Common Clerkship Policies
Office of Medical Education Contacts (Third and Fourth Years)
|Richard Brower, M.D.||Associate Dean for Medical Education||915-215-4329||Richard.Brower@ttuhsc.edu|
|Maureen Francis, M.D.||Assistant Dean for Medical Education||915-215-4333||Maureen.Francis@ttuhsc.edu|
|Lourdes Davis||Course Coordinator, Years 3 & 4||915-215-4393||Lourdes.Davis@ttuhsc.edu|
|Christy Graham||Course Coordinator, Year 3||915-215-4624||Christy.email@example.com|
|Rebecca Aranda||Coordinator, Hospital Clerkships||915-215-5034915-577-7593||Rebecca.firstname.lastname@example.org|
Disability Support Services
TTUHSC El Paso is committed to providing equal access to learning opportunities to students with documented disabilities. To ensure access to the educational opportunities in the clinical setting, please contact the Director of Disability Support Services (DSS), Dr. Tammy Salazar, to engage in a confidential conversation about the process for requesting accommodations in the classroom and clinical setting. Accommodations are not provided retroactively, so students are encouraged to register with DSS as soon as possible. More information can be found on the DSS website:
Attendance at clinical duties and didactics is mandatory. Unexcused absences will not be tolerated and may result in disciplinary action, potentially including a requirement to repeat a clinical block or rotation. Students have allotted institutional holidays as stated in the student handbook and on each academic calendar.
Students assigned to William Beaumont Army Medical Center will be excused from duty on institutional holidays. Students will be expected to work on military training days that do not coincide with institutional holidays. If the clinic to which the student is assigned is closed, the student will be assigned duties on campus for the day.
Students are required to attend both the first and last days of the rotation. The only excused absences will be for interviews, illnesses (with doctor’s note), or documented family emergencies. Students will not be excused in order to depart for an away or international rotation.
Absences are only excused at the discretion of the Clerkship/Course Director. Commonly excused absences include:
- Illness/health care appointment
- Family emergency
- Death in the family
- Religious holidays (please see the Religious Holy Days Policy in the Student Affairs Handbook)
- Presenting at a national conference
- Interviews for residency (MS4 only)
Absences in the Third Year
During the third year, a student is expected to attend all clinical and didactic activities. If a student will be absent for any activity, they must obtain approval from the clerkship director. If the clerkship director determines that a student’s absence(s) compromises the student’s ability to attain the necessary competencies, they may require the student to make up days or complete alternate assignments. If a student is required to make up time, this must be completed during unscheduled time and the hours worked must be in compliance with the duty hour policy.
If a student is absent more than four days per block or 12 days during third year, it will be reviewed by the associate dean for student affairs. Excessive absences could be a violation of the Student Code of Conduct and may be forwarded to the Grading and Promotions Committee (GPC).
In the event of an emergency that results in an absence from clerkship duties, the student must notify the clerkship coordinator AND the Office of Student Affairs as noted above as soon as possible.
If a student begins a third-year clerkship block and then takes a prolonged leave (> two weeks), then the student will be required to:
- Make up any clinical time missed in the next open clerkship block (this would be block one of the next academic year for students who are “on cycle” and block two of the next academic year for students who are “off cycle”).
- Once the student completes the pending clinical work, the student can then schedule
the pending National Board of Medical Examiners (NBME) exams and the Objective Structured
Clinical Examination (OSCE) at the next available offering.
- The NBME dates are published in the Common Clerkship Policies. NBME exams are generally administered every four weeks.
- The next available OSCE may be a remediation date or the scheduled OSCE at the end of the block.
- Didactic material that is missed can be viewed through CANVAS, where videos, slides
and readings are posted.
- Students can meet with faculty to discuss any questions they have about didactic material.
- There may be additional make-up assignments at the discretion of the clerkship directors.
- Make-up for clinical time missed, coursework and testing will need to be completed before beginning year-four clerkships. Exceptions to this can only be made with approval of both the Office of Medical Education and the Office of Student Affairs.
In the fourth year, a student may have no more than three excused absences in a four-week block without having to make up that time. However, if the Clerkship/Course Director determines that a student’s absence(s) compromised the student’s ability to attain the necessary competencies, they may require the student to make up days or assignments, regardless of the number of days missed. It is also at the discretion of the Clerkship/Course Director to give the student an alternative assignment to satisfy all or part of the make-up time. If a student is required to make up time, this must be completed during unscheduled time and the hours worked must be in compliance with the duty hour policy.
