Department of Health Sciences, Physician Assistant Program: Policy on End of Curriculum Assessment

Unit Policy

Title

Department of Health Sciences, Physician Assistant Program: Policy on End of Curriculum Assessment

Introduction

Purpose

This Policy establishes the requirements and processes for Physician Assistant (PA) Program (Program) students (Students) regarding the End of Curriculum (EOC) Assessment.  

Scope

This Policy applies to all Students who matriculate into the Program.

Policy

Policy Statement

Students must receive a passing grade on each component of the EOC Assessment in order to progress to Program completion. The EOC Assessment is comprised of the following three (3) components:

  1. A Written Examination.
  2. Objective Structured Clinical Examinations (OSCEs).
  3. Evidence-Based Medicine Assessment.

Students take the EOC Assessment in the eleventh month of their cohort’s Clinical Phase (November), which is one month prior to graduation (December). To be eligible to take the EOC Assessment, a Student must have completed and passed all required and elective Supervised Clinical Practice Experiences (SCPEs).

The dates for the Written Examination and OSCEs vary year to year and are published for each cohort at the beginning of the first semester of the Clinical Phase (January).

Exam Attendance

Students are required to attend each component of the EOC Assessment. A Student who fails to take an examination due to Unapproved Absence or Excessive Tardiness may be referred to the Student Progress Committee for further consideration of professionalism concerns and for determination of whether the Student will be scheduled for a make-up examination.

Make-up Examinations

Make-up examinations for Approved Absences are scheduled by the Program’s Director of Clinical Education (DCE). Make-up examinations for Unapproved Absences or Excessive Tardiness, if determined appropriate by the Student Progress Committee, will be scheduled by the Director of Clinical Education.

Written Examination

Details

The Written Examination is comprised of three hundred (300) questions (250 scored), which are divided into five (5), sixty (60)-question sections. The examination is five hours long and scheduled for one (1) day. Students with approved testing accommodations through the University Compliance Office are required to make every effort to take the examination at the University Compliance Office Testing Center. In accordance with PA Education Association (PAEA) Assessment Exam Policies, Students with approved accommodations for increased testing time are required to take the examination in two (2) parts with each part on a separate day and with no more than seven (7) days between each day of testing. For students with approved accommodations each part of the Written Examination will consist of five (five), thirty (30)-question sections.

The PAEA allows an individual Student only two (2) attempts of the Written Assessment. If a Student fails both their first and second examination attempts, they will have exhausted all examination attempts allowed by PAEA.

Content
  1. Students are provided with the Written End of Curriculum Examination Blueprint and Written End of Curriculum Examination Content Area List to assist them in their preparation for the examination.
  2. The examination assesses Students in Clinical Vignette Format to assess critical thinking and problem-solving abilities.
Grading Threshold
  1. The Written Examination utilizes scaled scores that have been mathematically transformed from one set of numbers (i.e. raw score) to another set of numbers (i.e. scaled score). This scaling method has been set by PAEA.
  2. The scale for the Written Examination is 1200-1800 (i.e., 1200 = lowest possible score, 1800 = highest possible score).
  3. The passing threshold set by the Program for the Written Examination is 1470.
Remediation
Failure of First Attempt

If a Student fails their first attempt of the Written Examination by not achieving the minimum score of 1470 OR has a score of a “zero” recorded due to Excessive Tardiness or Unapproved Absence:

  1. The Student will be referred to the Student Progress Committee.
  2. The Student will be placed on Academic Probation.
  3. The Student will be required to meet with the DCE and their academic advisor within five (5) business days of the examination to discuss performance, remediation assignments, and improvement strategies.
  4. The DCE will, in conjunction with the Student Progress Committee, establish a date for the Student to complete any remediation assignments, including any Individualized Learning Plans (ILPs) developed. Timing of retesting, in alignment with PAEA policy and based on the Student’s remediation needs, will be determined.
    1. Per PAEA policy, Students must retake the examination no sooner than sixty (60) days from the date of the initial attempt.
  5. The Student’s ability to retest will be contingent upon their successful completion of all remediation assignments and continued adherence to all Program expectations and policies.
  6. The Student’s Program completion will be delayed.
Failure of Second Attempt

If a Student fails their second attempt of the Written Examination:

  1. The Student will be referred back to the Student Progress Committee for consideration of Program dismissal.
  2. In the event the Student is permitted to retake the Written Examination, the Student will take a Program-designed examination that is comparable in terms of scope and format to the PAEA’s EOC Written Examination.

