The philosophy of CCLCM is that assessment should enhance learning. As such, you are provided feedback on your progress in basic science, research and clinical disciplines from multiple sources. This feedback allows you to identify your own strengths and weaknesses in comparison to defined, expected standards of performance.
No grades or comprehensive exams are given. Rather, you will submit essays and supporting evidence of your achievement of the nine competency milestones to the Medical Student Performance and Review Committee to inform promotion recommendations 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 and Scholarship: Demonstrates knowledge and skills required to interpret, critically evaluate, and conduct research.
Knowledge for Practice: Demonstrates knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences as well as the application of this knowledge to patient care.
Interpersonal and Communication Skills: Demonstrates effective listening, written and oral communication skills with patients, peers, faculty and other health care professionals in the classroom, research, and patient care settings.
Professionalism: Demonstrates commitment to high standards of ethical, respectful, compassionate, reliable and responsible behaviors in all settings, and recognizes and addresses lapses in professional behavior.
Personal and Professional Development: Demonstrates the qualities required to sustain lifelong personal and professional growth.
Patient Care: Demonstrates proficiency in clinical skills and clinical reasoning; engages in patient-centered care that is appropriate, compassionate and collaborative in promoting health and treating disease.
Teamwork and Interprofessional Collaboration: Demonstrates knowledge, skills and attitudes to promote effective teamwork and collaboration with health care professionals across a variety of settings.
Systems Based Practice: Demonstrates an understanding of and responsiveness to health care systems, as well as the ability to call effectively on resources to provide high value care.
Reflective Practice: Demonstrates habits of ongoing reflection and analysis to both identify learning needs, increase self-awareness and continuously improve performance and personal growth.
One of the unique core elements of CCLCM is the competency-based assessment and portfolio system. You will use assessment portfolios to document your individual progress and performance. This approach fosters a non-competitive learning environment where collaborative learning can thrive and where you take responsibility for self-directed learning that addresses your individual needs.
The electronic educational portfolio is evidence of your progress. The portfolio allows you to reflect on your strengths and improvement areas based on the evidence you have accumulated and develop learning plans to build upon strengths and address improvement areas. This process helps you develop the skills of self-directed learning and reflective practice critical for successful physician-investigators.
You will share your ePortfolio with your physician advisor and work closely with your advisor to create formative and summative portfolios. The uploaded portfolios can then be viewed online by your physician advisor and the Medical Student Performance and Review Committee.
This system tracks your clinical experience and helps ensure its congruence with the learning objectives of clinical rotations. You can record every educationally significant clinical encounter and your specific roles and learning points in these encounters, request and receive feedback from faculty and house staff, and search and review these 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 ensure that you are getting the clinical experiences you should in order to meet each rotation’s learning objectives.
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, you construct portfolios to document your progress in the competencies and provide evidence demonstrating your development as a doctor and researcher. Physician advisors review their students’ portfolio essays and assessment evidence for each competency and help students create learning plans to build upon strengths and areas of improvement. Physician advisors also help navigate the curriculum and provide coaching to support their students’ personal and professional development.
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
Bierer, S. B., & Dannefer, E. F. (2016). The learning environment counts: Longitudinal qualitative analysis of study strategies adopted by first-year medical students in a competency-based educational program. Academic Medicine, 91(11), S44-S52. DOI: 10.1097/ACM.0000000000001363.
