formative assessment examples in medical education

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• Published: 14 April 2023

Fostering formative assessment: teachers’ perception, practice and challenges of implementation in four Sudanese medical schools, a mixed-method study

• Elaf Abdulla Almahal   ORCID: orcid.org/0000-0001-8147-3659 1 ,
• Abrar Abdalfattah Ahmed Osman   ORCID: orcid.org/0000-0002-4992-6598 1 ,
• Mohamed Elnajid Tahir   ORCID: orcid.org/0000-0002-3057-6612 2 ,
• Hamdan Zaki Hamdan   ORCID: orcid.org/0000-0001-9269-8239 3 , 4 ,
• Arwa Yahya Gaddal   ORCID: orcid.org/0000-0001-6790-9989 1 ,
• Omer Tagelsir Abdall Alkhidir   ORCID: orcid.org/0000-0001-8195-3513 5 &
• Hosam Eldeen Elsadig Gasmalla   ORCID: orcid.org/0000-0003-2590-8587 6 , 7  

BMC Medical Education volume  23 , Article number:  247 ( 2023 ) Cite this article

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Formative assessment (assessment for learning) enhances learning (especially deep learning) by using feedback as a central tool. However, implementing it properly faces many challenges. We aimed to describe the perception of medical teachers towards FA, their practice, challenges of implementing FA and present applicable solutions. A mixed-method, explanatory approach study was applied by administering a validated questionnaire to 190 medical teachers in four medical schools in Sudan. The obtained results were further studied using the Delphi method. Quantitative analysis revealed that medical teachers perceived their grasping of the concept of FAs and their ability to differentiate formative from summative assessments as very well (83.7%) and (77.4%), respectively. However, in contradiction to the former results, it was noteworthy that (41%) of them mistakenly perceived FA as an approach conducted for purposes of grading and certification. The qualitative study defined the challenges into two main themes: lack of understanding of formative assessment and lack of resources. Medical teachers’ development and resource allocation were the main recommendations. We conclude that there is misunderstanding and malpractice in implementing formative assessment attributed to the lack of understanding of FA as well as the lack of resources. We as well present suggested solutions derived from the perception of the medical teachers in the study and evolved around three approaches: faculty development, managing the curriculum by allocating time and resources for FA, and advocacy among stakeholders.

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Introduction

Enhancing learning using feedback as a central tool of formative assessment (FA) is of paramount importance [ 1 ]. However, implementing formative assessment appropriately in developing countries such as Sudan faces challenges. Medical education in Sudan can be traced from 1924 when the first medical schools were established, during the 1970s, two other medical schools were added. In the last 30 years between the 1990s and 2022, the number of medical schools increased rapidly to more than 70 medical schools. Medical education in Sudan has been enhanced mainly because the different stakeholders (academics and policymakers) have been working on addressing the challenges. In 2018, Sudan Medical Council (established in 1955) was awarded recognition status by the World Federation of Medical Education. Making it the first accrediting body among the Arabian countries and the tenth worldwide [ 2 , 3 ]. Identifying the challenges of implementing FA is the first step towards formulating an approach to resolve them and would positively impact the growing number of medical schools in the country. Guidelines in medical education are context-dependent; thus, this work will add to the Sudanese library that addresses national issues in education based on local cultural context. This study applied a mixed-method, triangulation approach to investigate the perception of 190 medical teachers across four medical schools in Sudan towards FA, their practice, their perceived challenges of implementing FA and present applicable solutions.

Literature review

FA definition, principles, purposes and practices: FA has been considered a distinguishing entity from summative assessment [ 1 , 4 ]. Its notion has shifted from the context of programme evaluation to being based on the benefits of the learners. It can be seen as a process performed during learning rather than a test at the end of the course [ 5 ]. The system of assessment is based on the balance between both summative and FAs [ 6 ]. It is the features of formative assessment that provide its benefits. Using feedback as a central tool, information about performance and competencies is collected to facilitate learning (especially deep learning) [ 5 , 7 ]. It motivates the students [ 8 ] and shifts their minds from focusing on just obtaining high grades on the final exam to engagement in learning and skills development [ 9 ]. Moreover, FA promotes learning outcomes by creating communication between the learner and the teacher via feedback [ 10 ]. Feedback is considered a keystone in FA [ 11 ] since feedback aims to support learners to achieve learning outcomes. It is a way to inform the learner about the gap between his/her current status and the learning outcomes, a comparison between the performance of the learner and the standard [ 12 ]. This comparison to the standard (a criterion) makes FA fitting for the criterion-referenced approach of standard setting [ 13 ], since it. The importance of feedback is paramount, generally, better performance in FAs is associated with better performance in the final exam, as reported by Krasne, Wimmers [ 8 ] and McNulty, Espiritu [ 14 ]. It must be noted, however, that even students who did not receive scores for success in FA were able to benefit from feedback that was useful in helping them succeed in their final examinations. This was primarily the result of their active participation in FA and the use of the feedback that they received during that time [ 5 , 11 , 15 ]. Furthermore, FA is a continuous process in which feedback is not the final element, but a continuous component that identifies improvements in the learner's performance [ 16 ]. Thus, FA is seen as one of the features of tomorrow’s education that is based on assessment for learning [ 4 ].

In this study, the term FA is used to indicate a process that is an assessment for learning, conducted in class, not judgmental, in which feedback is provided, and it is not taking part in the final summative assessment.

Challenges of implementing FA were investigated. The lack of FA implementation is considered a deficiency in medical education practice [ 17 ]. Nevertheless, it is attributed to the way FA is perceived by both medical teachers. The lack of comprehension of the concept of FA and its value [ 18 ] leads to resistance possibly attributed to perceptions driven by the educational traditions in the clinical setting [ 17 ]. There is a positive correlation between the awareness and perception of medical teachers toward FA and its application [ 19 ]. The lack of awareness about feedback as an important tool in FA was reported to be a challenge that creates a gap between students' expectations and teachers' perceptions [ 20 ]. Giving feedback to a diverse set of students was perceived to be potentially challenging with different cultures and languages especially if the feedback contained negative elements [ 21 ]. Aside from the lack of awareness, challenges such as time and resource constraints were spotted [ 19 ]. These constraints were sometimes manifested as difficulties in finding time for preparation, and the overcrowded schedules of the staff as well as the students which in turn affected their commitment to FA [ 22 ].

This study aimed to describe the perception of medical teachers towards FA, their practice, the challenges they face in implementing FA and their suggested solutions.

