CLINICAL EXPERIENCE SHEET (CES) AND NEW END-OFROTATION ASSESSMENT (EORA)

(Updated on 9 July 2014)

What is CES?
Clinical experience sheet (CES) is a record of an individual students learning
activities of a two-week rotation. CES clearly defines what are required for
student during this week as stated in the rotation programme (e.g. attendance of
ward rounds, certain clinics, observing certain procedures, studying of key diseases)
and is rotation-specific. Generally, it consists of two categories of records:
compulsory activities that require signing off by doctors and desirable
activities that student self-ticks to guide own learning.

What is the new EORA?

The new End-of-Rotation Assessment (EORA) is conducted at end of the two-week
rotation (except for Endocrine/Nephrology Rotation), usually at a Friday morning. It
is a Long Case Assessment based on one (or two) randomly selected
patient(s) from the patient pool allocated to the individual student to look
after during the whole two weeks. The individual student is evaluated by the
teacher (preferably the same specialist who looks after the same patients) as a
typical Long Case Assessment whereby the students ability to take history, conduct
physical examination and interpret signs, order appropriate investigations and
interpret them, formulate diagnoses/problem lists and manage treatment (including
progress in hospital) are evaluated. The EORA tests whether the student to have
studied, understood and assisted in managing his or her own allocated patients
during the rotation. It is an open-book assessment where individual student
should know the case well and is able to present to the teacher the appropriate
diagnoses and management. The EORA also provides opportunity to assess
students professional behaviors/interactions with patients over time. Finally,
the EORA also seeks to teach and thus is conducted with other students as in a
teaching ward round.

Rationale for CES and EORA:

It is noted that our students do not spend enough time in wards to follow up
patients that they have clerked or to study the course of disease in patients as a
necessary means to study well medicine. Many provisional diagnoses may be
1

changed or affirmed following investigations or new development of symptoms and

signs. Furthermore, many students come for only formal bedside or clinic teaching
and disappear quickly into library or elsewhere. They do not join ward rounds
despite repeated emphasis of its importance. Many seem to do minimum to study
cases despite witnessing a wealth of clinical materials in wards and clinics. EORA
based on own allocated patients forces the individual students to clerk and manage
a small number of patients over a period of time and seek to address these student
problem of frequent absentees in wards and clinics. CES provides a clear record of
what the students have been doing in the rotation and especially if a student has
fallen short in meeting the required learning objectives.

Implementation of CES:
Each student carries his or her own sheet
The student gets signature of doctors for signing off on the compulsory items
(marked in BOLD) on the appropriate day (Day 1 to 10 according to 5 working days
in a week). These generally are:
1) Specialist ward rounds
2) Attendance of specialty clinics/formal bedside teachings
3) Observation or assisting of important procedures/investigations
The student ticks off desirable items that guide own learning. They include:
1) Key medical conditions to clerk and study
2) Review of own allocated patients
3) Uploading case write-up
The CES is reviewed by PMC teachers at end of 6-week rotation during portfolio
review.
Failure to achieve adequate number of key learning activities will lead to barring of
the students from subsequent examinations or progression.

Implementation of EORA:
Towards the end of rotation (usually the Friday morning)
Conduct as a small group of 3-4 students as in a teaching ward round
To randomly select one patient from the students allocated patient pool to conduct
EORA (Teacher can decide to do more than one patient to assess the student if
judge necessary)

To spend no more than 20 minutes for each student in his or her EORA
To score fail to meet expectations, meet expectations or exceed in expectations
in each of the seven skill domains and give feedbacks on each where necessary:
1.
2.
3.
4.
5.
6.
7.

Knowledge base
History
Examination
Formulation diagnosis/clinical reasoning
Investigations
Management (include progress to date)
Professionalism (include communication)

To let other students listen in, learn and interact where appropriate
The student hand in their EORA form to Nancy at end of each rotation (except for
Endocrine/Nephrology where there is no EORA)
The EORA performance will translate into a certain numerical marks in Continuous
Assessment (20% of total final marks).