Clerkship Clinical Assessment Rubric 2019-2020

Undeveloped competencies Emerging competencies Attained competencies
Medical Expert
Knowledge
Lacks knowledge of key basic science concepts related to common maladies For basic problems: Relates basic science principles to clinical problems.
For other common and urgent problems, struggle to relate basic science principles to clinical problems.
For common and urgent problems: Relates basic science principles to common and urgent clinical problems.
History taking
Histories are disorganized and overly detailed. Focus is on a questionnaire approach. Able to take a systemic and accurate medical history that generally focuses on one or two hypotheses. Adjusts the depth and focus of histories to detect most key and some relevant minor findings that generate relevant hypotheses.
Physical examination
PE are overly detailed or perfunctory. Maneuvers are incorrectly performed. Does not explain actions to the patient. PE are focused on only one hypothesis or on some irrelevant hypotheses. Maneuvers are correctly performed but misinterpreted. Explains actions to the patient. PE depth and focus are generally appropriate. Detects most key findings and some relevant minor findings. Explains actions to the patient.
Diagnosis
May have some difficulty identifying chief complaint when multiple problems exist. Unable to identify some major patient problems. Independently identifies chief complaint and major patient problems but has difficulty prioritizing them. Independently identifies and prioritizes major patient problems.
For identified problems: Unable to come up with differential diagnosis. For identified problems, identifies some common and dangerous diagnostic possibilities. For identified problems, Identifies most common and dangerous diagnostic possibilities.
Investigations
Plans of investigations relate to the patient problems but are incomplete and not prioritized. Plans of investigation relate to patient problems but are not prioritized. Orders need major adjustments before being co-signed. Plans of investigation relate to patient problems and their priority. Orders need minor adjustments before being co-signed.
Unable to interpret results of common diagnostic and screening tests. Interprets results of common diagnostic and screening tests. Interprets results of common diagnostic and screening tests.
Management
Plans of management do not relate to patient problems. Plans of management relate to patient problems but are not prioritized. Orders need major adjustments before being co-signed. Plans of management relate to patient problems and their priority. Orders need minor adjustments before being co-signed.
Describes the proposed treatment plan but does not consider possible complications. Explains anticipated effects and some possible complications of the proposed treatment plan. Explains anticipated effects and possible complications of the proposed treatment plan.
Documenting the encounter
Written documents are organized according to McGill template, but information is not always in correct section and some key information is missing. Lots of irrelevant information is also included. Written documents are organized and information is found in the correct section but some relevant information is missing. Written documents are organized, relevant and legible. Some minor relevant information is missing.
Case presentations are long, unfocused and simply repeat patient’s terms. Case presentations are organized and complete but overly long. At times, able to translate patient’s terms into medical terminology. Case presentations are succinct, accurate, well organized and generally able to use medical terminology to represent patient’s terms.
Procedures
Describes most indications but knows few contraindications as well as few risks and benefits of the procedure. Describes most indications and contraindications and most risks and most benefits of the procedure. Describes all indications and contraindications and most risks and most benefits of the procedure.
Lacks the skills to perform the procedure. Demonstrates the skills to perform the procedure but doesn’t succeed. Demonstrates the skills to perform the procedure and succeed.
Doesn’t recognize complications of the procedure or doesn’t know to seek help when necessary. Recognizes complications but is unsure how to address them. Recognizes complications and seeks help when necessary.
Patient requiring urgent or emergent care
Does not consistently recognize when a patient is sick, or does not always correctly differentiate when to seek help and when to approach a problem independently. Consistently recognizes when a patient is sick and seeks help but may not do so in less urgent situations. Consistently recognizes when a patient is sick, when to seek help, and when to approach a problem independently.
Plans of investigations relate to the issue but are incomplete and not prioritized. Struggles to initiate a concurrent treatment plan. Plans of investigation relate to issue but are not prioritized. Initiates a concurrent treatment plan although incomplete. Plans of investigation relate to patient problems and their priority. Initiates a concurrent treatment plan adapted for the issue.
Communicator
Condescending, offensive, or judgmental Courteous Courteous and warm
Moderately at ease, uses appropriate language as well as different types of questions. Generally at ease, uses appropriate language. Most frequently uses open to closed-ended questions. Consistently uses open to closed-ended questions, clarifies statements that are not clear and periodically summarizes to verify understanding.
Interrupts inappropriately, ignores patient’s answers or misses on patient’s answers and/or non-verbal cues. Does not verify for understanding or does not address concerns. Attentive and responsive to patient’s answers. Verifies occasionally for understanding. Attentive and responsive to patient’s answers and blatant non-verbal cues. Verifies for understanding and addresses concerns.
Does not introduce him/herself and/or does not explain the purpose of the visit.
Does not show sensitivity to patient preference (alone, with family, etc.) as applicable.
Introduces him/herself, their role in the patient’s care and explains the purpose of the conversation.
Positions him/herself to communicate comfortably.
Introduces him/herself, their role in the patient’s care and explains the purpose of the conversation.
Positions him/herself to communicate comfortably.
Provides incomplete information to the patient or not adapted to the patient's needs (e.g. using medical jargon) or in an inappropriate manner. Does not provide information in an organized, logical manner.
Does not make any follow up plan on issues raised during the discussion. Does not seek help in managing the difficult communication situation.
