MS3 Class Meeting

September 4, 2018

AGENDA

•Career Advising

•Miscellaneous Announcements

•Preparation for RIA Weeks

•Grades

•Wrap Up and Q&A

Career Advising

•What should I be focusing on now?•Being the best MS3 student you can!

•Specialty choices – embrace every rotation as that is your specialty of choice!

•AAMC CiM may help.

•Letters of recommendation (LOR) only if experience a major bond with a faculty member.

Career Advising

•What about 4th year???

•We will have CA meetings Dec-Jan to plan schedules and discuss away rotations.

•Will have CA meetings in April-May to outline residency application strategy and process.

•Will have CA meetings in June-Sept to help actually complete your applications!!!

Career Advising

•I want to know…what does 4th Year look like?

•Organized in 4 week blocks:•3 required AIs (Acting Internships)•Floor, Unit and ER

•5 Electives•Your choice…here or away

•3 Professional Development•Study for Step 2, Interviews, travel/vacation

Career Advising

•We’re here for you!

•Dr. Kanner: Neurology, Neurosurgery, Dermatology, Ophthalmology, Psychiatry, Family Medicine•Dr. Pearlman: Surgery and Surgical

Subspecialties•Dr. Farina: Emergency Medicine•Dr. Pawelczak: Pediatrics•Dr. Yacht: Internal Medicine• Jodi: Anesthesia, Radiology, OB/GYN

Miscellaneous Announcements

• Sunrise: Student Progress Note going LIVE!

• Selective: Go through proper channels if you need to make changes

• End of Cycle Evaluations: don’t do on your phone!

• Jewish holidays- let us know ASAP if you need to miss Clinical Skills or Core Learning (make up required) and haven’t told us yet

•All Patient Logs are due by Friday, September 7, 2018 at 5:00pm.

•All evaluations are due by Monday, September 10, 2018 at 11:55pm.

Preparation for RIA Weeks: Subject Exams

TUESDAY SEPTEMBER 18TH, 10AM TO 1PM, SOMW134

TUESDAY SEPTEMBER 20TH, 10AM TO 1PM, SOMW134

NEUROLOGY PSYCHIATRY

SURGERY MEDICINE

OBGYN PEDIATRICS

Preparation for RIA Weeks: Subject Exams

•NBME Subject Exam (Shelf)• 110 multiple choice questions

• Medicine will have some short answer• 2 hours and 45 minutes• Incredibly low threshold national wide

for passing•Will get scores before you get your final

grade (with instructions for how to interpret them)

• Laptops- see RIA letter for details

• Exam Policy- see RIA letter for details

•KEEP THE NOISE DOWN! •Walk AWAY from the MET to

commiserate when you are done

Preparation for RIA Weeks: Clinical Skills

•Behind the Curtain: Demystifying Clinical Skills

Preparation for RIA Weeks: Clinical Skills

MONDAY SEPT 10TH

WEDNESDAY SEPT 12TH

FRIDAY SEPT 14TH

NEUROLOGY PSYCHIATRY SURGERY

MONDAY SEPT 17TH

WEDNESDAY SEPT 19TH

FRIDAY SEPT 21ST

OBGYN MEDICINE PEDIATRICS

Preparation for RIA Weeks: Clinical Skills

•What should I bring?•White coat•Your ID•Stethoscope•Blank note pad to write on (no cheat sheets)•Pen•Your examsoft password•Reflex hammer & tuning fork for Neurology•Laptop for Medicine•No electronic devices- including smart

watches

Preparation for RIA Weeks: Clinical Skills

•Professionalism Contract- you can lose points on your grade if you don’t take this seriously•Dress professionally (careful with shoes)•Be on time

• Remember to anticipate time to park- don’t get towed• Note earlier start time for Medicine• Call Student Affairs on call phone or CLI if running late

•Be respectful to EVERYONE•Clean up after yourself

•Academic Honesty•Don’t share cases

Preparation for RIA Weeks: Clinical Skills

•6 stations per clerkship• 15 minutes per case with a 5 min warning and a

2 minute warning•Hypothesis-driven history and physical (unless

otherwise specified); Remember the mental status exam is the physical exam for Psychiatry•One telephone case in Medicine and Pediatrics

•Post-encounters on examsoft•Clinical reasoning style questions and notes• In psychiatry, will go back into the room for

another SP encounter for 3 of the stations

Preparation for RIA Weeks: Clinical Skills

•How should I study?•Content knowledge through studying for

shelf•Review Communications Checklist•Review relevant cases in First Aid for USMLE

Step 2 CS•Review differential diagnosis for common

symptoms (Book Symptom to Diagnosis)•Practice with each other through role play

CORE CHECKLIST PAGE 1

CORE CHECKLIST PAGE 2

Clinical Skills Words of Wisdom• Don’t forget to elicit a chief complaint• It is easy to forget empathy when the cognitive load is high from

clinical reasoning- consider starting with “Impact Concerns Explanatory model” before jumping into the HPI- these questions pull for emotional content to empathize with.

