MED 8710 Core Experiences
Block Rotation-based Stream
Phase 4, Class of 2026
Academic Year 2024-2025

Assessment Plan

The Core Experiences course immerses learners in the clinical environment through experiences in core disciplines with a focus on prescribed experiences in Anesthesia, Emergency Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, Rural Family Medicine, and Surgery.  In the block rotation-based stream, learners are trained in these disciplines in a sequential curriculum.

Entrustable Professional Activities (EPAs) provide the framework for workplace-based assessment. The following EPAs must be assessed in the block rotation-based stream:

EPA 1: Obtain a history and perform a physical examination adapted to the patient’s clinical   situation.

EPA 2: Formulate and justify a prioritized differential diagnosis.

EPA 3: Formulate an initial plan of investigation based on the diagnostic hypotheses.

EPA 4: Interpret and communicate results of common diagnostic and screening tests.

EPA 5: Formulate, communicate and implement management plans.

EPA 6: Present oral and written reports that document a clinical encounter.

EPA 7: Provide and receive the handover in transitions of care.

EPA 8: Recognize a patient requiring urgent or emergent care, provide initial management and seek help.

EPA 9: Communicate in difficult situations.

EPA 10: Contribute to a culture of safety and improvement.

EPA 11: Perform general procedures of a physician.

EPA 12: Educate patients on disease management, health promotion and preventative medicine.

EPA 13: Collaborate as a member of an interprofessional team.

EPA 14: Incorporate the relevant social determinants of health (SDoH) and cultural safety in relation to patient’s illness and management planning.

Learners are expected to achieve documented entrustability in EPAs 1-14 by the end of the course.

Course Structure

The course includes clinical and academic teaching (e.g. academic half day presentations, online modules) in each of the Core Disciplines: Anesthesia, Emergency Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, Rural Family Medicine, Surgery.

Disciplines will be encountered in a sequence of rotations over the duration of the course.

Original work, completed wholly by the learner, is expected to be submitted in this course. The use of an artificial intelligence tool like chatGPT is not permitted.

Objectives

EPAs are linked to clinical objectives (in C-Blue) for each required clinical experience.

Course Assessment

Assessment is administered by each rotation/discipline at each site but collated and monitored by the Undergraduate Medical Education (UGME) office to ensure progression through the Core Experiences course. Learners will receive their grades from the Undergraduate Medical Education (UGME) office via One45.The Phase 4 Progress Committee conducts a comprehensive review of learner performance throughout the Core Experiences course and plans the remediation (up to and including repetition of the course) required to meet course success criteria.

Assessment Summary

Learners are assessed regularly throughout the Core Experiences course using the formative and summative modalities listed below. Individual disciplines require additional discipline-specific assessments. Competency-based assessments do not result in numerical scores. Numerical scores are only reported for MCQ-based examinations.

1) Formative assessment

• Mid-point ITARs for rotations greater than 2 weeks
• E-clinic Cards
• Progress testing at 0 (beginning of Phase 4), 4, and 8 months
• Internal Medicine self-assessment: completion of 8 SIMPLE cases
• Obstetrics and Gynecology MCQ examination
• Pediatrics mid-term assignment
• Pediatrics completion of CLiPP cases
• Pediatrics Health Advocate essay
• Rural Family Medicine completion of Learn-FM cases
• Rural Family Medicine Rourke Baby Record 18 month e-module
• Rural Family Medicine formative MCQ examination

 2) Summative assessment

• Summative ITARs at end of each rotation
• Prescribed Clinical Experiences completion
• Mini-CEX: One per discipline (except Anesthesia)
• Progress testing in the last month of Core Experiences course
• Anesthesia mandatory technical skills log (checklists)
• Anesthesia completion of 5 online modules with MCQ quiz for each
• Emergency Medicine completion of EM teaching modules
• Rural Family Medicine Academic Half Day presentation and participation

Assessment Tools

In Training Assessment Report (ITAR) (formative mid-point and summative end point)

The formative and summative ITARs are based on EPAs. The Clerkship Discipline Coordinator (CDC) makes the final summative entrustment decision for the assessed EPAs and documents this in the final ITAR for the rotation. Summative entrustment is based on preceptor-completed ITARs but may be informed by other assessments.

