Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
The Permanente Medical Group, Oakland, CA, USA.
Perm J. 2024 Mar 15;28(1):76-80. doi: 10.7812/TPP/23.062. Epub 2023 Dec 1.
Ambulatory clerkships, including longitudinal integrated clerkships (LICs), face challenges to assessment, including time pressure and clinical demands on preceptors. High-quality clinical assessment is critical to implementing competency-based medical education, generating valid grades, and supporting learning. This importance is further heightened with the new pass/fail scoring for US Medical Licensing Exam Step 1, discontinuation of US Medical Licensing Exam Step 2 Clinical Skills, and the growing concern for bias in assessment.
The Kaiser Permanente Bernard J. Tyson School of Medicine's LIC spans the first 2 years with 50 students per class. In 2021-2022, the authors created a new faculty role, the clinical assessment specialist (CASp). CASps are highly trained clinical teachers who directly observe clerkship students in the ambulatory setting, provide feedback, and complete competency-based assessment forms.
CASps completed 186 assessments of first-year (Y1) LIC students and 333 assessments of second-year (Y2) LIC students. Y2 students achieved average higher milestones and were rated as requiring less supervision compared to Y1 students. Y1 students rated CASps more favorably than Y2 students. Preceptors rated the contribution of CASps similarly across both years. Clerkship directors described benefits including identification of at-risk students and value of augmenting preceptor assessments.
The CASp role may offer an innovative way to generate valid assessment of student performance, offset clinical pressures faced by preceptors, identify at-risk students, and mitigate bias, especially in an LIC. Future studies may examine assessment validity, including use in summative assessment.
CASps are an innovative approach to clinical clerkship assessment.
门诊实习，包括纵向综合实习（LICs），在评估方面面临挑战，包括时间压力和导师对临床的要求。高质量的临床评估对于实施基于能力的医学教育、生成有效成绩和支持学习至关重要。随着美国医师执照考试第 1 步采用新的通过/不通过评分、停止美国医师执照考试第 2 步临床技能考试，以及对评估中存在偏见的日益关注，这种重要性进一步提高。
凯撒永久医疗集团伯纳德 J. 泰森医学院的 LIC 贯穿前 2 年，每班 50 名学生。在 2021-2022 年，作者创建了一个新的教师角色，即临床评估专家（CASp）。CASp 是经过高度培训的临床教师，他们直接在门诊环境中观察实习学生，提供反馈，并完成基于能力的评估表。
CASp 完成了 186 名一年级（Y1）LIC 学生和 333 名二年级（Y2）LIC 学生的评估。Y2 学生平均达到更高的里程碑，并且被认为比 Y1 学生需要更少的监督。Y1 学生对 CASp 的评价比 Y2 学生更有利。导师对这两年的 CASp 贡献评价相似。实习主任描述了 CASp 的优势，包括识别有风险的学生和增强导师评估的价值。
CASp 角色可能提供了一种创新的方法，可以对学生的表现进行有效的评估，减轻导师面临的临床压力，识别有风险的学生，并减轻偏见，特别是在 LIC 中。未来的研究可以检验评估的有效性，包括在总结性评估中的应用。
CASp 是一种创新的临床实习评估方法。
