Narrative Assessments for Courses and Clerkships

Authorizing Body:               Curriculum Committee

Author:                                 Office of Medical Education

Date Issued:                         July 15, 2019

Last Update:                         July 30, 2020


To ensure that a narrative description of a medical student’s performance, including their non-cognitive achievement, is included as a component of the assessment in each required course and clerkship of the medical education program whenever teacher-student interaction permits this form of assessment.

Scope and Applicability:

All courses and clerkships within the School of Medicine’s M.D. Curriculum, in which there is sufficient teacher-student interaction to permit this form of assessment. Sufficient teacher-student interaction is that which allows for direct observation of individual student behaviors across one or more of the non-cognitive competency domains.

Standard Guidelines:

  1. In all courses or clerkships in which the teacher-student interaction permits the teachers or instructors to provide descriptive information about a student’s performance, a narrative assessment must be included as part of the formative or summative assessments.
    1. Assessments based on individual observations of student behaviors should contain a narrative component; these could include peer assessments, faculty assessments, clinical performance assessments, and objective structured clinical exams.
    2. Where possible, course and clerkship directors should identify opportunities through which students could be assessed and receive feedback in all competency domains of the clerkship/course.
  2. A narrative description may constitute a summative portion of the grade in the form of a grade paragraph of the course or clerkship, and thereby become a permanent part of the student record.
    1. Clerkships or courses, in which a portion of student learning is in the non-knowledge domains, should consider using summative, narrative assessment, i.e. grade paragraphs, to capture student performance in those non-cognitive domains.
    2. For each semester of the curriculum, the Curriculum Committee should identify a minimum number of courses or clerkships which will include summative, narrative assessments that become a permanent part of the student record. Each semester must have at least one course or clerkship that provides students with summative narrative paragraph, ideally at least three.
      1. For M1 and M2, in courses where possible grade paragraphs will be documented.
      2. For M3 and M4, all required clerkships will document grade paragraphs. 
  3. Alternatively, the narrative description may be used to fulfill a formative purpose, guiding learning and used for feedback.


The term “non-cognitive” is defined as those competency domains essential for physicians that are outside of the knowledge domain, specifically interpersonal and communication skills, patient care skills, practice-based learning and improvement, systems-based practice, interprofessional collaboration, professionalism, and personal and professional development.