It has been a tradition at the Yale University School of Medicine that students do not receive grades in their basic science courses. However, there always has been, and there continues to be, a genuine attempt on the part of the faculty through small group and seminar interactions to recognize excellence and, conversely, to identify students in academic difficulty so that they can receive special help. The non-competitive atmosphere of the first two years also works to encourage students to ask for help themselves. The fact that this is indeed the case is evidenced by the numbers of students who freely identify themselves each year to the associate dean for student affairs asking for help with time management, study skills and tutoring. 

Assessment at Yale is designed to meet the needs of the students, faculty, and School of Medicine, while maintaining a commitment to the Yale System of Medical Education. The following policy was established by the Educational Policy and Curriculum Committee regarding examinations and commentaries from course directors: All students are required to solicit and obtain no fewer than five “commentaries” from faculty in five different required preclinical courses. Requests to faculty should be made before the conclusion of the learning experience. Since small group teaching remains one of the crucial elements in the Yale Plan of Medical Education, “commentaries” are generally based on performances in teaching conferences or laboratories. These “commentaries” may be supplemented by signing the optional examinations, writing a paper, or taking an oral exam if the student chooses. Students should not expect that a commentary from their clinical tutor will serve this purpose since clinical performance will be more extensively assessed during the third year clinical rotations. Commentaries should be sent to the associate dean for student affairs ideally within thirty days after the conclusion of the course. A minimum of five course “commentaries” from the basic sciences curriculum should be included in the official student record in the Office of Student Affairs before the student advances to the third year. One of the purposes of basic science “commentaries” is to provide the student with feedback about his/her performance and to provide truly representative and meaningful statements that can become a part of the student’s permanent file. The associate dean frequently uses whatever comments are available to support student requests for scholarships or research grant applications and for the dean’s letter written in the fourth year.

Students must successfully complete and demonstrate proficiency in every required course before going on to the next year. Proficiency may be demonstrated through a variety of assessment strategies in addition to written exams such as research papers, reaction papers, problem sets, oral exams, or essays. The mechanism by which students demonstrate proficiency is determined by the course director. There are two types of examinations: qualifying examinations which students must take successfully, and assessment examinations which students are expected to take to satisfy themselves that they are learning the required material. Most courses in the first two years offer a final qualifying examination. The Modules of the Mechanisms of Disease course offers self assessment exams which are written in “board” style questions. Students take all exams with a code number assigned to the student by the registrar. (See section on Coding System.) 

Students must take exams on or by the time indicated in the course schedule. A student may request an extension from the course director if the student believes that events out of his or her control (sickness, family issues) have interfered with mastering the course objectives. If these events affect more than one course/exam, require significant absence from school or are causing distress for the student, the student must see the associate dean for student affairs. Exams may not be postponed for non-emergent reasons such as to run in a marathon or take a trip.

The registrar assigns a special, randomly selected code number (known only to the registrar) to all first-year students at the beginning of the year. Students use their numbers on all assessment exercises and course and clerkship evaluations, and faculty post results using these numbers.

Faculty should construct comprehensive and challenging exercises for each required course in order to provide students with a significant learning experience during the assessment process. These exercises may be in-class or take-home or on-line. The course director should review the performance of students and establish criteria for satisfactory performance. The scored assessments should be promptly returned to students. Every course director is encouraged to hold voluntary review sessions to discuss content related to assessment exercises.

The code number of a student is reported to the registrar by the course director under the following circumstances: 

Remediation for a failing grade on a qualifying exam is individualized and is up to the discretion of the course director. Remediation is not a punitive process. At all times the emphasis is on supporting the student to allow the student to learn what is needed to be a successful physician. The registrar reports the name of the student to the associate dean for student affairs in situations 1 and 3 above, and also if a student fails more than one exam regardless of whether or not the student has successfully remediated. The associate dean will then meet with the student to discuss what barriers may be keeping the student from successfully qualifying and what can be done to help the student. At her discretion, the associate dean may share this information with the deputy dean for education and the Progress Committee. While students are given wide latitude for anonymity within this system as long as they are successfully progressing, students who are having difficulties will not be left to flounder. (See section on Progress Committee.) Students who are experiencing academic or other difficulties may choose or be assigned a neutral faculty member to serve as an advocate and adviser. The role of this person is to be available to the student and help keep the student involved and on track. This faculty member is not involved in the student’s evaluation or promotion.

All departments will provide an easily accessible tutorial program for any student who wishes extra help, special tutoring, or retesting. There will be an individual in each department assigned to this function that students can easily approach who is usually the DMS. Practice examinations will be made available and computer programs will be developed for review and self-teaching. A special computer room and learning center for students is available in the basement of the medical library. Students Helping Students (SHS) is a student directed tutorial and review for each of the basic science courses. In addition, a more private tutorial system is in place for students who wish extra help in that way. It can be accessed through contacting the associate dean for student affairs. The Office of Student Affairs has a fund to pay tutors for medical students requesting help. Sometimes students mostly need help with organization of study materials and time management. Upper class students who provide such help on an individual basis will also be paid for their time by the Office of Student Affairs.

Commentaries are narrative descriptions that provide students with feedback about their performance as well as opportunities for academic and professional growth and development. Academic Advisors will review commentaries and support students in areas needing improvement. 

Commentaries will be provided in the following pre-clinical courses and clerkship:

• Preclinical Clerkship (years 1 and 2) 
• Professional Responsibility 
• Physiology 
• Histology 
• Epidemiology and Public Health 

Students have the option of requesting additional commentaries from faculty in other courses and modules. 

