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STANDARD 9: TEACHING, SUPERVISION, ASSESSMENT, AND STUDENT AND PATIENT SAFETY

A medical school ensures that its medical education program includes a comprehensive, fair, and uniform system of formative and summative medical student assessment and protects medical students’ and patients’ safety by ensuring that all persons who teach, supervise, and/or assess medical students are adequately prepared for those responsibilities.

9.1 PREPARATION OF RESIDENT AND NON-FACULTY INSTRUCTORS

In a medical school, residents, graduate students, postdoctoral fellows, and other non-faculty instructors who supervise, teach or assess medical students are familiar with the learning objectives of the required learning experience in which they participate and are prepared for their roles in teaching and assessment. The medical school provides resources to enhance and improve residents’ teaching and assessment skills, with central monitoring of their participation in those opportunities provided.

Definitions taken from CACMS lexicon- Learning objectives: Statements of what medical students are expected to be able to do at the end of a required learning experience.- Required learning experience: An educational unit (e.g., course, block, clerkship rotation or longitudinal integrated clerkship) that is required of a student in order to

complete the medical education program. These educational units are usually associated with a university course code and appear on the student’s transcript. Required learning experiences are in contradistinction to electives, which are learning experiences of the student’s choosing.

SUPPORTING DATA

Table 9.1-1 | Provision of Objectives and Orientation Source: School-ReportedList each required learning experience where residents, graduate students, postdoctoral fellows, and other non-faculty instructors supervise, teach, or assess medical students. Add rows as needed for each campus.

Campus Required learning experienceTypes of trainees who provide

supervision/teaching/assessmentHow objectives are provided

and teachers oriented

Table 9.1-2 | Resident Preparation to Teach Source: School-ReportedBriefly summarize the program(s) available to residents to prepare for their roles in supervising, teaching and assessing medical students in required clinical learning experiences. For each program, note whether it is sponsored by the department or the medical school, whether the program is required or optional (R/O), and whether resident participation is centrally monitored (Y/N), and if so, by whom. Add rows as needed for each campus.

Campus Program name/brief summary

Medical school (M)

or department

(D)

Required/ optional

R/O

Central monitoring

of attendance?

Y/N By whom?Emergency medicineFamily medicineInternal medicineObstetrics gynecology

CACMS DCI– Standard 9 (AY 2018-2019)

PediatricsPsychiatrySurgeryLongitudinal integrated clerkshipOther (list):

NARRATIVE RESPONSE

a. Describe how the relevant department or the medical school’s administration ensures that residents and non-faculty instructors are oriented to the learning objectives and to the methods of assessment for the required learning experiences in which they participate.

b. Describe how data provided by medical students or faculty members on the quality of resident teaching are used to improve the quality of resident teaching and/or supervision.


9.2 FACULTY APPOINTMENTS

A medical school ensures that supervision of medical students is provided throughout required clinical learning experiences by members of the medical school’s faculty.

Definition taken from CACMS lexicon- Required clinical learning experience: A subset of required learning experiences that take place in a health care setting involving patient care that are required of a

student in order to complete the medical education program. These required clinical learning experiences may occur any time during the medical educational program.

SUPPORTING DATA

Table 9.2-1 | Faculty Appointments Source: School-ReportedList any required clinical learning experiences where students are being supervised, and assessed by individuals who are NOT medical school faculty members (do not include residents/fellows). Add rows as needed for required clinical learning experiences and for each campus.

Campus Required clinical learning experienceNumber of individuals who are NOT

medical school faculty members

Number of individuals who supervise in this required clinical learning

experience

NARRATIVE RESPONSE

a. Describe how the medical school ensures that supervision of medical students is provided throughout required clinical learning experiences by members of the medical school’s faculty at all instructional sites.

b. Describe the steps being taken to provide faculty appointments to individuals who are not medical school faculty members.

c. If teaching and assessment of students in required clinical learning experiences is carried out by individuals who do not hold faculty appointments at the medical school, describe how the teaching and assessment activities of these individuals are supervised by medical school faculty members to ensure that the teaching is aligned with the learning objectives, is of good quality and that the learning environment is appropriate.

