Student Feedback and Evaluation

A critically important aspect of the clinical clerkship is the numerous occasions on which the students receive feedback on their performance. While some of this feedback or evaluation is formal and factored into the student's final grade, most of the time it is “formative”:  less formal, "ungraded" and used to help the student accomplish the goals of the clerkship.  Formal feedback and evaluation in core areas of clinical skills and knowledge base are provided, using clinical performance evaluations, performance on an observed interview/oral exam, a patient write-up assignment, performance on Team Based Learning activities and the NBME subtest.

Clinical Performance

Throughout the clerkship the student will receive evaluation and feedback including suggestions for improvement regarding her/his performance in the clinical setting. This evaluation takes several forms:

Informal/Ongoing

The clinical supervisors (attendings and residents) will provide guidance and feedback that will help the student develop the ability to function in a manner that is independent while making a significant contribution to the treatment team.

Formal

On two separate occasions during the rotation students receive written and verbal feedback from their attending physician(s). This will occur at the end of weeks three & six of the psychiatry clerkship.

  • UNC: Students rotating at UNC will have two clinical evaluation forms completed. Your final clinical grade will be the average of the two clinical evaluations.
  • CRH: Students rotating at CRH will have one clinical evaluation form completed unless they switch units after the first three weeks.  Those who switch units will have two clinical evaluations (as at UNC), one after the first three weeks and another after the second three week period.    In addition, students rotating at CRH who stay on the same unit all six weeks will receive a mid-clerkship evaluation at the end of their first three weeks at CRH.  The final clinical grade will be the clinical evaluation at the end of the six weeks or the average of the two, if the students switch units.
  • CMC: Students rotating at CMC will have one overall clinical evaluation form completed by Dr. Mundle at the end of the six week period which will summarize grades and comments for the entire period.  They will also have a mid-clerkship evaluation completed by Dr. Mundle after the first three week period.

 Mid-Clerkship Meeting with Clerkship Director

Additionally, Dr. Malloy will meet individually with each student midway through the clerkship to review progress, feedback, goals, concerns and the clinical log.

Uniformity of Clinical Performance Evaluation

For purposes of uniformity of clinical evaluation, the following descriptions are used as guidelines by faculty of this Department in grading.  Please note that because part of the clerkship grade is not based on clinical performance, the below descriptors cannot apply to the final clerkship grade.

  • An "HONORS" student puts in extra time above and beyond what is expected of her/him. She/he is almost always actively involved in activities and/or discussion, shows evidence of outside readings which go beyond the requirements of the course and displays maturity and tact in her/his interactions with staff and patients. She/he shows generally superior knowledge and skill in performing interviews in her/his therapeutic work with patients, in write-ups, and discussing relevant psychiatric issues.
  • The "HIGH PASS" student attends all required meetings and conferences and is a frequent participant, tending to apply knowledge that she/he has obtained during the rotation and in her/his first years of training to clinically relevant situations. This student may or may not make use of outside readings beyond what is required for the course, but definitely shows that she/he has mastered most of the concepts involved in the required readings. She/he should be able to make reasonable differential diagnostic choices given a new patient. Her/his write-ups should be organized and include pertinent data without leaving anything of major significance out.
  • The "PASS" student shows evidence of difficulty in grasping concepts on some occasions, although there is evidence that the student has done the required reading. She/he has some difficulty in applying what has been read to actual clinical situations. Her/his attitude may be one of indifference or low level interest. She/he just doesn't seem to be interested and/or able to consistently integrate the work of this rotation into clinical practice.
  • The “FAILING” student may miss assignments or may be repeatedly late for appointments, conferences, etc. She/he consistently shows a deficient attitude towards both the material and/or the patient population and/or has mastered an insufficient amount of material from the core curriculum and/or has demonstrated insufficient skills to complete minimal requirements for passage. This student must repeat the course.

Team Based Learning (TBL) Exercises

To assist you in developing your knowledge base and preparing for the NBME subtest, you will complete four TBL modules.  Your performance on the Individual Readiness Assurance Tests (IRAT's) and Group Readiness Assurance Tests (GRAT’s) will account for 10% of your grade, i.e., each TBL  counts 2.5% toward the final grade.

Patient Write-Up

As in many other clerkships, in the Psychiatry Clerkship we evaluate each student’s ability to 1) write up a history and physical exam and  2) document clearly a discussion of differential diagnosis and a treatment plan.  These are due to Mrs. Myra Daniel by 8:30 AM on the fourth Friday of the clerkship.

You may drop off a hard copy in Room 317 MacNider to Mrs. Daniel or e-mail the write-up to her at mdaniel@med.unc.edu.

The write-up should include identifying data (NOT the patient's name or medical record number),  chief complaint, history of the present illness, past psychiatric history (if applicable), past medical history, family history, detailed personal/social history, pertinent findings on physical exam, and a complete mental status examination. This should be followed by a discussion of the complete differential diagnosis (psychiatric, medical diagnoses and pertinent psychosocial contributors) and outline of a treatment plan (safety, biological, psychological and social).  Dr. Malloy will make evaluating comments on the write-ups and assign a score from 0-5 using the below rubric; they will be returned by the end of the clerkship.

Write-Up Rubric

0 Points

Write-up not submitted, evidence of plagiarism, and/or grossly lacking in detail in the history and physical. No discernible clinical reasoning.

