Requirements/ Grading

2012-2013 Grade Criteria

Overview

An extremely 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 less formal, not graded, and used to help the student accomplish the goals of the clerkship.

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 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 months two and five of the psychiatry clerkship.

Your final clinical grade will be the average of the two clinical evaluations.

Uniformity of Evaluation

For purposes of uniformity of evaluation, the following descriptions are used as guidelines by faculty of this Department in grading:

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.

Oral Examination

The evaluation of medical students and residents is moving toward direct observation of interactions with patients (remember the upcoming Clinical Practice Exam - CPX). In keeping with this trend the Psychiatry Clerkship oral exam format has been changed to assess the skills involved in direct patient interaction.

During the second month 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:

  • Establishing rapport
  • Eliciting historical information
  • Performing a mental status examination
  • Presenting the information obtained in an organized fashion
  • Discussing the differential diagnosis
  • Formulating a basic treatment plan

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

  • Patient interview (30 minutes)
  • Presentation of the patient (5-10 minutes)
  • Discussion of the differential diagnosis (5-10 minutes)
  • Discussion of the treatment plan (5-10 minutes)
  • 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 interviews. If the first exam time approaches (mid-second month) and you do not feel adequately prepared, discuss this with the psychiatry mentor 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. I strongly encourage you to look this over carefully prior to your practice sessions.

Psychiatric Knowledge

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 in-office clinical experience, the 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 only 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 UNC students' performance over the past several years on the Psychiatry Subtest.

Final Grade

The final Psychiatry Clerkship grade consists of three components:

1. Clinical Performance

60%

2. Oral Exams

20%

3. NBME Psychiatry Subtest

20%

 

100%

The scores received by the student in each of the three components are added together to yield a total score with the range of possible scores being 0 - 100. The following shows the conversion of the total score to the final clerkship grade:

Honors

90 & over

High Pass

82 - 89

Pass

70 - 81

Fail

< 70


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

Honors

Shelf Exam > 74th percentile score and ORAL EXAM > 14

High Pass

Shelf Exam > 22nd percentile score and ORAL EXAM > 10

Pass

Shelf Exam > 3rd percentile score and ORAL EXAM > 8

Fail

Shelf Exam <  3rd percentile OR ORAL EXAM < 8

* percentile scores subject to change after the end of each quarter of the year based on national percentile score ranges.

If you have any questions about the above evaluation procedures, please contact Dr. Buie at 828-294-9494.