MED 8710 Core Experiences
Block Rotation-based Stream
Phase 4, Class of 2023
Academic Year 2021-2022

Assessment Plan
 
The Core Experiences course immerses learners in the clinical environment through experiences in core disciplines with a focus on prescribed experiences in Anesthesia, Emergency Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, Rural Family Medicine, and Surgery. In the block rotation-based stream, learners are trained in these disciplines in a sequential curriculum. EPA refers to Entrustable Professional Activity.
 
EPAs that must be assessed in the block rotation-based stream:
 
EPA 1:            Obtain a history and perform a physical examination adapted to the patient’s clinical situation.
EPA 2:            Formulate and justify a prioritized differential diagnosis.
EPA 3:            Formulate an initial plan of investigation based on the diagnostic hypotheses.
EPA 4:            Interpret and communicate results of common diagnostic and screening tests.
EPA 5:            Formulate, communicate and implement management plans.
EPA 6:            Present oral and written reports that document a clinical encounter.
EPA 7:            Provide and receive the handover in transitions of care.
EPA 8:            Recognize a patient requiring urgent or emergent care, provide initial management and seek help.
EPA 9:            Communicate in difficult situations.
EPA 10:          Participate in health quality improvement initiatives.
EPA 11:          Perform general procedures of a physician.
EPA 12:          Educate patients on disease management, health promotion and preventative medicine.
EPA 13:          Collaborate as a member of an interprofessional team.
EPA 14*:         Incorporate the relevant social determinants of health (SDoH) and cultural safety in relation to patient’s illness                               and management planning.
 
Learners are expected to achieve documented entrustability in EPAs 1-13 by the end of the course. Achieving entrustability in EPA 14 is strongly encouraged but not required.
 
*pilot introduction of EPA 14
 
Course Structure
Core Disciplines: Anesthesia, Emergency Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, Rural Family Medicine, Surgery
Disciplines will be encountered in a sequence of rotations over the duration of the course.
 
Objectives
EPAs are linked to clinical objectives (in C-Blue) for each required clinical experience.
 
Teaching and Learning Methods
Clinical bedside teaching
Academic teaching - academic half day presentations and online modules.
 
Assessment
Assessment is administered by each rotation/discipline at each site but collated and monitored by the Undergraduate Medical Education (UGME) office to ensure progression through the Core Experiences course. The Phase 4 Management Team decides on promotion from this course through a comprehensive review of learner performance. The Phase 4 Management team plans remediation specific to a learner's requirements as per the results of assessments throughout the Core Experiences course.
 
Assessment Methods
 
In Training Assessment Report (ITAR) (formative mid-point and summative end point)
The formative and summative ITARs are based on EPAs. ITARs are completed by the Clerkship Discipline Coordinators based on feedback from e-clinic cards and other assessments.
 
E-clinic Cards (formative)
E-clinic cards are completed using T-Res app and are based on the EPAs as appropriate to the rotation. A supervisor’s written assessment of a learner’s performance must be regularly completed throughout core block rotations using the designated e-clinic card app in T-Res (minimum two per week with a minimum of 5 EPAs per week represented).
 

1. Clinic cards are part of your formative assessment. They contribute to your further development by documenting a coaching conversation between you and your preceptor.
2. Clinic cards should contain comments about your progress towards entrustability in an EPA as well as coaching tips to help you achieve entrustability.
3. Clinic cards are based in the ‘coaching conversation’ you have with your preceptor. Comments should be a brief, accurate documentation of the actual feedback you receive.
4. Clinic card comments are formative, so they do not have to be on your final ITARs or the MSPR.
5. To ensure that the feedback in your clinic cards is accurate and useful for your continuing development, your preceptors have the responsibility to review it and sign off only if they feel it reflects the feedback given.
6. Professionalism is valued as a core competency and a requirement of your MD program. You should keep professional values of accountability and integrity in mind when completing your clinic cards.

Assessment of EPA 14
E-clinic cards, mid-point ITARs and/or ITARs may be used to document learner performance. EPA 14 may be assessed in any rotation. Learners should discuss appropriate assessment opportunities with their preceptor and/or the Clerkship Discipline Coordinator. Assessment of EPA 14 is not included when determining learner progress in the Core Experiences course.
 
Prescribed Clinical Experiences (summative)
Learners are required to log each Prescribed Clinical Experience in T-Res at least once during the Core Experiences course.
 
Mini-CEX (summative)
Learners must complete at least one mini-CEX assessment of witnessed and assessed history and physical/mental status examination in each rotation except Anesthesia.
 
