Taking an Assessment in ASCEND Phase 2

During ASCEND Phase 2, assessment is based on workplace-based, longitudinal evaluation of clinical performance, supplemented by standardized written examinations. Assessments are designed to determine whether students demonstrate progressive readiness for entrustment across core functional domains, including knowledge application, clinical reasoning, communication, professionalism, and procedural skills.

Phase 2 assessment is intentionally multi-modal and longitudinal. No single assessment, observation, or examination is intended to independently determine clerkship performance. Final clerkship outcomes reflect aggregate performance across required assessment components.

Assessment formats, requirements, timing, and weighting are determined by each clerkship in accordance with institutional policy. Clerkship-specific requirements, deadlines, and grading criteria are published in the Clerkship Information Sheet (CIS), MedInfo, and clerkship Blackboard site. Students are responsible for reviewing and adhering to these materials.

Passing Assessments and Clerkships

• Passing standards for Phase 2 assessments are established at the clerkship level and aligned with institutional grading and promotion policies.

• To pass a clerkship, students must satisfactorily complete all required assessment components and meet the clerkship's minimum performance standards.

• CIS specify required assessments, grading weights, and consequences of non-completion or unsatisfactory performance.

• Failure to complete required assessments, regardless of performance in other areas, may result in a failing clerkship grade.

• Clerkship directors retain final authority over clerkship grades in accordance with institutional policy.

Assessment Methods

Assessment methods may vary by clerkship but align with the functional domains outlined below. More specific information regarding assessment administration is in the Medinfo app.

Functional Domain	Assessment Methods	Operational Description
Asynchronous, Online, Written (Formative / Low-Stakes)	AMBOSS quizzes (non-timed) Clerkship and PEAKS 2 - Written case presentation	Online, written submissions are completed independently. Asynchronous and self-paced. Deadlines may apply, but no fixed testing time.
Synchronous, In-Person, Oral Presentation	Clerkship and PEAKS 2 - Oral case presentation	In-person verbal presentation to faculty or clinical team. Fixed time expectations. No written component at the time of delivery.
Workplace-Based, Direct Observation (Psychomotor + Oral)	Direct Observation of Clinical Skills – Workplace or skills card	In-person, real-time observation during patient care or structured encounters. Oral communication and physical exam skills are assessed. Timing is governed by clinical workflows.
Structured Clinical Skills Assessment (Simulation Center)	Clerkship and PEAKS 2 - Direct Observation of Clinical Skills – Morchand	In-person at clinical skills center. Fixed-length stations. Oral and psychomotor tasks. Highly structured, scheduled encounters.
Standardized, Timed, Written Exams (Externally Governed)	NBME Clinical Science Subject Exam (“Shelf”)  NBME Customized Exam (CAS Exam)  PEAKS 2 - NBME CCSE	Online, remotely proctored, multiple-choice exams. Fixed time limits. Accommodation parameters governed by NBME policies.
Standardized, Timed, Written Exams (Institutionally Governed - Blackboard)	“Homegrown” MCQ exam (Blackboard – Palliative Care)	Online, written, timed exam administered via Blackboard. Time accommodations and breaks determined institutionally.
Longitudinal, Indirect Performance Assessment	Clinical performance evaluation	Ongoing faculty assessment across the rotation. No discrete task, modality, or timing. Reflects cumulative performance rather than a single event.

Asynchronous, Online, Written Assessments

AMBOSS Quizzes

AMBOSS quizzes may be used by clerkships as formative or low-stakes assessments to support knowledge acquisition and clinical reasoning.

• Quizzes are completed independently and asynchronously.

• Deadlines are set by the clerkship and must be met.

• Absence from clinical duties does not exempt a student from completing assigned quizzes unless explicitly approved by the clerkship.

• Students with approved extended-time accommodations must access quizzes directly through AMBOSS: https://www.amboss.com/us) and will see the quiz assigned to them. This quiz will have the appropriate time setting.

• Failure to follow accommodation procedures does not constitute grounds for quiz retakes.

Written Case Presentations

Written case presentations assess clinical reasoning, organization, and documentation skills.

• Submissions must follow clerkship-specified format, platform, and deadlines.

• Late or missing submissions are subject to grading penalties or failure, as defined by the clerkship.

• Technical difficulties do not excuse late submission unless documented and reported according to clerkship policy.

Synchronous, In-person, Oral Assessments

Oral Case Presentations

Oral case presentations are required clinical assessments.

• Students are expected to be prepared to present when requested.

• Format, timing, and evaluation criteria are determined by the clerkship.

• Failure to complete required oral presentations may negatively impact clinical performance evaluations.

• Requests for alternate presentation opportunities are granted at the discretion of the clerkship and are not guaranteed

Direct Observation Assessments

Workplace-Based Direct Observation of Clinical Skills

Workplace-Based Direct Observations (DOs) are required components of Phase 2 assessment and evaluate performance in authentic clinical settings.

• Observations occur during routine clinical activities or structured encounters.

• Timing is governed by clinical workflows and clerkship expectations, not fixed testing windows.

• Clerkships define the required number and type of observations.

• Students are responsible for initiating, scheduling, and completing required observations within the clerkship timeframe.

• Failure to complete required observations may result in an incomplete or failing clerkship grade, regardless of performance on other assessments.

Structured Clinical Skills Direct Observation (Simulation Center/Morchand Center)

Simulation or Standardized Patient–Based Direct Observations evaluate clinical skills in structured, standardized environments. These assessments may include standardized patient encounters, procedural simulations, or structured clinical skill stations.

• Conducted at The Morchand Center for Clinical Competence in Annenberg 13th Floor.

• Fixed-length stations with standardized scoring tools and trained evaluators and occur at scheduled dates and times.

• These assessment days are designated restricted days.