This was a cross-sectional, mixed-method study. The study consisted of two phases. Phase one was quantitative and data collected this way were further investigated qualitatively in phase two, this is an explanatory approach to mixed-method studies [ 23 ]. In the quantitative phase data about the perception and current practices of the teacher regarding FA were collected using a questionnaire. Then, based on the responses to the questionnaire, further identification of challenges in the implementation of FA and recommended solutions was conducted using the Delphi technique, a qualitative data collection tool. For ease of description, each section below is denoted whether it applies to phase one, two, or both phases.

Setting and context (for both phases – Fig.  1 )

Explanatory mixed-method

For both phases of the study, the selection of medical schools was based on several criteria, first, the medical school must be among the largest medical schools in Sudan in terms of the number of medical teachers. Second, the selected medical schools must represent both public and private sectors, and third, the selected medical schools must represent both classical and integrated curricula. These criteria were followed to ensure representativeness and reflect all the diversities among medical schools in the country. To this end, we selected four medical schools, each one with no less than 200 students/batch and full-time staff ranging from 55 to 120. Two schools represent the public and private sectors. One of the public schools adopts a classic curriculum while the other one adopts an integrated curriculum, the same goes for the two private schools. This combination of (public/private) and (classical/integrated curricula) was intended to include and represent all the varieties in Sudanese medical schools.

Phase one: quantitative study

In this phase, the sample size was calculated, and a questionnaire was developed and sent to a sample of medical teachers.

Sampling and sample size (for phase one)

The population are teachers at four medical schools. Inclusion criteria include all full-time appointed teachers who are ranked from the lecturer and above, teaching assistants are excluded since they are not allowed to develop and conduct assessments.

The sample size of 165 was calculated by an online Open-epi calculator, based on the predicted anticipated subjects. After we estimated the eligible population in the four universities, we assumed that 50% of the medical teachers will participate in this phase of the study. This would give the study an 95% power to detect differences of 0.05 at the α-level [ 24 ].

Questionnaire development and validation (for phase one)

A questionnaire (see appendix ) was developed following a thorough search in the literature; the questionnaire consists of 22 questions covering three domains: demographic data, perception of FA, and practice. The first domain consisted of 4 questions about gender, job title/rank, years of experience (in teaching) and the department, the second domain consisted of statements about the perception of FA, with a five-point Likert scale (5 = strongly agree, 4 = agree, 3 = I am not sure, 2 = disagree, 1 = strongly disagree) while the third section consisted of statements about the practice of medical teachers concerning FA, with three-points Likert scale (3 = never, 2 = sometimes, 1 = regularly).

The questionnaire was in English since medical education in Sudan is in the English language. It was tested in a pilot study, in which three experts (minimum ranking of assistant professors, with experience in health professions education, questionnaires development and validation and at least 10 years experience in teaching and student assessment) first reviewed it to validate the contents, minor changes were applied following their recommendations, the changes focused on simplifying the language of the questionnaire by replacing some sophisticated terms by simpler ones. Then it was introduced to 33 university teachers to investigate its face validity, practicality and reliability [ 25 , 26 ]. Cronbach’s alpha was calculated. It was 0.63 for questions regarding the perception and 0.55 for questions regarding the practice.

The questionnaire was then sent out via a google form link to the medical teachers in the targeted medical schools.

Phase two: qualitative study: the delphi technique

The Delphi technique is a qualitative approach to reaching a consensus. It consists of an iterative process [ 27 ].

Aim: The technique aimed to answer two questions: a) What are the challenges of implementing FA in your setting? b) What are the suggested solutions? The questions were constructed after a systematic search in the literature using the search terms (challenges/difficulties of implementing/ implementation/ of FA and fostering/enhancing FA). The search was conducted in PubMed and Scopus during the period from January to May 2020 and included all types of articles in the English language published since 2000.

Participants (in phase two): a group of six university teachers was invited, the recruitment of participants followed a nonprobability purposive sampling, and the group consisted of assistant professors who were experts in the field of medical education (including a master's degree as a minimum, active participation in the education development units and with publications in medical education), with experience in university teaching not less than five years, they represented the basic medical sciences and clinical sciences departments.

Validity and reliability: the two questions were piloted in a group of five experts in medical education. With experience in university teaching ranging between 5 to 10 years. The purpose was to ensure the clarity and simplicity of the wording, regarding reliability, the group of participants consisted of six, and the recommended number of participants that ensures reliability is ranging between 6 to 12 [ 28 ] with some authors referring to 7 participants as a minimum [ 29 ].

Ethical issues and anonymization: participants gave their written consents before participation, they were not aware of the identities of each other; however, they were known to the authors. The results of the study were not affecting the participants. Hence there was no conflict of interest, and to our best knowledge, no participants' bias was noted.

Informing the participants: written information was provided with the questionnaire in the first round describing the nature of the process, some key features of FA were written to keep the participant engaged and to avoid any confusion with the summative assessment.

Cutoff point: We agreed that the cutoff for continuation is 70% consensus [ 30 ], i.e. if 70% of statements gained consensus the study would be determined to be complete. To adapt to the hectic schedules of the participant, no deadline for the ending of each round was set.

Consensus roles: if the statement gained more than three on average on a 5-point Likert scale, then this was considered as consensus. If the score was less than three, then the statement was discarded.

Round one: consisted of open-ended questions, and there was no feedback in this stage, from the responses of round one, the authors produced statements that were put for ranking in a 5-point Likert scale and used in the successive rounds.

Consecutive rounds: the first three authors reviewed input, and topics were arranged and modified after discussions between the mentioned authors, in the successive rounds, newly introduced topics, modified topics, and topics not reaching the consensus were presented along with their statistics.

Data analysis (for both phases)

Phase one: quantitative.

Ordinal data obtained from the participants’ responses to the questionnaire were converted to quantitative data. The collected data were analyzed using the Statistical Package of Social Sciences (SPSS), and they were summarized and presented as frequencies.

Phase two: qualitative

Each statement was ranked in the next rounds. The scores were tabulated. The consensus roles were applied to determine the number of statements that reached consensus.

Ethical approval

Was obtained from Al-Neelain University Ethics Review Board.

Quantitative: formative assessment: perception and practice

Following the introduction of the questionnaire, the respondents were 190 medical teachers out of 288 across all four medical schools (which is a bigger number than the target sample size of 165). The average of respondents in each medical school was 66 ± 2.6% of the total targeted population in that school. Demographic data showed the percentage of males was 47.9% and females 52.1%. Assistant professors share was half the respondent and the faculty who teach basic medical sciences and clinical sciences are almost equal (Table 1 ).