Progress Testing (formative and summative)
Learners will write the NBME Comprehensive Clinical Science examination at 0 (beginning of Phase 4), 4, 8 months, and in the last month of core clerkship as a progress test. This is a multiple-choice question (MCQ) examination to assess clinical knowledge. The first three examinations will be formative and learners will be provided with feedback on their performance. The final examination will be summative but will not be reported on the MSPR. Learners who fail the final examination will write a reassessment examination prior to the beginning of their fourth year.
           
Exam dates for class of 2023
            0 (beginning of Phase 4):     August 20, 2021
            4 month:                              December 3, 2021
            8 month:                              April 8, 2022
            Final:                                    July 29, 2022
            Reassessment:                     August 11, 2022
 
Discipline-specific Assessments (formative and summative)
Anesthesia: completion of teaching modules; procedural checklists
Emergency Medicine: completion of EM teaching modules
Internal Medicine: completion of online cases
Obstetrics/Gynecology: MCQ examination
Pediatrics: mid-term assignment; CLiPP cases; Health Advocate essay
Rural Family Medicine: Rourke Baby Record 18 month e-module; presentation and participation in student led Academic Half Days; completion of Learn-FM online cases; formative MCQ examination
 
These competency-based assessments do not result in numerical scores with the exception of the formative and summative progress tests, and the Rural Family Medicine formative MCQ examination.
 
 
Assessment Plan Core Block Rotation-based Stream
Learners are assessed regularly throughout the Core Experiences course.
 
  Formative assessment

1. Mid-point ITARs for rotations greater than 2 weeks
2. E-clinic Cards
3. Progress testing (NBME Comprehensive Clinical Science Examination) at 0 (beginning of Phase 4), 4, and 8 months
4. Obstetrics and Gynecology MCQ examination
5. Pediatrics mid-term assignment
6. Pediatrics completion of CLiPP cases
7. Pediatrics Health Advocate essay
8. Rural Family Medicine completion of Learn-FM cases
9. Rural Family Medicine Rourke Baby Record 18 month e-module
10. Rural Family Medicine formative MCQ examination

 
  Summative assessment

1. Summative ITARs at end of each rotation
2. Prescribed Clinical Experiences completion
3. Mini-CEX: One per discipline
4. Progress testing (NBME Comprehensive Clinical Science Examination) in the last month of Core Experiences course
5. Anesthesia mandatory technical skills log (checklists)
6. Anesthesia completion of 5 online modules with MCQ quiz for each
7. Emergency Medicine completion of EM teaching modules
8. Internal Medicine self-assessment: completion of 8 SIMPLE cases
9. Rural Family Medicine Academic Half Day presentation and participation

 
Progress Testing Scores
The pass score for the final progress test will be determined based on the progress test performance from the classes of 2020-2022. The pass score is 50 and will be used for the final progress as well as the reassessment test.
 
For the formative (0, 4 and 8 month) tests, the mean and standard deviation for each test will be used to determine a Z-score for each learner’s score on the test. The Z- score indicates how well the learner has performed relative to the mean score for all learners writing that test. The following benchmarks for performance will be used:
Satisfactory:               Z-score -1.5 or greater
Borderline:                 Z-score -2.0 or greater; less than -1.5
Unsatisfactory:           Z-score less than -2.0
 
All learners with an unsatisfactory score will be required to meet with a member or members of the Phase 4 Management Team to develop a learning plan to address their educational needs.
 
All learners with a borderline score will be offered the opportunity to meet with a member or members of the Phase 4 Management Team to develop a learning plan to address their educational needs.
 
Learners with a satisfactory score may also request a meeting with a member or members of the Phase 4 Management Team if they are interested in further coaching.
 
Phase 4 Comprehensive Review
At 6, 9 and 12 months: An assessment profile will be created for each learner by the UGME office and reviewed by the Phase 4 Management Team. The progress of any learner not progressing as expected (e.g. not meeting the criteria below) will be discussed at the related comprehensive review. Learner performance in EPA 14 is not included in the criteria for continued progress and the comprehensive review.
 
A learner must meet the following criteria for continued progress in MED 8710 Core Experiences (Block Rotation-based Stream) without discussion at the 6-month comprehensive review:
 

1. Documented entrustability in a majority of all EPAs within at least one rotation,
2. At least 2 assessments entrustable for at least one EPA,
3. All summative ITARs to date indicate the learner is “progressing as expected”,
4. Satisfactory score in most recent progress test,
5. Completion of all discipline-specific assignments to date at a satisfactory level, and
6. No documented concerns with professionalism.

