Exam Preparation

Practice Exams

• Practice Exam (Requires Learn@UW Log In)
• Practice OSCE Scenarios

PCC Final Exam

There are four components to the final exam:

• OSCE exam: 25% of final grade
• Community Project Presentation: Pass/Fail
• On-line Closed Resource multiple choice exam: 5% of final grade
• Open Resource short answer/essay exam: 5% of final grade

1. OSCE - Last Thursday AM of the Rotation, (see email from Christie Legler) (25% of final grade)
   Students will be divided into four groups. Two groups will start with the OSCE and the other two groups will start with the Community Project presentations. Group assignments and room numbers will be sent via email. The OSCE is a clinical or practical examination. Each station tests performance of a set of clinical skills from the clerkship objectives. Students are provided with a brief case scenario and specific tasks to complete. The student then interacts with a standardized patient trained to provide a similar experience for each student. In most stations an assessor is present and uses a checklist of competencies to evaluate the student's performance. The PCC OSCE consists of 6 stations, each lasting 10-12 minutes and, because the OSCE is used for evaluation, students will receive minimal feedback on their performance in the station itself. Examples of skills that might be tested are: delivery of a problem assessment, negotiating a treatment plan, performing a focused physical exam, taking the history of a common primary care problem. Here are helpful hints for preparing for the OSCE exam.
2. Community Project Presentation (Pass/Fail)
   Students will present a description of the community, the project, background and project impact on the community, with focus on interest in working with underserved communities.
3. Proctored, Closed Resource Exam (one hour): Last Thursday of the rotation (5% of final grade)
   Following the OSCE and Community Project Presentation, students will take a short closed resource, aka 'shelf' exam. This exam consists of approximately 30 multiple choice questions designed to evaluate the knowledge and problem-solving skills students that are expected to learn on the clerkship. It is timed, but not designed to be time-constrained.
4. On-line (Learn@UW), "Open Book" Exam [1.5 hours] (5% of final grade)
   The on-line exam is available from 11 am on the last Thursday through 5 pm the last Friday of the Clerkship. The exam is open-reference to allow students to use references with which they are familiar; but has time constraints so that students will benefit from being facile with using on-line resources or creating their own. Students cannot use other people for help.

   The format is a Modified-Essay Quiz (MEQ), a series of short-answer questions based on a clinical case. Students are given a portion of case information and are asked about the next step in managing the case. Some of the questions require the use of evidence-based medicine concepts.

Evaluation and Grading

You will be responsible for demonstrating competency in the core learning objectives on the final exam whether they are taught via Problem-Based Learning (PBL), in the clinical setting or independent study.

Near the end of the rotation, your primary clinical preceptors and other preceptors who have worked with you three or more half-days will be required to evaluate your clinical performance using a standardized clinical evaluation form. If you work with many preceptors at a clinic, the primary preceptor will often summarize the evaluation ratings for the clinic.

Those grading you will receive an evaluation form and an accompanying grid for guidance.

Typically, preceptors grade students as "Competent" or "Needs Improvement" unless the student has exemplary performance. If a preceptor's verbal feedback has been "You are doing great!!" it does not necessarily meant the preceptor will check boxes under "Advanced". It is the student's responsibility to elicit comprehensive feedback.

Each clinical preceptor who has worked with the student three or more half-days will evaluate the student's clinical performance, using the clinical evaluation form supplied by the Medical School's office. The small group leader will evaluate the student's performance in the Problem Based Learning sessions using the mentor evaluation form.

Each preceptor evaluation is weighted, based on the number of half-days with the student. In other words, the evaluation from a preceptor who worked with a student for 21 half days will count more than an evaluation from a preceptor who worked with a student for 7 half days. The final grade is determined by the Clerkship Director.

Because PCC final grades are determined by a number of carefully selected components, it is rare that a final grade is changed. If you have concerns about your grade, contact Christie Legler. If you wish to review the specific results of your OSCE or online exam, contact Doug Smith, MD. Only if you are able to provide new or revised information about your performance will a grade change be considered. These requests should be submitted in writing and with appropriate documentation to the PCC Director, David Deci, MD

Final Grade:
50% Clinical (average of all preceptors)
10% Problem Based Learning and Dr/Pt Communication sessions
5% Professionalism (attitude, dress, punctuality, engagement, completion of administrative tasks)
35% Final Exam (25% OSCE, 5% closed resource Multiple Choice, Pass/Fail Community Project Presentation and Reflection, 5% open resource Modified Essay)

Grading Process and Policies

Student grading is an important aspect of the Clerkship learning experience, and we take grade assignment very seriously. Components of the final Primary Care Clerkship grade are defined on the clerkship website, and may change annually according to curricular needs. Although specific examination items are rotated, the overall exam components and their fraction of the final clerkship grade remain constant during an academic year.

