End of Third Year Assessment

End of Third Year Assessment Student Schedules (BU Login Required)

Orientation Videos

EOTYA Orientation:

https://bostonu.zoom.us/rec/share/nO3N0oAR1gVEbgL4inQJB20s48XpwpucQI5kXtN2YjzJ5qQO9ntpU6Cdvfelzvqv.S9ZTez0FebiWAkIG(Access Password: B5xdW?mR)

Healer Clinical Reasoning Examination Orientation:

https://bostonu.zoom.us/rec/share/WAm38trJRt0HtX8wzbiOKbWCZ6_8fLehABxCECpdnx6EcVej5DodnDqCHzDH0H9m._rZVUVasp6VNnVe5(Access Password: !BTDe5Mt)

Assessment Objectives

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

Overview

In 2004 Boston University Chobanian & Avedisian School of Medicine instituted a clinical skills examination called 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 feedback should enable students to create SMART (Specific, Measurable, Achievable, Realistic, Timely) goals and strategies to enhance their knowledge and skills in areas that observers in which observers felt they could improve. One original purpose of this examination was to prepare students for USMLE Step 2 CS but it was officially discontinued in 2021.

This year students will also complete a NON-GRADED, ONLINE CLINICAL REASONING EXAMINATION. The exam consists of 4 computer-based simulated cases that they will complete on the Healer app that was created by the NEJM to help practice and assess clinical reasoning.

Structure

Standardized Patient Portion in the CSSC:

The End of Third Year Assessment (EOTYA) is a six station clinical skills evaluation that is like 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.

NEJM HEALER CLINICAL REASONING FORMATIVE EXAM (I.E., NO GRADE)

During the student’s scheduled EOTYA day, they will also complete 4 online simulated cases using the NEJM Healer website. You will have two hours to complete the cases. If you have your EOTYA session in the morning, you will complete the Healer examination in the afternoon from 1-3 pm and if you have your EOTYA session in the afternoon, you will complete the Healer examination in the morning from 10am-noon. There will be additional time provided to those who need accommodations. Please look at the schedule to find your assigned time.

This is a pilot so you will not be graded on it. HOWEVER, please take it seriously and do your best. We are using Healer to discover where there are gaps in the clinical reasoning curriculum and to find ways to help you learn clinical reasoning better. Please practice at least 3-5 cases (it’s kind of fun) so you understand how the application works and can navigate through the logistics easily.

If you haven’t used/signed up for Healer yet, use the following link to do so:

https://healer.nejm.org/app/access/sign_up
Sign up w/learner invitation code: BUSM-LEARNER-105162789 (institution = Healer editorial contributor)
DO NOT ACCIDENTALLY ACCESS THE FOLLOWING CASES WHICH ARE THE EXAM CASES:
Alvarez, Lara
Lavoie, Thomas
Mitchell, Andrew
Peterson, Jack
They should be hidden from view but just in case.

YOU MUST SIGN-UP FOR HEALER AND MAKE SURE IT IS WORKING FOR YOU BEFORE THE DATE OF YOUR EOTYA SESSION.

If you have any trouble accessing the website or practicing cases, please reach out to Matt O’Rourke, the NEJM managing editor for Healer, morourke@nejm.org.

Feedback

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 using the BUSM-Faculty Feedback for EOTYA. 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 33 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.
FEEDBACK (8 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.

Excused Clerkship Absence

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. Christine Phillips or Dr. Joe Rencic.

Grading

Each Standardized Patient 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:

Interview
Physical Examination
Communication Skills
Write-up

For grading purposes, a minimum passing competency level is identified for each skill area.

Students with scores above the minimum passing level on all sections of the EOTYA are defined as having “Passed the EOTYA.”

Students who score just slightly above the passing level will receive a marginal score. Students who perform marginally in 1 or more domains are not required to retake the EOTYA. The MEO does reserve the right to require mandatory coaching for students who have received marginal grades. However, in most cases, students will be encouraged, but not required to get coaching.