OSCEs

Details
  1. The OSCEs are comprised of simulated patient scenarios that have been created by principal faculty, utilizing the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) standards, standards of the profession, and programmatic competencies as guidance.
  2. Instructional objectives and rubrics are published to help guide Student preparation.
  3. Each simulated patient encounter scenario has a designated time limit for each component. All Students must complete each component within the allotted amount of time, outside of reasonable accommodations. Grading will cease at the time limit for each component.
    1. Any accommodations must be established with the University Compliance Office in advance of an examination. Accommodations cannot be applied retroactively.
  4. The components of the simulated patient encounters include:
    1. Timed preparation for the encounter;
    2. Timed performance of the encounter, which may include (but is not limited to) obtaining a history, performing a physical examination, administration of diagnostic testing, interpretation of diagnostic testing, performing technical skills, patient education, and/or counseling;
    3. Timed preparation of an oral presentation;
    4. Timed delivery of oral presentation to a faculty member; and
    5. Timed and proctored written documentation.
  5. The evidence-based medicine component may be part of the above simulation patient encounter or may be a written, proctored assignment.
Grading Threshold
  1. Students must achieve a minimum score of 70% on each OSCE simulated patient encounter scenario and the evidence-based medicine component.
  2. Each OSCE encounter grade will be calculated using the following weighted scoring from each component of the encounter:
    1. Standardized patient encounter (including performing technical skills, as appropriate): 50%
    2. Oral presentation: 25%
    3. Written documentation: 25%
Remediation
Failure of First Attempt

In the event a Student fails the initial attempt by not achieving the minimum score of 70% on one or more of the OSCEs OR has a score of a “zero” recorded due to Excessive Tardiness or Unapproved Absence:

  1. The Student will be referred to the Student Progress Committee.
  2. The Student will be placed on Academic Probation.
  3. The Student will be required to meet with the DCE and their academic advisor within five business days of the examination to discuss performance, Remediation assignments, and improvement strategies.
  4. The DCE will, in conjunction with the Student Progress Committee, establish a date for the Student to complete any Remediation assignments, including any Individualized Learning Plans (ILPs) developed. Timing of retesting will be determined based on the Student’s Remediation needs and logistics required to conduct another simulated patient encounter.
  5. The Student’s ability to retest will be contingent upon successful completion of all Remediation assignments and continued adherence to all Program expectations and policies.
  6. The Student’s Program completion may be delayed.
Failure of Second Attempt

If a Student fails the second attempt of the an OSCE:

  1. The Student will be referred back to the Student Progress Committee for consideration of Program dismissal.
  2. An OSCE encounter may not be remediated or retested more than two (2) times.
    1. Should a Student decelerate and repeat the course, the Student is offered the same number of testing, remediation, and retesting opportunities as the rest of the cohort they are Decelerating into.

Evidence-Based Medicine Assessment

The EOC Evidence-Based Medicine Assessment is a proctored assessment of application of evidence-based medicine. This assessment is embedded in PASC 822 Clinical Seminar III and is a must-pass element of the course.

Evidence-Based Medicine Assessment Remediation
Failure of First Attempt

In the event a Student fails the initial attempt by not achieving the minimum score of 70% on the Evidence-Based Medicine Assessment OR has a score of a “zero” recorded due to excessive tardiness or unapproved absence:

  1. The Student will be referred to the Student Progress Committee.
  2. The Student will be placed on Academic Probation.
  3. The Student will be required to meet with the DCE and their academic advisor within five business days of the examination to discuss performance, remediation assignments, and improvement strategies.
  4. The DCE will, in conjunction with the Student Progress Committee, establish a date for the Student to complete any remediation assignments, including any Individualized Learning Plans (ILPs) developed. Timing of retesting will be determined based on the Student’s remediation needs and logistics required to conduct another simulated patient encounter.
  5. The Student’s ability to retest will be contingent upon successful completion of all Remediation assignments and continued adherence to all Program expectations and policies.
  6. The Student’s Program completion may be delayed.
Failure of Second Attempt

In the event a Student fails the second attempt of the Evidence-Based Medicine Assessment:

  1. The Student will be referred back to the Student Progress Committee for consideration of Program dismissal. As noted in the Student Progress Committee policy, the committee will review the Student’s entire academic record to inform its decision.
  2. The Evidence-Based Medicine Assessment may not be remediated or retested more than twice.
    1. Should a Student decelerate and repeat the course, the Student is offered the same number of testing, remediation, and retesting opportunities as the rest of the cohort they are decelerating into.

Definitions 

Academic Probation – A formal status assigned to a Student who fails to meet the Program’s defined academic standards. While on Academic Probation, Students remain enrolled in the Program but are subject to additional oversight and support measures, which may include mandatory meetings with faculty, completion of remediation assignments, and adherence to learning contracts. Academic Probation serves as an opportunity for the Student to improve academic performance and return to good academic standing; however, continued deficiencies in academic performance or nonadherence to policies and academic standards may result in further actions by the Student Progress Committee, including Deceleration or dismissal from the Program.

Approved Absence: A Student’s absence from an examination for which the Student received prior approval from the Program’s Director of Clinical Education (DCE).