SUPPORTING DOCUMENTATION


a. Copy of the formal policy requiring physicians who supervise medical students in required clinical learning experiences to hold faculty appointments in the medical school. (Appendix 9.2 a)


9.3 CLINICAL SUPERVISION OF MEDICAL STUDENTS

A medical school ensures that medical students in clinical learning situations involving patient care are appropriately supervised at all times in order to ensure patient and student safety, that the level of responsibility delegated to the student is appropriate to his or her level of training, and that the delegated activities supervised by the health professional are within his or her scope of practice.

SUPPORTING DATA

Table 9.3-1 | Clinical Supervision and Level of Responsibility Source: AFMC GQProvide data from the AFMC Graduation Questionnaire (AFMC GQ) on the percentage of respondents that agree/strongly agree (aggregated) that they are appropriately supervised during required clinical learning experiences so as to ensure student and patient safety. Also provide data on the percentage of respondents that agree/strongly agree (aggregated) that the level of responsibility given was appropriate. Add rows as needed for each campus.

% agree/strongly agree

The level of supervisionensured my safety

The level of supervision ensuredthe safety of the patientsfor whom I provided care

I was given appropriate responsibility

for patient careCampus Required learning experience 2017 2018 2017 2018 2017 2018

Emergency medicineFamily medicineInternal medicineObstetrics gynecologyPediatricsPsychiatrySurgeryLongitudinal integrated clerkshipOther (list):

NARRATIVE RESPONSE

a. Describe how departments and the medical school central administration ensure that medical students are appropriately supervised during required clinical learning experiences so as to ensure student and patient safety.

b. What mechanisms exist for medical students to express concern about the adequacy and availability of supervision and how and by whom are these concerns acted upon?

c. What mechanisms are used during required clinical learning experiences to ensure that the level of responsibility delegated to a medical student is appropriate to the student’s level of training and experience?


d. Provide examples of how the clerkship director or the student’s preceptor ensures that the activities delegated to medical students while under the supervision of a health professional who is not a physician are within the scope of practice of that health professional.


a. Copy of any policies or guidelines related to medical student supervision during required clinical learning experiences that ensure student and patient safety. (Appendix 9.3 a)


9.4 ASSESSMENT SYSTEM

A medical school ensures that, throughout its medical education program, there is a centralized system in place that employs a variety of measures (including direct observation) for the assessment of student achievement, including students’ acquisition of the knowledge, core clinical skills (e.g., medical history-taking, physical examination), behaviors, and attitudes specified in medical education program objectives, and that ensures that all medical students achieve the same medical education program objectives.

Definition taken from CACMS lexicon- Medical education program objectives: Statements of what medical students are expected to be able to do at the end of the educational program i.e., exit or graduate level

competencies.

SUPPORTING DATA

Table 9.4-1 | Observation of Clinical Skills Source: AFMC GQProvide data from the AFMC Graduation Questionnaire (AFMC GQ) on the percentage of respondents that agree/strongly agree (aggregated) that they were observed by a faculty member or a resident in all required clinical learning experiences. Provide data from other sources for required clinical learning experiences that are not evaluated in the GQ. Add rows as needed for each campus.

Campus Required clinical learning experiences

School %History Physical exam (Mental status – Psych)

2016 2017 2018 2016 2017 2018Emergency medicineFamily medicineInternal medicineObstetrics gynecologyPediatricsPsychiatrySurgeryOther (list) indicate data source

Table 9.4-2| Observation of Clinical Skills Source: ISAProvide data from the independent student analysis (ISA) on the percentage of respondents in year 3 and year 4 that agreed (responded Yes) that they were observed by a faculty member or a resident at some point during the time they were taking a patient’s history and performing a physical examination (for psychiatry- a mental status examination) in each of the following required clinical learning experiences.

Campus Required clinical learning experiences

School %History Physical exam

Year 3 Year 4 Year 3 Year 4Emergency medicineFamily medicineInternal medicineObstetrics gynecologyPediatrics


PsychiatrySurgery

Table 9.4-3 | Methods of Assessment – Year One Source: School-ReportedList all required learning experiences in the first year of the curriculum. Indicate the total number of exams. Indicate items that contribute to a grade and whether narrative assessment for formative or summative purposes is provided by placing a “Y” for Yes in the appropriate column(s). Include evaluations provided by faculty members or residents in clinical experiences and small group sessions (e.g., a facilitator evaluation in small group, problem-based, case-based teaching). Use the row below the table to provide specifics for each occurrence of “Other”; number each entry and provide the corresponding number in the table. Add rows as needed for each required clinical learning experience and for each campus where there are differences across campuses.