• Even if the underlying condition seems obvious you MUST ask pertinent positives and negatives on history and perform pertinent parts of the physical exam. Consider pausing before the physical and jotting the following notes to yourself and at least think through what you might have missed on history and need to do on PE :

DIFFERENTIAL Risk factors History Physical exam

1. Most likely Dx

2. Alternative Dx

3. Must not miss Dx

Clinical Skills Words of Wisdom Continued

•Telephone cases:•Goal is to decide if needs to be seen urgently

or not- think red flags/warning signs• If doesn’t need to be seen- educate the

patient about the red flags/warning signs•Remember to express empathy verbally

Grading of Clinical Skills

Communication

Assessed by SP checklist

Integrated Clinical

Encounter

Majority of grade

Assessed by SP checklist and post-

encounters

Clinical Reasoning

• Pertinent positives/negatives from history & physical exam

English Proficiency

Assessed by SP Checklist

Professionalism

Assessed by SP Checklist

GRADES

• Clinical Performance (45%)• Including faculty/resident feedback, ACE Rounds, and clinical

reasoning exercises (written exams, notes, and write ups).

Standardized Assessments (55%)• Standardized examinations, including NBME and

standardized patient encounters

• Professional & Administrative – Conditional Triggers for Lower Grades• Attendance• Timely submission/completion of assignments, evaluations

and logs• Professional etiquette in all forms of communication (written

and verbal)

Inherent Tension

Normative

Grading

Grading by Pre-set Standard

Philosophically aligned with our principles

Performance-based cut-offs

No Curve

Compared to a standard

Required by AAMC for MSPE

Arbitrary Cut-off

Curve

Compared to each other

A Compromise

Normative

Grading

Grading by Pre-set Standard

OVERALLGRADE

Individual Components

This Year…

Clerkship Shelf CSE ACE Rnds Notes/WU/Exams

Fac/Res FB

Med * 30% 25% 15% 15% 15%

Surg 30% 25% 15% 15% 15%

Peds 30% 25% 30% combined

15%

OBGYN 30% 25% 15% 15% 15%

Neuro 30% 25% 30% combined

15%

Psych 30% 25% 30%combined

15%

• *Note LHH Medicine: ACE Rounds and Notes are a combined grade worth 30%

• MWR or DNM in Professionalism may lower your grade

A few words on components:• Shelf/NBME clinical subject exam

• There are practice exams you can purchase

• Cut-offs for Honors/High Pass/Pass recommended by NBME and vary by clerkship-you will receive your scores and the standards

• Clinical Skills Exam

• Communication, Professionalism, and English Proficiency based on pre-set standards

• Integrated Clinical Encounter graded normatively (ie graded on curve)

• ACE Rounds

• Graders calibrate to each other in end of cycle conference call based on whole cohort

• The form is not converted to a grade

• Notes/Write-ups

• Graders calibrated by ACE Director and assessment team

• Grades based on preset standards- not all items weighed equally

• Exams

• Graded normatively (i.e. on a curve)

• Comments from Faculty-Resident Feedback

• Based on pre-set standards

• Will appear on your Dean’s letter “Medical Student Performance Evaluation”

• Negative comments stricken unless they become a pattern.

NOTE: More about standards and grades once grades are released!!!

Grade Appeals

• SEE POLICY FOR DETAILS

• “Concerns related to personality conflicts or malice should be brought forth within ten (10) business days of the incident or posting of an assessment grade, and prior to the assignment of the final course grade, to ensure a fair and expeditious investigation.”

• “A student must submit an appeal, in writing, to the course director via the grade appeal form within ten (10) business days of the posting of the final course grade.”

Gradesposted

10 days

Complete Grade Appeal Form (from

SOMACE)

Grade Appeal

Committee reviews

If meets criteria,

forwarded to ACE Director

Decision Rendered

5 days

FinalAppeal to

Dean

10 days 5 days

Common Grading Myths Debunked• My Clinical Skills grade is a high pass (or pass) but I got honors on my shelf,

therefore the Clinical Skills grade must be wrong.

• My Written Exam grade is a high pass (or pass) but I got honors on my shelf, therefore the Written Exam grade must be wrong.

• How could I get an honors on Surgery Clinical Skills and a pass on Medicine Clinical Skills but I did the exact same thing in both!

• If I get honors on the Communication part of Clinical Skills, how could I get an overall pass on Clinical Skills?

• My ACE Rounds facilitator didn’t give me any constructive criticism-therefore I should have gotten Honors on ACE Rounds.

• My ACE Rounds facilitator said I improved dramatically from midcyclefeedback, therefore I should have gotten Honors on ACE Rounds.

• All of my peers said I gave great presentations and participated well in ACE rounds, therefore I should have gotten Honors on ACE Rounds.

• My shelf score was 75th percentile- at any other school that would have been an honors.

• I got “5’s” on all of the write-up rubric questions except for one, why did I get a high pass?

• My attending is a harsh grader- my grade is unfair.

• I know Standardized Patients make mistakes- I saw it with my video review in F100W- I want to see my videos or I want my test regraded by video.

Remember

•Grading in medicine is an artificial construct

•A Pass is NOT a Fail

•Your worth is not measured by your grades!!!!!!

Wrap Up and Q&A