E-clinic Cards (formative)

E-clinic cards are completed using the T-Res app and are based on the EPAs as appropriate to the rotation. Written assessment of a learner’s performance must be regularly completed throughout core block rotations using the designated e-clinic card app in T-Res.

• E-clinic cards contribute to a learner’s formative assessment. They are used for ad hoc EPA assessment in the workplace and reflect the entrustment of the learner for that specific task/EPA in the context of the specific clinical encounter.
• E-clinic cards should contain actionable comments and accurately document the feedback by the preceptor.
• Formative feedback from e-clinic cards does not appear on final ITARs or the MSPR.

Assessment Methods

Prescribed Clinical Experiences (summative)

Learners are required to log each Prescribed Clinical Experience in T-Res at least once during the Core Experiences course.

Mini-CEX (summative)

Learners must complete at least one mini-CEX assessment of witnessed and assessed history and physical/mental status examination in each rotation except Anesthesia.

Progress Testing (formative and summative)

Learners will write a progress test at 0 (beginning of Phase 4), 4, 8 and 12 months of the Core Experiences course. This multiple-choice question examination assesses clinical knowledge. Exam questions from the National Board of Medical Examiners (NBME) bank are used for this purpose. The first three examinations will be formative and learners will be provided with feedback on their performance. The final examination will be summative but will not be reported on the MSPR. Learners who fail the final examination will write a reassessment examination prior to the beginning of their fourth year.          

Exam dates for class of 2026
0 (beginning of Phase 4): August 16, 2024
4 month: December 6, 2024
8 month: April 4, 2025
Final: July 25, 2025
Reassessment: August 8, 2025

Progress Testing Scores

The pass score for the final progress test will be determined using a norm-referenced standard setting method. This will be based on the summative progress examination performance of previous cohorts. The pass score is TBD and will be used for the final progress as well as the reassessment test.

For the formative (0, 4 and 8 month) tests, the mean and standard deviation for each test will be used to determine a Z-score for each learner’s score on the test. The Z- score indicates how well the learner has performed relative to the mean score for all learners writing that test. The following benchmarks for performance will be used:

Satisfactory: Z-score -1.5 or greater
Borderline: Z-score -2.0 or greater; less than -1.5
Unsatisfactory: Z-score less than -2.0

All learners with an unsatisfactory score will be required to meet with the Phase 4 Assessment Lead or delegate to develop a learning plan to address their educational needs. This does not apply for the baseline (0 month) test.

All learners with a borderline score will be offered the opportunity to meet with the Phase 4 Assessment Lead or delegate to develop a learning plan to address their educational needs.

Learners with a satisfactory score may also request a meeting with the Phase 4 Assessment Lead or delegate if they are interested in further coaching.

Phase 4 Comprehensive Review

At 6, 9 and 12 months: An assessment profile will be created for each learner by the UGME office and reviewed by the Phase 4 Progress Committee. The progress of any learner not progressing as expected (e.g. not meeting the criteria below) will be discussed at the related comprehensive review.  The Phase 4 Progress Committee may require a learner to meet with the Phase 4 Assessment Lead or delegate to discuss the outcomes of the review.

A learner must meet the following criteria for continued progress in MED 8710: Core Experiences (Block Rotation-based Stream) without discussion at the 6-month comprehensive review:

1. Documented entrustability in a majority of all EPAs within at least one rotation,
2. At least 2 assessments entrustable for at least one EPA,
3. All summative ITARs to date indicate the learner is “progressing as expected”,
4. Satisfactory score in most recent progress test,
5. Completion of all discipline-specific assignments to date at a satisfactory level, and
6. No documented concerns with professionalism.