Students are defined as having “Failed the EOTYA” if they receive a score less than the minimum passing level on one or more skill areas of the EOTYA. Those students are required to receive coaching and retake the EOTYA in the 2nd block of the 4th year.

Upon completion of the EOTYA, grades will be forwarded to the Registrar, OAA and OSA, but will not appear on the student’s transcript.

NOTE: The Healer examination does not count for a grade, as mentioned previously.

Retaking the Exam

All students who fail the EOTYA must retake the examination before their Dean’s letter can be sent. Students who fail will be required to receive coaching to help them successfully pass the EOTYA retake.

Any student who fails the EOTYA on second attempt will be required to complete an additional sub-internship designed by the MEO.

Dates for Practice & Retake of EOTYA

Coaching for students who Fail will be determined in collaboration with your assigned faculty member

TBA

Mandatory Retake of EOTYA for students who Fail

TBA

What to Bring

What students need to bring:

Stethoscope
Watch with a second hand.
White lab coat with name tag

Reference materials or cell phone use are not allowed during the exam.

Directions

The Clinical Skills and Simulation Center (CSSC) is in the basement of the Evans Building. Take the elevator or stairs down one flight and follow signs to the CSSC.

Standardized Patients

The Standardized Patients (SPs) are highly-trained actors who have been taught to evaluate clinical skills. They work for a company called New England Clinical Skills Consulting. Some of them are the same standardized patients students met in Doctoring-2(previously known as ICM2)

Faculty

Faculty from all six required third-year clerkships are involved in observing and providing feedback for the EOTYA. In addition, faculty members and Medical Education Office Faculty review cases with students at the end of each EOTYA session. Students receive feedback from at least two faculty members during the EOTYA.

EOTYA Co Course Directors:

Christine Phillips, MD and Joseph Rencic, MD

Honor Code Form

Please review HONOR CODE form before attending your EOTYA Session

Advice and Comments About the EOTYA

What past students say they learned from the EOTYA:

This is a learning opportunity, not just an evaluation (though I would not have believed it if you had told me that beforehand).
I found the feedback from the standardized patients to be constructive. In addition, they reinforced ways in which I do well.
I know more medicine then I thought I did.
I was worrying more about the science but the patient was commenting on my way of communicating.
The more open-ended questions I use, the more information I get per question.
Try starting the interview with at least two open-ended questions, “Take me back to when your problem started.”… “Are there other things I should know about your problem?”
If an open-ended question yields some information, then you should follow it with another open-ended question.
Multiple questions in one sentence should be avoided (e.g., “Do you have fatigue, shortness of breath, or chest pain?”).
Summarization is useful because the patient will let you know if you missed anything (e.g., “I’m going to summarize what you’ve told me. If I’ve missed any important details, please let me know.”)
Using transitional statements is useful in preparing the patient and helping them be honest (e.g., I’m going to ask you some personal questions regarding your health which may help me to take better care of you. You do not have to answer any of them. If you do answer, your responses will be kept confidential.”
It is useful to ask a patient about his or her concerns or worries because knowing the patient’s perspective will help you address these issues throughout the visit and make the patient feel like you care about them.
I should think about differential diagnoses while I am interviewing and examining the patient.
There is a tension between “connecting with the patient” and gathering data efficiently. Making small connections through brief comments can increase rapport but still allow you to finish on time (e.g., “I’m so sorry your father had a heart attack. I hope he is doing better now.”).
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. In general, you can follow the patient’s train of thought with 1 or 2 additional questions but if that approach leads to a significant tangent, get back to the interview structure.
Keep the interview structure in mind or write it down on your scrap paper once the encounter begins so you stay organized and don’t miss anything (e.g., CC, HPI, PMH, PSH, Meds, All, FH, SH, ROS).
I should always ask about family history and medications. Remember to ask about doses and frequencies of medications, as well as herbals and supplements.
Don’t do a full ROS. It takes too long. Do a ROS focused on the patient’s chief concern. You cannot go wrong asking about constitutional, pulmonary, cardiac, and GI systems and then any other system that seems relevant.

Sample Case 2021

Click to View Sample Case