Reimagining clinical education at Cornell

Daniel J. Lopez College of Veterinary Medicine, Cornell University, Ithaca, NY

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Jonathan H. Wood College of Veterinary Medicine, Cornell University, Ithaca, NY

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Marnie C. FitzMaurice College of Veterinary Medicine, Cornell University, Ithaca, NY

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Lauren C. Roberts College of Veterinary Medicine, Cornell University, Ithaca, NY

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Jodi A. Korich College of Veterinary Medicine, Cornell University, Ithaca, NY

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Introduction

To keep pace with rapid changes in the veterinary profession and evidence-based teaching methods, the Cornell University College of Veterinary Medicine has begun a comprehensive redesign of its clinical curriculum. In May 2023, as a first step in this ongoing project, Cornell launched a new competency-based clinical rotation assessment, feedback, and coaching system.

For clinical rotations, previous competency assessments, variable grading rubrics, and traditional letter grades have been replaced by a universal assessment system and a Satisfactory/Unsatisfactory grading scheme. Clinical educators evaluate students using a set of attributes aligned with an outcomes-based competency framework. Student performance is scored on a five-point entrustment scale (see below). Key advantages of the entrustment scale include strong inter-rater reliability and ease of implementation. Students appreciate the authenticity of the assessment system, which allows them to more accurately calibrate their performance level relative to that of an entry-level clinician.

Faculty feedback on the new approach has been positive. Dr. Ursula Krotscheck, Section Chief of Small Animal Surgery, says, “I anticipate that the usefulness of this system and the feedback it naturally generates will be much more likely to create practice-ready veterinarians than the previous grading systems.”

Entrustment scale, attributes and feedback

The entrustment scale defines a student’s ability to effectively demonstrate an attribute:

Clinical rotation faculty customize their scoring rubric by selecting attributes they can consistently evaluate from an organized menu. Attributes are aligned with competency domains and incorporate knowlege, skills, and attitudes that are essential to becoming a competent veterinarian. The three broad collections of attributes are: universal attributes, assessed by every rotation; specialized attributes, evaluated on some rotations; and service-specific attributes, which can only be assessed by the specific rotation.

All members of the clinical care team, including clinical faculty, licensed veterinary technicians, and house officers, can now provide multi-source written feedback on student performance. This provides a more comprehensive evaluation of students for attribute score determination and incentivizes positive workplace behavior and teamwork. Web-based training modules were distributed as part of the new assessment program launch to ensure that all evaluators provide effective feedback to support student learning.

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Fourth-year Cornell veterinary students are now being evaluated via a universal assessment system and a Satisfactory/Unsatisfactory grading scheme.

Citation: Journal of the American Veterinary Medical Association 261, 8; 10.2460/javma.23.06.0319

Student performance and coaching

Assessment scores are captured in a web-based reporting system that allows the course leader and students to monitor their progress over time. Students who perform below the standard in any attribute are identified and entered into a tiered coaching program, which provides structure for students to reflect on their performance and develop improvement plans under the guidance of a faculty coaches who are trained to support self-regulated learning. These faculty coaches provide attribute-specific learning support to students with identified needs. Students must successfully complete any assigned coaching program requirements prior to graduation, ensuring all students meet every competency standard.

Positive culture change

The new clinical assessment system is designed to create a positive culture of teaching and learning on clinical rotations at Cornell. Clear and standardized frameworks for assessing and coaching students allow faculty to provide more valuable feedback and support for student learning. Messaging to students emphasizes the value and goals of the feedback and support in helping to identify and address opportunities for growth, while building trust and confidence in the clinical rotation educational process.

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