A learner must meet the following criteria for continued progress in MED 8710: Core Experiences (Block Rotation-based Stream) without discussion at the 9-month comprehensive review:

1. Documented entrustability in a majority of all EPAs within at least one rotation,
2. At least 2 assessments entrustable for the majority of EPAs for which there are 3 or more assessments,
3. All summative ITARs to date indicate the learner is “progressing as expected”,
4. Satisfactory score in most recent progress test,
5. Completion of all discipline-specific assignments to date at a satisfactory level, and
6. No documented concerns with professionalism.

A learner must meet the following criteria for successful completion of MED 8710: Core Experiences (Block Rotation-based Stream) without discussion at the 12-month comprehensive review:

1. Documented entrustability in a majority of all EPAs within at least four rotations, with at least the last two rotations (excluding Anesthesia and Emergency Medicine) having documented entrustability in a majority of all EPAs,
2. At least 2 assessments entrustable for EPAs 1-14,
3. All summative ITARs indicate the learner is “progressing as expected”,
4. Passing grade in the final progress test,
5. Completion of all discipline-specific assignments at a satisfactory level, and
6. No documented concerns with professionalism.

To inform the decision about progression for each learner, the Clinical Discipline Coordinators will present documentation of pre-entrustability or entrustability in the form of the various discipline-specific assessment methods.

Remediation and Reassessment

All discipline-specific assignments must be completed at a satisfactory level as determined by each discipline. Learners failing a discipline-specific assignment must be reassessed. A learner may be reassessed only once for each failed assignment.

The performance of any learner with an unsatisfactory or borderline score in the initial NBME progress test, the 4 month NBME progress test, or the 8 month NBME progress test; or failing the final NBME progress test will be discussed during the comprehensive review. Learners who fail the final progress test will write the NBME progress test as a reassessment prior to the beginning of their fourth year. Reassessment will be at the discretion of the Phase 4 Progress Committee. It will review progress test performance in conjunction with the clinical assessment for the Core Experiences course.

Documented professionalism concerns for any learner will be discussed at the comprehensive review. Remediation and reassessment will be at the discretion of the Phase 4 Progress Committee.

Course Success Criteria

To pass the course, a learner must:

• Achieve documented entrustability in a majority of all EPAs within at least four rotations, with at least the last two rotations (excluding Anesthesia and Emergency Medicine) having documented entrustability in a majority of all EPAs
• Achieve at least 2 assessments entrustable for EPAs 1-14
• Achieve “progressing as expected” in all summative ITARs
• Receive a passing grade in the final progress test or reassessment
• Complete all discipline-specific assignments at a satisfactory level
• Have no outstanding concerns with professionalism

The Phase 4 Progress Committee uses the comprehensive review and remediation data to inform the pass or fail decision for each learner in the Core Experiences course. Where the support cannot be made by consensus, a majority vote will be required. The final promotion to graduation decision is made by the Promotions Committee at the end of Phase 4 based on achievement of all course success criteria across all Phase 4 courses.

As outlined in the MD program objectives, the Faculty of Medicine at Memorial University values professionalism as a core competency and a requirement of the MD program. Recognizing that medical learners are developing their professional identity, professionalism lapses will be remediated where possible and appropriate. Unsuccessful remediation will result in failure of the Phase.  Professionalism lapses may render a learner incompatible with continuation in the MD program (as outlined in the Memorial University Calendar Regulation 10.5 Promotion).

As outlined in Section 10.5.2 and 10.5.3 of the Regulations for the Degree of Doctor of Medicine in the University calendar, learners with a Fail grade in any course cannot be promoted to graduation. Even in the absence of any Fail grades, a learner for whom substantial concerns about performance have been expressed may either be required to repeat the Phase or required to withdraw conditionally or unconditionally.

Definition of rural site

For the province of Newfoundland and Labrador, a rural site is defined as having a population of less than 50,000 people and not within a one hour commute of a population centre exceeding 100,000. For the province of New Brunswick, rural includes any location outside the main centers of New Brunswick (Moncton, Saint John, Fredericton).

 

Version date: June 11, 2024
Reviewed by SAS: April 24, 2024
Approved by UGMS: June 19, 2024