If a student is absent more than six days in a semester during fourth year, it will be reviewed by the associate dean for student affairs. Excessive absences could be a violation of the Student Code of Conduct and may be forwarded to the GPC.
When a student is going to be absent, they are required to notify: 1) the Clerkship Coordinator BEFORE their shift begins. Acceptable forms of notification are email (preferred), phone call or text message. Please see individual clerkship syllabus for clerkship-specific contact requirements; 2) The Office of Student Affairs by emailing email@example.com.
If a student is absent:
- Orientation day (for MS3s and MS4s, orientation is a graded activity), a doctor’s note on the health care provider’s letterhead or prescription paper is required. The absence is subject to the institution’s Missed Graded Activities Policy. Please see the Student Affairs Handbook for more information.
- More than 2 consecutive days due to illness, a doctor’s note on the health care provider’s letterhead or prescription paper is required.
- While presenting at a national conference, copies of the invitation to present and travel itinerary are required.
- When interviewing for residency (MS4s only), copies of the invitation to interview and travel itinerary are required.
Students who miss an NBME exam must make arrangements with the Office of Medical Education to make up the exam on the next scheduled exam date.
Third-year students who must remediate an NBME exam will need to complete the exam before their fourth-year coursework begins. The schedule for the remediation exam must be approved by the associate dean for student affairs.
Fourth-year students who must make up an NBME exam will take the exam on the next scheduled exam date, even if it falls on vacation time. Students who are required to make up days will take the exam on the next available date following the make-up days. Students may delay the exam if the next exam date falls during another clerkship with a required NBME. Exceptions will also be made for approved away rotations.
During fourth year, all remediation must be completed in time for certification for graduation.
No special arrangements (additional exam dates/times) will be made.
- Friday, June 8, 2018
- Friday, June 22, 2018
- Friday, June 29, 2018
- Friday, July 6, 2018
- Friday, August 3, 2018
- Tuesday, August 28, 2018
- Friday, August 31, 2018
- Friday, September 28, 2018
- Friday, October 26, 2018
- Friday, November 2, 2018
- Wednesday, November 21, 2018
- Friday, November 30, 2018
- Tuesday, December 18, 2018
- Friday, December 21, 2018
- Friday, January 4, 2019
- Friday, January 25, 2019
- Friday, February 1, 2019
- Friday, February 22, 2019
- Friday, March 22, 2019
- Friday, April 19, 2019
- Tuesday, April 30,2019
- Friday, May 3, 2019
- Thursday, May 16, 2019
- Friday, May 24, 2019
- Friday, May 31, 2019
All medical students must maintain compliance with occupational health requirements in order to participate in clinical rotations. This is monitored by the Office of Student Affairs.
In addition, many health care facilities and offices require students to be credentialed to attend procedures and/or care for patients. The Office of Medical Education will work closely with Student Affairs and the individual clerkships to file the paperwork necessary for each facility. It is each student’s responsibility to answer emails and comply with required appointments (such as for fingerprinting at WBAMC) and to complete all required paperwork in a timely manner. If students fail to comply with deadlines and are unable to attend a rotation as a consequence, it may be reflected in the student’s final assessment as a professionalism issue. Please note that the Office of Medical Education and the appropriate clerkship will notify students if there are facilities that are not approved for medical student rotations. The students should not perform clinical duties or procedures at any facility that is not approved even if their community preceptor goes to that facility.
If a student does not complete the required credentialing process, then they may NOT enter that facility and work as a medical student.
Clinical Grading Policy
Student clerkship performance is based on the clerkship director’s judgment as to whether the student honors, passes or needs improvement on each of eight competencies described by the PLFSOM discipline performance rubric. The final clerkship performance assessment is conducted at the end of the rotation based on the student’s level of performance at that point in time. Students are not penalized for lower levels of performance early in their rotation. It is expected that over the course of the block, student performance will have improved in many or all categories, based on constructive feedback and growing familiarity with the clinical discipline and patient care. In other words, the final assessment is not an average of the student’s performance over the entire rotation but represents their final level of achievement.
Possible final grades are “honors,” “pass” “fail” and “in progress.” There is no cap or quota on the number of students eligible for honors designation. The overall grade is based on the eight competency scores as described below. No student who “needs improvement” in any competency on the final clerkship evaluation is eligible for honors.
