MED 8710 Core Experiences
Longitudinal Integrated Clerkship (LIC) Stream
Phase 4, Class of 2025
Academic Year 2023-2024

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 LIC stream, learners are trained in these disciplines in a longitudinal, integrated curriculum.

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

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 all of the 13 EPAs by the end of the LIC. Achieving entrustability in EPA 14 is strongly encouraged but not required.

*pilot introduction of EPA 14

Course Structure
Core disciplines: Anesthesia, Emergency Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, Rural Family Medicine, Surgery.
Disciplines will be encountered in an initial mini burst followed by integrated experiences over the duration of the LIC.

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

Teaching and Learning Methods
Clinical bedside teaching
Academic teaching – academic half-day presentations and online modules

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

Course Assessment
Assessment is administered by the LIC leadership at each site but collated and monitored by the Undergraduate Medical Education (UGME) office to ensure progression through Core Experiences. The Phase 4 Management Team decides on promotion from this course through a comprehensive review of learner performance. The Phase 4 Management Team plans remediation specific to a learner’s requirements as per the results of assessments throughout Core Experiences. Learners will receive their grades from the Undergraduate Medical Education (UGME) office via One45.

Assessment Summary
Learners are assessed regularly throughout the LIC using the formative and summative modalities listed below. Competency-based assessments do not result in numerical scores. Numerical scores are only reported for MCQ-based examinations.

Formative assessment 

• Clinic cards (T-Res): minimum one card per clinical day, expectation for one card per clinical half-day
• Interprofessional Collaborator Assessment: completed for learning experiences led by allied healthcare professionals as deemed appropriate.
• Formative ITARs once every 6 weeks by the Primary LIC Preceptor and by other disciplines at 24 weeks
• Formative meeting once every 4 weeks with LIC Coordinator: identify EPAs to focus on in subsequent 4 weeks; learner ensures feedback is received for all EPAs over the LIC
• A progress review every 12 weeks with the LIC Coordinator using all of the accumulated assessment data to create an ongoing learning plan specific to the individual needs of the learner
• Minimum of one formative Mini-CEX in each of Emergency Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, Rural Family Medicine, and Surgery.
• Progress testing (MCQ examination using NBME item bank) at 0 (beginning of Phase 4), 4, and 8 months
• Obstetrics and Gynecology MCQ examination at 6 months
• 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

Summative assessment

• Summative ITAR at end of LIC: Every EPA is assessed a minimum of 2 times as entrustable during Core Experiences. If unable to ensure this clinically, other forms of assessment will be designed, e.g. written essays, oral examinations
• Summative ITARs for each discipline at end of LIC
• Prescribed Clinical Experiences completion
• Mini-CEX: One per discipline for all core disciplines
• Progress testing (NBME Comprehensive Clinical Science Examination) in the last month of core clerkship
• Anesthesia mandatory technical skills log (checklists)
• Anesthesia completion of 5 online teaching modules with MCQ quiz for each
• Emergency Medicine completion of EM teaching modules
• Internal Medicine self-assessment: completion of 8 SIMPLE cases
• Rural Family Medicine Academic Half Day presentation and participation

Assessment Tools

In Training Assessment Report (ITAR) (formative and summative)
The formative and summative ITARs are based on EPAs. A formative ITAR will be completed by the Primary LIC Preceptor every 6 weeks, and by the other disciplines at 24 weeks, based on feedback from e-clinic cards and other formative assessments. The Primary LIC Preceptor and other disciplines will complete a summative ITAR at the end of the LIC. A final summative ITAR will be completed by the LIC Coordinator at the end of the LIC.

E-clinic Cards (formative)
E-clinic cards are completed using T-Res2 app and are based on the EPAs. Learners in the LIC are required to complete a minimum of one e-clinic card per clinical day, with one clinic card required for each clinical half-day. Each EPA must be assessed on a new e-clinic card.

• 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.

Interprofessional Collaborator Assessment (formative)

In addition to e-clinic cards, allied healthcare professionals may assess a learner’s collaboration competency using the Interprofessional Collaborator Assessment rubric. This assessment is formative and may contribute to the formative record for EPA 13. The LIC Coordinator will review the feedback from allied healthcare professionals with the learner during the 12-week progress review. The assessment by allied healthcare professionals is not included for summative entrustment decisions for EPA 13 or determining learner progress.

Assessment Methods

Assessment of EPA 14
E-clinic cards, progress reports and/or ITARs may be used to document learner performance. EPA 14 may be assessed in any rotation. Learners should discuss appropriate assessment opportunities with their preceptor and/or the LIC Coordinator. Assessment of EPA 14 is not included when determining learner progress in the Core Experiences course.

Prescribed Clinical Experiences (summative)
Learners are required to log each Prescribed Clinical Experience in T-Res once (minimally) during the LIC.

Mini-CEX (formative and summative)
Learners must complete one formative mini-CEX assessment of witnessed and assessed history and physical/mental status examination for each of Emergency Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, Rural Family Medicine, and Surgery. Learners must complete one summative mini-CEX assessment of witnessed and assessed history and physical/mental status examination for each of the 8 core disciplines.

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 2024

0 (beginning of Phase 4)	August 18, 2023
4 month	December 1, 2023
8 month	April 5, 2024
Final	July 26, 2024
Reassessment	August 9, 2024

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 53 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 Management Team. The progress of any learner not progressing as expected (e.g. not meeting the criteria below) will be discussed at the related comprehensive review.
A learner must meet the following criteria for continued progress in MED 8710: Core Experiences (LIC Stream) without discussion at the 6-month comprehensive review:

1. Documented entrustability in EPAs 1, 4, 6, and 13 based on most recent formative ITAR for Family Medicine and formative discipline ITARs completed to date
2. At least 2 assessments entrustable for each EPA,
3. All formative ITARs to date indicate 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 (LIC Stream) without discussion at the 9-month comprehensive review:

1. Documented entrustability in EPAs 1, 2, 3, 4, 5, 6, 8, 10 and 13 based on most recent formative ITAR for Family Medicine and formative ITARs completed to date
2. At least 2 assessments entrustable for each EPA,
3. All formative ITARs to date indicate 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 (LIC Stream) without discussion at the 12-month comprehensive review:

1. Documented entrustability in a majority of EPAs within at least four disciplines based on the summative discipline ITARs
2. At least 2 assessments entrustable for EPAs 1-13,
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 LIC Coordinator will present documentation of pre-entrustability or entrustability of each EPA 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, including repeating MED 8710, will be at the discretion of the Phase 4 Management Team. The Phase 4 Management Team 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 Management Team.

Course Success Criteria

To pass the course, a learner must:

• Documented entrustability in a majority of EPAs within at least four disciplines as documented in the summative discipline ITARs
• Achieve at least 2 assessments entrustable for EPAs 1-13
• Achieve “progressing as expected” in the summative ITAR completed by the LIC Coordinator, compiling all assessment data
• 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 final decision on passing or failing the MED 8710 Core Experiences course occurs during the Phase 4 Management Team comprehensive review and will be made by consensus decision. In the absence of a consensus, the decision will be made via anonymous vote amongst the Phase 4 Management Team. In this case final decision requires a majority vote.

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:  March 13, 2023
Reviewed by SAS: April 26, 2023
Approved by UGMS: May 17, 2023