All
seven clerkships use “PRIME” for clinical assessment. PRIME is a method for
providing specific behavior based feedback on clinical performance. As a
learner progresses through his or her training, he / she should also
progress developmentally in his / her ability to gather the patient’s
relevant history and laboratory information, interpret that data, and
suggest appropriate management plans. At all levels of training the student
should behave in a professional manner and should demonstrate
self-education. Verbal formative and summative feedback from faculty and
house staff on a student’s clinical performance should incorporate the PRIME
scheme. Ideally, the student should receive feedback on his / her clinical
performance frequently, including at the mid-point of the rotation so that
if improvement is needed, there
would be time left to demonstrate improvement in clinical performance.
PROFESSIONALISM
Professionalism begins upon arrival to medical school and is continuous
rather than a developmental acquisition of skills. Student should
consistently demonstrate professional behaviors
•
Demonstrates respect, compassion, and integrity
•
Is
reliable, trustworthy, and responsible
•
Demonstrates sensitivity and responsiveness that supercedes self-interest
•
Demonstrates commitment to excellence, self improvement, and adaptability
•
Arrives
punctually
REPORTER
•
Collects relevant and reliable (accurate) patient data
•
Develops
a trusting relationship with patient in collection of data
•
Communicates data orally and in writing in a complete, organized, and
logical manner
INTERPRETER
•
Recognizes normal and abnormal
•
Interprets abnormal findings and tests
•
Identifies and prioritizes problems
•
Summarizes relevant info from the history, physical exam, and labs and then
develops an appropriate assessment using semantic qualifiers (e.g. acute /
chronic, bilateral / unilateral, local / systemic).
•
Creates,
ranks, and justifies differential diagnoses
•
Modifies
assessment based on new information
•
Considers population health issues in developing differential diagnoses
•
Incorporates psychosocial issues and patient’s understanding in patient
assessment
MANAGER
•
Chooses and justifies appropriate diagnostic tests and treatment plans
•
Modifies
plans based on results and response to treatment
•
Incorporates patient preferences/needs in negotiating a mutually acceptable
treatment plan
•
Demonstrates competency in performing procedures (if required by clerkship)
•
Interacts with other providers and systems to provide continuity of care
EDUCATOR
Educating
self begins on the first day of medical school. The student should
consistently be educating self. As student progresses through training,
education of others becomes more prominent
•
Identifies knowledge gaps for patient, self, and team and addresses them
•
Shares
new information with others
•
Evaluates the quality of evidence found
•
Accepts
responsibility for education of self and the team
•
Provides
clear explanations to patient with verification of understanding
When
faculty and / or house staff evaluates a student,
he / she will give the student a rating (see below) and will write a
narrative regarding the student’s performance in each of the PRIME domains,
and will include comments on the student’s strengths and areas for
improvement. A grade (outstanding, good, satisfactory, marginal, or
unsatisfactory) will also be assigned by the evaluator.
“Minimally” ……….. < 10% of time
“Inconsistent” ……. 10-50% of time
“Consistently” …… 51-90% of time
“Always” …………. > 90% of time
“Not Observed” ….. Not observed
Guidelines for assigning grades are as follows:
(Note:
deficiencies in Professionalism or Educator could lower a student’s grade)
•
Inconsistent reporter …………………………… Marginal (1.0) or Unsatisfactory (0.0)
•
Consistent reporter ……………………………… …………………Satisfactory (2.0)
•
Consistent reporter, starting to interpret ……… ……………Good (3.0)
•
Consistent reporter / interpreter, starting to manage …… Outstanding (3.6)
•
Consistent reporter, interpreter, manager …… ……………..Outstanding (4.0)
In Phase II Clerkships, expected performance for passing (grade of
Satisfactory) in each of the PRIME areas is:
Professionalism – should be consistent for passing
Reporter – should be consistent for passing
Interpreter – minimal activity OK for passing
Manager – minimal activity OK for passing
Educator – should be consistent for passing
In summary, passing level (Satisfactory) for Phase II students is being a
consistent Reporter as well as being consistently Professional and making
consistent efforts as an Educator. Increased efforts at Interpreter level
move a student toward Good. Building on this, additional efforts as a
Manager move a student toward Outstanding. Deficiencies in Professionalism
or Educator could lower a student’s grade.
