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Medical Education
Medical Student Education

Assessment and Grading in the Bridges Curriculum

The approach to assessment of student performance in the Bridges Curriculum is a program of assessment that is integrated across the curriculum beyond any one subject or course and which embraces the philosophy of assessment FOR learning. The Bridges Curriculum program of assessment promotes each student’s individual path toward competence in the unique knowledge, skills, and attitudes that characterize the Bridges physician. In the assessment FOR learning philosophy, assessment activities contribute significantly to student learning by giving each student ongoing information (data and other feedback) about performance that is key to guiding their individual next steps in the UCSF MD competencies and milestones.

Seven core competencies and associated milestones define the expectations for students throughout the curriculum. Frequent formative assessments will guide students’ future learning, promote reflection, and help shape students’ values about continuous improvement of their practice of medicine. Periodic summative assessments ensure that students have mastered the necessary knowledge, skills, and attitudes needed to advance to the next level of their training.

Student assessment in the Bridges Curriculum is designed to meet multiple goals:

  1. Provide ongoing feedback to students about their learning
  2. Promote deep learning, critical thinking, and habits of inquiry aligned with the Bridges Curriculum mission
  3. Determine that students have attained by graduation the knowledge, skills, and attitudes at a level of mastery necessary to provide high-quality care
  4. Prepare students to excel on USMLE licensing exams

Assessment in Foundations 1

In Foundations 1, these goals are accomplished through multiple assessment methods. Assessments are based on the UCSF competencies and milestones that describe the development of the different physician competencies necessary in clinical practice. Assessments are intentionally connected or sequenced over time and across courses to enable demonstration of individual progression. Assessments and grading are planned, coordinated, and integrated across all elements of the curriculum.

The School has developed several key resources to support student learning and professional development:

Coaches: Learning and professional development is supported throughout medical school by mentorship and guidance from Coaches. Each student is assigned a clinician educator Coach who provides advising and mentoring, teaches foundational clinical skills, and supports the student in reviewing individual progress and setting learning goals.

Dashboard: The Bridges Student Dashboard houses performance data for each student and provides space for students to reflect on progress with their Coach and to generate individual learning plans. Students take responsibility for the mastery of skills and knowledge with frequent receipt of information in their dashboard, regularly reflecting on ways to improve, and seeking additional practice.

ARCH Weeks: Assessment, Reflection, Coaching, and Health (ARCH) Weeks are four weeks in the Foundations 1 phase of the Bridges Curriculum that provide students dedicated time for reflection on competency development, enable learning planning with Coaches, and provide opportunities for consolidation and integration of learning.

Grading: In Foundations 1, students receive one grade for each of the Interdepartmental Studies (IDS) courses. This grade integrates student performance in all elements within the IDS course, including the Clinical Microsystem Clerkship (CMC), Foundational Science (FS) blocks, the Core Inquiry Curriculum (CIC), and ARCH Weeks. Integrated grades encourage students to connect all of the knowledge and skills they are learning in the classroom and in clinical settings, just as a physician integrates knowledge and skills in patient care.

Weekly Checkpoints: Frequent formative assessment activities for medical knowledge throughout Foundations 1 come in the form of Weekly Checkpoints. Weekly, students complete multiple choice questions (MCQs) and open-ended questions (OEQs) designed to confirm if students have achieved the expected level of competency with the material for the week. The Weekly Checkpoints have additional benefits because the act of testing has a positive direct impact on learning. Numerous studies suggest the active process of retrieving information from memory strengthens memory more and leads to longer retention than re-studying or reviewing material: this phenomenon is called “the testing effect.” Studying this way has been shown to improve both immediate and delayed diagnostic accuracy as well as skill acquisition. Though the Checkpoint activities are open-book, students are encouraged to practice retrieving information from memory, and testing how and when completion of the Checkpoints works best for their learning.

Checkpoint MCQs: Each week, the MCQ Checkpoint provides 20-25 MCQs that test key objectives from the week. Students may complete the MCQ Checkpoint as many times as they wish, adjusting incorrect answers to improve their understanding and scores, until the Checkpoint closes at the end of the week. A score of at least 50% is required for the MCQ Checkpoint to be considered complete. All answers and detailed explanations are released when the Checkpoint closes on Sunday. The MCQ Checkpoints serve as an efficient study aid and key mechanism for self-assessment, and allow students to practice the types of questions asked on the USMLE Step 1.

Checkpoint OEQs: Each week, the OEQ Checkpoint provides two clinical vignettes, each with 2-3 associated questions that explore interdisciplinary applications of basic and clinical knowledge. Students choose one vignette and submit answers to the associated questions before the Checkpoint closes at the end of the week. On Sunday, after the Checkpoint closes, model answers for both sets of OEQ questions are released. Students are asked to complete a reconciliation, whereby after comparing their answers to the model answers, they reflect on their level of understanding, and, if necessary, request additional help with their learning. The OEQ Checkpoints are designed to provide students with practice of skills they need to apply on the Summative OEQ exams, including application rather than recall, critical thinking, and written communication skills.

The Weekly Checkpoint assessments deliberately emphasize test-enhanced learning, by combining frequent repeated information retrieval, mixed practice in both recognizing and producing answers, and self-evaluation in response to testing. Because these approaches are so critical and effective for learning, completion of Weekly Checkpoints is one of the Foundations 1 course requirements in the Practice-Based Learning and Improvement competency, and completion of Weekly Checkpoints will be displayed in the Bridges Student Dashboard for each student.

Summative Medical Knowledge Assessments

Summative assessments of medical knowledge will occur at the end of each Foundations 1 Foundational Science (FS) block and in some cases at mid-point in an FS block. These summative assessments will consist of Open-Ended Questions (OEQs) and, in some cases, a separate laboratory practical exam. Summative OEQs assessments are closed-book exams (unless specifically indicated to be an open-book exam) consisting of 3-5 clinical scenarios, each with 3-5 associated OEQs. Each Summative OEQ exam will take 3-4 hours to complete. The OEQs on the summative assessments are similar in format to the Weekly Checkpoint OEQs and are designed to emphasize application of knowledge (rather than recall of facts), critical thinking, and written communication skills. This approach promotes deeper learning and longer-term retention than other test formats. 

 

1. Brown, P.C., Roediger, H. L., & McDaniel, M. A. (2014). Make It Stick: The Science of Successful Learning, Cambridge, MA: The Belknap Press of Harvard University.

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