Learning Objectives

1. Block directors [clerkship block directors (CBDs) and Foundation of Doctoring (FOD) Directors] will work together and with their block committees and thread directors to design learning objectives for each block that will foster student acquisition of required knowledge, skills, attitudes, and professional behavior consistent with the overall educational goals and objectives of the SOM.
2. Block directors will be responsible for ensuring that learning objectives are stated explicitly at the beginning of each block.  They will assure that site directors are aware of the clerkship-specific objectives and global objectives of the school with the explicit expectation that the objectives will be transmitted to the faculty and residents teaching at each site.
3. Learning objectives will include promoting self-directed learning and self-evaluation.
4. Block directors will be responsible for ensuring that block faculty direct students to the resources necessary to accomplish the learning objectives.
5. Clinical block directors will collaborate with other curriculum leaders to develop learning objectives that integrate basic science, clinical medicine, and threads (Cultural Competency, Bioethics and Humanities, Society and Medicine, and Informatics/Evidence Based Medicine) through all four years of the curriculum.

Content and Schedule

1. Block curricula will
   • focus on clinical material that provides a foundation for the student’s future medical education.
   • provide opportunities to learn and apply basic science and threads material in a clinical context.
   • foster student’s professional development
2. Block directors will use a variety of teaching/learning methods that will:
• encourage active learning in all venues
• provide independent learning opportunities with patients
• provide structured instruction on specific clinical skills
• integrate basic science and thread concepts
• include exercises that involve searching, analyzing, presenting, and discussing the literature as it applies to the content of the block, a case, or a patient.
3. Faculty charged with directing clinical rotations will structure a curriculum to incorporate the following student duty hour requirements (previously approved by COC):
• no more than 80 hours a week of scheduled participation* averaged over 4 weeks
• no more than 30 consecutive hours of scheduled participation* during one period of time
• a minimum of 24 consecutive hours scheduled off in 7 days averaged over 4 weeks
  * In addition to clinical responsibilities, calculation of scheduled participation must include the Foundations of Doctoring course and occasional activities mandated by the Dean of Student Affairs.
4. Policies on attendance, sick leave, vacations and leaves of absence are described in the Academic Policies and Procedures handbook under “Attendance Policies”. (Previously approved by COC but now modified)
• Attendance on clinical rotations is required.  Rotations end on the last Friday afternoon of each rotation. 
  
  Involuntary Absences- serious illness, family illness, jury duty, and academic difficulties will be discussed with CBD and Student Affairs and a remediation plan developed by the Clerkship Block Director in conjunction with the student. Any involuntary absence longer then two days needs to be discussed with Student Affairs.
  
  Voluntary Absences: (Wedding, Travel, Local or National Board Meetings) from required clerkship activity are generally not permitted- but unique circumstances maybe discussed with the Course Block Director. In the rare instances when accommodation can be made, a remediation plan will developed by the Clerkship Block Director in conjunction with the student. Requests must be put in writing and reasonable documentation will be required.
5. Block directors will provide an overview of the block at orientation.
6. Students will receive call schedules from the CBDs or coordinator one week in advanced of their first call date.
7. Intra-clerkship periods consisting of 2 days in the block will be used to include basic science or thread material that is associated with clinical material in the block. Intra-clerkship periods can be arranged as each block committee considers is appropriate but must include all the students in the block and provide structured instruction and assessment of material.
8. For the Rural and Community Health course, students will be required to have transportation to and complete a rotation in a rural community, with exceptions for hardship which will be approved through the Dean of Students office; and 2). Other rural or AHEC rotations may be taken in other blocks. (COC approved 11/20/06)
9. Block faculty will make educational and reference materials available no later than orientation.
10. Block final exams will be held on Fridays; there will be no scheduled night call on the preceding Thursday.
11. Block committees will develop and provide on-going input and oversight for the block. They should be a resource for the CBDs. The composition of the block committees should include a multi-disciplinary group with representatives from the Threads, Basic Science, appropriate members from clinical disciplines relevant to the block, and when possible fourth year students or residents.

