Clinical Clerkship Educational Guidelines
Clinical Clerkship Programs at MSUCOM Base Hospitals Management Of The Training Program
The Clinical Clerkship Program is the culminating phase of the MSUCOM program. As such, it must be designed and administered so as to be consistent with the goals of the College. It is essential that the collective faculty of the College, those on campus and those in the community, have a common understanding of the total curriculum and the role the Clinical Clerkship Program plays in developing the professional competence of MSUCOM students. Coordination and communication are critical elements of successful management of the educational program.
A. Program Administration
The Clinical Clerkship Program (including both C3 and R2 portions) is administered by the clinical departments in conjunction with Academic Programs and Student Services. Academic administration of the program is delegated to the Office of Academic Programs and the Director of Medical Education (DME) at the clinical training centers. The Clinical Clerkship program process and student database is managed by the Office of Student Services.
The hospital based portion of the Clinical Clerkship Program is cooperatively designed and managed by the College and the clinical training center. The on-site manager/coordinator of the total educational program is the Director of Medical Education (DME). The DME establishes guidelines for maintaining quality assurance of service training programs, coordinates students' schedules, maintains student training records, manages hospital educational programs, and serves as training center liaison to College administrators in the matters of program development, management and student evaluation and remediation. The on-site student clinical training within the core services (General Internal Medicine, Family Medicine, Pediatrics, Obstetrics & Gynecology, Neurology, Psychiatry, General Surgery, Anesthesiology, Radiology, and Emergency Medicine) is coordinated by staff physicians designated by the DME. These training coordinators manage the clinical clerkship training plan, make student/supervisor assignments, monitor the students' professional development, and work together with their teaching faculty and on-campus counterparts to evaluate and revise the training plan.
In some instances, Psychiatry and Neurology are coordinated through the MSU Departments of Psychiatry and Neurology (respectively) and are under the supervision of department-designated community-based trainers.
Each clinical clerkship rotation is intended to enhance the student's professional competence. Each service's clinical training plan must include teaching/learning activities specifically directed toward developing the seven AOA approved core clinical competencies: Osteopathic Philosophy and Osteopathic Manipulative Medicine, Medical Knowledge, Patient Care, Interpersonal and Communication Skills, Professionalism, Practice-Based Learning and Improvement and System-Based Practice. Assigned readings, student presentations, morning report or grand rounds, staff review of students' history and physical examinations and progress notes, student presentations of consults, and attendance at hospital-sponsored lectures/seminars are considered essential elements of a quality clinical clerkship training program.
The specific objectives, as delineated by the respective clinical department faculty and described in the clinical rotation protocols, should be reviewed by the student together with the clinical supervisor(s). Student responsibilities with regard to patient care, lecture attendance, presentations, readings, examinations, etc., and the specific criteria by which the student's performance will be assessed must be fully understood by the student at the beginning of the clerkship rotation. Continuous assessment of the student's performance and timely feedback to the student are essential elements of an effective training plan. Minimally, the evaluation plan should include:
- The student's routine performance of clinical tasks (patient work-ups, consults, presentations, etc.) should be continuously evaluated and immediate oral feedback be given by clinical supervisors, i.e., staff physicians, residents, interns, and other health professionals.
- The student's overall performance vis-a-vis the stated objectives must be formally evaluated, using evaluation forms provided by the College, discussed with the student, signed by the clinical supervisor, student, and DME and forwarded to the College.
Training Center Educational Programs And Facilities
The Clinical Clerkship Program is viewed as an integral part of the training center's overall clinical education and continuing medical education programs. Therefore, it is presumed that students will participate in existing training programs, including lecture series, special conferences and seminars, service journal clubs, grand rounds, morning report, etc. In fact, it is presumed that the students' participation in these programs will be a part of the training plan for each clinical rotation and their participation will be properly monitored and evaluated.
To ensure a quality Clinical Clerkship Program, the College requests that the clinical training center:
- Prepare a weekly or monthly list of all educational programs (lectures, conferences, seminars, television tapes, movies, etc.) being conducted at the hospital.
- Provide regularly scheduled morning report, grand rounds, conferences, seminars and/or lectures in all major medical disciplines and require students' participation in these programs.
- With the on-campus faculty, cooperatively develop and present specific classes and conferences for students and/or trainers.
- Encourage students to keep up with the agreed upon set of directed readings for each rotation through questioning and/or review of the material in the context of patient care.
- Ensure that students have access to library facilities and other learning resources in the same manner as other hospital personnel and that utilization of those resources is provided or in the service training plan.
- With the on-campus faculty and administration, cooperatively evaluate the educational programs to ensure their relevance and effectiveness for students.
- Provide regular feedback to the College regarding students' preparation for the clinical training program.
- Implement and maintain a system for review of students' history and physicals, consultations, and progress notes. Regularly provide feedback to students on their development regarding these components of the training program.
- Conduct regular administrative meetings with students to discuss in-house problems, controversial issues in medicine, etc.
Student Orientation And Responsibility
The essential feature of the Clinical Clerkship Program is the student's participation as an active member of the patient care team on the clinical rotation to which s/he is assigned. It is recognized, however, that typical MSUCOM students entering the Clinical Clerkship Program have had very limited exposure to the clinical environment, particularly in the institutional setting. The role of the student in patient care must be explicitly defined and explained to the student. The student is directly responsible to the clinical supervisor for his/her patient care performance and to the DME for following training center policies and fulfilling general trainee obligations.
The student will be oriented to his/her roles and responsibilities through:
- on campus Clinical Clerkship Program Orientation during semester 6 and 7 of the Preclerkship Program
- general policy statements published in College documents
- a formal orientation to the training center by the DME
- training center and/or service written guidelines
- on-service orientation by the training coordinator
Implementation Of The Program
The Office of Academic Programs will coordinate student scheduling with the DME and distribute final schedules for each student.
The clerkship rotation week is Monday through Sunday. Duty hours for each rotation and assignment of students on weekends and holidays during a scheduled clinical rotation are determined by the hospital's Medical Education Office. It is recommended (though not required) that students be assigned to duty hours ranging from 40-60 hours weekly and not exceeding 60 hours weekly. Night duty may be a component of rotations.
The DME will review and sign evaluation forms submitted and signed by clinical supervisors and students, then forward the forms to the Office of Student Services. The MSUCOM Office of the Registrar within the Office of Student Services will log receipt of the forms and forward them to the sponsoring department for appropriate administrative action. Students have continual access to the status of rotation evaluation forms submitted to the MSUCOM Office of the Registrar by noting a completion date posted to their "on-line" schedule.
The MSUCOM Office of the Registrar within the Office of Student Services maintains the master schedule for all students in the Clinical Clerkship Program. Questions regarding location of students and notice of changes in student rotation schedules should be referred to this office. Student training problems should be directed first to the DME, who in turn may consult with College administrators as s/he deems appropriate. Student absences of more than 3 consecutive days, illness or injury, etc., should be promptly reported to the Office of Student Services, which will notify appropriate College administrators. Serious problems of a student's professional behavior should be referred directly to the Clerkship Curriculum Director of Academic Programs and Associate Dean of Student Services.