Campus (if applicable)Required learning

experienceNo. of exams

Student performance assessment

MCQ, key features exam

Short answer, knowledge application exercises

Lab orpractical

examOSCE/SP

exam

Small group assessment by

faculty/resident

Paper ororal

presentation

Other*(specify below)

Narrative feedback as part of an

assessment

*Other

Table 9.4-4 | Methods of Assessment – Year 2 Source: School-ReportedList all required learning experiences in the second year of the curriculum. Indicate the total number of exams. Indicate items that contribute to a performance assessment and whether a narrative is provided by placing a “Y” for Yes in the appropriate column(s). For faculty/resident ratings, include evaluations provided by faculty members or residents in clinical experiences and small group sessions (e.g., a tutor, facilitator evaluation in small group, problem-based or case-based teaching). Use the row below the table to provide specifics for each occurrence of “Other”; number each entry and provide the corresponding number in the table. Add rows as needed for each required clinical learning experience and for each campus where there are differences across campuses.

Campus (if applicable)Required learning

experienceNo. of exams

Student performance assessment

MCQ, key features exam

Short answer, knowledge application exercises

Lab orpractical

examOSCE/SP

exam

Small group assessment by

faculty/resident

Paper ororal

presentation


Narrative feedback as part of an

assessment

*Other

Table 9.4-5 | Methods of Assessment – Year 3 Source: School-ReportedList all required clinical learning experiences in the third year of the curriculum. Indicate the total number of exams per clinical learning experience. Indicate items that contribute to a grade and whether narrative assessment for formative or summative purposes is provided by placing a “Y” for Yes in the appropriate column(s). For faculty/resident ratings, include evaluations provided by faculty members or residents in clinical experiences and small group sessions (e.g., a facilitator evaluation in small group or case-based teaching). Use the row below the table to provide specifics for each occurrence of “Other”; number each entry and provide the corresponding number in the table. Add rows as needed for each required clinical learning experience and for each campus/instructional site where there are differences across campuses/instructional sites.

Student performance assessmentMCQ, key features exam, knowledge Preceptor Other*


Campus/instructional site(if applicable)

Required clinical learning experience

No. of exams

application exercises

Oralpresentation

faculty/resident assessment

OSCE/SP exams (specify below)

*Other:

Table 9.4-6 | Methods of Assessment - Year 4 Source: School-ReportedList all required clinical learning experiences in the fourth year of the curriculum. Indicate the total number of exams per clinical learning experiences. Indicate items that contribute to a grade and whether narrative assessment for formative or summative purposes is provided by placing a “Y” for Yes in the appropriate column(s). For faculty/resident ratings, include evaluations provided by faculty members or residents in clinical experiences and small group sessions (e.g., a facilitator evaluation in small group or case-based teaching). Use the row below the table to provide specifics for each occurrence of “Other”; number each entry and provide the corresponding number in the table. Add rows as needed for each required clinical learning experience and for each campus/instructional site where there are differences across campuses/instructional sites.

Campus/instructional site(if applicable)

Required clinical learning experience

No. of exams

GradeMCQ, key features exam, knowledge

application exercisesOral

presentation

Preceptorfaculty/resident

assessmentOSCE/SP

exams


*Other:

NARRATIVE RESPONSE

a. Describe the assessment system of the medical education program that monitors student achievement of the medical education program objectives throughout the duration of the MD program. Describe the committees or groups involved in the decision-making process for student advancement and the type of information that is used in the decision-making process. Describe how remediation plans are developed and how remediation is monitored to ensure that deficiencies are effectively addressed.

b. For each comprehensive clinical assessment (e.g., OSCE or standardized patient assessment) that occurs at the program level i.e. independent of required learning experiences, describe when in the curriculum it is offered, the general content areas covered by each, and the purpose of the assessment (formative to provide feedback to the student and/or summative to inform decision-making about student advancement or graduation).

c. Identify the required learning experiences that include a formal assessment (either for formative or summative purposes) of the following areas:

1. history taking

2. physical examination


3. communication skills

4. clinical decision-making


a. Any data from internal sources (e.g., completion of MiniCEX forms, confirmation by the preceptor or resident, or student perceptions) regarding observation of history taking and performance of a physical examination. (Appendix 9.4 a)


9.5 NARRATIVE ASSESSMENT

A medical school ensures that a narrative description of a medical student’s performance, including his or her non-cognitive achievement, is included as a component of the assessment in each required learning experience in the medical education program whenever teacher-student interaction permits this form of assessment.