• Planned absences are not permitted except for approved major religious holidays.

• Emergencies must be reported prior to the scheduled start time.

• Approved make-up assessments are scheduled at institutional discretion.

• Students are responsible for adjusting their schedules to attend assigned make-up dates. Inability to attend an assigned make-up does not entitle the student to an additional opportunity.

• Failure to attend or complete required simulation-based observations may result in a zero or failure of the assessment and may result in clerkship failure.

Workplace-Based DOs and Simulation-Based DOs are distinct assessment modalities. Completion of one type does not satisfy requirements for the other unless explicitly stated in clerkship materials.

All required Direct Observations must be completed in accordance with clerkship expectations to receive a passing grade.

Standardized, Timed, Written Exams

NBME Clinical Science Subject Exams (“Shelf Exams”)

All ASCEND clerkships include an end-of-clerkship summative examination administered by the National Board of Medical Examiners (NBME). These examinations assess discipline-specific clinical knowledge using standardized multiple-choice questions.

• Online, remotely proctored examinations

• Fixed time limits governed by NBME policy

• Administered in accordance with NBME security standards

• Required component of the clerkship grade

Exam Administration

Scheduled Exam Times

• Students must report to their assigned Zoom proctoring room by 8:45 AM on the scheduled exam date, as listed on the Google Calendar and Academic Calendar.

• Exams begin at 9:00 AM sharp.

• Students who arrive after 9:00 AM will not be permitted to sit for the exam.

• Published end times are approximate and assume an on-time start under standard testing conditions.

• NBME technical issues, internet connectivity problems, personal laptop issues, or weather-related disruptions may delay exam completion.

• The school does not guarantee examination end times and will not reimburse or reschedule students who miss travel arrangements due to delayed completion.

Preparation for Exam

• NBME laptop pre-certification is required to identify potential software conflicts.

• Students are strongly encouraged to re-certify their devices prior to each exam.

• Certification instructions are available at: https://wbt.nbme.org/wbtexam/home

• Students with approved accommodations involving adaptive software (e.g., screen readers) must test this software in advance.

• Failure to complete required pre-certification does not constitute grounds for rescheduling.

One week Prior to Exam

• Students will receive a Clerkship Blackboard announcement from the Office of Curricular Affairs detailing exam logistics and instructions.

• Students with approved accommodations will receive separate communication regarding accommodation logistics.

• Students are responsible for reviewing all pre-exam communications.

Exam Day

• NBME Shelf Exam days are designated restricted absence days.

• Planned absences are not permitted except for approved major religious holidays.

• Unplanned absences due to emergency must be reported prior to the scheduled start time.

• Approved make-up examinations are scheduled on designated dates listed on the Academic Calendar.

• Students are responsible for attending assigned make-up dates.

• Students must comply with all NBME Rules and Conduct: https://www.nbme.org/common-questions/exam-rules-and-conduct

• Technical issues during the exam will be managed by the proctor in accordance with NBME procedures.

Borrowing a Laptop

• A limited number of backup laptops are available for exam use.

• Students who require a laptop may proceed to the laptop storage bin located outside the CA Operations Team Office in Annenberg 13-40, where available laptops may be checked out and must be returned immediately following the examination.

• Laptops are distributed on a first-come, first-served basis.

Clerkship-Specific Blackboard Exams

Some clerkships administer institutionally developed exams.

• Exam format, timing, proctoring, and make-up policies are determined by the clerkship.

• Students are bound by clerkship-specific exam instructions.

• Failure to comply with exam requirements may result in a zero.

Longitudinal Performance Assessment

Clinical Performance Evaluations

Clinical performance evaluations reflect aggregate professional and clinical performance across the clerkship.

• Based on multiple observations by faculty and residents.

• Not determined by a single encounter or evaluator.

• Professionalism concerns may independently affect clerkship outcomes.

• Narrative and numerical evaluations are interpreted collectively by the clerkship leadership.

Clerkship directors retain final authority in synthesizing performance data.

Postponing or Rescheduling Phase 2 Assessments

Planned Absences

• Assessment days are restricted.

• Religious holiday exceptions require at least 30 days’ advance approval.

• Approved absences require completion on assigned make-up dates.

Unplanned Absences

• Emergencies must be reported before the assessment start time.

• Documentation may be required.

• Make-ups are granted at institutional discretion.

Unexcused Absences

• Unexcused absences result in a zero and may result in clerkship failure.

• Appeals based on misunderstanding of policy are not grounds for reversal.

Students with Testing Accommodations

Testing accommodations are approved through the Office of Student Disability Services.

• Students should request accommodations as early as possible to allow adequate time for implementation.

• Accommodations are not retroactive.

• Accommodations are implemented by the Clinical Curriculum Team in the Office of Curricular Affairs and/or clerkship-specific coordinators.

• Students who experience an accommodation-related issue during an assessment must contact [e-mail] immediately.

Students should be aware that certain accommodations (e.g., extended time, separate location, alternate testing devices) may be visible to others during exam administration.

• Students may elect to opt out of approved accommodations by emailing the Director of Disability Services at least two weeks prior to the scheduled assessment.

• For additional information, visit: https://icahn.mssm.edu/education/students/disability

Assessment-Specific Implementation

AMBOSS Quizzes

• Students complete AMBOSS quizzes independently within the designated timeframe.

• The Office of Curricular Affairs cannot access or modify individual AMBOSS accounts.

• Only students with approved accommodations may adjust quiz timing in accordance with their approved accommodation.

Proctored NBME Shelf Exams

• The Clinical Curriculum Team receives approved accommodation information directly from Student Disability Services.

• Approved accommodations are implemented in accordance with NBME policies.

• Students will receive email communication detailing accommodation logistics (e.g., testing room, timing adjustments).