Clinical Skills: Skills used to make patient care decisions. Examples of Clinical Skills include, but are not limited to, history taking, performing physical exams, patient counseling, diagnostic reasoning, diagnostic studies interpretation, effective communication, teamwork, and professionalism.

Clinical Phase: The second phase of the Program’s curriculum following a Student’s successful completion of the Preclinical Phase. The Clinical Phase consists of three semesters focused on supervised clinical rotations in a variety of healthcare settings and emphasizes the application of the medical knowledge, patient care, professionalism and cultural humility, interpersonal and communication skills, systems-based practice, and self-assessment skills acquired during the Preclinical Phase with the overall goal of preparing Students for entry into the PA profession.

Clinical Vignette Format (in the context of a multiple-choice exam): Patient-related cases and scenarios that are often used to describe a problem in a multiple-choice examination.

Competencies: The medical knowledge, interpersonal, Clinical and Technical skills, professional behaviors, and clinical reasoning and problem-solving abilities required for PA practice.

EOC OCSEs: A series of examinations that consist of simulated patient encounters, designed to assess a Student’s mastery of the Program’s Competencies.  The EOC OCSEs are embedded within the PASC 822 Clinical Seminar III course.

EOC Written Examination: a multiple-choice examination created by the Physician Assistant Education Association (PAEA) (see PAEA End of Curriculum Examination) designed to evaluate PA students’ medical knowledge. Per PAEA policy, the EOC Written Examination must be: (i) administered within the final four months of the Program; and (ii) proctored live and in-person.

Excessive Tardiness: Occurrence of a Student being more than fifteen (15) minutes late for an examination. A Student who is excessively tardy for an examination will not be permitted to sit for that examination and, as a result, will receive a score of “zero” on the examination. 

Individualized Learning Plan (ILP): A structured document provided to Students who do not meet the passing threshold of the Preclinical Summative Assessment (Written and/or OSCEs). The ILP addresses academic deficiencies and supports student improvement through four core components: Review, Reflect, Relearn, and Retest.

Objective Structured Clinical Examination (OSCE): A standardized assessment tool used to evaluate a Student’s Clinical and/or Technical skills in a simulated environment.

Preclinical Phase: The first year of the Program’s curriculum encompassing both didactic and experiential learning. The Preclinical Phase consists of three semesters designed to provide foundational medical knowledge, patient care, professionalism and cultural humility, interpersonal and communication skills, systems-based practice, and self-assessment skills that prepare Students for the Clinical Phase of the curriculum.

Remediation: The Program-defined process for addressing deficiencies in a Student’s knowledge and skills, such that the correction of these deficiencies is measurable and can be documented.

Supervised Clinical Practice Experience (SCPE): Supervised encounters with patients, either in-person or by telemedicine, that include comprehensive patient assessment, involvement in patient care decision-making, and result in a detailed plan for patient management.

Summative Evaluation: An assessment of the learner that is conducted by the Program to ensure that the learner has met the Program’s competencies for the medical knowledge, interpersonal, clinical and technical skills, professional behaviors, and clinical reasoning and problem-solving abilities required for entry into the profession. This evaluation consists of more than a listing and review of Student outcomes otherwise obtained in the course of the Program.

Technical Skills: Procedural skills. Examples of Technical Skills include, but are not limited to, performing diagnostic studies, intravenous line insertion, surgical scrubbing, cast application, and suturing.

Unapproved Absence: A Student’s absence from an examination for which the Student did not receive prior approval from the DCE. A Student with an Unapproved Absence for an examination will receive a score of “zero” on that examination.

Related Requirements

External Regulations

Unit Policies, Standards, and Procedures

Contact Information

Any reader of this Policy needs to be able to contact someone with questions about this Policy or to provide feedback. The Policy can name:

  • A particular individual (i.e. John Doe),
  • A specific title (i.e. Associate Director of Ethics and Policy), and/or
  • A general contact (i.e. policy@unc.edu).

That person will be the point of contact for all questions relating to the Policy in general.

If there are individuals/groups that have particularized knowledge of subsections of this Policy, those people/groups may be listed under “Other Contacts” to provide additional information to the reader.

Primary Contact

Name:

Telephone:

Email:

Other Contacts (if applicable)

Subject:

Name:

Telephone:

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Publication Details

  • Who is the “Issuing Officer”? ___________
    This is the person with the authority to issue this Policy on behalf of the University –  they must be a Dean/Vice Chancellor/Unit Head or that person’s designee.
     
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    This is when the Policy goes into effect.
     
  • What is the “Next Review Date”? ___________
    The Policy should be reviewed on a regular basis to make sure all content, links, etc. stay up-to-date. The default interval for review is one (1) calendar year but you may choose a date three (3) calendar years away for items that are less risky and/or less likely to change over time (for example, policies that rely on external regulations). You may also choose a date that fits best with your Unit’s annual schedule.
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