Section 7: Grading and Evaluation of Clinic Rotations

7.1 Grading

Students earn graded credit for each of their required clinic rotations. Students are required to complete and pass all of their assigned clinic rotations, even when they have already fulfilled their patient contact and hourly requirements. Clinical rotations are graded using a pass/fail system.

  • Grade of “P” (Pass): The student has met the requirements to pass the rotation on their clinical evaluation and has completed a total of 48 hours (12 shifts) or more (or 44 hours/11 shifts during the summer). The student may not have missed more than two (2) shifts on their graded rotation, and any misses must be made up as noted in Section 6.2 above. These hours will change accordingly with any future changes to clinic shift length.
  • Grade of “I” (Incomplete): The student has met all requirements for passing the rotation according to their final clinical evaluation, but is missing up to 8 hours/2 shifts on their timesheet.
    • Any missed shifts are required to be made up by the end of the following the term.
    • Shifts made up the following term are logged in the “Holiday and Makeup Shift” timesheet, initialed by the supervisor for that makeup shift, and submitted to the registrar by the student by the end of week 12 of the term. Once the needed shifts are made up, the registrar will convert the “I” grade to a “P.”
    • If missing shifts are not made up by the end of the term following the receipt of an “I” grade, the “I” will be changed to an “F” (Fail), and the student will be required to complete an additional rotation.
  • Grade of “F” (Fail): The student has not met the clinical and/or attendance requirements for passing the rotation.
  • Grade of “RP” (ND) or “R” (CCM): The student has been required to complete a clinical skills building course (remediation). This grade may be given even if a student has missed up to two (2) shifts during the term, as outlined in Section 5.5 of the Grading Policies.

If students have more than two (2) absences on a single clinic rotation, they cannot be accurately graded by their faculty supervisor and will receive a failing grade for that rotation. Exceptions may be made in the event of multiple clinic closures beyond the student’s control.

7.2 Clinical Learning Objectives

At the beginning of each term, supervising faculty will provide students with an orientation to the rotation by clearly defining their expectations of students, the objectives of that clinic rotation, and the manner in which they will measure student achievement. This orientation is provided so that students have an understanding of their learning objectives on that shift, and the manner in which they will achieve these objectives and be graded on them.

7.3 Evaluation Process

Naturopathic Medicine Program

Proficiency Examinations

ND students are required to pass an OSCE before moving forward in each stage of clinical training. The OSCE 1 examination (clinic entrance examination) is taken and passed before the student becomes a secondary intern. The OSCE 2 examination (primary status examination) must be passed before the student becomes a primary intern, and successful completion of the OSCE 3 examination (exit examination) is required to graduate from the program.

Midterm Evaluation

During the sixth week of each term, students meet with their clinical supervisors to discuss their clinical performance. The evaluation covers clinical skills, knowledge, thought processes and professional behavior. The meetings are designed to give students constructive feedback, identify areas of excellence or concern, and assess students’ overall progress in an informal, supportive atmosphere. Week six reviews may be provided to students in written form, but are not tracked through the Registrar’s Office.

Final Evaluation

Final evaluations of all ND students are conducted during either week 11 or week 12 of each term. Supervising faculty meet with each student individually to discuss their evaluation of the student’s performance over the duration of that clinic rotation. Student grades are based on the student’s overall clinical performance as reflected in their final evaluations. Grades are submitted on the pass/fail grading system. Students must repeat a failed rotation, and the faculty member must document areas the student will need to further develop during their required skills-building course.

Evaluation of Supervisors

At the end of each quarter, students complete evaluations of their faculty supervisors. The evaluations are reviewed by the dean of the College of Naturopathic Medicine, with input from the associate dean for clinical education and the chief medical officer.

Classical Chinese Medicine Programs

Clinic Entrance Examination

All CCM students take a practical point location examination at the beginning of the winter quarter prior to starting their internship year. Students failing this examination are given the opportunity to remediate this exam later in the same term. If the student fails the remediation exam, they must enroll in the Advanced Point Location course in the spring quarter. CCM students also take a written clinic entrance examination during the first half of the spring term prior to becoming an intern. The written examination covers the foundational course material needed to assume responsibility for direct patient care. Students who fail this examination are given the opportunity to remediate the exam later in the same term. A remediation fee is applied. Should a student fail the written examination for a second time, their entrance into the clinic is delayed for a term, during which the student will have time to address weak areas. Another written exam will be given toward the end of this term.  

Evaluation of Clinical Rotations

Faculty evaluate students during week 6 using a form that assesses achievement of level-specific clinical competencies. They discuss their evaluation with students in a one-on-one meeting, during which they identify any “critical non-performance” issues that must be corrected by the end of term for successful completion of the rotation. Final evaluations of students are conducted during either week 11 or 12 of the term. Supervising faculty meet with each student individually to discuss their evaluation of the student’s performance over the duration of that clinic rotation. Student grades are based on these evaluations. In addition, students do a self-evaluation prior to meeting with their clinical faculty member. Grades are submitted as pass or fail. Students must repeat a failed shift.

Clinic Exit Examination

During the final quarter of their training, interns perform an intake and examination on an actual patient or a patient-actor, and then determine a diagnosis (with differential) and devise a treatment approach. Students provide oral and written explanations of their findings and plan. An evaluation rubric is used to grade the student. This practical examination tests whether the student has mastered the level of clinical knowledge, skills and attitudes needed to graduate and become a practitioner with sole responsibility for patient care. Students who do not pass have the opportunity to remediate the exam later in the same quarter. A remediation fee is applied.

Evaluation of Supervisors

At the end of each quarter, observers and interns complete evaluations of their faculty supervisors. The evaluations are reviewed by the associate dean for clinical education and the program dean with input from the chief medical officer.

7.4 Clinical Remediation

Students who require extra support in meeting minimal levels of clinical competency are counseled and referred for additional instruction by their clinical supervisors or the program dean.

ND Clinical Skills Enhancement

Clinical skills enhancement courses are generally scheduled over a six-week period of time; students may be referred to this course at any point during the term. The clinical skills enhancement instructor carefully assesses each student’s abilities and works with them directly throughout the duration of the course. At the end of the course, the instructor reassesses the student’s abilities and determines if the student should continue with the course. A faculty member may require or recommend a clinical skills enhancement course, even if a student receives a passing grade, if the faculty member feels the student needs additional help to improve their clinical competency. 

OSCE Skills Tutorial
ND students who fail an Objective Structured Clinical Examination (OSCE) twice will be referred to an OSCE skills tutorial for three sessions. If the student passes this course, the student may re-take their exam.

CCM Clinical Skills Remediation

Clinic evaluations of CCM student performance are done during week 6 of the term to provide midterm feedback and identify areas of weakness, including those that must be remediated before the end of term in order for the student to pass the clinic rotation. The clinical supervisor, in collaboration with the CCM associate dean of clinical education and the program dean, can assign remediation work, which can include attendance at weekly clinical skills tutorial labs overseen by the clinical supervisor, associate dean of clinical education, and/or the AOM resident.