The study of the knowledge revealed that the medical teachers perceived their understanding of the concept of FAs (83.7%) and the difference between formative and summative assessments as very well (77.4%), they also perceived feedback as a keystone in FA (87.4%). Furthermore, they appear to realize the benefits of FA, such as it encourages deep learning, as well as the association between better performance in FAs and the final exam (Table 2 ). However, it was a notable contradiction that (41%) of them mistakenly perceived FA as an approach conducted for purposes of grading and certification with about 18% didn’t know whether this fact about FA is correct or not, another contradiction was that 43% agreed that the student’s final grades in a course are collected from his/her grades in the FAs (and about 18% are not sure). Also, when asked if FA is criterion-referenced, (42%) didn’t know the answer and (22%) said it is not.

The study of the practice revealed that only a third of the participants regularly conduct FA and provide feedback to students in FAs. Regarding adding the scores obtained by the student in the FA to his/her final grades at the end of the course/semester/year. Third of the participants reported doing that regularly, with another third doing it sometimes (Table 3 ).

The most employed assessment tool used in FA was the MCQs A-Type followed by OSCE (Fig.  2 ), while the least tool to be used were MCQs R-Type and the essays.

Assessment tools used in FA

Qualitative: challenges and suggested solutions

Six experts participated in the first and second Delphi rounds (Fig.  3 ). In the first round, two open-ended questions were sent, the first question inquired about the challenges of implementing formative assessment while the second question was about the suggested solutions.

The process of Delphi

All the Delphi panellists were senior medical teachers with a minimal ranking of assistant professors. The first round generated 12 items. Following the second round, a consensus was reached by all of the panellists and the final number of items was 10 across four main themes (Table 4 ). Two themes were about the challenges of implementing FA and the other two themes were about the suggested solutions.

Concerning challenges, the participants agreed on the lack of understanding as one of the two themes. They elicited an inadequate understanding of the role of formative assessment, lack of staff commitment, students don’t focus on the formative assessment because of its timing as a feature for this theme. The other theme was about logistics and resources. This includes a large number of students (per staff) and the lack of resources.

Concerning suggested solutions, the participants agreed on the lack of resource allocation as one of the two themes. They elicited time allocation, resource allocation, adoption of a reasonable student-staff ratio and the use of online assessment/other technologies as features for this theme. The other theme was faculty development. This includes the training of staff.

FA enhances deep learning using feedback as a central tool. However, the benefits of FA are only gained by doing it properly and overcoming the challenges associated with its implementation. The current study investigated the perception of medical teachers about FA and their practice via quantitative analysis. The qualitative assessment is used to explain the quantitative findings: the gaps in understanding and implementing FA revealed by the quantitative analysis were further studied qualitatively, as a result, factors that contribute to the challenges in implementing FA were elaborated along with the suggested solutions.

Perception and practice of the medical teachers: what does the quantitative analysis show?

The study of how much medical teachers know about FA revealed that while most of them believe they understand FA, the detailed further questions reveal that they don’t (Table 2 ). The same inconsistency was found between their perceived knowledge and their actual practice. While most of the participants acknowledge the value of FA, only a third of them conduct FA regularly (Table 3 ). Which raises a red flag about “what we think we know”. This inconsistency was explained when combining the qualitative data retrieved by experts since the “lack of understanding” of the concept of FA was highlighted in the Delphi study. This reveals that most of the medical teachers included in the current study mistakenly believe they comprehend the notion of FA. However, this phenomenon is not unique, and it was also noted previously [ 18 ]. Therefore, the issue of the “lack of understanding” is deeply rooted as a challenge.

Another manifestation of the lack of understanding was reported when the participants asked about the most assessment tool they use in FA. It was the MCQs A-Type (Fig.  2 ). While MCQs R-Type was less utilized. Both formats are objective assessment tools with a restricted response. they comprise three components: question (or stem), which can be a scenario or clinical vignettes, lead-in questions, and options. In the A-type MCQs, the options (distractors) vary between three and five but usually around four or five responses with one correct (or one best) answer. While in R-type, there can be up to 26 options [ 31 , 32 ]. The R-Type MCQs are reported to be well suited for encouraging deep learning [ 33 ] and assessment of clinical reasoning [ 34 , 35 , 36 ], the same goes for the free-response (or open-ended) questions, which can assess the higher levels of cognitive functions and clinical reasoning [ 37 ]. The figure also shows less utilization of workplace-based assessment which is known for having feedback as a primary feature. The minimal use of assessment tools that are proven to assess clinical reasoning (and thus suitable for deep learning) shows less regard for FA as an approach to enhance deep learning. Reflecting the lack of understanding of FA with the consequent neglect of its most important trait: giving feedback.

Challenges of implementing FA and suggested solutions: lack of understanding

The fragile commitment towards FA from both the medical teachers and the students is attributed to their lack of understanding of the nature of FA rather than resistance. Resistance was manifested in round one of the Delphi study when the participants generated statements such as “lack of time” and “implementation of formative assessment is exhausting”. These statements later were dropped due to non-agreement between the participant. Instead, statements related to the lack of understanding subsequently dominated the second round of the Delphi study.

Faculty development was presented as a suggested solution. The issue of enhancing the understanding of medical teachers of FA was indicated by many authors. It has been reported that clinical teachers have little knowledge about using some assessment methods as workplace-based assessment in the context of assessment for learning [ 17 ]. also, they perceive the process of giving feedback as difficult and complicated [ 38 ]. Our results shed the light on an educational culture that neglects FA and relies on summative assessment, this was also noted in other parts of the world such as Saudi Arabia [ 7 ], India [ 39 ], Malaysia [ 4 ], and Pakistan, in which even the few institutes that employ FA do not emphasize on feedback as to its major and crucial part [ 40 ].

The same issue of the lack of understanding of FA applies to the students and affects how they respond to and expect from FA. An example of this is perceiving FA as less of an important issue since its marking is not included or summed with the scores of the final exam. Subsequently, the students will be less encouraged to actively participate in the process [ 15 ]. Another example is that the students may not perceive the FA as an opportunity for learning, [ 38 ]. Furthermore, cultural and educational traditions impose a challenge to the proper implementation of FA. Although this study doesn’t represent evidence in the Sudanese context, it was reported previously in different contexts. The “culture of shy” that suppresses students from active participation plays an important role [ 7 ]. The challenges of navigating within a multicultural setting might concern the medical teacher especially if there is “negative” feedback provided as part of FA [ 21 ].

