Core Clerkships: Assessment and Grading

As of 2019, UCSF no longer assigns honors grades in core clerkships. The reasons for this change are to support students’ learning rather than focus on performance and ‘looking good’, and to promote fairness, equity, and wellbeing early in students’ clinical training.

The new approach to assessment emphasizes students’ development of essential skills, and students’ own accountability for their learning by seeking feedback and setting goals.

1. Assessment maximally facilitates learning (assessment for learning) through appropriate and frequent feedback to students.
2. Assessment incorporates a developmental perspective.
3. There is a match between teaching, learning and assessment. Students feel that they are assessed on the skills they are trying to learn and improve.
4. Assessment activities generate feedback that is useful for students to guide their own learning and for faculty to be able to ensure students’ learning is on track to achieve the competencies of the clerkship.

The Bridges Brief Observation Tool (BBOT) is used for a short observation of student performance in one of these areas:

1. Gathering history from a patient
2. Conducting physical examination
3. Delivering an oral presentation
4. Procedure
5. Writing a note for chart
6. Communication with a patient or family
7. Patient Advocacy
8. Other (write in)

The student is responsible for requesting observation and feedback with the BBOT from an attending, resident or intern supervisor; a supervisor can also offer to initiate this. After the supervisor observes the student, the supervisor gives feedback in person to the student. The supervisor or student documents the observation through a Qualtrics form that is accessed by scanning a student’s QR code. The form includes a single rating about the amount of supervision needed, and narrative comments about skills observed.

The student must initiate and receive 2 BBOTs per week. By the end of the clerkship, the student must receive at least 1 of each (clinical interaction, written work, and oral presentation), and at least 2 total from faculty and 2 from residents (if site has residents). Over a given clerkship, up to one-quarter of a student’s BBOTs can be completed by an intern. Students are encouraged to collect more than the minimum to gather more feedback.

Students must write 2 SMARTIE learning goals in first week of clerkship. At the midpoint of the clerkship, the student will meet with the clerkship or site director to review information from the Bridges Brief Observation Tools collected to date, the students’ SMARTIE goals from week 1, and the student’s midpoint reflection on progress to date and plans for the remainder of the clerkship. The purpose of this meeting is for the clerkship/site director and student jointly to assess learning progress and guide planning for the remainder of the clerkship.

Each clerkship will assign an evaluation form to attendings and residents who work with the student for a minimum amount of time defined by that clerkship. Overall, fewer faculty and residents will be assigned to complete these forms than in the past, in order to focus on those supervisors who know the student best and had the most contact with the student. Interns will not complete summary evaluations.

The final grade of Pass will be achieved by completing the following:

1. Completion of BBOTs: 2 per week as described above
2. Learning goals
3. Midpoint feedback meeting with clerkship director or site director
4. Achievement of expectations on evaluations completed by attendings and residents
5. Pass Clerkship exam
6. Log core clinical experiences, including completion of observed H & P and midpoint feedback in MedHub Procedures

The clerkship grading committee serves to determine that students have achieved clerkship competencies and completed assigned activities. The grading committee is responsible for generating high quality narratives that describe individual student performance. The narrative should include description of the student’s competence in: patient care, knowledge/clinical reasoning and communication/professionalism.