A student who fails professionalism may receive a pass or a fail overall at the discretion of the course director, regardless of the scores on all other items.
Third and Fourth Years
Overall grade is based on the assessment in each of the eight competencies, NBME score (see Table 1 for clerkship-designated thresholds for pass and honors), OSCE performance (if applicable) and professionalism.
- Honors if all of the following are true:
- Passes NBME exam, if applicable, at or above the clerkship-designated score for honors on first attempt.
- Passes OSCE, if applicable, on first attempt.
- Minimum of four of the eight individual competencies rated as “honors” on the final clerkship evaluation.
- No individual competency rated as “needs improvement” on the final assessment.
- Pass if all of the following are true:
- Passes NBME exam, if applicable, at or above the clerkship-designated score for pass on the first or second attempt.
- Passes OSCE, if applicable, on first or second attempt.
- Minimum of six of the eight individual competencies rated as pass or better on the final clerkship evaluation.
- No more than two individual competencies rated as “needs improvement” on the final clerkship assessment.
- Professionalism concerns are, in the judgment of the course director, not significant enough to warrant a fail on the final clerkship evaluation.
- A failing clinical assessment is assigned if any of the following are true.
- Three or more individual competencies rated as “needs improvement” on the final clerkship assessment.
- NBME exam, if applicable, below the designated clerkship score for pass after two attempts.
- Failure of final exam (other than NBME), if applicable, after two attempts.
- Failure of OSCE, if applicable, after two attempts.
- Professionalism concern deemed by the course director significant enough to warrant a fail on the final evaluation.
- If a student receives a final grade of “needs improvement” in three or more competencies in any of the clerkships, they will be referred to the GPC.
- If a student fails three NBMEs or three OSCEs within the third year, they will be referred to the GPC and a notation will be made on the Medical Student Performance Evaluation (MSPE).
An in progress grade will be assigned any student who has not completed required assignments or examinations or who has not fulfilled all clinical experience obligations, pending completion of the required work.
Table 1: Clerkship-Designated Scores for Pass and Honors
|Clerkship||PLFSOM-Equated Percentage Correct Score Required for PASS(>designated score)||PLFSOM-Equated Percentage Correct Score Required for HONORS (>designated score)|
*Please note that the NBME reports scores as equated percentage correct scores in all clerkships except emergency medicine. The scores for EM have been reported as scaled scores. This is expected to change in AY 2018-2019. The norm table and score equivalency tables provided by the NBME will be used to adjust between equated percentage correct scores and scaled scores.
Please note: Each fourth-year elective has its own specific grading assessment forms. Final grades possible are honors, pass and fail. Please refer to the syllabus for each elective for more information on the specific grading policy.
Class rank will be calculated at the completion of third-year clerkships and will be included in the student’s MSPE prepared by the Office of Student Affairs. The ranking will be based on competency grades, professionalism, NBME scores and OSCE performance. Contribution of each element will be as follows:
- 30% based on competency grades from 6 third-year clerkships in knowledge for practice, patient care, interpersonal and communication skills, practice-based learning and improvement, system-based practice, interprofessional collaboration, and personal and professional development.
- 30% based on performance in the end of block OSCEs.
- 30% based on NBME subject exam scores from the 6 third-year clerkships.
- 10% based on competency grades in professionalism from all 6 third-year clerkships.
Referral to Grading and Promotion
Third-year students will be referred to the GPC if they receive “needs improvement” in three or more competencies on any clerkship final assessments or if they fail a clerkship. Fourth-year students will be referred to the GPC if they receive “needs improvement” in two or more competencies on any required fourth-year rotations (including emergency medicine, neurology, sub-internship and critical care) or if they fail a clerkship.
Progress of all students will be reviewed by the GPC twice per year in the context of all coursework, student’s professionalism, evidence of progressive improvement and personal circumstances. Performance in other blocks or clerkships will be taken into consideration by the GPC.
In year three:
|If a student||Then|
Failure of one clerkship:
|Fails two clerkships (same definition as above)||
|Fails the NBME in 3 different clerkships (on first attempt)||
|Fails 3 clerkships||
|Rated as “needs improvement” in 3 or more competencies on any clerkship final assessments||
|Issues of Professionalism/Clerkship Director Concerns||
* The remedial work will not be counted as elective time in satisfying the conditions for graduation.