Thus, fostering FA requires different strategies. This includes providing an enabling environment, advocacy, training of the staff as well as the students, and implanting FA in the curriculum. Faculty development was also recommended by Harrison, Konings [ 41 ] and Konopasek, Norcini [ 6 ]. In our context, the authors believe that raising awareness about the value of FA among faculty and students as well will significantly improve implementation by shifting the focus from assessment of learning to assessment for learning.

Challenges of implementing FA and suggested solutions: logistics and resources

The second theme that emerged from analyzing the qualitative assessment was the lack of resources. In the context of the investigated medical schools in this study, the issue of student-staff ratio was featured as a challenge and as an issue to be addressed among the suggested solutions. However, this issue was raised by other studies which indicate challenges such as logistic difficulties related to the number of students, technological aspects, as well as time constraints [ 39 ]. In Sudan, many medical schools suffer from a low faculty/student ratio, which in turn puts an overload on the faculty making them unable to find time for FA. The authors consider FA is not adequately addressed in many medical curricula in the country.

Resource allocations require allocating time for FA in the timetable. The use of technology and formative e-assessment is a recommendation of the current study as well as other studies [ 5 , 11 , 42 ]. E-assessment can utilize social media, and thus provide an opportunity for FA to be conducted at ease without the restraints of a tight timetable. Accrediting bodies also have their role by including FA as part of the requirements of the accreditation process [ 40 ]. We believe addressing FA with little or no focus on the medical curricula is an issue that needs attention. Part of allocating resources is emphasizing FA in the curricula.

Fostering FA is not an easy task, it faces challenges based on the culture of “assessment of learning” and includes the lack of understanding of FA as well as the lack of resources. The medical teachers' perception and practice of FA are in desperate need of improvement. Implementation of FA requires a strategy of three approaches: faculty development, managing the curriculum by allocating time and resources for FA, and advocacy among stakeholders.

Limitations

Although the included schools are among the largest across the country (in terms of staff number), the variation of the type of curricula and the type of medical schools was considered. But the results from this study are confined to the medical schools included in it. And since only a third of the participants were engaged in “regular” conduction of FA, the results regarding practices such as “the selection of assessment tools”, “providing feedback” and “adding the scores obtained by the student in the FA to his/her final grades of the end of the course/semester/year” are confined to this third. However, it doesn’t affect the perception of FA of the whole participants. FA tools presented in this study are limited and there is a potential for generating more options through other tools like observation or interviews in any similar future studies.

While we anticipate that an extended investigation that includes all the medical schools will yield the same conclusion, this expectation remains to be validated before generalizability is assumed.

Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

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Faculty of Medicine, Al-Neelain University, Khartoum, Sudan

Elaf Abdulla Almahal, Abrar Abdalfattah Ahmed Osman & Arwa Yahya Gaddal

Department of Human Physiology, AlMughtaribeen University, Khartoum, Sudan

Mohamed Elnajid Tahir

Biochemistry Department, Faculty of Medicine, Al‑Neelain University, Khartoum, Sudan

Hamdan Zaki Hamdan

Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia

Anatomy Department, University of Medical Science and Technology UMST, Khartoum, Sudan

Omer Tagelsir Abdall Alkhidir

Anatomy Department, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan

Hosam Eldeen Elsadig Gasmalla

Clinical Anatomy and Imaging, Warwick Medical School, University of Warwick, Coventry, United Kingdom

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Elaf Almahal, Abrar Osman and Hosam Eldeen Elsadig Gasmalla wrote the main manuscript text. Omer Alkhidir prepared and reviewed all the figures. Mohamed Elnajid Tahir and Hamdan Hamdan prepared and checked all the tables. Arwa Gaddal participated in reviewing the manuscript. All authors reviewed the manuscript. The author(s) read and approved the final manuscript.

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Correspondence to Hosam Eldeen Elsadig Gasmalla .

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Almahal, E.A., Osman, A.A.A., Tahir, M.E. et al. Fostering formative assessment: teachers’ perception, practice and challenges of implementation in four Sudanese medical schools, a mixed-method study. BMC Med Educ 23 , 247 (2023). https://doi.org/10.1186/s12909-023-04214-3

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Received : 12 July 2022

Accepted : 30 March 2023

Published : 14 April 2023

DOI : https://doi.org/10.1186/s12909-023-04214-3

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Med Student Handbook Google Custom Search

• 1.04 Student Assessment in the MD Program

Assessment plays an essential role in the education of students at Harvard Medical School (HMS).  The purposes of assessment are several:

•  To reliably collect relevant performance information to support each student’s individual understanding of their growth and achievement;
•  To provide information that facilitates students’ partnerships with faculty and advisors in creating individualized learning plans to ensure academic success and achievement of the competencies of professional development;
•  To determine each student’s readiness for successful transitions in progressive phases of the curriculum and, ultimately, graduation;
•  To use collated performance information as feedback to course and clerkship directors, faculty, and curriculum leadership to maintain ongoing curricular quality.

Assuring appropriate progress toward and eventual attainment of the core competencies required of Harvard medical students is an ongoing, dynamic, critical endeavor. These core competencies   include medical knowledge; critical thinking and inquiry; patient care; professionalism; interpersonal and communication skills; and organizational and social determinants of health care. Achieving and maintaining the core competencies is vital for our students, our faculty, our affiliated institutions, and especially for the patients and communities our graduates will serve.

Assessment of students at HMS takes many forms and is integrated into the educational process. In classrooms, in learning studios, in laboratories, and at affiliated clinical sites, assessment is an ongoing, virtually continuous process. Course directors generally determine the methods, formats, and frequency of student assessment that best reflect the content and objectives of the course or clerkship (see Section 2.03 , Grading and Examination ). Some assessments may involve written examinations; others involve the collection and curation of the observations of faculty in preclerkship courses and supervising clinical faculty and preceptors in clinical settings. Clinical simulation exercises (objective structured clinical examinations – OSCEs, simulated patient encounters, and simulation labs) provide additional opportunities to assess an array of competencies, including clinical skills, medical knowledge, interpersonal and communication skills, professionalism, and reasoning ability.

Assessment may be formative and/or   summative. It may be quantitative (e.g., multiple-choice examinations, NBME subject examinations, OSCEs) or qualitative (e.g., verbal feedback given by preceptors to students based on direct observation of clinical encounters ) . It may be delivered in written form or via a discussion between the student and faculty. Regardless of how they are structured, obtained, or delivered, all assessments are clearly focused on and aligned with the stated objectives of each course or clerkship. These objectives are derived from and directly mapped to the six core competencies   that HMS students must attain prior to graduation. Assessment discussions and written narratives provide students with feedback on their performance and, when appropriate, include suggestions for enhancement or improvement.

