Surgery Clerkship Assessment and Grading Policy
2019-2020
Students are responsible for being aware of the following assessment policies:
Student performance assessment policies for the Surgical Clerkship use the following as a
foundation for the assessment and grading policies:
Assessment policy for Phases 2 and 3 Link here
Examination policy Link here
Section I: Components of the grade
Your clerkship grade will be derived from the following components:
Component % (or points)
towards final grade
Faculty/resident clinical performance assessment 30
OSCE 30
NBME 20
Seminar 10
Professionalism 10
An explanation of each component follows the above table
A. Clinical Score
At the end of each four-week block (Abdominal Surgery and Selective Surgery), the assigned
faculty preceptor and senior resident will submit an evaluation of your performance using the
Feinberg School of Medicine standard performance appraisal form. They are asked to remark on
areas of strengths and weaknesses and overall performance. Your score will be calculated based
on your demonstrated competency with the following EPA’s:
TypeofSkill
Knowledge
ClinicalSkills
Professionalism
TypeofAssessment
ObjectiveTesting
(OSCEandShelf)
Subjective
Assessment(Evals,
Profess.,Seminar)
EPA 1: History taking and physical exam
EPA 2: Clinical reasoning, differential diagnosis, application of fund of knowledge
EPA 5: Oral presentation of patient
EPA 6: Written Notes
EPA 7: Medical decision making and incorporation of the literature
EPA 9: Contributes as a member of the team
Based on the clerkship director’s assessment of rating patterns by faculty and residents, as well
as other extenuating factors (e.g. professionalism issues) the clerkship director may modify the
final clinical grade.
B. OSCE
This test is an objective assessment of your ability to integrate the skills, attitudes and clinical
information presented during the clinical clerkship. In this practical exam you will interview
and/or examine standardized patients and follow-up with computer prompted questions related to
the simulated experience. There are 5 patient scenarios in all. The exam lasts 2.5 – 3 hours.
Your score will be based on your ability to ascertain relevant information from the patient,
formulate a differential diagnosis and develop a basic management plan. Each patient care
simulation is standardized for all students.
C. NBME Subject Examination
The National Board of Medical Examiners produces this examination from its bank of multiple
choice items. It reflects the content of the USMLE Step II Clinical Knowledge examination.
This exam is administered on the final day of the clerkship, and will be 110 questions and 2
hours and 45 minutes long. In addition to evaluating your surgical knowledge, you will gain
experience with the style of examination that you will take early in your fourth year. The NBME
Surgery Subject exam includes material on the presentation, pathophysiology, and management
of common surgical problems. The Surgery Objectives, which can be found on EMERG, should
be used to serve as a guide for studying.
D. Professionalism and Professionalism Compliance points:
The surgery clerkship requires active participation from the students. You are professional
students and your professionalism in that role will be judged. Professionalism and participation
is worth 10 percent of your overall final score for the Surgery Clerkship. Each student is given
the maximum 10 points at the start of the clerkship. Points are deducted according to the
Professionalism and Participation Points Policy.
E. Seminar Session Assessment:
The surgery clerkship seminars consist of three separate two-hour sessions in a problem based
learning format. Students work as a group to lead discussions on their designated topic. Students
will be assessed on their presentations, their contributions to the group discussion, and
assessment of knowledge base.
Section II: Calculation of final grades
Grades are assigned by a faculty committee. Summative evaluations (grades and comments) are
reported to the Feinberg School of Medicine Office of Medical Education six weeks following
the end of the clerkship.
The grades are determined by the total number of points based on the weighted contributions of
the various assessment elements: OSCE, NBME subject, seminar and Clinical Performance
Evaluations. The Pass/Fail composite score cut point and the criteria for High Pass/Honors for
the academic year is set by faculty grading committee. When a numerical score falls closely
between two grades, the Surgery Faculty Grading Committee will evaluate all components of the
student’s performance to determine the final grade. Faculty will discuss students whose scores
fall below the cut point for pass/fail and prescribe a remediation plan.
Grading Scale
Honors 82
High Pass 78
Pass* 66
Fail**
***
For students above the overall score cutoff of 78 for High Pass or 82 for Honors, the following is
used to determine eligibility to receive High Pass or Honors.
Honors(Needtomeetbothstandards)
HighPass(Needtomeet1outof2standards)
ShelfExam Achieveascoreof72orhigher
Minimumpassingscoreis62
OSCEExam Achieveascoreof70orhigher
Minimumpassingscoreis60
* Students below the pass cut point will receive a Requires Extra Time grade and a remediation
plan will be determined by the clerkship director. This may include remediation of a proscribed
amount of time. The amount of time needed will vary. After successful completion of the
remediation plan the grade will be “Pass” and the number of additional weeks needed will be
noted on the transcript.
** A grade of fail will be given in any of the following circumstances.
Failing the NBME shelf exam three times.
