Education / Medical Student Education / Office of Medical Education / Integrated Curriculum / M3: Integrated Clinical Clerkships / Competency Based / What is the CBG Pathway?

What is CBG Pathway?

Purpose: Pilot pathway was created to transform the clerkship year to a competency-based model that attempts to foster a growth mindset in students.

5 main objectives of this pathway

  1. Competency-based assessment without grading to help students focus on growth.
  2. Make defensible decisions about a student’s competency development.
  3. Transparent external communication to residency programs while minimizing potential disadvantages to the students.
  4. Foster a growth mindset in students during the clerkship year.
  5. Program Evaluation to explore outcomes of this pathway.

Given the principles of CBME, we used a programmatic approach for assessment

EPA Ratings using an App MedOneStop workplace global assessment Direct observation EPA assessment QR self-directed narrative feedback Clerkship requirements (modules, simulation, shelf, CDM, documentation, etc.)
Senior Resident and Faculty Senior Resident and Faculty. Trained Assessor (not supervisor) Any healthcare professional n/a
One rating, one word 13 items narrative, global question EPA ratings and words Qualitative only Quantitative and Qualitative
6 per month 4 per month Trial 3 per month Same as other students

For the entrustment rating scale on the app and the workplace global assessment we used the following scale

"I would do it." "I would talk them through it." "I would direct them from time to time." "I would be available just in case." "I would not need to be there." "I never observed"
Student required complete guidance or was unprepared; I had to do most of the work myself Student was able to perform some tasks but required detailed directions Student demonstrated some independence and only required intermittent prompting Student functioned fairly independently and only needed assistance with nuances or complex situations. Students functioned with complete independence, understands risks and performs safely, practice ready  
WBAs in UME-How Many Are Needed? A Reliability Analysis of 5 AAMC Core EPAs Implemented in the Internal Medicine Clerkship

The following are 3 screenshots of the CBME app that students used to seek feedback and assessment data. The app was created by Seth Overla and Dr. Laurah Turner at the University of Cincinnati. Students use the app on their phone by completing the first page (name of supervisor, date, complex vs. routine case, their name, and the EPA they want to be assessed).  

The student then asks the supervisor to complete the EPA at the moment (or before) it was observed. Once the second screenshot comes up of the EPA rating scale, they hand their phone to the supervisor who completes the rating scale (Figure 6) and types or dictates any additional narrative into the free text box. This entire process is intended to take the supervisor 60 seconds or less. In the ideal circumstances, it also leads to a formative conversation about their performance and how they can improve moving forward. 

Matthew Kelleher, MD MEd 

Associate Professor of Internal Medicine and Pediatrics 
Internal Medicine Associate Program Director 
Co-director of the M1 and M2 Clinical Skills Course and Assessment of Core EPAs (ACEPA) 
Cincinnati Children's Hospital Medical Center/University of Cincinnati Medical Center 
Phone: 513-584-7474
CCHMC Email: Matthew.kelleher@cchmc.org
UC Email: kellehmw@ucmail.uc.edu
Twitter: @kelzj3 

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