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.

SUPPORTING DATA

Table 9.1-1 | Provision of Objectives and Orientation / Source: School-reported
List 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 experience / Types of trainees who provide supervision/teaching/assessment / How objectives provided and teachers oriented
Table 9.1-2 | Resident Preparation to Teach / Source: School-reported
Briefly 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 Medicine
Family medicine
Internal medicine
Obstetrics Gynecology
Pediatrics
Psychiatry
Surgery
Longitudinal Integrated Clerkship
Other (list):

NARRATIVE RESPONSE

a.  Describe any medical school policies that require residents and non-faculty instructors to be prepared for their role in supervising, teaching or assessing medical students.

b. 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.

c. 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.

d. Describe any medical school or relevant department programs that prepare graduate students or post-doctoral fellows to teach or assess medical students.

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.

NARRATIVE RESPONSE

a. Describe the steps taken to provide faculty appointment to physicians who will supervise, teach and assess medical students in required clinical learning experiences.

b. Describe how, by whom, and how often the faculty appointment status of physicians who supervise, teach and assess medical students in required clinical experiences is monitored.

c. List any required clinical learning experiences where students are being supervised, and assessed by physicians who are not medical school faculty members (do not include residents/fellows). Describe the steps being taken to provide faculty appointments to these physicians.

d. Where 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 ZZ)

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, level of responsibility and scope of practice / Source: AAMC CGQ
Provide data from the AAMC Canadian Graduation Questionnaire (CGQ) on the percentage of respondents that agree/strongly agree (aggregated) that they received adequate supervision during required clinical learning experiences. Also provide data on the percentage of respondents that agree/strongly agree (aggregated) that they were given appropriate responsibility for patient care. Add rows as needed for each campus.
Campus / Required learning experience / School %
Appropriately supervised / Appropriate level of responsibility
2013 / 2014 / 2013 / 2014
Emergency Medicine
Family medicine
Internal medicine
Obstetrics Gynecology
Pediatrics
Psychiatry
Surgery
Longitudinal Integrated Clerkship
Other (list):
Table 9.3-2 | Clinical supervision and level of responsibility / Source: AFMC GQ
Provide 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.
Campus / Required learning experience / % agree/strongly agree
The level of supervision
ensured my safety / The level of supervision ensured
the safety of the patients
for whom I provided care / I was given appropriate responsibility
for patient care
Emergency Medicine
Family medicine
Internal medicine
Obstetrics Gynecology
Pediatrics
Psychiatry
Surgery
Longitudinal Integrated Clerkship
Other (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.

SUPPORTING DOCUMENTATION

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

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.

SUPPORTING DATA

Table 9.4-1 | Observation of Clinical Skills / Source: AAMC CGQ and AFMC GQ
Provide data from the AAMC Canadian Graduation Questionnaire (CGQ) and 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 CGQ or GQ. Add rows as needed for each campus.
Campus / Required clinical learning experiences / School %
History / Physical Exam
2013 / 2014 / 2015 / 2013 / 2014 / 2015
Emergency Medicine
Family Medicine
Internal Medicine
Obstetrics Gynecology
Pediatrics
Psychiatry
Surgery
Other (list) indicate data source
Table 9.4-2 | Methods of Assessment – Year One / Source: School-reported
List 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” 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 experience / No. of Exams / Student Performance Assessment
MCQ, Key features exam / Short answer, knowledge application exercises / Lab or
Practical Exam / OSCE/SP
Exam / Small group assessment by Faculty/
Resident / Paper or
Oral Presentation / Other*
(specify below) / Narrative Feedback as part of an assessment
*Other
Table 9.4-3 | Methods of Assessment – Year 2 / Source: School-reported
List 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” 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) / Name of required learning experience / No. of Exams / Student Performance Assessment
MCQ, Key features exam / Short answer, knowledge application exercises / Lab or
Practical Exam / OSCE/SP
Exam / Small group assessment by Faculty/
Resident / Paper or
Oral Presentation / Other*
(specify below) / Narrative Feedback
*Other
Table 9.4-4 | Methods of Assessment – Year 3 / Source: School-reported
List all required clinical learning experiences in the third year of the curriculum, adding rows as needed. 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” 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 / Number of exams / Student Performance Assessment
MCQ, key features exam, knowledge application exercises / Oral
Presentation / Preceptor
Faculty/Resident assessment / OSCE/SP Exams / Other*
(specify below)
*Other:
Table 9.4-5 | Methods of Assessment - Year 4 / Source: School-reported
List all required clinical learning experiences in the fourth year of the curriculum, adding rows as needed. 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” 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) / Name of required clinical learning experience / Number of exams / Grade
MCQ, key features exam, knowledge application exercises / Oral
Presentation / Preceptor
Faculty/Resident assessment / OSCE/SP Exams / Other*
(specify below)
*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

SUPPORTING DOCUMENTATION

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

b. Samples of the specific or standardized forms used in the assessment of the following clinical and cognitive skills. Indicate on a cover page the required learning experiences where each form is used and whether the results are used for formative (feedback) and/or summative purposes.