After Diagnostic Challenge

Assessments

Feedback is defined as “information about a person’s performance of a task and then applied to be used as a basis for improvement.” Assessing your performance throughout the DCs will enhance your learning experience and provide you the opportunity to improve before stepping into the fourth year clinic rotations and eventually into the “real world.” Below are the 4 areas that you will be assessed during each DC experience.

The “debriefing” session is a final meeting with all members of your clinic, the Client and the Facilitator on your case. This opportunity allows for face-to-face feedback from your Facilitator and Client.

The debriefing is an important part of the DC for the facilitators, clients, and for the students.

This typically occurs the day before Grand Rounds (Thursday). Be sure to schedule at least 60 minutes near the end of the exercise for this activity. (Your facilitator will assign your debriefing time)

The debriefing can be very helpful in planning your Grand Rounds presentation and handout.

The debriefing also provides a very valuable, final opportunity to discuss the following:

  1. The Case
    1. Resolution of any unanswered questions or problems
    2. Strengths & weaknesses of the case
    3. Effectiveness of the case as part of the DC exercise
    4. Suggestions for change or improvements
  2. Client Issues
    1. How effectively the client conveyed realism
    2. Clinic/client agreement on client issues
    3. Suggestions for change or improvements
  3. Learning Issues
    1. Basic science
    2. Medicine
    3. Problem solving
    4. Clinic interactions
    5. Client relations
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At the end of the exercise, we will gather 2 pieces of evaluative data from you and your classmates – Peer Review of each clinic member and Effectiveness of your clinic’s Grand Rounds presentation.

Peer Review Expectations:

Below are some of the characteristics of an effective DC clinic member that we think are most important.

  • Is prepared and contributes to the work load in an equitable manner.
  • Participates in the group discussion and contributes valuable information/ideas.
  • Listens to and encourages the input of others.
  • Provides criticism in a constructive and positive manner.
  • Accepts criticism or debate and is open to discussion of his or her ideas.
  • Is not overly serious or restrictive, such that the group task is both educational and enjoyable.
  • Provides leadership (although not everyone in the group can be a leader.)

Most members of your class will ultimately end up working in some sort of group practice. There, your interactions with colleagues, staff, and clients will help determine both your professional happiness and your success. The ability to work effectively in this kind of collaborative setting is every bit as important as your clinical ability. We hope that the DC will, in some small way, help you to consider and develop these very important interpersonal skills.

Therefore, at the end of the exercise each of your associates will be asked to score your performance. The form will be provided as a survey link in your TEAMs clinic folder. You are welcome to start the evaluation process as the DC progresses (can copy & paste from a word document – once you start the survey you have to complete), but it will be due the following business day after Grand Rounds.

Members of the DC Group will consider these scores and award 0 or 5 points to each student.  Students marked as “Needs improvement” or “Poor” by a majority of their colleagues will receive 0.

Example:

Self Evaluation

Peer Evaluation

Grand Rounds Presentation- Student Evaluation:

At the end of the exercise, we will ask your classmates to evaluate the effectiveness of your Grand Rounds presentation. Each Clinic will give feedback to 2 clinics during their presentations through a provided ink and assigned clinics. This feedback will be given to the clinic, please provide constructive feedback. 

A form similar to the one provided below is used.

Student Evaluation Form – DC Grand Rounds
[1]  Organization and clarity of presentation
[2]  Knowledge of subject area (including ability to answer questions).
[3]  Effectiveness of teaching materials (e.g. overheads, PowerPoint, etc.).
[4]  Overall effectiveness in conveying; relevant learning issues from case
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In order to maximize the learning during both DC exercises, you will be asked to both give and receive feedback about your performance as a team member and your work with your client.

By practicing this skill, you will learn about how to positively impact your team. You also will have the rare opportunity to hear an honest appraisal of your performance from respected colleagues. Although difficult, many students say this experience is extremely valuable.

We urge you to step out of your comfort zone and take full advantage of this opportunity.

360 degree Feedback

Example Agenda for the Exercise
Art of Effective Feedback
How to help Colleagues Excel
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At the end of the exercise, your clinic will receive a written evaluation and score from you facilitator. These will emailed to your clinic within 7-14 days after DC Grand Rounds.

You be evaluated on the following criteria – scored as follows:

  • Unsatisfactory
  • Needs significant improvement
  • Needs slight improvement
  • Meets expectations/Very good
  • Exceeds expectations/Exceptional

Medical Record

The Medical Record was organized, legible, and accurate. The final version provides a complete record that would allow reconstruction of what happened in the case retrospectively.
The Master Problem List was updated at each submission. New problems were added as they were recognized. Problems were combined or defined at a higher level of understanding when an explanation became apparent. The problem list was resolved appropriately at the end of the exercise.
The Assessment component of the daily progress report (SOAP) consistently addressed the high yield problems, providing analyses and updated DfDx lists. The analyses reflected careful consideration of the problems, but were relatively succinct. The rationale for considering, ranking and ruling out DfDx’s was clear.
As part of the assessment and overall thinking processes, the problems in the case were appropriately brought together and INTEGRATED. In other words, the fact that individual students were SOAPing individual problems did not deter the group from seeing the case as a whole and connecting the problems in an appropriate manner.
The Plan component of the SOAP clearly and concisely indicated the clinic’s planned course of action. The rationale for each test or procedure was apparent. For procedures, the plan provided sufficient basic detail to effectively communicate that the clinic understood how the procedure was performed and expected or possible findings. At each submission, there was a Master Plan, which was written so that it allowed the facilitator to know explicitly what the clinic wanted to do (e.g. drug dose & route)