All courses and clerkships clearly define and provide students with information on how and when students are being assessed; the format and timing of those assessments; how the assessments are being used (formative and/or summative); and how the assessments are being reported (mid-course/mid-clerkship; final grade report; transcript; Medical Student Evalution  [MSPE] ). Students are informed as to who has access to which assessments (students, faculty, course/clerkship director, advisors, coordinators/staff, deans). HMS leadership and course/clerkship directors define the expectations for satisfactory completion (and in some cases, achievement of honors or honors with distinction) of the course/clerkship.

PROGRESS ( Pro fessional G rowth and E ducational S upport S ystem)

PROGRESS has two overarching goals: 1) comprehensive and holistic assessment of all students in their competency development toward the HMS MD program’s six core competencies , and 2) provision of longitudinal learning support for students who would benefit in any of the six competency domains.

The work of PROGRESS is conducted by the PROGRESS Professional Development Committee (PDC), which is charged with conducting regular periodic high-level reviews of the academic performance of all HMS MD students and, using a data-driven approach, identifying students who may benefit from additional learning support. The PDC works in close alignment with the support function of PROGRESS and other units within the Program in Medical Education (PME). With this primary assessment function, the PDC serves as a sub-group of the Assessment Subcommittee of the Educational Policy and Curriculum Committee (EPCC). In order to provide a longitudinal and holistic view of a student’s trajectory from matriculation to graduation, the PDC includes core faculty and administrative staff who represent key stakeholder groups knowledgeable about students’ academic experiences: faculty representatives from across the three phases of the MD curriculum: Preclerkship (Pathways and HST), Principal Clinical Experience (PCE), and post-PCE ; the assessment and evaluation team in the Office of Medical Education (OME); learning support experts; and academic society advisors.

The PROGRESS PDC meets periodically and at important curricular transition points to review students’ academic trajectories to identify consistently marginal or inconsistent performance that suggests students who are not ready for subsequent curricular phase transitions and those who are at risk of continued academic struggle or potential failure. PROGRESS PDC activities include a holistic review, discussion of possible causes for a student’s academic struggle, and referral and plans for learning support. These activities are closely linked to the Office of Learning Resources and Support (OLRS) and the Clinical Learning Coaching Program (CLCP), the HMS Academic Societies advising system and the Office of Student Affairs (OSA), and when indicated, the Promotion and Review Board (PRB).

The intended impact of PROGRES S is to regularly review and identify students who can benefit from academic learning support and to work centrally to support activities that enhance students’ medical knowledge and clinical skills growth, as well as the development of the expected behaviors of a medical professional. The system is grounded in the use of student’s performance data and a joint understanding of the integrative nature of said progressive performance indicators and behaviors. Ultimately, the mission of PROGRESS is to provide students with a broad range of individualized learning support to ensure successful completion of the MD curriculum and to graduate excellent clinicians, per the mission statement of Harvard Medical School .

Formative and Summative Assessment

The purpose of summative assessment is to make a judgment of a student’s ability to meet the objectives of a course or clerkship, as well as their readiness to advance to the next phase of the curriculum, based on their successful achievement of learning objectives: a demonstration of knowledge, skills, and attitudes that are necessary for advanced learning. Summative assessments are judgments of student performance relative to expected standards.  Summative assessments often include a discussion with the student and, importantly, provide a written narrative that presents information, observations, and evaluations of the student’s performance. Such assessments may include test scores in addition to observations made in the classroom, learning studio, or laboratory. Observations and comments from supervising clinicians on clerkships provide a significant portion of the summative assessment at the end of clerkships. The summative assessment provides end-of-course or end-of-clerkship evaluation of the student’s overall performance with careful attention to the student’s achievement of the stated course/clerkship learning objectives – objectives developed to support attainment or maintenance of core competencies.

Since AY16, the following key elements have been incorporated into the clinical assessment of students:

• Formative and summative assessments in clinical courses, clerkships, subinternships and electives include observations and evaluations of performance using the competency-based framework of Entrustable Professional Activities (PDF) (EPAs) . EPAs are aligned with HMS core competencies and mapped to clinical experiences and different phases of the curriculum and provide a platform for assuring that students are prepared for their next stages of training and to provide safe and effective clinical care.
• Grading in the required/core clerkships in the Principal Clinical Experience (PCE) is Satisfactory/Unsatisfactory (S/U) to align with the assessment strategy in the prior p hase of the curriculum (S/U) and the education philosophy at HMS of supporting a growth/development orientation in contrast to a performance orientation.
• Grading in required subinternships and all clinical electives is Honors with Distinction; Honors; Pass; Unsatisfactory .

Policy on Formative Assessment in the HMS Curriculum

Preclerkship and clinical curriculum.

All preclerkship courses (including clinical courses), required clerkships and clinical electives provide formal formative assessment of each student by the midpoint of the course, if not earlier. Depending on the specific course or clerkship, this formative feedback may take one or more of several forms:

• Individual meetings between faculty and students, at which progress in the course is reviewed and any necessary recommendations are made for remediation, enrichment, or modification of learning strategies;
• Narrative feedback provided by faculty members to individual students in written form, accompanied by any necessary recommendations made for remediation, enrichment, or modification of learning strategies;
• The provision of individual results and class-wide statistics to each student after an objective measurement of knowledge acquisition, such as a multiple-choice examination, with accompanying recommendations individualized to students with different levels of performance.

Policy on Written Summative Narrative Assessment in the HMS Curriculum

Preclerkship curriculum.

• Courses in which the primary mode of instruction allows for longitudinal faculty and student engagement in active learning settings, including but not limited to small groups, large groups, CBCL groups, and clinical preceptorships provide a narrative assessment of each student at the end of the course describing the student's achievement of expected performance, including individual faculty members' observations of any notable performance behaviors of individual students within the group. Performance behaviors describe a student's demonstration and achievement of expected course objectives, including cognitive and non-cognitive behaviors. 
• Narrative assessments may also be provided for any student based on direct observation.

Clinical Curriculum

All clerkships/clinical electives that are four weeks or more in duration and in which the primary mode of instruction is clinical immersion and bedside teaching, provide a written summative narrative assessment of each student at the end of the clerkship. In most cases, this narrative assessment is the synthesis of multiple narratives submitted by individual faculty and residents who have worked with the student during the clerkship. Additional inputs that contribute to the narrative assessment may  include NMBE subject examinations; oral examinations; CEX (Clinical Evaluation Exercises); progress toward entrustability as outlined in the mapped EPAs for the clinical experience; and comments about relevant learning behaviors and achievement. 