Grading and Promotion Committee Review for Year 4
- Rating of “needs improvement” in two or more competencies in any required clerkship final assessments for remediation, repeat of year, dismissal.
- Failure of a required or elective experience in the fourth year – review by the GPC for remediation, repeat of year or dismissal.
- Failure of more than one block in year four – review for remediation, repeat of the year or dismissal.
- Failure of Step 2 CK or CS on first attempt – no review required by the GPC but student must log a pass of CK and CS by May 1 in order to graduate in May.
- Failure of Step 2 CK or CS on the second attempt – discussion by GPC of remediation and delay of graduation.
- Failure of Step 2 CK or CS on the third attempt — dismissal.
- Students are required to complete Op-Log entries on all patients with whom they have direct, hands-on clinical contact, i.e., take all, or a significant part of the patient’s history, conduct a physical examination, perform or assist in diagnostic or treatment procedures, write orders, participate in treatment decisions, etc. A student will also be expected to complete Op-Log entries on patients seen with an attending or resident where clinical teaching and learning through observation is an explicit goal of the encounter.
- Students will document each problem/diagnosis addressed by the student at the time
of the encounter, e.g., if a patient has the following diagnoses listed on his/her
record—DM type 2, hypertension, and osteoarthritis, but the student only addresses
the OA during the encounter, OA is the only problem that would be recorded in the
Op-Log for that encounter. If the student addresses more than one problem in a given
encounter, then they should list the diagnosis primarily addressed at the visit first,
and then the other diagnoses, in order, following this.
- Students are expected to record their encounters in OP-Log at least weekly. Regardless of where the assessment falls in a week, students must have their Op-Log recordings up-to-date at least 24 hours prior to the scheduled mid- clerkship formative assessment and by 5:00 p.m. the Monday of NBME week.
- For hospitalized patients, a student will complete an entry at the time they assume care of the patient and each day that they have direct, hands-on contact.
- Timely, complete and accurate clinical encounter Op-Log entries will be a component
of the clerkship assessment. Students who do not meet expectations in the documentation of their clinical experiences
will not be eligible for honors designation.
- Students will not document incidental patient-encounters. Each clerkship will operationally define “incidental encounters” for its purposes.
- Each clerkship has identified mandatory conditions that students must encounter during
the clerkship. If a student does not see a patient with the mandatory condition or
procedure at the designated level of involvement, then an alternative assignment must
be completed to fulfill the requirement. Please see the Op-Log sections in each syllabus.
- Note that the required diagnosis must be listed first in the Op-Log in order to fulfill the requirement.
- Each encounter logged can only be used to satisfy one requirement. For example, if a student sees a patient with chest pain who has DM and HTN, this entry will only satisfy the chest pain requirement. It will not satisfy three requirements.
- For specific diagnoses (such as colic or child abuse), this can be adjusted at the
discretion of the clerkship director.
- We expect that students will document a minimum number of encounters per clerkship.
Please note that these are minimum expectations, and as such, a student may not qualify for honors if they only meet
the minimum expectation (honors designation indicates a student went above and beyond).
- Deliberate falsification of Op-Log entries is an honor code violation.
- There will be two one-week intersessions in the third year, one following block two and one following block three. The entire class will participate in the activities. Content will integrate the experiences in the clinical rotations during year three with concepts from the year one and two coursework.
- This is a two-credit course required for graduation.
- Dates for the class of 2020:
- January 7 to 11, 2019
- May 6 to 10, 2019
- Attendance and participation in the intersession activities is mandatory.
- Please refer to the intersession syllabus for complete details and to review the objectives, a sample calendar and assessments.
2. End-of-Year-Three OSCE
- Cases are designed to elicit a process of history-taking and physical examination that demonstrates the examinee’s ability to list and pursue various plausible diagnoses. Diagnostic reasoning will be evaluated in the note portion of the examination.
- The EOY OSCE is scheduled during the May intersession.
- Demonstrate competency in history, physical examination skills and diagnostic reasoning appropriate to the level of the student.
- Accurately document a focused history, physical examination, assessment and corresponding clinical reasoning in the record.
- Make informed decisions about the initial diagnostic work-up for each scenario and document in the record.
- Demonstrate communication skills in providing patient education and counseling when appropriate to the situation.
- Demonstrate sensitivity, compassion, integrity and respect for all people.