These commentaries are generally a short letter or paragraph. They are based primarily on student participation and performance in small group teaching sessions or laboratories. The areas of evaluation include: 

• Collaboration - ability to work with peers, faculty and staff-showing respect for differing points of views, not dominating discussion and empowering and engaging others to share in the discussion. 
• Preparation - ability to discuss and apply the material thoughtfully showing familiarity with sources and even evidence of going beyond provided readings. 
• Initiative – supplementing activities and discussions of the group using additional and outside resources. 
• Professionalism - demonstrating enthusiasm for learning, regular participation in sessions and the ability to accept and respond constructively to feedback. 
• Oral and written communication skills - demonstrating clarity and organization. 

*Items in italics indicate evidence of leadership and merit recognition and comment.

Commentaries are not for inclusion in the Dean’s Letter that is submitted as part of the residency application process. Commentaries will be sent to the students, their Academic Advisors and the Office of Student Affairs for inclusion in the students’ permanent record.

It is important to have a formal assessment of clinical skills to determine whether students have achieved the required level of competence in history taking, physical examination, communication and clinical reasoning. 

For Yale medical students, this formal assessment occurs in the clinical skills facility at the University of Connecticut. Students are directly observed and video taped evaluating simulated patients. This includes taking a focused history, performing a physical examination and demonstrating clinical reasoning. 

If a student fails to demonstrate competency in this assessment, she/he meets with a member of the Yale Skills Assessment Team to review his/her performance based on established criteria and create an action plan for improvement. The student then returns to UCONN for re-assessment in six to eight weeks.

1. Students must pass the UCONN4 Clinical Skills Assessment as a requirement for graduation. 

2. UCONN4 is offered in the months of May, June and July. Students will be scheduled to take it in one of those months as close to the completion of their clerkships as possible, recognizing that some students such as those who have postponed a clerkship will have to take the assessment before they have completed all of their clerkships. 

3. If a student fails on their first attempt, the student and his/her Academic Advisor are notified and a plan is made for remediation. Two additional attempts to pass within the next 12 months are permitted.

4. Failure on all three attempts results in dismissal. The Progress Committee will be notified and based on extraordinary circumstances, may permit the student one additional attempt to pass.

Evaluations of performance on the various clinical clerkships are extensive. They include house staff and faculty observations of the student’s clinical and interpersonal skills, knowledge base, problem-solving ability, and professional behavior. This evaluation is in the form of both a narrative commentary and a numerical rating system. The narrative sections of the student’s evaluations, which summarize the student’s overall performance as well as the word grades, are included in the student’s dean’s letter, which is sent to residency programs to which students apply in their fourth year. Overall performance in each clerkship is indicated by word-grades such as “Honors,” “High Pass,” “Pass,” and “Unsatisfactory.” A second purpose of the student’s evaluation is to encourage the student’s growth and learning through providing constructive feedback in a section of the evaluation not to be used in the dean’s letter. 

A remedial program will be designed by the associate dean for student affairs in consultation with the appropriate department and with the Progress Committee for those students who receive “Unsatisfactory” on an evaluation. The clerkship director is responsible for a students’ final grade on a clinical clerkship. The clerkship director has the discretion to override a numerical grade, if the clerkship director has evidence of poor academic or professional performance not accounted for in the numerical assessment.

Faculty are responsible for meeting with students at the beginning, middle, and end of the rotation to set performance expectations and provide feedback. In addition, faculty should meet with students to review a student’s final evaluation with the student before submitting it to the department. The EPCC established a policy that clerkship evaluations must be made available to the student within 30 days of the end of the clerkship. In an effort to improve the turn around time of student evaluations, the Office of Education sends a list to all clerkship directors with the names of students with outstanding evaluations on a monthly basis and these same lists are being brought to and discussed at the monthly clerkship directors’ meeting with the deputy dean of education. For departments that are continuously delinquent, the chair of the department may be involved.

The Family Education Rights and Privacy Act of 1974 (commonly known as FERPA or the Buckley Amendment) mandates that all “commentaries” and evaluations be available to the student. Most evaluations are available to students on line through MedHub and commentaries and evaluations are kept in a file in the Office of Student Affairs and students are welcome to review them periodically and to make copies for their personal records. Now that evaluations are filled out electronically, students will automatically receive copies by email.

Course and clerkship evaluation is conducted for the purpose of improving the medical school curriculum. These anonymous evaluations are used extensively when clerkships are reviewed and are considered in support of applications for promotion of faculty. Students’ comments and suggestions are highly valued and should be made constructively and with care. Students’ evaluations of faculty are not shared with the faculty until the student has been evaluated by the faculty to avoid the introduction of possible bias. Students’ clinical clerkship evaluations may not be released to them if they have not completed their evaluations of clerkship.

Evaluations of performance on the various clinical clerkships are extensive, representing a composite of house staff and faculty opinion. There is a section for the individual instructors’ recommendations for future learning. Words are used to define overall performance as follows: Honors, High Pass, Pass, and Unsatisfactory. They are expected to be completed and available to the student in a month but no more than 60 days from completion of the clerkship. 

Revisions to evaluations are discouraged. Any student who disputes an evaluation must write a letter to the clerkship director copying their academic advisor and the associate dean for student affairs in which the grounds for appealing the grade are explained. The clerkship director will investigate the student’s reasons for a change of grade and will decide on the merits of the request. Final decisions regarding clerkship evaluations rest with the clerkship directors. Students are not to approach attendings or residents to ask them directly to revise their evaluation or grade. Students who do so will not have their appeal considered by the clerkship director who is the only one who can change a grade. Evaluations are completed on line using the MedHub program.