The achievement of the mission and objective of the clerkship in surgery is based partly on pure objective measurements as through examinations. Not only at the departmental level, but at the National Board of Medical Examiner level. The students are graded on their cognitive knowledge, judgmental skills and diagnostic ability in both examinations. Both examinations are approximately 100 questions. The departmental examination is given without a time limit, whereas the National Board of Medical Examiner Clerkship surgical examination has a two-hour time limit. An appropriate score is necessary to achieve a pass, should any of the students fail either of the exams, scoring below a predetermined failure level, the student is asked to retake the exam within 90 days.
Subjectively the students are given an oral examination by three individual examiners. Students are presented a case and then they are asked to work up the patient, work out an appropriate diagnosis, and have a reasonable management plan for that patient.
A new important concept in the measurement of objectives is the OSCE examination. Where standardized patients who have been carefully trained, not only in their illness, but in their evaluation of students, are seen by individual students in each of the clerkships during the middle of the clerkship. They are asked to do a focused history, usually a focused physical examination. They are asked to make a differential diagnosis and then they maybe asked to have a management plan. The OSCE examination requires the student to write a S.O.A.P. note, and those S.O.A.P. notes are evaluated by the clerkship coordinator and also by the scoring system and yet a new wrinkle in the OSCE program is that the student will not write a S.O.A.P. note, per say, but will present his findings to the OSCE mentor in a 5 to 7 minute presentation. The mentor has an opportunity to help make the OSCE a formative process and it is hoped that the performance of the OSCE during the clerkship will help the students when they are asked to do OSCE’s as part of the National Board of Medical Examinations. So far, the OSCE program worked well and in surgery we have a variety of cases that are being used at OSCE standards.
Finally, each student is asked to choose people who will evaluate the students on their clinical skills performance. Their professionalism and cognitive knowledge. These objectives are carefully spelled out in the orientation process and every effort is made to standardize the measurement of these objectives.
The LCME survey also asks how success is measured, and I would suggest that the National Internship Residency matching plan and the National Board of Medical Examiners provide a chance for the students to perform. The achievement of success is that 80% of the students who are choosing surgery as a career get one of their top three choices when selecting a place for graduate training program. We also have made the observation that many of the Mercer graduates in surgery had in fact stayed in the State of Georgia and are fully needing the mission of the school which is to provide surgical care in the rural parts of Georgia.