 
A learner must meet the following criteria for continued progress in MED 8710 Core Experiences (Block Rotation-based Stream) without discussion at the 9-month comprehensive review:
 

1. Documented entrustability in a majority of all EPAs within at least one rotation,
2. At least 2 assessments entrustable for the majority of EPAs for which there are 3 or more assessments,
3. All summative ITARs to date indicate the learner is “progressing as expected”,
4. Satisfactory score in most recent progress test,
5. Completion of all discipline-specific assignments to date at a satisfactory level, and
6. No documented concerns with professionalism.

 
A learner must meet the following criteria for successful completion of MED 8710 Core Experiences (Block Rotation-based Stream) without discussion at the 12-month comprehensive review:
 

1. Documented entrustability in a majority of all EPAs within at least four rotations, with at least the last two rotations (excluding Anesthesia and Emergency Medicine) having documented entrustability in a majority of all EPAs,
2. At least 2 assessments entrustable for EPAs 1-13,
3. All summative ITARs indicate the learner is “progressing as expected”,
4. Passing grade in the final progress test,
5. Completion of all discipline-specific assignments at a satisfactory level, and
6. No documented concerns with professionalism.

 
To inform the decision about progression for each learner, the Clinical Discipline Coordinators will present documentation of pre-entrustability or entrustability in the form of the various discipline-specific assessment methods.
 
Remediation and Reassessment
All discipline-specific assignments must be completed at a satisfactory level as determined by each discipline. Learners failing a discipline-specific assignment must be reassessed. A learner may be reassessed only once for each failed assignment.
 
The performance of any learner with an unsatisfactory or borderline score in the initial NBME progress test, the 4 month NBME progress test, or the 8 month NBME progress test; or failing the final NBME progress test will be discussed during the comprehensive review. Learners who fail the final progress test will write the NBME progress test as a reassessment prior to the beginning of their fourth year. Reassessment, including repeating MED 8710, will be at the discretion of the Phase 4 Management Team. The Phase 4 Management Team will review progress test performance in conjunction with the clinical assessment for the Core Experiences course.
 
Documented professionalism concerns for any learner will be discussed at the comprehensive review. Remediation and reassessment will be at the discretion of the Phase 4 Management Team.
 
Course Success Criteria
 
To pass the course, a learner must:
 

• Achieve documented entrustability in a majority of all EPAs within at least four rotations, with at least the last two rotations (excluding Anesthesia and Emergency Medicine) having documented entrustability in a majority of all EPAs
• Achieve at least 2 assessments entrustable for EPAs 1-13
• Achieve “progressing as expected” in all summative ITARs
• Receive a passing grade in the final progress test or reassessment
• Complete all discipline-specific assignments at a satisfactory level
• Have no outstanding concerns with professionalism

 
The final decision on passing or failing the MED 8710 Core Experiences course occurs during the Phase 4 Management Team comprehensive review and will be made via consensus decision.  In the absence of a consensus, the decision will be made via anonymous vote amongst the Phase 4 Management Team.  In this case final decision requires a majority vote.
 
As outlined in the MD program objectives, the Faculty of Medicine at Memorial University values professionalism as a core competency and a requirement of the MD program. Recognizing that medical learners are developing their professional identity, professionalism lapses will be remediated where possible and appropriate. Unsuccessful remediation will result in failure of the Phase.  Professionalism lapses may render a learner incompatible with continuation in the MD program (as outlined in the Memorial University Calendar Regulation 10.5 Promotion).

As outlined in Section 10.5.2 of the Regulations for the Degree of Doctor of Medicine in the University calendar, learners with a Fail grade in any course cannot be promoted to the next Phase. Even in the absence of any Fail grades, a learner for whom substantial concerns about performance have been expressed may either be required to repeat the Phase or required to withdraw conditionally or unconditionally.

Learners will receive their grades from the Undergraduate Medical Education (UGME) office via One45.

Definition of rural site
 
For the province of Newfoundland and Labrador, a rural site is defined as having a population of less than 50,000 people and not within a one hour commute of a population centre exceeding 100,000. For the province of New Brunswick, rural includes any location outside the main centers of New Brunswick (Moncton, Saint John, Fredericton).

 
Version date: November 16, 2021
Approved by SAS: April 28, 2021
Approved by UGMS: November 17, 2021