Logging of Required Clinical Experiences
Rationale
The faculty of a medical school define the types of patients and clinical conditions that medical students are required to encounter, the skills to be performed by medical students, the appropriate clinical settings for these experiences, and the expected levels of medical student responsibility.
The core clinical required rotations of the third and fourth years of medical school prepare students to practice effectively and with increasing independence as they transition to resident physicians. As such, the Clinical Curriculum Committee has determined those clinical experiences, involving specific diagnoses and clinical skills, that are essential elements required for graduation from medical school
in preparation for increasing levels of responsibility.
The purpose of this logging policy is to ensure that every student participates in all the required clinical experiences, distributed throughout the core M3 and M4 clerkships. Clinical clerkship directors and the Office of Medical Education monitor the fulfillment of logging requirements in order to ensure the adequacy and equivalence of patient experiences for each student and site and make adjustments as needed.
Scope
The process of logging clinical experiences includes the development and review of required clinical experiences, identification of alternative methods to achieve these experiences if not accomplished in clinical setting, distribution of these experiences throughout the core clerkships, student documentation of the experiences, and oversight by clerkship directors, curriculum committees, and the Office of Medical Education.
Stakeholders Affected by this Policy
Compliance with this policy is mandatory for all Brody School of Medicine clerkship directors and coordinators, medical students, and indicated Office of Medical Education faculty and staff.
Definitions
Logbook: Refers to the centrally managed, web-based logging system for monitoring student completion of the required clinical experiences and skills within each clinical block.
Required Clinical Experiences/Skills: The combination of clinical conditions, signs, symptoms, procedures, or skills, the level of student responsibility, required setting, acceptable alternative methods, and the distribution across the required clerkships.
Criteria for Level of Involvement of Clinical Conditions and Procedures/Skills:
- Full Involvement/Performed: Rounds on the patient; interviews patient, obtains consent and completes history and physical examination; writes notes; contributes to diagnostic and/or treatment plan for patient; responsible for following patient for the course of treatment. Student physically participates in procedures on the patient and is responsible for interpreting data.
- Limited Involvement/Observed: Student participates in rounds but does not perform history or physical examination primarily. Student is present for the procedure, including critical aspects of history and either observes the entire procedure, or performs limited physical examination to identify abnormalities. Not responsible for notes, diagnostic or treatment plan, or continuity of care.
Alternative Method: As specified by the Clinical Curriculum Committee and the Executive Curriculum Committees, a method other than a patient encounter may be used to meet a required clinical experience. These methods may include simulation, simulated task trainer, lab, workshop, or a targeted patient encounter.
Targeted Patient Encounter: Clinical supervisors can assist students in identifying patients with the required clinical conditions and intentionally involve the student in the patient’s care in order to facilitate learning.
Completion of logging requirements: Refers to evaluating a patient with the required clinical condition and logging of all required information in the Elentra system.
Responsibilities
Multiple people contribute to the distribution, collection, and data entry.
Student
Responsible for logging experiences in a timely fashion and monitoring progress on achievement of required clinical experiences. The student is responsible for taking the log to midclerkship feedback meeting for review with clerkship director and for seeking out faculty and the clerkship director if they experience difficulty in achieving logging requirements.
Curriculum Management Specialist
Primary contact for clerkship directors, clerkship coordinators, and students for questions related to data entry and reports. This person is responsible for generating the clerkship cohort log for required clerkship experiences’ one week before the end of the rotation and again at the end of the clerkship. This information will be communicated to the course and clerkship directors. This person will be responsible for generating spreadsheets for presentation at the Clinical and Executive Curriculum Committees.
Clerkship Coordinator
Responsible for instructing the students to bring a copy of patient experiences log and the mid-rotation reflection form to the mid-rotation feedback meeting. Responsible for reviewing reports and communicating with the students and clerkship directors about deficiencies one week before the end of the clerkship and at the end of the clerkship.
