The philosophy of CCLCM is that assessment should enhance learning. As such, students are provided feedback on their progress in basic science, research and clinical disciplines from multiple sources. This feedback allows students to identify their own strengths and weaknesses in comparison to defined, expected standards of performance.
No grades or comprehensive exams are given. Rather, students submit essays and supporting evidence of their achievement of the nine competency standards to the Medical Student Promotion and Review Committee for review and promotion to the next year.
This competency assessment is similar to the assessments used in residency training in the U.S. as mandated by the Accreditation Council for Graduate Medical Education (ACGME).
The nine competencies are:
- Research: Demonstrate knowledge base and critical thinking skills for basic and clinical research and skill sets required to conceptualize and conduct research.
- Medical Knowledge: Demonstrate and apply knowledge of human structure and function, patho-physiology, human development and psycho-social concepts to medical practice.
- Communication: Demonstrate effective verbal, nonverbal and written communication skills in a wide range of relevant activities in medicine and research.
- Professionalism: Demonstrate knowledge and behavior that represents the highest standard of medical research and clinical practice, including compassion, humanism, and ethical and responsible actions at all times.
- Personal Development: Recognize and analyze personal needs (learning, self-care, etc.), and implement plans for personal growth.
- Clinical Skills: Perform appropriate history and physical examination in a variety of patient care encounters, and demonstrate effective uses of clinical procedures and laboratory tests.
- Clinical Reasoning: Diagnose, manage and prevent common health problems of individuals, families and communities. Interpret findings and formulate action plan to characterize the problem and reach a diagnosis.
- Healthcare Systems: Recognize and be able to work effectively in the various healthcare systems in order to advocate and provide for quality patient care.
- Reflective Practice: Demonstrate habits of analyzing cognitive and effective experiences that result in identification of learning needs leading to integration and synthesis of new learning.
One of the unique core elements of CCLCM is the competency-based assessment and portfolio system. Educational portfolios are used by students to document their individual performance. This approach fosters a non-competitive learning environment where collaborative learning can thrive, and students take responsibility for self-directed learning that addresses their individual needs.
The electronic educational portfolio is evidence of students’ progress. The portfolio allows them to reflect on their own strengths and weaknesses based on the evidence they have accumulated, and to develop learning plans to improve performance. This process helps them develop the skills of self-directed learning and reflective practice.
Online assessment forms are used to collect qualitative competency-based feedback from peers and faculty. The assessments are available to students and their physician advisors immediately in the ePortfolio. The students can review the feedback, add keywords and notes, and tag the assessments for future use as evidence for specific competencies. They also can sort all their assessments by competencies, targeted areas for improvements and areas of strength.
Students share their ePortfolio with their physician advisors and work closely with them to write their formative and summative portfolios. While writing these, they use bibliography tools to cite their evidence. The uploaded portfolios can then be viewed online by the physician advisors and the promotions committee.
Clinical Assessment System
This system integrates patient and procedure logs, and formative and summative assessments during clinical rotations at multiple sites within Cleveland and elsewhere. The system tracks the student's clinical experience and helps ensure its congruence with the learning objectives of the rotations. Students can record every educationally significant clinical encounter and their specific roles and learning points in these encounters, request and receive feedback from faculty and house-staff, and search and review this data using dynamic flexible reporting tools.
The system maintains a database of teaching faculty at four major teaching hospitals in Cleveland and allows them one-click access to student assessment forms. Discipline and rotation leaders have extensive, up-to-date reports that allow them to scan for outliers, drill down to specifics and ensure that students are getting the experience for which the rotations were designed.
Assessors provide within- and end-of-rotation feedback to students based on these powerful reporting tools. The system also helps CCLCM meet numerous LCME accreditation requirements during the clinical years.
The assessment process is student-centered and student-driven, with strong support from physician advisors who meet with students regularly and guide them throughout the five-year curriculum.
A few times each year, students document their progress in the competencies with essays and provide evidence demonstrating their development as doctors and researchers. Physician advisors review their students’ essays and evidence, and help them create learning plans to address areas of weakness and to build on areas of strength.
How Students Adapt
Perhaps the best way to learn how the program’s assessment system works is from the students themselves.
Many students are uncertain about what to expect from a competency-based assessment system, particularly when exams and grades are completely removed from the equation. Some aren’t sure how to gauge their learning; others fear that the absence of grades might affect their motivation; and still others are uncomfortable with using feedback as a tool for improvement.
Once students adapt to the new assessment system, they not only find it useful during medical school, but they also anticipate how well this approach will serve them as future physicians.
The following excerpts are from Altahawi F.; Sisk B; Poloskey S; Hicks C; and Dannefer EF. Student perspectives on assessment: Experience in a competency-based portfolio system. Med Teach. 2012;34(3):221-5.
“My attitude on feedback shifted from the criticism to the constructive. The system seemed to be working for me to improve on many aspects of becoming a doctor that would not necessarily have been addressed otherwise.”
– Student 1
“By receiving targeted feedback in lieu of a sterile number or letter grade, I was better able to understand and accept my strengths and weaknesses.”
– Student 2
“As I moved through my clinical years, I found my entire approach to my education had changed. I was even actively seeking feedback and acting on it without prompt from the system. This approach in itself was received well by all those around me and resulted in overwhelmingly positive interactions.”
– Student 1
“In addition to requesting written feedback, I found myself verbally requesting feedback from residents and attending physicians at the midpoint and end of each rotation. In addition, I shared areas of performance that I planned to work on improving at the start of each rotation so that those supervising were able to comment on my progress.”
– Student 3
“At this point in my education, 5 years after I first engaged in the portfolio-based system, I have come to rely on the feedback that I receive; the written comments I received from my residents and attendings are a much better barometer of how I am performing and what I can work on than any grade might be.”
– Student 4
“In fact, during a recent visiting elective at an outside program, I made an extra effort to practice this approach despite that program’s grade-based system. Although the forum for frequent written feedback was not in place, my experience within the CCLCM system had made me confident and comfortable enough to seek verbal critiques, which helped me improve my performance and gain significantly more from that rotation than I otherwise might have.”
– Student 4
Read the entire paper here.
View additional faculty research papers on assessment:
- Dannefer, EF; Henson, LC. The portfolio approach to competency-based assessment at the Cleveland Clinic Lerner College of Medicine. Acad Med. 2007;82:493–502.
- Dannefer, EF; Prayson, RA. Supporting students in self-regulation: Use of formative feedback and portfolios in a problem-based learning setting. Med Teach. 2013;35: 655-60.