Essential Information, Tools, and Forms

CBES Essentials

  • Summary of Criteria for Pass and Pass with Distinction

Pass

  • Direct observations of clinical skills completed (2 per clerkship)
  • RIME Interpreter
    • Solid Reporter skills
    • Emerging Interpreter skills

Pass with Distinction

  • Direct observations of clinical skills completed (2 per clerkship)
  • RIME Manager
    • Solid Reporter and Interpreter skills
    • Emerging Manager skills
 

RIME Stage Descriptions

Adapted from Pangaro & Holmboe, Evaluation Forms and Global Rating Scales, in Holmboe & Hawkins eds., Practical Guide to the Evaluation of Clinical Competence, Mosby 2008 p 40.

  • Focus at this stage:  Reliable, accurate, complete data-gathering and presentation of clinical information
  • Emphasis on the S/O (Subjective/Objective) part of SOAP. 
  • Student is able to answer the “What” questions (What’s the patient’s blood pressure?  What medications is he taking?  What findings are present on physical exam?)
  • Students are expected move through the reporter stage during preclinical training, i.e. Practice of Medicine

Expected Transitions

  • Focus at this stage: Diagnostic reasoning. 
  • Emphasis on the A (Assessment) part of SOAP. 
  • Student can answer the Why questions: e.g. Why does this patient have chest pain? What does this exam finding mean?
  • Begins to see how details fit together.
  • Data-gathering and reporting become more purposeful, more focused on pertinent positive and negative information and exploring diagnostic possibilities.
  • Students are expected to move into the interpreter stage during their core clinical training
  • Focus of this stage:  treatment planning - including diagnostic testing and therapy.  
  • Emphasis on the P (Plan) in SOAP. 
  • Student can answer the How or What Next questions:  e.g. How do we solve or treat this clinical problem?  What do we need to do next for the patient?
  • Data-gathering and decision-making become more flexible, individualized, patient centered.  Student thinks critically about recommendations, takes a more sophisticated approach to using medical literature to support patient care.
  • Students at this stage take primary responsibility for ensuring patients’ well-being and making sure care plans are carried through.  Patients, fellow team members, and staff view the student as patients’ primary provider.
  • Students are expected to move into the manager stage at the sub-internship level and beyond.
  • At the Educator stage, students
    • Reflect on experiences to identify learning needs
    • Define important questions to learn about in more depth
    • Takes ownership for self-improvement
  • *Features of the Educator stage are threaded through all other stages.

Pass

  • No concerns
  • Patient logs, other assignments complete

Pass with Distinction

  • No concerns
  • Patient logs, other assignments complete
  • Multisource feedback requested from one patient, one non-MD staff member, one peer
  • Evidence of Exceptional Professionalism and Interpersonal Communication (with both patients and members of the medical team)
  •  
 
  Pass Pass with Distinction
Ambulatory Medicine 65% 82%
Critical Care 50% 80%
Family Medicine 65% 85%
Internal Medicine* 64 83
Neurology* 63 80
OBGYN* 62 81
Pediatrics* 63 83
Psychiatry* 66 86
Surgery* 61 81

* Clerkship uses NBME Subject Exam.  Passing score reflects 5-10th percentile nationally; Pass with Distinction reflects 75th-80th percentile nationally.

Forms

Professionalism & Interpersonal Communication Multisource Feedback Survey (for non-MD staff and peers)

Tools

Additional information on evaluation of performance in clinical clerkships

Clerkship Educators Guidebook