The PCC follows the UWSMPH Educational Policy Council directive on grade distribution, which states that no more than half of students may receive an A or AB, and no more than half of these may be A’s.

The PCC Director determines all final grades.

Grading Process

Evaluations are compiled, converted to numeric scores, and a final score calculated. The final scores are then placed into a raw grade distribution. Typically, the conversion of final score to grade is as follows:

*This scoring rubric is based on the last three years’ performance data and is not a guarantee of future scoring. Grades will generally be rounded to the nearest hundredth, i.e. 4.393 would be rounded down to 4.39, and 4.396 would be rounded up to 4.40. The PCC Director does have discretion to consider qualitative comments in the determination of borderline grade assignments.

**Adjustments of the grade cut-off points may be required as clinical and OSCE performances trend upward over the course of the academic year. This corresponds to the students’ increased clinical and examination experiences, and therefore reflects expected growth rather than comparatively improved performance. The Clerkship Director will review the raw grade distribution of each rotation of students before determining whether an adjustment is required.

Missing Evaluations: We make every effort to obtain an evaluation from all preceptors whom the student worked with for three or more clinic sessions. Occasionally, however, we simply cannot obtain an evaluation within the allotted schedule; in this case we will generally submit the student’s grade excluding that evaluation. If the missing evaluation contributes more than 25% of the clinical grade (typically 10 or more clinic sessions), the Clerkship Director will discuss options with the student, including a Temporary Incomplete grade or grade assignment without that evaluation.

Grade Inquiries

Because PCC final grades are determined by components carefully selected to reflect student physician performance, it is rare that a final grade is changed. We are glad to review grades with students upon request as follows:

1. If a student has a concern that their grade may have been miscalculated or wishes to view the breakdown of the evaluation components, they should contact the Clerkship Coordinator, Christie Legler.
2. Examinations: Students who wish to review their OSCE or online exam in order to improve performance on future tests should contact the PCC Examination Director, Doug Smith, MD.
   • OSCE: If a student has a concern regarding an OSCE station scoring, the clerkship Exam Director will review the videotape of the station and other representative stations. If it appears that the station scoring is incorrect, the Exam Director may rescore the station or calculate an OSCE grade without the station.
   • Open resource exam: If a student has a concern regarding the open resource exam scoring, the Clerkship Exam Director will review the scoring. If it appears that the scoring is incorrect, the Exam Director may rescore the exam or calculate an exam grade without this component.
   • Closed exam: If a student has a concern regarding a question on the closed exam, he or she should submit a written statement to the Clerkship Director. The Clerkship Exam Director and Clerkship Director will review the question, and may give full or partial credit for alternative answers.
   • Community project: Given the nature of the scoring, there is no appeal process feasible for the community project evaluation.
3. Preceptor Evaluation: If a student has a concern about a particular preceptor evaluation, he or she should contact the Clerkship Coordinator or Director as soon as possible. In this event, all of the student’s clinical evaluations will be reviewed by the Clerkship Director, looking for consistency/outliers. If, in the opinion of the Director, the student’s concern is valid and the evaluation seems out of line with other evaluations, the Clerkship Coordinator will calculate the student’s grade with or without the evaluation. If disqualifying the evaluation would change the student’s grade, the Director may consider doing so.
   • An example of a valid concern would be the following: A student writes to the Clerkship Coordinator/Director before grades are submitted, indicating that he/she was concerned about a particular preceptor evaluation because that preceptor expressed that ‘No M3 student should ever get an Advanced.’ On review, this preceptor’s evaluation seems significantly lower than any other. The Clerkship Director may exclude that evaluation and discuss future evaluations with this preceptor.
   • Because most of our preceptors are volunteers, and there is some inherent variability in preceptor grading, we will not ask an individual preceptor to review or modify his/her evaluation.
4. Small Group Leader Evaluation: Given the nature of the interaction as well as the high level of engagement of the small group leaders in the clerkship, there is no appeal process feasible for the small group leader’s evaluation.

Only if a student is able to provide new or revised information about his/her performance will a final grade change be considered. These requests must be submitted in writing and with appropriate documentation to the PCC Director, David Deci, MD.

We welcome feedback on our grading procedures as we do on all aspects of the Primary Care Clerkship.