Timeline of Grade Submission and Use of Assessments in the MSPE

Final grades are to be submitted by the course/clerkship director within 4 weeks of the end of the course/clerkship to the Registrar’s office , with an absolute deadline of 6 weeks. The final grade is composed of the actual grade (i.e., Honors with Distinction; Honors; Satisfactory/Pass; Unsatisfactory) and the summative narrative (where required).

Formative assessments of any type (written or verbal) are not included in the MSPE. All final grades, however, are included in the MSPE, including summative narratives from all required clinical clerkships and subinternships. Preclerkship course summative narratives are not included in the MSPE.

Policy on Appeal of Assessment Results

A variety of assessment tools are employed throughout the curriculum to ensure that students are achieving course or clerkship learning objectives and HMS-wide program objectives, during all phases of the MD program (Preclerkship, PCE [Principal Clinical Experience], and Post-PCE). The implementation of these assessment tools often results in numerical scores; narrative comments based on direct observation of students that serve both formative and summative purposes; clinical skills evaluations; and/or other measures of academic and clinical performance. These results are in turn used to determine course and clerkship grades and narrative assessments. For more information about grading and assessment, see Sections 1.04: Student Assessment in the MD Program and 2.03: Grading and Examinations .

As a component of establishing a fair and formal process for determining a grade, students may request reconsideration of their assessment results and course/clerkship grades.

First Level of Appeal

A student’s initial request for reconsideration of an original grade or narrative evaluation should be raised via email with the course/clerkship director who determined the original grade or narrative evaluation, within six weeks* of notification of the grade and/or evaluation to the student. The initial communication from the student should take the form of an email directly to the relevant course/clerkship director, noting the aspect(s) of the evaluation the student would like reconsidered and the proposed basis for that reconsideration.

Students are encouraged to consult with their Academic Society advisor before submitting an initial request for reconsideration.

• The course/clerkship director is expected to respond within two weeks of receiving the request for reconsideration. The response should take the form of an email directly to the student and to their Society advisor. If the original grade and/or narrative is to be altered in any way, the email must also be sent to the HMS Registrar.

It is expected that most concerns will be settled at the first level of appeal. In unique circumstances, if the student is not satisfied with the outcome of the first level of appeal, a second level of appeal is available.

Second Level of Appeal

If the student is not satisfied with the outcome of the first level of appeal, a further written appeal may be submitted to the appropriate governance committee within two weeks of receiving a response to the prior appeal. The appropriate subcommittee of the Educational Policy and Curriculum Committee/EPCC (see table below) will obtain input from the relevant course/clerkship director and will review the appeal at its next regularly scheduled meeting and in consulation with the Assessment Subcommittee of the EPCC.

• Students are required to consult with their Academic Society advisor before submitting a request at the second level of appeal.
• The original grade or narrative evaluation;
• The student’s written request for appeal;
• The course or clerkship director’s response;
• Additional data as determined by the relevant subcommittee as needed to reach a conclusion.
• The student and course/clerkship director are not expected to appear before the subcommittee during the review, but do have the option to do so.
• All EPCC subcommittees have full voting student members who have the same access to information as other committee members. Upon appointment to these subcommittees, students are informed of their responsibilities regarding the confidential handling of sensitive information about their peers.
• Subcommittee members who have a conflict of interest with a student who has requested further appeal must recuse themselves from the appeal proceedings.
• After reviewing relevant materials and thoroughly discussing the appeal, the subcommittee will vote to support or deny the appeal based on its merits. All appeals are decided by a simple majority vote of the voting members of the relevant committee.
• The governance subcommittees will respond within two weeks after its consideration of the appeal. Written notice of the governance committee’s decision will be sent to the HMS Registrar (using the standard HMS Appeal of Assessment Results form), who will make any necessary revisions to the original grade and will keep a record of the appeal process.
• The HMS Registrar will provide written notification of the governance subcommittee’s decision to the student, to the student’s Society advisor, and to the course or clerkship director. Notification will ordinarily be sent within 10 business days of the governance subcommittee’s notification to the HMS Registrar.

Final Appeal for All Grades

In all cases, for students who have a concern that is not settled after the determination at the second level of appeal, a written appeal should be submitted to the Assessment Subcommittee, which will have the final authority to determine if the grade should be reconsidered. This committee will consider all previous decisions before making a final determination.

* In the above text, all indications of time refer to calendar units (e.g., 7 days refers to 7 calendar days, not business days ; a week refers to 7 calendar days).

• Being a Student at Harvard Medical School
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• 6. Financial Obligations
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41 Formative assessment

• Published: October 2013
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Assessment is a complex process, serving a wide range of differing functions. Formative assessment is a powerful driver for learning, involving a dynamic interaction between students and their teachers to drive up the quality of the educational process. Grounded in social constructivist theories of education, effective formative assessment, or assessment for learning, utilizes constructive feedback as the tool by which students gain confidence and skills in self-regulation and reflection as well as the autonomy required for lifelong learning. In a programme of formative assessment, students are aware of the learning outcomes of the curriculum and the requirements for success. They are encouraged to examine their learning needs in order achieve their goals and also to engage in assessment of their own work and that of their peers, thereby developing a deeper understanding of their subject. Within an educational institution, assessment procedures should be explicitly aligned with the intended learning outcomes so that both formative and summative assessments directly facilitate learning and are embedded in curriculum design and review. By placing assessment at the heart of learning, a well developed programme of formative assessment can be an effective way of influencing institutional culture, ensuring that data gathered from all forms of assessment are analysed and used in a programme of continuous educational improvement. Formative assessment is employed in all educational sectors and has particular relevance to medical education in which observed practice and experiential learning are central to the educational process. The valuable skills for lifelong learning which are fostered by effective formative assessment are a feature of medical education and a key requirement for good medical practice.

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Formative Assessment Strategies for Healthcare Educators

Formative assessments are those lower-stakes assessments that are delivered during instruction in some way, or 'along the way' so to speak. As an educator, it was always a challenge to identify if or what my students were understanding, what skills they had acquired, and if or how I should adjust my teaching strategy to help improve their learning. I’m guessing I am not alone with this. In medical education, the pace is so fast that many instructors feel like they do not have the time to spare in giving assessments ‘along the way’, but would rather focus on teaching everything students need for the higher-stakes exams. With medical education being incredibly intense and fast, this is completely understandable. However, there must be a reason so much research supports the effectiveness in administering formative assessments….along the way.