Definitions taken from CACMS lexicon- Narrative assessment: A written description of a student’s performance that is provided in addition to a grade (e.g., pass/fail, letter or number) to help guide learning.- Non-cognitive: Refers to the physician’s intrinsic CanMEDS roles- Required learning experience: An educational unit (e.g., course, block, clerkship rotation or longitudinal integrated clerkship) that is required of a student in order to


SUPPORTING DATA

Table 9.5-1 | Narrative Assessment Source: School-ReportedList all required learning experiences that do NOT provide a written description of the medical student’s performance as a component of the assessment. Add rows as needed.

Campus Required learning experience

NARRATIVE RESPONSE

a. Describe how the medical school ensures that a narrative description of a medical student’s performance, including his or her non-cognitive achievement, is included as a component of the assessment in each required learning experience in the medical education program whenever teacher-student interaction permits this form of assessment.

b. If a narrative assessment is not provided in a required learning experience where teacher-student interaction could permit it to occur (e.g., there is small group learning), provide the reason(s).


9.6 SETTING STANDARDS OF ACHIEVEMENT

A medical school ensures that faculty members with appropriate knowledge and expertise set standards of achievement in each required learning experience in the medical education program.

Definition taken from CACMS lexicon- Required learning experience: An educational unit (e.g., course, block, clerkship rotation or longitudinal integrated clerkship) that is required of a student in order to


NARRATIVE RESPONSE

a. Describe how and by whom the standards of achievement are set for the following:

1. required learning experiences

2. the curriculum as a whole (i.e., graduation requirements)

b. Describe how the medical school ensures that faculty members with appropriate knowledge and expertise set the standards of achievement for required learning experiences and for the curriculum as a whole.


9.7 TIMELY FORMATIVE ASSESSMENT AND FEEDBACK

A medical school ensures that the medical education program provides timely formative assessment consisting of appropriate measures by which a medical student can measure his or her progress in learning. Each medical student is assessed and provided with formal formative feedback early enough during each required learning experience four or more weeks in length to allow sufficient time for remediation. Formal feedback occurs at least at the midpoint of the learning experience. In medical education programs with longer educational experiences (e.g., longitudinal integrated clerkship, year-long courses) formal feedback occurs approximately every six weeks. For required learning experiences less than four weeks in length alternate means are provided by which a medical student can measure his or her progress in learning.



SUPPORTING DATA

Table 9.7-1 | Formative Assessment Years One and Two Source: School-ReportedFor each required learning experience in the first and second year, list the type of formative assessment provided (e.g., quizzes, practice tests, study questions, formative OSCEs). Add rows as needed for each campus.

Campus Required learning experienceLength of learning experience

(in weeks) Type(s) of formative assessment available

Table 9.7-2 | Amount and Quality of Formative Feedback Source: ISAProvide data from the Independent Student Analysis (ISA) on the percentage of respondents that were satisfied/very satisfied (aggregated) with the amount and quality of formative feedback received:

School %Year 1 Year 2 Year 3 Year 4

In the first and second yearsIn the third and fourth years N/A N/A

Table 9.7-3 | Mid-Point Feedback Source: AFMC GQProvide data from the AFMC Graduation Questionnaire (AFMC GQ) on the percentage of respondents that agree/strongly agree (aggregated) with the following statement: “I received feedback early enough in this experience to allow me to improve my performance”. Add rows as needed for each campus.

CampusSchool %

2016 2017 2018Emergency MedicineFamily medicineInternal medicineObstetrics gynecologyPediatrics


PsychiatrySurgery

Table 9.7-4 | Mid-Point Feedback Source: ISAProvide data from the independent student analysis (ISA) on the percentage of respondents that agreed (responded Yes) that they received mid-point feedback for each listed required clinical learning experience. Provide administrative data if available, documenting the provision of mid-point feedback for each required clinical learning experience. Specify the data source. Add rows as needed for each campus.

