medical students’

perceptions of the utility of mid-point feedback and its relationship to the criteria used for summative grading in required learning experiences.



a. Any medical school policy or similar document requiring that medical students receive formative feedback by at least the mid-point of required learning

experiences of four weeks (or longer) duration. (Appendix GGG)

b. Any medical school policy or similar document requiring that medical students receive formative feedback approximately every six weeks for longer required

learning experiences (half year, year long or longitudinal integrated clerkship). (Appendix HHH)


9.8 FAIR AND TIMELY SUMMATIVE ASSESSMENT

A medical school has in place a system of fair and timely summative assessment of medical student achievement in each required learning experience of

the medical education program. Final grades are available within six weeks after the end of a required learning experience.

SUPPORTING DATA

Table 9.8-1 | Availability of Final Grades Source: School-reported

For each required clinical learning experience, provide the average number of weeks, and the minimum/maximum number of weeks it took for students to receive grades

during the most-recently completed academic year. Also provide the percentage of students that did not receive grades within 6 weeks. Add rows as needed for each

campus.

Campus

Required clinical learning experience

AY 2014-15

Average Min Max %

NARRATIVE RESPONSE

a. List any learning experience in the first two academic years of the curriculum where all students did not receive their grades within six weeks during the most

recently-completed academic year.

b. List any specific clinical learning experience sites that are not complying with the school’s guidelines for the timeliness of grade reporting.

c. Describe how and by whom the timing of provision of the learning experience grades is monitored and the steps taken if grades are not submitted in a timely

manner. How does the medical school ensure that learning experience grades are reported to students on schedule?


a. Policy or directive that specifies the timeframe for the reporting of grades. (Appendix III)


9.9 SINGLE STANDARD FOR PROMOTION / GRADUATION AND APPEAL PROCESS

A medical school ensures that the medical education program has a single standard for the promotion and graduation of medical students across all

locations and a fair and formal process for taking any action that may affect the status of a medical student, including timely notice of the impending

action, disclosure of the evidence on which the action would be based, an opportunity for the medical student to respond, and an opportunity to appeal

any adverse decision related to promotion, graduation, or dismissal.

NARRATIVE RESPONSE

a. Describe how and by whom the medical education program ensures that a single standard (i.e., set of policies) for promotion and graduation is applied across

all instructional sites, including geographically distributed campuses.

b. Summarize the due process protections in place at the medical school when there is the possibility of the school’s taking an adverse action against a medical

student for academic or professionalism reasons. Include a description of the process for appeal of an adverse action, including the groups or individuals

involved at each step in the process.

c. Describe the means by which the due process policy and process are made known to medical students.


a. The policy that specifies that there is a single standard for promotion and graduation. (Appendix JJJ)

b. The due process policy and procedure. (Appendix KKK)

standard 9: teaching, supervision, assessment, and student ... · pdf filecacms dci (november...

Documents