One reason formative assessments are proven so useful is they provide meaningful and useful feedback; feedback that can be used by both the instructor and students.

Results from formative assessments should have a direct relation to the learning objectives established by the instructor, and because of this, the results provide trusted feedback for both the instructor and student. This is incredibly important. For instructors, it allows them to make immediate adjustments to their teaching strategy and for the students, it helps them develop a more reliable self-awareness of their own learning. These two things alone are very useful, but when combined, they can result in an increase in student outcomes.

Here are 5 teaching strategies for delivering formative assessments that provide useful feedback opportunities.  

1. Pre-Assessment:

Provides an assessment of student prior knowledge, help identify prior misconceptions, and allow instructors to adjust their approach or target certain areas

• When instructors have feedback from student assessments prior to class, it is easier to tailor the lesson to student needs.
• Posing questions prior to class can help students focus on what the instructor thinks is important.
• By assessing students before class, it helps ensure students are more prepared for what learning will take place in class.
• Pre-assessments can provide more ‘in-class’ time flexibility- knowing ahead of time which knowledge gaps students may have allows the instructor to better use class time in a more flexible way...not as many ‘surprises’ flexibility.

2. Frequent class assessments:

Provides students with feedback for learning during class, and provides a focus for students related to important topics which help increase learning gains

• Adding more formative assessments during class increases student retention.
• Frequent formative assessments help students stay focused by giving them natural ‘breaks’ from either a lecture or the activity.
• Multiple formative assessments can provide students with a “road-map” to what the instructor feels is important (i.e. what will appear on summative assessments).
• By using frequent assessments, the instructor can naturally help students with topic or content transitions during a lecture or activity.
• The data/feedback from the assessments can help instructors better understand which instructional methods are most effective- in other words, what works and what doesn’t.

3. Guided Study assessments (group or tutorial):

‍ Provides students with opportunities to acquire information needed to complete the assessment, for example through research or group work, and increases student self-awareness related to their own knowledge (gaps)

• Assessments where students are expected to engage in research allows them to develop and use higher-level thinking skills.
• Guided assessments engage students in active learning either independently or through collaboration with a group.
• Small group assessments encourage students to articulate their thinking and reasoning, and helps them develop self-awareness about what they do and do not yet understand.
• Tutorial assessments can provide the instructor real-time feedback for student misconceptions and overall understanding- allowing them to make important decisions about how to teach particular topics.

4. Take-Home assessments: ‍

Allows students to preview the instructors assessment style, are low-stakes and self-paced to allow students to engage with the material, and provides the instructor with formative feedback 

• Assessments that students can engage in outside of class gives them a ‘preview’ of the information that they will likely need to retrieve again on a summative exam.
• When students take an assessment at home, the instructor can receive feedback with enough time to adjust the classroom instruction to address knowledge gaps or misconceptions.
• Take home assessments can help students develop self-awareness of their own misunderstandings or knowledge gaps.

5.“Bedside” observation:

Informs students in clinical settings of their level of competence and learning, and may improve motivation and improve participation in clinical activities.

• Real-time formative assessments can provide students with critical feedback related to the skills that are necessary for practicing medicine.
• On the fly assessments can help clinical instructors learn more about student understanding as well as any changes they can make in their instruction.
• Formative assessments in a clinical setting can equip clinical instructors with a valuable tool to help them make informed decisions around their teaching and student learning.
• Bedside assessments provide a standardized way of formatively assessing students in a very unpredictable learning environment.

The challenge for many instructors is often in the “how” when delivering formative assessments. Thankfully, improving teaching and learning through the use of formative assessments (and feedback) can be greatly enhanced with educational technology. DaVinci Education’s Leo platform provides multiple ways in which you can deliver formative assessments. With Leos’ exam feature you can:

• Assign pre-class, in-class or take-home quizzes
• Deliver IRATs used during TBL exercises to assess student individual readiness
• Deliver GRATs used during TBL exercises by using Leo’s digital scratch-off tool to encourage collaboration and assess group readiness
• Monitor student performance in real-time using Leo’s Monitor Exam feature
• Customize student feedback options during or following an assessment

References:

Burch, v. c., seggie, j. l., & gary, n. e. (2006, may). formative assessment promotes learning in undergraduate clinical clerkships. retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16751919, feedback and formative assessment tools . (n.d.). retrieved from http://www.queensu.ca/teachingandlearning/modules/assessments/11_s2_03_feedback_and_formative.html, hattie, j. and timperely, h. (2007). the power of feedback. review of educational research , 77, 81–112, heritage, m. 2014, formative assessment: an enabler of learning, retrieved from http://www.amplify.com/assets/regional/heritage_fa.pdf, magna publications, inc. (2018). designing better quizzes: ideas for rethinking your quiz practices . madison, wi., schlegel, c. (2018). objective structured clinical examination (osce). osce – kompetenzorientiert prüfen in der pflegeausbildung , 1–7. doi: 10.1007/978-3-662-55800-3_1, other resources.

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2023-24 Bulletin

Formative assessment and feedback for medical students policy.

—This policy applies to Gateway Curriculum students.—

Formative assessment is critical to high-quality medical education, and, as such, central to the educational mission of Washington University School of Medicine (WUSM). In keeping with Liaison Committee on Medical Education (LCME) standard 9.7, WUSM is committed to ensuring that each medical student is provided with formative assessment on their performance, including noncognitive achievement, early enough in their training to allow sufficient time for improvement. For the purposes of this policy, the term formative assessment is defined as any no-/low-stakes assessment, including narrative assessment, performed during the learning experience for the purposes of supporting the student's ability to achieve competence and meet their maximum potential. This information must be communicated to a medical student in a timely manner so that the student has the ability to modify their thinking or behavior to improve subsequent performance in the medical curriculum.