Problem Oriented Approach & Case Management

(including the use of laboratory tests and diagnostic procedures)

The clinic demonstrated a logical approach and used sound problem solving methods
The clinic demonstrated a strong existing knowledge base – i.e. they appropriately used their veterinary school education to this point.
The clinic effectively identified the relevant gaps in their knowledge and filled those gaps by independent research. When given time and opportunity (especially the evening), the clinic came back better prepared with an improved knowledge base, a clearer understanding of the important questions, revised hypotheses, and new ideas regarding their approach to the case.
The clinic was able to justify all laboratory tests and diagnostic procedures based on specific DfDx or hypotheses that reflected suspected target organs or pathophysiology mechanisms.
The clinic was able to work and think independently.
The clinic had a good idea of how results could or would be interpreted. In the case of new or unfamiliar tests, the clinic did appropriate research to understand the indications, contraindications, sensitivity, specificity, and availability. In the end, they were able to properly interpret results or to recognize how the test/procedure may not have been appropriate.
The clinic’s approach to the case was realistic for a “real life” setting and reasonably economic. The clinic adapted to limitations imposed by the client (e.g. financial or philosophical limitations).

Client Communication

(a separate evaluation completed by the client will be provided to each clinic)

OVERVIEW: The clinic acted in a professional manner. The clinic effectively kept the client informed and educated on the status of their DC animal. The clinic was able to provide justification for any course of action they proposed, was able to explain the meaning of test and procedure results, effectively answered the client’s questions, and addressed the client’s concerns & needs. Everyone in the clinic played an active role in the client interactions, including at least one stint as primary speaker.

Teaching Effectiveness

 (Oral Presentation and DC Handout)

The oral presentation was well organized and effectively presented. The presenters spoke clearly and made effective use of audiovisual aids, especially those that were provided as part of the case. When presenting images (including cytology, radiographs, gross lesions, and microscopic lesions), the presenters effectively pointed to the key features. It was clear that the clinic associates the key issues and the images they were utilizing. The allotted time was used appropriately.
The audience was able to follow what had transpired in the case from presentation of the animal on Day 1 until resolution. As part of presenting the case, the clinic emphasized key findings, key decisions made by the clinic, and diagnostic dilemmas. The DfDx’s were clearly indicated and it was clear how the DfDx list changed as more information was obtained.
The clinic effectively balanced presentation of the case with presentation of the final diagnosis, pathophysiology, critical DfDx’s and Learning Issues. As a result, students in the audience came away from the presentation with a good understanding of the disease or diseases studied and relevant issues surrounding the disease, including any Public Health considerations. It is important that the clinic did not neglect basic science issues that are relevant to the courses which participate in the DC’s (pathology, clinical pathology, bacteriology/mycology, toxicology, virology, and immunology).
The clinic effectively and thoughtfully presented their “Learning Issues” for the case. From a teaching and learning standpoint, this is one of the more important aspects of the presentation.
Members of the clinic effectively answered questions from colleagues and guests in the room.
The use of humor or “theater” in the presentation was not excessive. Attempts to be “entertaining” did not detract from the effectiveness of the presentation as a vehicle to share with colleagues and visitors what the clinic had learned through their DC case.
The clinic’s HANDOUT met professional standards as the students might expect of a handout used in a Continuing Education meeting or conference. It followed the basic guidelines, was well organized and well written.
The clinic’s handout was very effective in providing a review of the disease or diseases that were examined through this case.
All figures used in handout contribute positively to the document, references are cited, and they take less than 25% of space in the entire handout.
The handout provided 2-3 quality references that someone could locate and utilize if they wished to learn more. The references included more than the standard veterinary textbooks, thereby reflecting a significant effort by the clinic to delve into the current literature.

Perceived Effectiveness as a Team

(i.e. a group practice)

The clinic was prepared and organized throughout the exercise.
Members contributed to the work load in an equitable manner and no one was inappropriately “missing in action” during the week
All members participated in the group discussions, as well as in the clinic’s interactions with both client and facilitator.
Especially after time to read, everyone contributed valuable information, hypotheses and ideas for how to proceed next.
Members of the clinic presented their ideas effectively and without prejudice for their own point of view.
Members were tolerant of each other and treated each other with respect.
Everyone listened sincerely to the input of others, including actively encouraging contributions from members who were less vocal by nature, had less clinical experience, or felt less comfortable with the species.
Members accepted debate and were open to new and different ideas, including ideas that were not their own.
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