# Endocrinology Clinical Skills Assessment Program: A Structured Clinical Assessment Program to Enhance Clinical Reasoning in Subspecialty Training

## TL;DR

A new program called ECSAP helps train endocrinology fellows by using case-based assessments and real-time feedback to improve their clinical reasoning and skills.

## Contribution

ECSAP introduces a structured, case-based formative assessment model for endocrinology training with standardized evaluations and feedback.

## Key findings

- ECSAP was implemented twice with consistent results, showing its reliability and perceived value.
- 100% of fellows agreed that ECSAP improved diagnostic reasoning and identified knowledge gaps.
- Faculty reported high satisfaction, with 100% noting enhanced ability to assess clinical skills and provide feedback.

## Abstract

Introduction: The Endocrinology Clinical Skills Assessment Program (ECSAP) was developed at Wake Forest University School of Medicine to enhance history-taking, diagnostic reasoning, and personalized feedback in endocrinology fellows. Recognizing a gap in formative clinical skill evaluation, ECSAP introduces standardized case-based assessments across key endocrine topics.

Methods: ECSAP sessions occur twice yearly and include four 25-minute standardized clinical scenarios (e.g., adrenal incidentaloma, hypercalcemia). Each case is pre-assigned to faculty, who provide fellows with a one-line prompt and standardized responses. Fellows navigate history, physical exam, labs/imaging, and assessment/plan components in real time. Faculty provide structured feedback and score fellows using detailed rubrics. Evaluations from both fellows and faculty assess program effectiveness.

Results: Over one academic year, ECSAP was implemented in two separate sessions, each involving four fellows and four to six faculty members. Despite the small cohort size, the consistency of responses across both sessions reinforces the reliability and perceived value of the program. Fellow evaluations demonstrated strong endorsement, with 100% agreeing that ECSAP improved diagnostic reasoning and helped identify knowledge gaps, and an average feedback usefulness rating of 4.8 out of 5. Faculty evaluations similarly reflected high satisfaction, with 100% reporting that ECSAP enhanced their ability to assess clinical skills and provide actionable feedback, yielding an average rating of 4.7 out of 5. These reproducible, positive outcomes across repeated implementations support the feasibility and educational impact of ECSAP as a complementary structured formative assessment model.

Conclusion: ECSAP is a reproducible, low-resource, case-based formative assessment model that complements existing clinical training. Fellows benefit from real-time feedback, while faculty gain structured opportunities for formative evaluation. Future directions include integration with competency-based milestones and expansion to other subspecialties.