Student Assessment

1. Block directors will be responsible for developing, administering, and evaluating the results of all formative and summative assessments in their block.
2. Block faculty will design summative assessment activities (designed for the purpose of grading) that match the stated learning objectives and teach formats used in the block and should include of knowledge, skills, and attitudes appropriate. Students will use their learning logs specific for clinical problems (required by LCME) in a consistent manner throughout the curriculum.
3. Block directors will include assessment of cognitive knowledge, observed structured clinical and patient care skills, communication skills, professionalism, integrated content, and self-directed learning skills in each block.
4. The Block directors will state explicitly the grading criteria and how such grades will be determined at the beginning of each block. Faculty will evaluate student performance in a variety of activities that will be as consistent as possible throughout the core blocks with some variation for different competency requirements.
5. Clinical grades will consist of Honors, High Pass, Pass, Fail, In Progress Pass and Incomplete Fail. Students MUST pass all required components of the clerkship (see specific clerkship requirements) in order to pass the course. The determination of a passing grade will be competency based. Specifically, students MUST receive an average rating of 3 on the clinical evaluation forms in order to pass the clinical component of the course. In addition, students must achieve better than 2 standard deviations below the mean on the clerkship written examination in order to pass the course. Finally, they must pass all other components of the course- standardized patient evaluations and project work if included in the grading process.
   Students will receive an IP for initial failure of the written exam, with the opportunity to retake the exam once before an IF is given. Students who fail the initial exam cannot receive honors in the course. Recording of the initial failure of the exam should be made below the MSPE comments line. Students who fail the clinical portion or multiple components of the composite grade will receive an IF. If students fail all aspects of the clerkship initially, an F may be given and the entire clerkship must be repeated. The remediation plan is at the discretion of the clerkship director. High Pass is not an official transcript grade at The University of Colorado but will be recognized and valued as a grade that can be incorporated into the Medical Student Performance Evaluation (MSPE).
   Honors grades should be reserved for a maximum of the top 20% of students in each block (as assessed at the completion of each block throughout the year) with a maximum cap of up to 30% of students being awarded honors per year, such that clerkship directors have the ability to further refine the awarding of honors after review of students performance on all measures at the completion of the clinical year. In other words, the top 20% of students in each block will receive honors at the end of that block. However, at the end of the clinical year, after review of all of the grading parameters and the performance of students throughout the year, clerkship directors will be able to review grades of students in the next 10% and increase the number of honors awarded to a maximum of 30% should they feel that it is warranted. This policy will be reevaluated at the end of the 2008/2009 academic year. Musculoskeletal Care and Emergency Care, which are 2 weeks in length will be graded on a pass/ fail basis only.
6. Written examinations should comprise a MAXIMUM of 20% of the overall clerkship grade; for those clerkships using a NBME Shelf Examination, the national mean, rather than the local mean should be used to determine grading.
7. Each clinical core block will use the same clinical assessment form for students approved by the CBD in March 2008. Clinical evaluations should comprise a MINIMUM of 50% of the overall clerkship grade. Clerkship block directors will review all medical student evaluation forms for inconsistencies and appropriateness of ratings. Evaluations which appear to be incongruent with the student’s expected level of performance (either better or worse) will be discussed with the evaluator (attending or resident) and changes in the evaluation will be made as dictated by that discussion. The purpose of these discussions are two-fold:
   1. Assure that the form adequately represents the student’s level of competency in each domain of skills assessed by the evaluation form. This is vital to assuring fairness in the grading system.
   2. Educate faculty on the use of a developmental rating scale and how such a scale differs from global rating scale. This is vital to assuring the overall success of the grading form.
   Ultimately, the clerkship block director reserves the right to assign the final grade based on all the information available to them. This grade will not be dictated solely by the clinical evaluation form ratings, but rather will include a broad assessment of a student’s achievement on all the required competencies described in the clerkship description.
8. The standardized patient evaluations for each block should be graded on a pass/ fail basis ONLY if used as part of the overall assessment of a student (as opposed to a learning module). The pass/ fail rule will stay in effect for the first academic year (2007/2008) and will be reassessed prior to the 2008/2009) academic year. Students will be required to retake an SP case(s) until a passing score is achieved.
9. Project work is not a required component of all clerkships. When project work is required, it should be included in the formal student grade. All grading of project work MUST include a grading rubric. Course may not use “extra credit” projects as a means to determine an honors grade.