1 Point

History and Physical lacking important details, little if any evidence of clinical reasoning in the assessment and treatment plan. Treatment plan lacking 2 or more elements of components: Safety, Biological/Medical, Psychological, Social interventions.

2 Points

History and Physical lacking some detail but critical information included. Some clinical reasoning included in the assessment and plan. Treatment plan lacking 1 or more elements of components: Safety, Biological/Medical, Psychological, Social interventions.

3 Points

History and Physical contains sufficient detail but with poor readability/flow. Clinical reasoning is basic, missing some potential considerations in the differential diagnosis.  Discussion of clinical reasoning is present but brief. Treatment plan lacking 2 or more elements of components: Safety, Biological/Medical, Psychological, Social.

4 Points

History and Physical contains sufficient detail, reads well.  Most potential considerations in the differential diagnosis included. Treatment plan covers elements of components: Safety, Biological/Medical, Psychological, Social, but with little detail. Discussion of clinical reasoning is present and based on findings obtained from history and physical and laboratory data/testing.

5 Points

Detailed History and Physical, reads well and is pertinent. Laboratory/study results included when applicable. Comprehensive differential diagnosis covering Axes I-V. Treatment plan covers elements of components: Safety, Biological/Medical, Psychological, Social interventions in detail. Discussion of clinical reasoning is present and based on findings obtained from history and physical and laboratory data/testing and also includes references.

If you have questions about this assignment, please contact Dr. Malloy.

Observed Interview/Oral Examination

The Psychiatry Clerkship directly assesses student clinical skills in interviewing, communication and clinical reasoning via an observed interview with a real patient.  During the sixth week of the psychiatry rotation, each student will be scheduled to do an oral examination. This involves the student performing a 30-minute interview with a patient unknown to him/her, and then over the next 20-30 minutes presenting and discussing that patient with an attending physician who observed the interview. This will allow an assessment of the student’s skills in the following areas:

  1. Establishing rapport
  2. Eliciting historical information
  3. Performing a mental status examination
  4. Presenting the information obtained in an organized fashion
  5. Discussing the differential diagnosis
  6. Formulating a basic treatment plan

An approximate time breakdown of the one hour exam is as follows:

  1. Patient interview (30 minutes)
  2. Presentation of the patient (5-10 minutes)
  3. Discussion of the differential diagnosis (5-10 minutes)
  4. Discussion of the treatment plan (5-10 minutes)
  5. Feedback on student performance (5-10 minutes) 

Students should learn the skills required for this examination in both your day to day clinical work and in observed (by faculty and/or residents) interviews. If exam time approaches (mid-week 3) and you do not feel adequately prepared, discuss this with the site coordinator (Dr. Mundle at CMC; Dr. Cook at CRH; Dr. Malloy -UNC) so further observed experience can be arranged.

You will also receive in your orientation packet a copy of the grading form your examiner will use for this exam (also available on the website). Familiarity with these expectations will make your Interview Skill Building Sessions more productive.

NBME Subtest

The acquisition of psychiatric knowledge is central to this clerkship. It is felt that this occurs as a part of all components within the clerkship including the on-ward clinical experience, the off-ward lectures and other presentations and independent study. While the amount of psychiatric knowledge acquired by the student is undoubtedly reflected in his/her performance in the clinical arena and in many of the other planned learning activities, it is formally measured at the conclusion of the rotation. All students are required to take and pass the National Board of Medical Examiners Subtest in Psychiatry. This exam comprises 20% of the final grade. Students' Standard Score will be converted to a 0 - 20 numerical score based on percentiles provided by the NBME of aggregate student performance by quarter of clinical training. Conversion information is available on the clerkship website.

Calculation of Final Grade

The final Psychiatry Clerkship grade consists of five components:

COMPONENT

POINTS

Clinical Evaluation

 50 points

Team-Based Learning Performance

 10 points

Patient Write-Up Assignment

   5 points

Observed Interview/Oral Exam

 15 points

NBME Subtest Performance

 20 points

TOTAL

100 points

The scores received by the student in each of the five components are added together to yield a total score with the range of possible scores being 0 - 100.

 Conversion of the total score to the final clerkship grade:

GRADE

POINT RANGE

HONORS

90 – 100

HIGH PASS

82 – 89

PASS

70 – 81

FAIL

BELOW 70

 In addition, students must also achieve the following percentile scores on the NBME Psychiatry Shelf Exam* and the oral exam score:

GRADE

NBME PERCENTILE

OBSERVED INTERVIEW/ORAL EXAM SCORE

HONORS

> 75th percentile

12.5

HIGH PASS

> 35th percentile

11.5

PASS

> 10th percentile

10.5

*NBME percentile scores may vary depending on quarter based on the NBME report.

 NBME SUBTEST FAILURE

A student who completes all course requirements but fails the NBME exam at the end of a clerkship automatically earns a grade of INCOMPLETE.  After the NBME exam is retaken and passed, the grade will be changed to a PASS.  Grades of PASS secondary to failure of an NBME exam must be explained in the Summary Comments in the MSPE.  The final calculated grade will not be altered by the retake of the NBME or the new score.  Numerically the final grade will be what it was prior to the retaking of the exam.  If a student fails the exam a second time, the student’s final grade will need to be discussed by the course committee based on the student’s overall performance.  Retaking the course may be warranted.

If you have any questions about the above evaluation procedures, please contact Dr. Malloy.