Provides complete information to the patient but not adapted to the patient’s needs (e.g. using medical jargon). Makes a plan but presents the next step in a random fashion. Assesses safety of the situation and seeks help as needed. Seeks to provide the patient with the right amount and type of information by exploring the patient’s starting point, checking for understanding and avoiding medical jargon. Makes a plan that is understood, with next steps articulated. Works with and includes (where relevant) other health care team members to manage the difficult situation. Assesses safety of the situation and seeks help as needed.
Develops a management plan without exploring and incorporating the patient’s perspectives and preferences. Engages patients by seeking patients’ perspectives and needs but struggles to adapt management plan. Engages patients by seeking patients’ perspectives and needs. Incorporates the patient’s perspective and preferences into clinical decisions.
Professional and Healer
Is insufficiently present to the patient or abandons the patient at critical times. Impairs attempts by patients, their loved ones or other members of the health care team to instill hope and/or an appropriate positive outlook. Recognizes opportunities to promote healing but may need guidance to best use these opportunities. Recognizes opportunities to promote healing and actively engages in them.
Aspects of the student’s behaviors are called into question. Attendance at academic sessions or for clinical activities is inconsistent, missing sessions or arriving late. Does not always follow the Dress Codes. Appearance is not consistent with a student in a professional Faculty.   Behaves honestly and with integrity. Attendance at academic sessions or for clinical activities is consistent and punctual. Follows the Dress Codes. Appearance is consistent with a student in a professional Faculty.
Argumentative or defensive when provided with feedback regarding challenges. Does not demonstrate improvement despite direct feedback. Initially defensive when provided with feedback but later demonstrates improvement. Open to feedback on both strengths and challenges. Demonstrates improvement in response to feedback received.
Provides information without verifying that relevant permissions have been obtained.
Communicates in a public or crowded space with others around, which may impact confidentiality.
Verifies who should be present and is aware of what information can and cannot be shared without permission.
Communicates in a public or crowded space with others around, but uses methods to minimize the impact like closing the curtains.
Verifies who should be present and is aware of what information can and cannot be shared without permission. ,br>Plans the encounter and communicates in a private setting.
Doesn’t obtain informed consent for care or procedures. Supplies partial information to the patient, therefore obtaining a partially informed consent for care or procedures. Obtains informed consent for care or procedures.
Collaborator
Is unaware of the roles of other health care members. Identifies other health care team members who could be involved. Coordinates with other health care team members to ensure appropriate care.
Does not respond to concerns raised by other team members. Fails to incorporate information provided by interprofessional team members into clinical decision-making. Shows an interest in better understanding the concerns of other team members by communicating with them, asking questions, and reading their notes. Involves the interprofessional team in patient care. Is responsive to concerns raised by other team members and incorporates their input into clinical decision-making.
For safe handover, omits important details of the patient’s clinical presentation and management plan, thereby affecting the continuity of care of the patient or fails to anticipate possible issues. For safe handover, transmits most relevant information of the patient’s clinical presentation and management plan. For safe handover, transmits relevant information of the patient’s clinical presentation and management plan and anticipates possible issues.
Manager
Disorganized. Struggles with time management. Does not always complete tasks on time or needs reminders to do so. Completes tasks without reminders but somewhat inefficiently. Demonstrates effective time management. Follows up on and completes expected patient-care tasks in order of priority.
Health Advocate
Ignores the health/risk behaviours. Is unaware of potential risky behaviors, family functioning or living situations that may jeopardize the safety of the patient. Elicits some information about the patient’s social determinants of health. Makes minor adjustments to adapt patient care to these needs. Enquires about the patient’s social determinants of health. Identifies opportunities to connect to resources or adapt patient management.
Lacks strategies to improve health care for patients of diverse culture backgrounds, lower socioeconomic status, or without robust support networks. With prompting:
Attempts to mitigate risk factors for vulnerability. Considers issues such as culture, socioeconomic status, and support networks when proposing management plans.
Independently:
Attempts to mitigate risk factors for vulnerability. Considers issues such as culture, socioeconomic status, and support networks when proposing management plans.
Does not consider routine preventive measures in management plan.
Does not direct to appropriate health care resources or does not refer with the adequate time standards.
Incorporates routine preventive measures into management plans.
With prompting and guidance: Identifies some health care resources for a patient and refers to these resources.
Incorporates routine preventive measures into management plans.
Independently identifies some relevant health care resources for a patient and refers to these resources.
Even when prompted, is unaware of patients’ readiness to change. When prompted, can report cues related to patients’ readiness to change if patients volunteered these. Spontaneously reports cues related to patients’ readiness to change if patients volunteered these.
Attempts to educate but mainly through the one-way provision of information in language that is not understood by the patient. Educates using language that is understood by the patient while using some medical jargon at times. Encourages the patient to ask questions. Attempts use of brief motivational interviewing techniques to elicit change needs from the patient rather than from the provider. Educates using language that is understood by the patient. Verifies for understanding of the education provided.
Scholar
Is unaware of salient performance gaps or limitations. Does not identify resources to help with these. Recognizes own areas of relative weakness in knowledge and skills or limitations, but needs prompting and guidance to identify a strategy to address this and take action. Demonstrates awareness of limitations. Recognizes own areas of relative weakness in knowledge and skills, identifies at least 1 strategy to address this and take action.
Unsure what topics to read. Unable to apply evidence to clinical cases. Consults literature to address clinical questions. Struggles to apply specific evidence to the individual patient. Consults literature to address clinical questions. Often identifies how specific evidence applies to the individual patient.