Campus Year 3 Year 4Emergency medicineFamily medicineInternal medicineObstetrics/gynecologyPediatricsPsychiatrySurgeryOther (list)

Data Source:

Table 9.7-5 | Longer Required Learning Experiences Source: School-ReportedProvide data for each longer required learning experience (half-year, year-long, or longitudinal integrated clerkship (LIC)) for the last three academic years from required learning experience evaluations or administrative data documenting feedback sessions on the percentage of respondents that agree/strongly agree (aggregated) or responded Yes that they received feedback approximately every 6 weeks. Specify the data source. Add rows as needed for each campus.

Campus AY 2015-16 AY 2016-17 AY 2017-18

Data Source:

NARRATIVE RESPONSE

a. Describe how the provision of formative assessment in required learning experiences, including clinical, is monitored:

1. within each learning experience

2. at the curriculum management level

b. For required learning experiences of less than four weeks duration, describe how students are provided with timely feedback on their knowledge and skills related to the required learning experiences objectives.



a. Any medical school policy or similar document requiring that medical students receive formative feedback by at least the mid-point of required learning experiences of four weeks (or longer) duration. (Appendix 9.7 a)

b. Any medical school policy or similar document requiring that medical students receive formative feedback approximately every six weeks for longer required learning experiences (half year, year-long or longitudinal integrated clerkship). (Appendix 9.7 b)


9.8 FAIR AND TIMELY SUMMATIVE ASSESSMENT

A medical school has in place a system of fair and timely summative assessment of medical student achievement in each required learning experience of the medical education program. Final grades are available within six weeks after the end of a required learning experience.



SUPPORTING DATA

Table 9.8-1 | Availability of Final Grades Source: School-ReportedFor each required learning experience, provide the average number of weeks, and the minimum/maximum number of weeks it took for students to receive grades during the most-recently completed academic year. Also provide the percentage of students that did not receive grades within 6 weeks. Add rows as needed for each campus.

Campus Required learning experienceAY 2017-18

Average Min Max %

NARRATIVE RESPONSE

a. Describe how the timing of provision of the learning experience grades is monitored and the steps taken if grades are not submitted in a timely manner. How does the medical school ensure that learning experience grades are reported to students on schedule?


a. Policy or directive that specifies the timeframe for the reporting of grades. (Appendix 9.8 a)


9.9 STUDENT ADVANCEMENT AND APPEAL PROCESS

A medical school ensures that the medical education program has a single standard for the advancement and graduation of medical students across all locations. The medical school has a fair and formal process for taking any action that may affect the status of a medical student, including:

a) timely notice of the impending action, b) disclosure of the evidence on which the action would be based, c) an opportunity for the medical student to respond, d) an opportunity to appeal any adverse decision related to advancement, graduation, or dismissal.

NARRATIVE RESPONSE

a. Describe how the medical education program ensures that a single standard (i.e., set of policies) for advancement and graduation is applied across all instructional sites, including geographically distributed campuses.

b. Summarize the process in place at the medical school when there is the possibility of the school’s taking an adverse action against a medical student for academic or professionalism reasons. Include a description of the process for appeal of an adverse action, including the groups or individuals involved at each step in the process.

c. Describe the means by which the above processes are made known to medical students.


9.10 STUDENT HEALTH AND PATIENT SAFETY

The medical school has effective policies to address situations, once identified, in which a student’s personal health reasonably poses a risk of harm to patients. These patient safety policies include:

a) timely response by the medical schoolb) provision of accommodation to the extent possiblec) leaves of absenced) withdrawal processes

SUPPORTING DATA

Table 9.10-1 | Student Health and Patient Safety Source: ISAProvide data from the independent student analysis (ISA) on the percentage of respondents that answered Yes to the following statement in the table. Add rows as needed for each campus.

CampusSchool %

Year 1 Year 2 Year 3 Year 4I know that my medical school requires me to report situations in which my personal health poses a risk of harm to patients

NARRATIVE RESPONSE

a. Summarize the medical school policies to address situations, once identified, in which a student’s personal health reasonably poses a risk of harm to patients. Provide an example in which a student’s personal health posed a risk to patient safety since the last full accreditation visit (and if none, provide a reasonable scenario) and describe the expected timeline of the medical school’s response, the accommodation that could be provided and the process for provision of a leave of absence and/or withdrawal.

b. Describe when and how medical students are informed about the above policies.


a. The medical school policies to address situations, once identified, in which a student’s personal health reasonably poses a risk of harm to patients. (Appendix 9.10 a)


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