Clinical supervisor evaluations during general surgery clerkships

Figures & data

Table

Practice points

Clinical supervisor evaluations during general surgery clerkships can lack validity because consultant surgeons rarely have the opportunity and time to directly observe medical students. In comparison, residents and interns frequently supervise students and are able to provide reliable and accurate clerkship performance evaluations. Inviting surgical residents and interns to provide clinical supervisor evaluations on clerkship performance may improve the overall validity of this form of student evaluation.

Table 1.  University of Auckland fourth-year general surgery clerkship learning objectives outlined in the clinical supervisor evaluation form

Domain 1 – acquisition and application of medical knowledge

Clinical knowledge (e.g. knowledge of common symptoms, understanding of disease and approach to disease/patient management including therapeutics)

Domain 2 – professional, clinical and research skills

Clinical patient assessment (ability to take history, perform basic clinical examination)

Clinical patient assessment (generate problem list and differential diagnosis)

Relevant procedural skills (e.g. venesection/suturing/arterial blood gas)

Communication skills^a (patients/families/healthcare team)

Reliability and dependability^a (punctuality, carrying out of instructions, time management)

Initiative and enthusiasm^a (gets involved, able to identify needs of the job, follows up without being prompted, thinks and plans ahead, shows commitment, asks questions of supervisors)

Responsibility for own learning^a (evidence of reading up on cases, attending teaching sessions, curiosity)

Domain 3 – population health and primary health care

Health promotion (knowledge of risk factors for illness and preventative strategies)

Location of patient illness in continuum of care (ability to plan future care and patient transition between primary, secondary and tertiary care)

Note: ^aLearning objectives related to student ‘professionalism’.

Table 2.  University of Auckland fourth-year general surgery clerkship clinical supervisor evaluation form: Grades and definitions

Scored grade	Acquisition and application of medical knowledge	Professional, clinical and research skills	Population health and primary health care
Excellent (4)	Outstanding underpinning knowledge which is applied to patients appropriately	Excellent professional, clinical, communication and procedural skills. Able to function well as a member of the team	Comprehensive understanding of (1) health promotion and disease prevention and (2) of the whole patient and issues surrounding their care
Satisfactory (3)	Good working knowledge which is usually well applied to patient care	Good standard of professional, clinical and communication skills. Works as a team member. Able to recognise gaps and correct them	Good awareness of health promotion and disease prevention. Understands the whole patient and their place in community/society
Some Reservations (2)	Several gaps in underpinning knowledge	Some deficiencies in professional, clinical and communication skills	Tends to see the patient in isolation. Limited awareness of health promotion and disease prevention
Major Deficiencies (1)	Major deficiencies in knowledge base or in the ability to apply knowledge	Major deficiencies in professional and clinical skills. Poor communication, inappropriate attitudes and limited insight	Rarely if ever considers the patient in the wider context. Poor awareness of health promotion and disease prevention

Table 3.  Clinical supervisor evaluation grades: internal consistency

	Cronbach-alpha coefficients
	Clinical ability	Professionalism	Total
Consultants	0.87	0.85	0.90
Residents	0.85	0.83	0.88
Interns	0.78	0.80	0.86

Table 4.  Clinical supervisor evaluation grades: Means and confidence intervals

	N	Mean grades (95% confidence intervals)
		Clinical ability	Professionalism	Total
Consultants	113	19.5*	14.3	33.8‡
		(19.1–19.9)	(13.9–14.6)	(33.1–34.5)
Residents	152	18.8†	14.0	32.8
		(18.5–19.1)	(13.7 – 14.3)	(32.3–33.4)
Interns	162	18.7†	13.8	32.5#
		(18.4–19.0)	(13.5–14.2)	(32.0–33.1)

Note: *Significantly different to †; ‡significantly different to # (p < 0.05).

Table 5.  Clinical supervisor evaluations: Correlation of mean grades to student OSCE results

Clinical supervisor	Evaluation component	Pearson correlation coefficient
Consultants	Clinical ability	0.26
	Total	0.27*
Residents	Clinical ability	0.54†
	Total	0.49†
Interns	Clinical ability	0.54†
	Total	0.49†

Note: *p < 0.05; †p < 0.01.