This is a pretty complicated topic, so I thought it deserves its own post. You probably already know that we don't have any tests or grades at CCLCM. But the Medical School Promotions and Review Committee (MSPRC), which is a group of faculty that evaluates whether we are ready to move on to the following year, needs to have some basis to make this decision. The MSPRC evaluates CCLCM students for promotion according to whether they have met nine competencies. These include 1) clinical and basic science research skills; 2) medical and biomedical science knowledge; 3) verbal and written communication skills; 4) clinical skills, including taking patient histories and physical examination; 5) clinical reasoning and diagnosis of patients; 6) professionalism, ethics, and personal responsibility; 7) personal and educational development; 8) knowledge of health care systems; and 9) reflective practice about learning needs and how to integrate knowledge. There are different expectations for students in each year of the curriculum.
Ok, so how do I go about proving that I have research skills and knowledge of health care systems and all the rest? This is why we have portfolios. We keep the portfolios on line in our CCLCM portal accounts. (If you want to see a sample CCLCM portal account, go to http://cclcm.ccf.org/ and login by typing "guest" as your userID and password. You won't be able to see a sample portfolio right now, unfortunately, but hopefully this will be a future addition to the portal guest account.) There are many types of evidence that go into the portfolios. Some evidence is collected there for us automatically. For example, we get regular evaluations from our our PBL groupmates, our PBL tutors, and our research and clinical preceptors. We also write self-evaluations each block. These evaluations largely comment about professionalism, but also cover research, medical knowledge, clinical skills, and communication. In addition, the faculty evaluations of the CAPP essays that we write each week can be used toward our medical knowledge competency. There is also a separate portfolio section for each student to add their own personal evidence that just pertains to that individual student. For example, I used writing this blog as evidence of my communications competency. Some of my classmates who are still doing research used that in their portfolios, but I didn't, because I haven't done any research since last summer. So our portfolios are not all identical.
Once per quarter (every three months), we write a formative portfolio essay. This was what I was describing earlier in the week. Writing the essay is a pretty big job with several parts. I always start by printing out all of my evidence, which comes out to be quite a stack of paper. Then I go through the evidence and look for the common themes. For example, both my clinical preceptor and my physical diagnosis preceptor said that I need to practice my clinical skills to become more comfortable with performing them. I also felt that I need to work on them more. So since this is a general theme, it's something that I addressed in my essay. The essay starts out with a paragraph about how much progress the student has made toward achieving their learning goals. Then there is a paragraph for each of the competencies. At the beginning of the first year, we were only expected to cover four of them. This essay, which was our second, covered seven of them. Our third formative essay next quarter will cover all nice competencies. The last part of the essay is a synthesis of your strengths and weaknesses, how this will affect your development and career as a physician, and our plan to improve our areas of weakness. At the end of the year, we write a summative portfolio based upon the three formative portfolios. It is the summative portfolio that is submitted for promotion consideration to the MSPRC.
This whole system sounds kind of complicated, and it probably would be pretty intimidating if we didn't have help. But we have our physician advisors (PAs), who are responsible for helping us assemble our portfolios and ensure that our learning plans will allow us to meet the competencies so that we will pass the MSPRC review. Contrary to popular belief, it IS possible for students to fail out of a pass/fail medical school! It doesn't happen very often though, because your PA is supposed to work with you to ensure that you'll be ready for review at the end of the year.