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

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.

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

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.