Required Clinical Experiences

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IUSM-PO-EDU-CUR-0012

Full Policy Contents

Scope
Policy Statement
Reason for Policy
Procedures
Definitions

ADDITIONAL DETAILS
Additional Contacts
Forms
Related Information
History

Effective: 10/28/2016
Last Updated: 3/09/2017

Responsible University Office:
Medical Student Education

Responsible University Administrator
Senior associate dean for medical student education

Policy Contact:
Chair of the Clinical Component Committee

RESPONSIBLE Clinical Component Committee leadership
ACCOUNTABLE Curriculum Council Steering Committee
SUPPORT Medical Student Education
CONSULT Phase 2 and 3 assistant deans
INFORM Clerkship directors and students

LCME Standards

6.2 Required Clinical Experiences
8.6 Monitoring of Completion of Required Clinical Experiences


Scope

Statewide clerkship/subinternship directors are expected to comply with this policy’s requirements for review and amendments. Statewide clerkship/ subinternship directors and coordinators, as well as students, are expected to comply with logging and reporting requirements. Attending faculty physicians, resident physicians, fellows, and volunteer clinical faculty are expected to be knowledgeable and mindful of these guidelines while medical students are rotating on their clinical services.


Policy Statement

All required clerkships and subinternships must define and monitor required clinical experiences and skills, as well as alternative methods for completion if required experiences cannot be met, with approval by the Clinical Component Committee. The global list of required clinical experiences and skills, as well as student achievement toward their completion, will be reviewed annually by the CCC to ensure appropriate reflection of the IUSM institutional learning objectives and adequacy of patient volume and case mix. An annual report will be provided to the CCSC. Since completion of required clinical experiences is necessary for passing each clerkship/subinternship at IUSM, clerkships/sub-internships will be responsible for ongoing monitoring and reporting. The CCC is responsible for oversight and annual global monitoring of completion across clerkships.


Reason for Policy

This policy is meant to ensure review, amendment, logging, monitoring, and oversight of required clinical skills during clerkships and subinternships at the Indiana University School of Medicine.


Approval

Approved by the Curriculum Council Steering Committee 1/12/2017.


Procedures

Expectations for required and alternative clinical experiences:

All required clerkships and subinternships must maintain and publish in their syllabuses a list of required clinical experiences that includes the following information:

  • The patient type/clinical condition and/or procedural skill.    
  • Clinical setting (ward/clinic/either).
  • Minimum level of student responsibility (observed/participated/performed).
  • Minimum number times the student is expected to complete the experience.
  • Minimum level of performance competency for completion (if relevant).
  • Type of faculty verification required (if relevant).

In addition, all required clerkships and subinternships must define and maintain a list of alternative clinical experiences for students to complete when unable to complete a required clinical experience. This occurs under the monitoring of the clerkship/ subinternship director, with approval of the CCC and CCSC.

Students at the IU School of Medicine are required to complete certain clinical experiences (or, when necessary, appropriate alternative experiences), as outlined in their clerkship and subinternship syllabuses.

Review and implementation of required clinical experiences:

Statewide clerkship directors are responsible for annually reviewing their respective list of required clinical experiences and alternatives and for recommending additions and/or deletions of experiences. The CCC is responsible for approving these required and alternative clinical experiences. The procedure governing this review is as follows for each academic year:

  • Four months before the earliest start date for clerkships: Statewide clerkship/ subinternship directors submit proposed changes to required clinical skills or report no changes to Medical Student Education to prepare for the CCC review. For example, for a June 1 start date, changes must be submitted no later than Feb. 1.
  • Three months before the start date for clerkships: The CCC reviews the complete list of required clinical experiences to ensure appropriate reflection of the IUSM institutional learning objectives and the completion rates to verify adequacy of patient volume and case mix. Report of the curricular review and final list of required clinical experiences is reported to the CCSC for final approval. For example, for a June 1 start date, the CCC would review the list of required clinical experiences at its March meeting.
  • Two months before the start date for clerkships: The approved list of required clinical experiences will be submitted to Medical Student Education Office of Curricular Affairs for entry into the program used for tracking procedures. For example, for a June 1 start date, the final list of required clinical experiences must be submitted no later than April 1.

Amendment of required clinical skills:

If changes to required clinical skills are advised, statewide clerkship directors must submit those proposed changes to the CCC via the Clerkship/Subinternship Modification Form. The CCC reviews the proposed changes in a timely manner and determines an appropriate timeline for implementation, whether for an upcoming rotation or the next academic year.

Logging completion of required clinical skills:                                   

Students must log their required clinical skills, including observed history and physical, following instructions in their clerkship syllabuses and/or handbooks. When logging required clinical experiences, a student should identify his/her level of responsibility, based on the amount of interaction with the patient, using the following definitions:

  • Performed – The student acted as an independent clinician with appropriate supervision:
    • Carried out a procedure/task that required physical skill and cognitive attention (i.e., did)
    • Put a plan into effect (i.e., executed or implemented);
    • Successfully completed the procedure/task/plan.
  •   Assisted – The student acted as a secondary clinician who:
    • Provided hands-on support to a primary clinician to carry out a procedure/task (i.e., physically aided);
    • Received assistance from a primary clinician to carry out a procedure/task;
    • Shared in the communal execution/implementation of a plan (i.e., helped);
    • Contributed to the completion of the procedure/task/plan as a team member.
  • Observed – The student acted as a bystander who:
    • Was present at an event without participating (i.e., a spectator);
    • Watched and/or listened attentively;  
    • Witnessed the completion of the procedure/task/plan without contribution

Students will be able to monitor their progress toward completion of their required clinical skills in the school’s education management system and their progress will be reviewed as part of their mid-rotation review. Following the mid-rotation review period, students continuing to have difficulty completing required experiences should contact the statewide clerkship/subinternship director for assistance.

Monitoring of completion of required clinical skills:

Statewide clerkship directors and coordinators are responsible for monitoring students’ completion of the required clinical experiences. Individual student’s progress toward completion of required clinical experiences will be included on all mid-clerkship reviews.

Clerkships will submit, on a semi-annual basis, a report of completion for each rotation, outlining the percentage completion of required clinical experiences, as well as the percentage of students who completed their clinical experiences with approved alternatives. These reports are submitted to the CCC for internal review and action as indicated, with a summary provided to the CCSC. If deficiencies in completion or overuse of alternative experiences are identified, clerkships and subinternships will be required to submit reports following completion of each rotation.

Medical Student Education uses a dashboard to track completion of required clinical skills. The dashboard is available to the clerkships/subinternships and the CCC for monitoring purposes.


Definitions

Required clinical experiences: Types of patients, clinical conditions, or procedures that students are required to complete as part of their clerkship or subinternship experience.

Alternative clinical experiences: Approved substitutions allowed when students are unable to complete required clinical experiences (e.g. online cases, simulations).


Additional Contacts

Subject Contact Phone Email
Policy; compliance W. Graham Carlos (317) 274-2042 wcarlos@iu.edu
Changes/updates Neelum Safdar (317) 274-4742 nsafdar@iu.edu
Technical assistance Joel Smith (317) 278-1762 joelsmit@iu.edu

Forms

Reporting Form for Completion of Required Clinical Experiences

Clerkship/Subinternship Modification Form


Related Information

Required Clinical Supervision Policy.


History

Approved by the Curriculum Council Steering Committee 10/28/2016.
Replaces Review, Amendment, Logging, Monitoring, and Oversight of Clinical Experiences.
Approved by the Curriculum Council Steering Committee 1/12/2017.
Procedure updated and approved by Clinical Component Committee 03/07/2017.

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