Required Clinical Experiences Policy
Overview/Rationale
VP&S ensures that all medical students gain sufficient exposure to essential clinical conditions, patient types, and procedural skills through structured and monitored required clinical experiences. These experiences form the foundation for developing clinical competence and align with the medical educational program objectives. This policy establishes expectations for completing required clinical experiences and ensures a system is in place for monitoring and supporting student completion of required clinical experience and for addressing any gaps in completion of these experiences, as required by accreditation standards.
Accreditation Standards
LCME Accreditation Standard:
6.2 Required Clinical Experiences
8.6 Monitoring of Completion of Required Clinical Experiences
8.7 Comparability of Education/Assessment
Stakeholders
This policy applies to medical students in the MD program at Columbia University Vagelos College of Physicians and Surgeons and to individuals and committees involved in directing and supporting required clinical clerkships, including faculty, residents, fellows, and staff.
Level of Student Responsibility
For each clinical experience, the expected level of student responsibility is defined as one of the following:
Observe Student actively observes the specific demonstrated procedure or clinical encounter and subsequently discusses the interaction with the provider
Participate
Patient type/ clinical conditions: Student actively demonstrates the skills required in the encounter, such as obtaining a patient history, conducting a physical examination, interpreting pertinent patient data, and/or presenting the case including a discussion of differential diagnosis, assessment, and plan
Procedures: student physically participates in patient procedures under direct supervision
Performs Student fully performs a specific procedure under direct supervision
Procedures
1. Development and Review of required clinical experiences
The Committee on Educational Policy and Curriculum (CEPC) is responsible for oversight and review of required clinical experiences. The CEPC reviews and approves changes to the required clinical experiences with input from clerkship directors and the MCY/D&I subcommittee. Required clinical encounters, skills, and alternatives are reviewed annually by the CEPC, with recommendations from clerkship directors and MCY/D&I subcommittee, to ensure alignment with the school’s medical education program objectives and adequacy of student clinical experiences.
2. Communication of Requirements for Required Clinical Experiences
Students are informed of requirements for required clinical experiences via clerkship syllabi, clerkship orientation sessions, OASIS Requirements Checklists, and mid-clerkship feedback sessions.
Residents are informed of requirements for required clinical experiences via Resident-as-Teacher training modules, clerkship syllabi, and clerkship orientation sessions.
Faculty who teach and assess students in the clerkship are informed of required clinical encounters and skills and the expected level of student responsibility for each through clerkship orientations run by clerkship directors, access to clerkship syllabi, and annual online training modules.
3. Student Logging of Required Clinical Experiences
Students are responsible for logging their required clinical experiences in the school’s centralized logging tool, OASIS, using the clerkship-specific “Requirements Checklist.” Completion of all required clinical experiences (or approved alternatives) is a requirement each clerkship. Students who fail to complete their required clinical experiences will receive a temporary grade of Conditional Pass (CP) until completion is documented.
4. Monitoring of Individual Completion
Each clerkship director, with assistance of the clerkship coordinator, monitors student completion of required clinical encounters and skills throughout the clerkship. Individual logs are reviewed prior to the end of the clerkship, and students who have not completed requirements are reminded to address deficiencies, and to make sure they have an opportunity to have the experiences. If experiences cannot be accessed, students are reminded about alternative experiences available to them. The results of log monitoring are discussed with students during the mid-clerkship review or at another time prior to the end of the clerkship if concerns arise, to ensure timely completion of the requirements checklist by students.
5. Review of Aggregate Completion Data
The clerkship coordinator and clerkship directors monitor the completion of all requirement checklists at the end of each MCY block. They notify any students with incomplete logs so that they may reach out to remind the students to bring them to date. Clerkship directors review aggregate data on student completion of clerkship-specific required clinical skills during annual clerkship CQI meetings. Aggregate data on students’ completion of required clinical encounters and skills are monitored by the MCY/D&I subcommittee and CEPC as part of the annual MCY phase review.
As part of the annual clerkship CQI, clerkship directors review aggregate data on completion rates across clerkship sites. Aggregate data on completion rates for all required clinical experiences are also reviewed by the MCY subcommittee at the annual MCY Phase Review. For any required clinical experiences that were not completed by 100% of students, the adequacy of patient volume and case mix is reviewed by the clerkship director and reported during the annual MCY phase review. Based on these data, the MCY subcommittee may propose changes to clerkship experiences to the CEPC.
6. Use of Alternative Experiences
Alternative experiences (e.g., simulations, online cases, videos, didactics) are available for each required clinical experience if a direct clinical encounter cannot be completed.
If any specific required clinical experiences needed to be satisfied with alternate methods by more than 20% of cases in aggregate or at a particular site, this will trigger a review by the clerkship director of the adequacy of patient volume and case mix and it will be reported during the annual MCY phase review. Based on this data, the MCY subcommittee may propose changes to the clerkship experiences to the CEPC.