10. 10. Block curricula will provide frequent opportunities for formative assessment. The primary purpose of formative assessment is to provide constructive feedback to students about their progress and monitor for improvement. Students will be required to participate in specified formative assessment activities mid-way during the course with their learning logs and mid-course review forms. Faculty will review these forms, sign them and forward to the course coordinator for CBD review.
11. Courses should consider using a committee to reconcile grades and assure consistency of grading within the course before the grade is awarded. Members of the committee should include clerkship directors, site directors at each hospital/ clinic, core clinical teaching faculty with frequent exposure to the students and/or chief residents if responsible for significant mentoring/ teaching of students.
12. Student assessments must be submitted no later than 6 weeks after the course is completed. Every attempt should be made to identify failing students earlier than this time period to allow remediation before the next block.
13. Block directors will have a low threshold to initiate the professionalism process and to remediate unprofessional student behaviors. If a professionalism issue was raised, the CBD will be required to investigate and complete a professionalism form. The professionalism process will follow the algorithm adopted by the Student Professionalism Committee. As with all professionalism reports, the proceedings of the committee will remain confidential. However, CBDs have the discretion to determine that professional behavior warrants the non-confidential inclusion of the behaviors on the final evaluation. A process for students to evaluate resident and faculty professionalism is underdevelopment throughout the HSC and will be added to the clinical policies once approved.
14. CBDs will serve as peer reviewers on difficult student assessment issues for other CBDs such that the CBDs as a group will provide assistance to clerkship directors on difficult or inconclusive assessment areas. This peer review process will be completed as soon as possible after the completion of a block. Students will be informed that their grades will be discussed in this peer review venue and they will be informed of the outcome.  Any grade of IF or F will be brought to this group as well as instances where there is a mis-match between the final grade and the written evaluations.  This process should improve grading consistency across clerkships. CBDs and the Dean of Students can initiate a review.
    The process will consist of the following – 1) CBDs or Dean of Student will notify Clinical Core Leader one week in advance of meeting of students to be brought to the group and the reason; 2) CBD will bring documentation of student performance so peer review process can comment on the situation; 3) students names will NOT be anonymous to the Clinical Core Leader or the Dean of Students but will be anonymous to the CBD peer review group. All names should be blacked out before distribution of material; 4) Clinical Core Leader and Dean of Students will work to optimize future rotations; 5) Executive sessions of the CBD will include SADE, Dean of Students, CBDs and Dean of Evaluation.
15. Block directors will notify the Dean of Students if, in their opinion, a student may be at risk of failure on future core clerkships.  Block directors will notify the Dean of students if any student will receive an IF or F in the course. If personal student issues surface in the block, which might affect future performance, the CBD will work with the student and encourage them to seek the support and guidance of the Dean of Students. The Dean of Students will work with the individual students and the clerkship directors of pending clerkships to help place the students in the most appropriate location to allow improvement in performance. CBDs will not inform clerkship faculty of such arrangements. Professionalism issues will be handled confidentially in accord with the professionalism process.
16. Students will also be required to pass an end of Phase III clinical assessment before graduation.
17. Faculty will utilize the Educational Development and Research Office (ED&R) and the Center for Studies in Clinical Excellence when developing assessment tools.

Evaluation and Development of Curriculum and Faculty

1. 1. Block Directors will be responsible for monitoring the quality of the block, including observation of faculty as educators. Block directors will work with the EAOC and ED&R to solicit and review standard online course and instructor evaluations.  ED&R will provide mid year and annual summary data comparing clerkship block evaluations and summary data within clerkship blocks across sites.
2. The Educational Development and Research Office (ED&R) will promote faculty and curriculum development by
• compiling and developing resources for block directors and faculty to use in curriculum design and implementation.
• organizing a required initial education session for all block directors and subsequent sessions for faculty, as needed, on learning objectives, active teaching formats, and assessment methods.
• working with block directors and threads to identify educational needs of their block faculty and formulate plans for appropriate faculty development.
3. Each student will be required to complete an end of course evaluation for each clinical clerkship block within 2 weeks of completing the course. Failure to complete these evaluations will result in your course grade being held or an Incomplete Pass (IP) for the course until your evaluation is complete.