Being unable to meet the clinical requirements of the clerkship after completing
additional time twice.
An egregious professionalism issue.
Honors High-pass Pass Needs more time
Preparation for
clinic
Students reviews the clinic
schedule prior to clinic, reviews
patients’ history and starts
templated notes prior to the
patient’s arrival.
The student will review with the
team including attending,
residents and nurses, regarding
which patients to see and team
expectations regarding tasks to
be performed.
Assists in communicating
follow-up plans to the nursing
team.
Students reviews the
history prior to seeing
the patient.
The student will review
with the team including
attending, residents
nurses, regarding which
patients to see and
team expectations
regarding tasks to be
performed.
Student arrives to clinic
on time.
Follows direction
regarding which
patients to see.
Student does not follow
the expected plan for
seeing patients.
History Taking Consistently performs thorough
work-ups on even the most
complicated surgical patients.
This includes eliciting pertinent
information unprompted, and
being able to clearly present
the cases in a logical manner.
Performs thorough
work-ups and elicits
pertinent information on
all routine and some/
surgically complicated
cases. Student should
be able to present the
cases in a logical
manner.
Produces complete
work-ups and elicits
pertinent information on
all or most routine
surgical cases.
Is unable to complete
work-ups or elicit
pertinent information on
routine surgical cases.
Physical exam Demonstrates the proper
techniques and is able to
perform a focused problem-
oriented examination. Able to
identify and interpret abnormal
findings.
Demonstrates the
proper techniques and
is able to perform a
focused, problem-
oriented examination.
Requires some
Requires guidance to
demonstrate the proper
techniques and is able
to perform a focused,
problem-oriented
Unable to demonstrate
proper physical exam
techniques.
guidance to identify and
interpret abnormal
findings.
examination. Requires
some guidance to
differentiate between
abnormal and normal
finding
Clinical
reasoning
Formulates a well thought out
and broad but relevant surgical
differential diagnosis and
thorough treatment plan, even
on complex patients.
Consistently formulates
a well thought out
differential on all of the
common diagnoses,
and occasionally on the
complex cases.
Is able to formulate a
well thought out
differential diagnosis on
routine cases,
occasionally needing
guidance.
Is unable to formulate a
differential diagnosis or
care plan.
Fund of
Knowledge
Demonstrates independent
reading by using literature to
support their plans and their
thinking. They should also
demonstrate in their
presentations and performance
that they have a superior
knowledge base.
Shows that they are
reading independently
and have an above
average knowledge
base in forming patient
plans and presentation
Shows that they are
reading independently
and need guidance in
applying their
knowledge to the
clinical setting.
Demonstrates a poor
knowledge base.
Oral
presentations
Oral presentations are succinct
and organized. Students are
able to identify and prioritize
the key points of the patient’s
presentation and articulate a
logical care plan, even with
complicated patients.
Oral presentations are
succinct and organized.
Students are able to
identify the key points
of the patient’s
presentation. Students
may need some
assistance in
formulating a logical
care plan with
complicated patients.
Students need some
assistance with
organizing findings and
formulating a care plan.
Oral presentations are
disorganized and
missing key
information.
Written notes Notes are clear, organized,
succinct and complete, even
with complicated patients.
Notes are clear,
organized, succinct and
complete with routine
patients.
Notes contain the key
information, but student
needs guidance in
organizing and/or
articulating the care
plan.
Notes are incorrect or
lack essential
information.
Preparation for
the operating
room
Demonstrates excellent
understanding of the
indications for surgery, the
basic steps of the operation
and the relevant anatomy.
Takes initiative to help with
tasks in the operating room.
Demonstrates
familiarity with the
indications for surgery
and is able to describe
the relevant anatomy.
Takes initiative to help
with tasks in the
operating room.
Has read the patient
history and reviewed
the anatomy.
Follows direction to
help with tasks in the
operating room.
Has not read about the
patient or the operation.
Does not help with
tasks in the operating
room.
Initiative Consistently demonstrates
initiative in caring for their
patients and is independent
and proactive in the execution
of their daily patient care
duties.
Consistently
demonstrates initiative
in caring for their
patients and is
independent and
proactive in the
execution of their daily
patient care duties.
They may occasionally
need direction in
performing their duties.
Is an independent
worker, but may need
prompting and direction
to understand their daily
duties.
Is unable to perform
daily clinical care
duties, despite regular
prompting and
guidance.
Professionalism Student demonstrates
exemplary courtesy and has
excellent interpersonal skills
with a strong work ethic.
Student is
demonstrates courtesy
and has very good
interpersonal skills with
a strong work ethic.
Student is cooperative
and will complete
assigned tasks.
Demonstrates unethical
or unprofessional
behavior. Other
professional grounds
for needing extra time
include dishonesty,
unexcused absences or
poor work ethics
including willful
negligence in patient
care duties.
