End of Third Year Assessment
End of Third Year Assessment Student Schedules (BU Login Required)
The assessment objectives are to:
- evaluate the students’ ability to interview and communicate with patients
- assess the students’ physical examination skills
- gauge the students’ ability to synthesize data and present it in written format
- provide feedback to students on their clinical skills
- measure the skills of the class as a whole such that individual and curricular deficiencies can be addressed
- create the opportunity to experience a timed clinical skills examination that is similar to the USMLE Step 2 CS exam
In 2004 Boston University School of Medicine instituted a clinical skills examination call the “End of Third Year Assessment”, or EOTYA.
The End of Third Year Assessment is scheduled on a series of dates in April and May. During the EOTYA students will receive performance-based feedback on clinical skills from both standardized patients and faculty members. This should promote their educational planning and self-assessment, and help them prepare for the USMLE Step 2 CS exam.
The End of Third Year Assessment (EOTYA) is a six station clinical skills evaluation that is similar to the End of Second Year Assessment (EOSYA). Students interview and perform targeted physical examinations on standardized patients. They verbalize to the patients what they think is going on and offer a diagnostic work up and treatment plan. They may provide counseling to the patient, and at times they may be asked to interpret data. After the patient encounter, students enter their write-up online.
After each interaction students receive feedback from the standardized patient. After at least one interaction a faculty observer (watching on closed-circuit TV) also provides feedback. All of the cases will be videotaped.
Upon completion of the EOTYA students receive a report comparing their performance to that of the overall class.
Anatomy of a Patient Encounter
Each patient interaction lasts 35 minutes. The time is divided as follows:
- PATIENT INTERACTION (15 minutes) Read the opening scenarios (Pay close attention to any student tasks listed.)Interview +/- physical exam
- WRITE-UP (10 minutes) Complete on-line post-encounter paperwork (PEP). The PEP is not usually a full write-up. There will be specific information requested. Note that only information gathered by the student can be reported. (See Sample Case)
- FEEDBACK (10 minutes) A faculty person will observe each student at least once and will give direct feedback. Students will receive feedback from each standardized patient as well.
All third-year clerkship directors are involved in preparing cases for the EOTYA. They are aware that students will miss a day of their clerkship in order to take the assessment. Students should make sure that their preceptors are aware of their EOTYA date, but do not need to ask permission to leave the clerkship that day. Students should not take overnight call the night before the EOTYA. Likewise, students should not round on their patients the morning of the EOTYA. Students who feel pressured to do so should contact their clerkship director or Dr. Stanfield.
Each EOTYA case represents one of the required third year clinical clerkships, but the majority of students have not yet completed all of them by the time they take the EOTYA. Therefore students receive a summative grade in each of four skill areas:
- Physical Examination
- Communication Skills
For grading purposes a minimum passing level is identified for each skill area. This level is set at two standard deviations below the class mean.
Students with scores above the minimum passing level on all sections of the EOTYA are defined as having “Passed the EOTYA”.
Students who have difficulty with interview, physical exam, or write-up skill areas are defined as having “Marginally Passed the EOTYA”. They will be informed of the area of deficiency and required to review their materials. Then they will be offered a retake of the EOTYA.
Students are defined as having “Failed the EOTYA” if they receive a score less than the minimum passing level on two or more skill areas of the EOTYA or if they fail the communications skills area. Those students are required to review their test materials and to retake the examination (see below).
Upon completion of the EOTYA grades will be forwarded to the Registrar, OAA and OSA, but will not appear on the student’s transcript.
Retaking the Exam
Those students who marginally pass the standard will have a grade of “Met” the standard recorded on their transcripts.
All students who fail the EOTYA must retake the examination before their Dean’s letter can be sent. Students who need to retake the EOTYA will be required to review all records of their performance with an appropriate faculty member and receive feedback before retaking the examination. Any student who does not perform well on the second attempt will be referred to the 3rd and 4th Year Promotions Committee.
What to Bring
What students need to bring:
- Watch with a second hand.
- White lab coat with name tag
Reference materials are not allowed during the exam.
Lunch and snacks will be provided.
The Clinical Skills and Simulation Center (CSSC) is located in the basement of the Evans Building. Take the elevator or stairs down one flight and follow signs to the CSSC.
The Standardized Patients (SPs) are trained patient educators from UMass Medical School. Some of them are the same standardized patients students met in ICM-2.
Faculty from all six required third-year clerkships are involved in observing and providing feedback for the EOTYA. In addition, faculty members and OAA Faculty review cases with students at the end of each EOTYA session. Students receive feedback from at least one faculty member during the course of the EOTYA.
Lorraine Stanfield, M.D.
Priya Garg, M.D.
Heidi Werner, M.D.
Megan Young, M.D.
Please review this ethics form before attending your EOTYA Session.
What past students say they learned from the evaluation:
- This is a learning opportunity, not just an evaluation (though I would not have believe it if you had told me that before hand).
- The more open-ended questions I use the more information I obtain.
- If an open-ended question yields some information, then you should follow it with another open-ended question.
- Multiple questions should be avoided.
- Summarization is useful.
- Using transitional statements is useful.
- It is useful to ask a patient about his or her concerns.
- I know more medicine then I thought I did.
- I should think about differential diagnoses while I am interviewing and examining the patient.
- I was worrying more about the science but the patient was commenting on my way of communicating.
- There is a tension between “connecting with the patient” and gathering data efficiently.
- I do not come across the way that I think I do.
- There is a natural tension between “following the thread” and conducting the interview in an orderly fashion.
- I should always ask about family history and medications.
- I found the feedback from the standardized patients to be constructive. In addition, they reinforced ways in which I do well.
- I feel more comfortable taking the Step 2CS exam after having done the EOTYA.
USMLE Step 2 CS
Comparing the EOTYA to the USMLE 2 CS Exam
The EOTYA is similar to, but not the same as, the USMLE Step 2 CS exam. The EOTYA is meant to test materials based on the required BU third year clerkships. There are six cases, instead of the eleven or so tested in the USMLE exam. For the EOTYA students have 15 minutes to intereact with the patient, 10 minutes to do the write-up, and 10 minutes to receive feedback. In the CS exam there is no feedback (you go right into the next case).
Fourth year BUSM students had this to say about comparing the two exams:
- The EOTYA was a good preparation as a timed clinical skills exam.
- The EOTYA cases are more realistic than the CS.
- The EOTYA cases are more complicated than the CS ones.
- The EOTYA is more of a learning experience than the CS (For example, you get immediate feedback.)
- The EOTYA cases are more like cases you would see in an office setting.
- The CS cases are more like cases you would see in an acute setting.
- The CS cases have more vague presentations (which lend themselves to broad DDx and diagnostic w/u).
- A series of open-ended questions were needed to get good information from the EOTYA patients. (The impression being that a single open-ended question triggered the patient to tell much of the history in the CS exam.)
- In the CS exam it seemed that each patient had one challenging question, “When can I go back to work?” for example. In the EOTYA you had to ask the patient more directly about his or her concerns, questions, etc.
- Students perceive that on the CS exam you just go through the motions of doing the PE. They felt that if you pay too much attention to actual physical findings (such as listening longer for a heart murmur) it could take time away from hitting other PE checklist items.
- All students asked felt that the book “First Aid for the CS Exam” was essential to properly prepare for the CS exam.