PURPOSE
To outline the rationale and requirements for providing a narrative assessment of medical student performance during educational sessions.

AUDIENCE
All School of Medicine faculty educators

LCME STANDARD
9.5 Narrative Assessment  

POLICY

  1. It is expected that a narrative description of a medical student’s performance, including non-cognitive achievement, be included as a component of the assessment in each required course and clerkship of the medical education program “whenever teacher-student interaction permits this form of assessment.” (LCME Functions and Structure of a Medical School, Element 9.5)
  2. Narrative assessment allows for professional development of students by highlighting unique strengths and areas for improvement.
  3. Narrative assessment can be formative or summative.
  4. In the pre-clerkship phase, faculty or facilitators must provide students with narrative assessment on their performance any time a session with 12 or fewer students meets four or more times with the same faculty facilitator. In I-EXPLORE, this applies to Team INQUIRE (problem-based learning), longitudinal clinical experience, and clinical skills.
  5. In the clerkship and post-clerkship phases, faculty or preceptors must provide students with narrative feedback on all summative clinical evaluations.

DEFINITIONS

  • Narrative Assessment: Written comments from faculty that assess student performance and achievement in meeting specific objectives of a course or clerkship, such as professionalism [and] clinical reasoning." (LCME Functions and Structure of a Medical School, Element 9.5)
  • Formative Assessment [Feedback]: Information communicated to a medical student in a timely manner that is intended to modify the student’s thinking or behavior in order to improve subsequent learning and performance in the medical curriculum. (LCME Functions and Structure of a Medical School, Element 9.7)
  • Summative Assessment: evaluation of student learning at the end of an instructional unit.
  • Self-Directed Learning: Includes all of the following components as a single unified sequence that occurs over a relatively short time: 1) the medical student’s self-assessment of learning needs; 2) the medical student’s independent identification, analysis, and synthesis of relevant information; and 3) the medical student’s appraisal of the credibility of information sources; and 4) the facilitator’s assessment of and feedback to the student on information seeking skills. (LCME Functions and Structure of a Medical School, Element 6.3)

PROCEDURE

Pre-Clerkship Phase

  1. Problem-based learning (PBL): Each PBL case week is considered a single session for the purposes of this policy. Formative narrative assessment will be provided by the PBL facilitators after every third or fourth case week and summative narrative assessment will be provided by the PBL facilitators after every sixth or seventh case week.
    1. This summative narrative assessment, and discussion thereof, are important components of the self-directed learning process.
    2. Formative verbal assessment (from self, peers, and/or facilitator) occurs weekly but does not constitute narrative assessment.
  2. Clinical skills: Students will receive formative narrative assessment during or after every fourth session. Summative narrative assessment occurs at least twice each academic year. Formative verbal assessment (from self, peers, and/or facilitators) occurs during or after every session but does not constitute narrative assessment.
  3. Longitudinal clinical experience: Students receive formative narrative assessment during or after each longitudinal clinical experience session and summative narrative assessment after every sixth longitudinal clinical experience session.
  4. Facilitators of small group sessions that meet the criteria for narrative assessment will receive an evaluation to complete on the student’s performance in the small group.
  5. Facilitators must complete the feedback within 1 week of receiving the evaluation notice.
  6. Any late evaluations will be reported to the course director/instructor of record (IOR).

Clerkship Phase

  1. All students in required clerkships must receive narrative feedback in addition to a final score or grade as part of their performance evaluation.
  2. All summative clinical evaluations must include a section for narrative comments.
  3. Narrative feedback must be submitted such that the student’s final grade may be certified no later than six weeks after the completion of a clerkship.

Post-Clerkship Phase

  1. All students in clinical electives must receive narrative feedback in addition to a final score or grade as part of their performance evaluation.
  2. All summative clinical evaluations must include a section for narrative comments.
  3. Narrative feedback must be submitted such that the student’s final grade may be certified no later than six weeks after the completion of a clerkship.

RESPONSIBILITY
Course Directors/IORs

REFERENCES
Liaison Committee on Medical Education, Structure and Function of a Medical School - Standards for Accreditation of Medical Education Programs Leading to the MD Degree

RELATED POLICY/POLICIES
Clinical Experiences and Mid-Clerkship Feedback Policy
Formative Assessment Policy
Timeliness of Summative Assessment Policy
Assessment by Healthcare Provider

POLICY OWNER
Committee on Educational Policy

REVIEWED AND APPROVED BY
Committee on Educational Policy*
Associate Dean of Curriculum and Medical Education

REVIEWED DATE and REVIEW CYCLE
November 2021, 3- year cycle