Guidelines for Evaluating Learners Clinical Performance

1. Guidelines for Evaluating
Learners’ Clinical
Performance

2. Know
Do
Learning Objectives
• The definition and purpose of evaluation.
• The preceptor’s role in evaluation.
• Strategies to make evaluation efficient and
useful.
• Eager to make evaluation more student-focused.
• Enthusiastic about encouraging learners to
self-assess.
• Use strategies that will help improve
techniques for evaluating learners’ clinical
performance.
Feel

3. Feedback Evaluation
Primary Differences between
Feedback & Evaluation
Schwiebert, L. P., & Bondurant, W. (2000). Summative Feedback, Evaluation, and Grading Students. In P. M.
Paulman, J. L. Susman, & C. A. Abboud (Eds.), Precepting Medical Students in the Office (pp. 81-87) Baltimore:
The Johns Hopkins University Press.
o Conveys information
o Formative
o Current performance
o Neutral (verbs/nouns)
o Fosters learning
o Conveys judgment
o Summative
o Past performance
o Normative statement
(adjectives/adverbs)
o Certification

4. Preceptor’s Role in Evaluation
 Before Rotation
- Understand program’s expectations
- Review goals and objectives
 During Rotation
- Gather information from multiple sources
- Provide feedback
- Use systematic method of recording
 End of Rotation
- Prepare for final evaluation
- Schedule and conduct summary meeting
- Complete and submit final evaluation

5. The Evaluation Process
① Collect data
② Review and collate data
③ Apply framework (competencies)
④ Determine level of competency
⑤ Share data with learner
During the Clinical Rotation

6. Use aVariety of Sources to
EvaluateYour Learner

7. ① Medical Knowledge
② Patient Care
③ Professionalism
④ Interpersonal Communication
⑤ Practice-based Learning: personal improvement
⑥ Systems-based Practice: system improvement
ACGME Core Competencies
acgme.org

8. Guidelines for Preparing
for the Final Evaluation
① Evaluation should be based on a systematic
observation recorded over a period of time.
② Evaluation should emphasize both changes in behavior
(improvement) and progress toward a goal.
Example: Julie’s suturing skills are comparable to
other first-year trainees. She has mastered proper
wound preparation. Her suture spacing and tension
are improving.

9. Guidelines, cont.
③ Evaluation should be both verbal and written
whenever possible.
④ Evaluation should be conducted in an
unhurried atmosphere.
⑤ Student should self-assess.
⑥ Evaluation should fulfill due process
procedures.

10. SampleWritten Comments
John is able to get to the important parts of a
history. He appeared kind and understanding.
He could quickly size up which individuals were
difficult patients.
Sheila had a bit of a hard time applying and adapting
her textbook knowledge to fit the real life cases that
are part of every family practice. While
this reality threw her at first, I noticed significant
improvement by the end of her time here.
UNDERSTANDING (problem solving, synthesis of
knowledge, originality, analytical ability)

11. SampleWritten Comments
SKILL (rapport, histories, physical examination, laboratory
organization, adaptability, use of hands)
Larry needs to work on taking a brief general history,
then concentrate on a more detailed history of the
current problem.
Bill does a good exam but is occasionally casual in
his attitude, writes incomplete notes, and is not as
thorough as he could be. Not so great with his
hands but makes up for it with strength of
personality. He will be popular with his patients.

12. SampleWritten Comments
KNOWLEDGE (scope and depth of faculty information)
I felt that Ann had a fairly narrow field of
knowledge regarding many of the cases we
encounter in this practice. Additional
exposure to textbook physical diagnosis
would help her improve in this area.
Ed worked hard to improve his differential
diagnosis skills. By the clerkship’s end, he
was performing at an appropriate level for a
third-year student.

13. SampleWritten Comments
ATTITUDE (intellectual curiosity, respect, integrity,
recognizes limitations)
Susan was excessively self-confident and needs to
better understand her limits. Despite giving her specific
feedback on this point several times, she still needs to
work on this area. Although intelligent, she often jumped
to conclusions without weighing all other possibilities.
I really got the feeling that Doug had a “just passing through”
attitude while he was in my office. He didn’t seem interested in
what was happening or in improving in areas where he was
weak (like doctor-patient communication skills), despite specific
feedback. He asked few questions and did not respond to my
efforts to get him thinking about the consulting-referring
physician interaction.

14. SampleWritten Comments
GENERAL COMMENTS (strengths and weaknesses)
Stan has good communication skills and establishes rapport
easily with a wide range of patients. He was able to get some
information from a complicated and uncommunicative patient
that has helped me greatly in that patient’s care. He has a
gentle style that I predict will make him a sought-after
physician once he is in practice.
Brad is quiet and reserved. I know that he cares about people
but sometimes his natural reserve can come across as
uncaring. He needs to continue to work on comfortable ways to
demonstrate warmth and build rapport during one-on-one
patient encounters. We discussed specific strategies such as
concentrating on eye-contact, using more non-verbal prompts,
and having a more relaxed posture during the interview.

15. A ‘Word Cloud’ of
Written Comments

16. Pre-Rotation Planning
① Review course materials and evaluation forms
from the program.
② Plan ways to observe and measure trainee
behaviors.
③ Check in with trainee:
a. Review form and your role in grading.
b. Consider learner self-assessment.
Summary

17. Summary
Core Rotation Activities
① Observe and provide regular, ongoing
trainee feedback.
② Use a system to record trainee observations.
③ Consider mid-rotation review, especially if
deficiencies are identified.

18. Summary
End of Rotation Activities
① Review evaluation criteria and form.
② Review student performance data.
③ Schedule and conduct final evaluation
session with trainee.
④ Complete and return evaluation form
promptly.

19. Use the strategies presented to
evaluate learners’ clinical
performance during mid- and final-
assessments.

20. What will you keep the same?
What will you do more of?
What will you do less of?
What will you stop doing?
What will you do differently & how will you do it?
What will you add?
LEARN – REFLECT -TEACH