Clerkship Director
Responsible for communicating the purpose of required experiences and clerkship specific experiences in the syllabus and during the clerkship introductory session. Additionally, the Clerkship Director will require that students complete the mid-rotation feedback reflection and will bring a copy to the mid-rotation feedback session. The Clerkship Director will assist the student in identifying opportunities to participate in the care of patients with the required clinical experiences. This person is responsible for communicating with the student if the requirements have not been met and will submit a grade of “In Progress” until all clerkship requirements are submitted. Any professionalism concerns due to incomplete or late logging will be directed to the Office of Student Affairs by the Clerkship Director.
Associate Dean for Medical Education
The Associate Dean, or their designee, is responsible for implementing the process defined by the curriculum committees to annually review the required clinical experiences, the appropriate level of responsibility, and the appropriate clinical setting. This position is expected to provide aid, guidance, and resources as needed throughout these processes. This person is responsible for ensuring compliance with the policies and reporting the process, required clinical experiences, and compliance to the curriculum committees.
Curriculum Committee
Responsible for the development of required clinical experiences, including the types of patients, clinical conditions, and skills that medical students are required to encounter, the appropriate clinical settings, the expected levels of medical student responsibility, distributions across the clerkships, and acceptable alternative experiences. The Clinical Curriculum Committee, with oversight from the Executive Curriculum Committee, is responsible for the development, oversight, and yearly review of these required clinical conditions.
Procedures for Implementation and Review
Required Clinical Experiences
To successfully complete each core clinical clerkship, a student must complete all of the required clinical experiences assigned to that clerkship.
Student Logging of Clinical Experiences
For each core clinical clerkship, students must log at least one patient encounter or
alternative method for each clerkship specific required clinical experience (condition/skill) including level of responsibility and clinical setting before the last day of the clerkship. Clerkship Director must approve the request to utilize an alternative method.
Each student will review their patient log with the clerkship director or designee during the required mid-rotation feedback session held at the midway point of the rotation. As needed, changes will be made to ensure that students have the opportunity to meet the required clinical experiences.
Falsifying patient encounters will constitute a violation of the student honor code and will be referred to the appropriate disciplinary committee for further action.
If, by the end of the clerkship, the logging requirements are not completed, as evidenced by the submission of required log reports to the clerkship director, a grade of “In Progress” will be assigned to the student until the log is received.
Failure to comply with the policy and turn in documents by the specified time will result in documentation and referral to the Student Professionalism and Community Standards Committee.
Central Monitoring by the Clerkship and Office of Medical Education
All Clerkships will introduce logging requirements in the clerkship orientation and the syllabus/Blackboard will identify clerkship-specific patient experience requirements.
Clerkship Directors and Clerkship Coordinators will distribute the list of required clinical experiences, along with institutional and clerkship objectives, to all faculty and residents involved in teaching.
Clerkship Directors or designee will meet with students during the mid-rotation feedback sessions to review patient log data and to assist students in identifying additional opportunities to evaluate patients with the required clinical conditions or develop a plan to utilize an alternative method. Clerkship Director must approve the request to utilize an alternative method.
One week before the end of the required core clerkships, a compliance report will be generated by the Curriculum Management Specialist and sent to the Clerkship Director, Clerkship Coordinator, and the Associate Dean for Medical Education. The Clerkship Director or Designee (Clerkship Coordinator) will contact each student with logging deficiencies to remind them of the requirements and deficiencies.
At the end of the clerkship, the Curriculum Management Specialist will generate a final report of required clinical experiences. Any student not in compliance with the policy will receive a grade of “In Progress” and will be reported to the Student Professionalism and Community standards Committee.
Logbook data for required clinical experiences will be centrally reviewed with the curriculum committees at least annually.
Logbook data and required clinical conditions, settings, and level of student responsibility, and alternative methods will be reviewed once a year to allow the Clinical Curriculum Committee to make recommendations to the Executive Curriculum Committee for updating the list of required experiences in required clerkships or required clinical experiences to ensure learning needs are met in an evolving environment.
Schedule for Review and Update
This policy many be reviewed and revised as necessary, but at least every three years.
Related Policies
None
Applicable Laws, Regulations & Standards
LCME Element 6.2
LCME 8.6 Monitoring of Completion of Required Clinical Experiences