The WUSM Gateway Curriculum is a fully competency-based, longitudinal curriculum. There are six competency domains modeled on the Accreditation Council for Graduate Medical Education core competencies: (1) Foundational Knowledge for Practice; (2) Patient Care; (3) Interpersonal and Communication Skills; (4) Professionalism; (5) Practice-Based Learning and Improvement; and (6) Systems-Based Practice. Within each of the competency domains, there are several Educational Program Objectives (WUMS MD EPOs). All curriculum is mapped to the EPOs in a course structure to ensure the adequacy of content coverage at the course, clerkship, phase and overall curriculum levels. Assessments occur within courses and clerkships but are collated longitudinally. Assessments are labeled as competency-contributing or non-competency-contributing. Non-competency-contributing assessments are provided purely for formative purposes and can be used by students to measure their own knowledge, attitudes and skills in preparation for competency-contributing assessments. Competency-contributing assessments are also formative in that no single assessment can result in a learner being deemed not competent. In addition, performance on any given assessment or combination of assessments within a course does not result in a student passing or failing that course. Determinations of competence in each of the WUMS MD EPOs is made by the Competency Attainment Committee (CAC) at the end of each phase of the curriculum; recommendations for progression or remediation are sent to the Committee for Academic Promotion (CAP), which makes the final determination (see the Policy for Review of Student Attainment of Competency and the Policy for Student Promotion and Appeals for details). In addition, the CAC reviews student assessments continually, with formal interim reviews occurring throughout each phase. During the clerkship phase (Phase 2), each clerkship has its own clinical competency committee (CCC) that reviews four of the Patient Care EPOs that have a specialty-specific context to make decisions about student achievement of competence in each of these four EPOs. The figure below depicts the frequency of formative and summative competency reviews by the CAC and the CCCs.

All students must receive meaningful formative assessment on their performance in each of the EPOs at regular intervals during each phase of the Gateway Curriculum. This may include the following:

• The inclusion of non-competency-contributing assessments in each course or clerkship. This includes resources created by course leads as well as those provided by WUSM to support learning (e.g., UWorld, Aquifer, similar materials) if appropriately aligned with the content covered in the course or clerkship.
• The inclusion of multiple low-stakes competency-contributing assessments (e.g., TBL knowledge assessments, just-in-time clinical assessments, peer feedback, quizzes, low-stakes observed structured clinical examinations [OSCEs], written assignments, midpoint clerkship feedback) throughout the curriculum with the ability to comprehensively review results and seek clarification.
• Early intervention by the Student Success Team (i.e., the Associate Dean for Student Affairs, the Assistant Dean for Assessment, and the Director of Student Success) and coach when low- or high-stakes competency-contributing assessments suggest a student may be struggling, appearing off-track for achieving competence, or demonstrating a sudden change in performance.
• Specifically for clerkships, a separate midpoint clerkship feedback session with the clerkship director or their designee is required within each clerkship. The focus of this session must include discussion of the student's progress toward competence in the patient care EPOs reviewed by the CCC. It should also include information received related to other competency domains/EPOs. If there are concerns about the student's ability to achieve competence, the Student Success Team and the coach must be notified and work with the student and clerkship to support the attainment of competence.
• Interim review of progression toward competency attainment by the CAC for each student in each of the WUMS MD EPOs to allow for the early identification of at-risk students. Communication of CAC interim judgements must be provided to students in formal letters that should also support student review and interpretation of their portfolios.
• Prior to the summative review made by the CAC, students must have the ability to review the constellation of their competency-contributing assessments in a comprehensive portfolio. The purpose of this portfolio review is to allow students to assess their own growth and development and to develop an understanding of how the individual assessments are contributing to competency in each of the EPOs. Each portfolio also includes information about whether there is sufficient data, thus far, for students to make inferences from the data about whether they should alter their behavior/learning plan.
• Students must have formal 1:1 reviews of their portfolios with their coaches periodically throughout each phase, and they are encouraged to discuss concerns with their coaches at any time regardless of whether there is a formal 1:1 review. Coaches review the student-created individual learning plans. Each student's plan and the coach's observations regarding learner performance in coaching small group teaching sessions are incorporated into a summary narrative assessment that is non-competency-contributing and used to help consolidate feedback and ensure progression toward competence. These formal coach-supported reviews must occur at least three times during Phase 1, twice during Phase 2, and three times during Phase 3.

Clerkships are responsible for documenting that each student has received formative assessment at the midpoint of their clerkship. Coaches are responsible for documenting that each student has received formative assessment at the time of each required 1:1 portfolio review. The Committee for Oversight of Medical Education (COMSE) will conduct oversight of student responses on both internal and external surveys to assess the amount and quality of formative and narrative assessment and make recommendations for change as needed to ensure that the intent of this policy is met.

Quality formative assessment ought to include reinforcement of things done well, identification of room for improvement or areas of growth, and specific strategies for improvement. Evidence for this feedback in the form of specific examples and observations should also be included.

Last approved on October 3, 2022

Contact Info

Formative Assessment and Feedback

Policy Statement

Boston University Chobanian & Avedisian School of Medicine ensures that each medical student is provided with formative assessment early enough during each required course or clerkship to allow sufficient time for remediation. Formative assessment occurs at least at the midpoint of each required course or clerkship four or more weeks in length.

Responsibilities

Course and clerkship directors are responsible for ensuring that students receive formative assessment in each required course or clerkship.

The Medical Education Committee and Curriculum & Assessment Office are responsible for compliance oversight and non-compliance follow-up.

Required Pre-clerkship Courses

• Students will receive formative assessment by at least the mid-point of each required pre-clerkship course
• Students must have access to course or module directors (or their faculty designees) throughout the course or module to solicit additional feedback regarding their performance.
• Formative assessment includes, but is not limited to, quizzes, practice questions, and verbal feedback.

Required Clerkships

• A mid-clerkship review meeting must occur by approximately the midpoint of each required clerkship with the clerkship director (or their faculty designee, such as a site director).
• Each clerkship director (or faculty designee), will provide mid-clerkship feedback in person to each medical student on the rotation at the midpoint for that clerkship and complete the mid-clerkship review form which should include a review based on the Clinical Student Evaluation Form (CSEF) domains and behavioral anchors.
• In addition, the mid-clerkship review should include a review of the student’s clinical log to ensure that the student is on track to meet all required diagnoses and procedures for that clerkship. If deficiencies are found, a plan will be developed with the student to ensure all requirements are met by the end of the clerkship.
• The clerkship director (or faculty designee) and student will sign the mid-clerkship review form at the end of the meeting.
• Students must have access to clerkship directors (or their faculty designees) throughout the clerkship to solicit additional feedback regarding their performance.

The Medical Education Committee monitors module, course, and clerkship assessment methods annually to ensure students are provided with sufficient feedback on their performance.

The Curriculum & Assessment Office monitors clerkships for compliance on mid-clerkship and end-of-clerkship evaluation to ensure compliance with this policy.

Non-compliance is reported to the Associate Dean of Medical Education and the Assistant Dean of Medical Education for Curriculum & Assessment for action.

Relevant LCME Element(s): 9.7 Formative Assessment and Feedback

Approved by the Medical Education Committee (MEC) on March 14, 2018.