Narrative Assessment Policy

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

Definitions

  • Demeaning: any comment that belittles or insults the student or appears to evaluate the student on criteria not related to course performance. Comments that are critical of course performance are not demeaning under this definition.
  • Discriminatory: any comment, whether intended or unintended, that potentially disadvantages individuals on the basis of age, race, color, ancestry, national or ethnic origin, religion, service in the uniformed services (as defined in state and federal law), veteran status, sex, sexual orientation, marital or family status, pregnancy, pregnancy-related conditions, disability, gender, perceived gender, gender identity, genetic information or the use of leave protected by state or federal law.
  • 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 Element 9.7)
  • 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 Element 9.5)
  • Obscene: any comment that is patently offensive by making explicit reference to sexual conduct.
  • 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 Element 6.3)
  • Summative Assessment: evaluation of student learning at the end of an instructional unit.
  1. A narrative description of a medical student’s performance, including non-cognitive achievement, must 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 Element 9.5)
  2. Narrative assessment can be formative or summative; it allows for professional development of students by highlighting unique strengths and areas for improvement.
  3. 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. This applies to Team INQUIRE (problem-based learning), longitudinal clinical experience, and clinical skills.
  4. In the clerkship and post-clerkship phases, faculty or preceptors must provide students with narrative feedback on all summative clinical evaluations, and it must be submitted such that the student's final grade may be certified no later than six weeks after the completion of a course.
  5. Narrative assessments that meet the definition of demeaning, discriminatory, or obscene must be edited, or the full assessment will be removed from the student's record for the course.

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 is provided by the PBL facilitators after every third or fourth case week and summative narrative assessment is provided after every sixth or seventh case week.
  2. Clinical skills: Students receive formative narrative assessment third or every fourth standardized patient encounter session. Summative narrative assessment occurs at least twice each academic year.
  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 receive a feedback form to complete on the student’s performance in the small group.
    1. Facilitators must complete the feedback within 1 week of receiving the evaluation notice.
    2. Any late evaluations will be reported to the course director.

Clerkship and Post-Clerkship Phase

  1. All students in required clerkships, required post-clerkship courses, and clinical electives must receive narrative feedback in addition to a final score or grade as part of their performance evaluation.
  2. All summative evaluations include a section for narrative comments.

Narrative Evaluation Editing and Redaction

If the course director learns of a narrative assessment that may require editing or redaction, they follow these steps:

  1. Compare the narrative assessment to the definitions provided for demeaning, discriminatory, and obscene.
  2. If the narrative assessment meets any of the definitions, the course director must discuss a revision with the assessor.
  3. If the assessor does not agree with revising the assessment, the course director will redact the evaluation altogether from the learner's course assessments.
  4. If the course director does not feel the narrative assessment meets the definition of demeaning, discriminatory, or obscene, but an involved party such as a students feels the narrative assessment should be redacted, the student may appeal the decision in writing to the Vice Dean of Medical Education within ten workdays of the date of assessment notification.

RESPONSIBILITY
Clerkship/Course Directors

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

RELATED POLICY/IES
Academic Assessment by Healthcare Provider
Clinical Experiences and Mid-Clerkship Feedback Policy
Formative Feedback Policy
Grade Appeal Policy
Timeliness of Summative Assessment Policy

POLICY OWNER
Committee on Educational Policy

REVIEWED AND APPROVED BY
Associate Dean of Curriculum and Medical Education
Clerkship Directors Workgroup
Committee on Educational Policy*
Curriculum Enrichment Advisory Committee
Curriculum Steering Advisory Committee
Executive Director of Clinical Education
Pre-Clerkship Phase Director
Team INQUIRE Lead

REVIEWED DATE and REVIEW CYCLE
November 2024, 3-year cycle

* indicates the Policy Owner