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Annual Clerkship Review Form
Clerkship Number & Name:
Instructional Period:
Clerkship Director Name(s):
Coordinator Name:
Reviewers Names:
Description of course content objectives:
1.
How do you ensure that the clerkship content is up-to-date? (Check all that apply)
 National guidelines
 Benchmark against other schools
 Emerging research
 Textbooks
 Other ___________________
2.
Indicate the approximate number used for your clerkship in each of the following areas:
Total
Large group lectures
Clinical faculty (including residents) for
teaching
Clinical teaching sites
Other (Please describe)
3.
Indicate how you ensure the educational comparability of each teaching site. (Check all that apply)
 Review student evaluation data
 Review of student logs/procedure lists
 Review student performance on end of clerkship exams (including USMLE Shelf exams)
 Review of clinical evaluations of students
 Regular meetings with site directors
 Site visits
 Other_________________________
4.
Based on review of the clerkship evaluation, describe any steps taken to improve areas of teaching at sites that
received ratings below 2.0 (Meets Expectations).
Briefly describe your procedures for tracking student encounters by providing the following information:
5. Indicate the criteria used for determining the number and types of patients needed to meet your objectives.
(Check all that apply)
 National standards
 Consensus among department faculty
 Consensus among site directors
 Educational materials and/or research
 Other __________________________
Revised 6/28/10
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6.
Do collect data electronically or on paper?  Paper
 Electronically
a. Who reviews these logs and how often?
Who Reviews
 Clerkship Directors
 Daily
 Weekly
 Site Directors
 Daily
 Weekly
How Often
 Mid – Rotation
 End of Rotation
 End of Clerkship
 Mid – Rotation
 End of Rotation
 End of Clerkship
 Mid – Rotation
 Daily
 Preceptors
 Weekly
 Other __________________
 Daily
 Weekly
 Daily
 Other __________________
7.
 Weekly
 Semi – Annually
 Annually
 Semi – Annually
 Annually
 Semi – Annually
 End of Rotation
 End of Clerkship
 Mid – Rotation
 End of Rotation
 End of Clerkship
 Mid – Rotation
 Annually
 End of Rotation
 End of Clerkship
 Annually
 Semi – Annually
 Annually
 Semi – Annually
Summarize your student data for the past academic year:
a)
What gaps have you identified in the student experiences?
b) Indicate how you are addressing those gaps? (Check all that apply)
8.
 CLIPP Cases
 Simulated Patients
 Didactic Sessions
 Videos of Patients
 Finding Additional Site(s)
 Virtual / Computer Based Cases
 Paper Cases
 Other: _____________________
 See Patients with Other Teams
 Other: _____________________
Indicate all forms of assessment that are used to assess your students. (Check all that apply)
Graded
Non-Graded
 Formal mid-term review or feedback
 Discussions or questioning & answering sessions
 Group projects
 Group projects
 Multiple-choice exam
 Informal or formal feedback from residents or staff
 Quizzes
 Multiple-choice exam
 Oral exams
 Performance evaluations
 Performance evaluations
 Quizzes or practice problems
 Reflections, journal entries, or essay exams
 Reflections, journal entries, or essay exams
 Shelf exam
 Shelf exam
 Written papers
Revised 6/28/10
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9.
Indicate if you made any of the following changes in your course this year. (Check all that apply)
 Add, remove or update curriculum content
 Add or update new course materials (i.e., e-learning, text)
 Add or remove curriculum activities
 Increase use of formative feedback (e.g., quizzes,
 Add or remove lecture topics/workshops
discussions)
 Add or remove clinical teaching faculty
 Increase use of technology for teaching
 Add or update clinical cases/correlations
 No change
a.
If a change was made, provide a brief description of and reason for the change.
b.
Describe how the change impacted your course or the students.
10. Would you like to consult with one of our Education Specialist or receive faculty development in any of the following
areas? (Check all that apply)
Consultation
Faculty Development
 Course development
 Course development
 Teaching skills
 Teaching skills
 Giving Feedback
 Giving Feedback
 Evaluation and Assessment
 Evaluation and Assessment
 Item Writing
 Item Writing
 Developing rubrics for scoring assessments
 Developing rubrics for scoring assessments
 Technology tools available for teaching
 Technology tools available for teaching
 Organizing course website or design
 Organizing course website or design
 Other _______________
 Other _______________
Revised 6/28/10