Inpatient and Outpatient Experiences in Clinical Training

Rationale

The Executive Curriculum Committee and its subcommittees is responsible for ongoing monitoring, review, and revision of all aspects of the curriculum to assure achievement of the institutional learning objectives. Undergraduate medical education should consist of a variety of inpatient and ambulatory clinical experiences that represent the continuum of care that patients experience. A variety of experiences in either the inpatient or ambulatory setting may meet the objectives of the clerkship. Brody School of Medicine at East Carolina University must ensure that students receive a well-rounded educational experience represented by a broad array of patient encounters that are representative of common medical practice. LCME element 6.4 requires a school’s faculty “ensure that the medical curriculum includes clinical experiences in both inpatient and outpatient settings.”

This policy establishes minimum standards for training in ambulatory and inpatient settings during the core clinical phase of the curriculum. It is recognized that this will need to change over time based on changing models of health care delivery. Currently, students should achieve a minimum threshold of instructional time in ambulatory care settings of 40% and inpatient settings of 40%. It is expected that some of the core clerkships will have varying amounts of ambulatory or inpatient care that are influenced by the objectives of the clerkship. It is the responsibility of the Executive Curriculum Committee to ensure that these standards are met across the clerkships and adjust the individual components based on the institutional learning objectives.

Scope

The process of determining an appropriate balance of inpatient and ambulatory clinical experiences is necessary to achieve a balanced medical education and is the responsibility of clerkship directors, the clinical curriculum committee and the executive curriculum committee to ensure that the threshold is met.

Definitions

Ambulatory clinical experiences take place in settings in which direct patient encounters occur in an outpatient setting, typically in outpatient clinic settings. Emergency Medicine encounters are designated as ambulatory clinical experiences.

Inpatient clinical experiences take place in settings in which direct patient encounters occur in an inpatient setting, typically in the hospital.

Clinical experiences in the longitudinal Radiology clerkship will not be tabulated for either ambulatory of inpatient clinical encounters since this content is integrated throughout the core clinical experiences and delivered asynchronously.

Responsibilities

The Office of Medical Education

Responsible for compiling information from clerkship directors on a yearly basis

Clerkship Directors

Responsible for recommending settings that support the delivery of the clerkship learning objectives as dictated by the institutional learning objectives.

Clinical Curriculum Committee

• Responsible for reviewing the aggregated information from clerkships to ensure that the thresholds for ambulatory and inpatient experiences are met.
• Responsible for making recommendations to ensure that institutional learning
  objectives are met through compliance with this procedure.

Executive Curriculum Committee

• Responsible for reviewing the aggregated information from the clerkships to ensure that the thresholds for ambulatory and inpatient experiences are met and compliance with the procedure.
• Responsible for overseeing the balance of ambulatory and inpatient clinical experiences to ensure a well-rounded medical education that reflects the medical conditions of the population.
• Responsible for modifying submitted recommendations to ensure a high-quality medical education that results in achieving the outcomes described in the institutional learning objectives.

Procedures for Implementation and Review

Clerkship directors and coordinators are apprised of student training requirements to ensure that training settings allow compliance in these goals. On a yearly basis, the clerkship directors are responsible for making recommendations to the Executive Curriculum Committee regarding environments that will best allow students to achieve the clerkship learning objectives.

This information is reviewed by the Clinical Curriculum Committee and submitted to the Executive Curriculum Committee. The Executive Curriculum Committee is responsible for reviewing the recommendations submitted by the Clinical Curriculum Committee to ensure that they meet the thresholds established by this policy and supports learning outcomes of the institutional learning objectives. It is the responsibility of the Executive Curriculum Committee to oversee and determine the appropriate distribution of inpatient, outpatient, and community clinical sites throughout the core clinical phase.

Related Policies

None at this time

Applicable Laws, Regulations & Standards

LCME 6.4