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Cornell University

Clinical Curriculum Redesign

One resource for the CUCVM Community

Frequently Asked Questions

Entrustment Scale

Why was the word “Unsafe/Inappropriate” chosen? Compared to the other entrustment scale values, “Unsafe/Inappropriate” possesses a more negative connotation that is off putting.

While “Emerging, Advancing, Competent, and Proficient” were specifically chosen because of their positive connotation as it relates to growth, we still operate in an environment where the health, safety, and life of our patients falls within our hands. Therefore, while we recognize that students will fall at varying levels on the positive scale of growth, there exists a level where an individual poses risk to the patient due to an attribute incompetency. “Unsafe/Inappropriate” was therefore chosen to represent this group, as it is our universities duty to ensure we graduate safe veterinarians.

Why was a “Proficient” level provided if the majority of students will not reach this entrustment scale level? It does not seem fair to have a level that is unachievable for many students.

While the primary goal is achieving “competency” at graduation within all attributes, our students’ growth does not end at graduation. A successful career in veterinary medicine will require lifelong learning and development, and using “proficiency” ensures an understanding that these levels exist. Uncommonly, we expect students to be able to demonstrate proficiency in some attributes (such as professionalism and collaboration/teamwork/interpersonal skills).

Universal Assessment Framework

How is this different from the grading we previously performed?

Within the Universal Assessment Framework, we have significantly improved the distribution of scores across the five entrustment level scales. This distribution allows meaningful growth to be tracked throughout the clinical year, which was impossible with the previous heavily rightward-shifted grade curve. In addition, students receive feedback about areas where they can continue to grow.

How is a grade of satisfactory versus unsatisfactory determined?

Each component of the Entrustment Scale is assigned a numerical score.

  • Unsafe/Inappropriate = 1
  • Emerging = 2
  • Advancing = 3
  • Competent = 4
  • Proficient = 5

On each rotation, the attribute scores are totaled and then averaged by the total number of attributes evaluated. A satisfactory score is ≥2.25 whereas an unsatisfactory score is <2.25.

For example, student A rotates through the Ophthalmology Service and receives the following scores:

  • Medical Knowledge: Emerging
  • Clinical Reasoning/Decision Making: Emerging
  • Professionalism: Competent
  • Collaboration/Teamwork/Interpersonal Skills: Competent
  • Oral Client Communication: Advancing
  • Service Specific: Emerging

Student A’s overall numerical score would be 2.83 [ (2 + 2 + 4 + 4 + 3 + 2)/6 =2.83 ] when evaluating all six attributes. Given that 2.83 ≥2.25, the final rotation grade assigned would be satisfactory.