- Scoring and Grading
- The student will receive two sub-scores:
- Integrated clinical encounter consisting of:
- A standardized patient checklist covering key elements of history and physical examination.
- SOAP note in the standard USMLE format with a focus on the assessment and plan and organization of the note.
- Communication and interpersonal skills
- A uniform checklist across all cases with a focus on fostering the relationship, gathering the information, providing information, helping the patient make decisions and supporting emotions.
- Integrated clinical encounter consisting of:
- The student will receive two sub-scores:
- Must pass each category (integrated clinical encounter AND communication and interpersonal
skills) across all six cases.
- Minimum passing score is 75%.
- If a passing score in either category or both is not achieved, the student will be required to repeat all stations of the examination.
- If a passing score in either category or both is not achieved on the second attempt, the student will be referred to the GPC.
- Successful completion of remediation is required to begin year-four coursework.
- COMPLETION of YEAR THREE is highly encouraged before taking USMLE STEP 2 CS.
- Please note that missing time to take Step 2 CS during block three will result in an unexcused absence. Please see the attendance policy on page two. Unexcused absences may result in disciplinary action, potentially requiring a student to repeat a clinical block or rotation.
3. Comprehensive Clinical Sciences Examination (CCSE)
- Each student is required to take the CCSE at the end of year three during the May intersession to determine readiness to take USMLE Step 2 CK.
- The associate dean for student affairs will discuss with the student if the score is of concern and decide on a plan of action.
- COMPLETION OF YEAR THREE is highly encouraged before taking USMLE STEP 2 CK.
- Please note that missing time to take Step 2 CK during block three will result in an unexcused absence. Please see the attendance policy on page two.
- Unexcused absences may result in disciplinary action, potentially requiring a student to repeat a clinical block or rotation.
4. Qstream participation
- Participation in the assigned Qstream modules is required.
- Qstream is an electronic platform for spaced learning. Concepts that are important across all clerkships will be covered in a series of Qstream modules. Examples include infection control and patient safety concepts.
- Reports regarding participation will be forwarded to the Clerkship Directors at the midpoint of the block and at the end of the block. Failure to participate may affect the student’s final grade in the related competency, such as system-based practice, practice-based learning and improvement and/or professionalism.
5. Critical Care Core Curriculum
- This is a series of online interactive modules that will address core topics that represent foundational knowledge and apply across critical care settings. Examples of topics addressed include nutritional support in the critical care setting, assisted ventilation and interpretation of arterial blood gases, hemodynamic monitoring, and physiology and common causes of shock.
- Completion of modules and quizzes is required.
- If modules are not completed by the end of the rotation, the student will receive a grade of “in progress” until all modules are completed in a satisfactory manner. Failure to complete these modules by the assigned deadline could result in a “needs improvement” in the professionalism competency on the final assessment.
Year Three and Year Four:
- MS3-MS4 ICE Case Presentation
- This requirement is effective for the class of 2019 and beyond.
- Each student is required to create a case presentation based on a case they see by December 31 of their fourth year. Cases should include the chief complaint, history of the present illness, past medical history, pertinent social and family history, initial exam findings, initial lab and imaging results (including negative results), clinical course and any available outcomes. Additionally, the case presentation must include five questions about the underlying basic science and/or diagnostic process. The presentation should tie the case to the most relevant PLFSOM scheme and explain the sequence of events /findings in relation to the diagnostic process. Faculty assessment and attestation forms are required at the time of submission. Further details will be provided as an update to these policies.
The CME requirement is a prerequisite for graduation!
- Expose students to the full continuum of medical education, including continuing medical education (CME).
- Provide students opportunities to broaden their clinical training by participating in approved Type 1 CME events.
- Reinforce the fact that all physicians are expected to be active, life-long learners and to take responsibility for maintaining and expanding their knowledge base.
- A minimum of 10 documented Type 1 credits must be completed by March 1 of the fourth year.
- Credits must be earned in at least three different disciplines (e.g., internal medicine and IM sub-specialties, surgery and surgical subspecialties, OB-GYN, pediatrics and pediatric sub-specialties, psychiatry, family medicine, etc.);
- At least five of the credits must involve live sessions.
- Clerkship-required learning activities that happen to carry CME credit (e.g., the lactation curriculum in OB-GYN) will not count toward meeting the CME requirement except for grand rounds sessions that have been approved for Type 1 credit by the CME office that students are required to attend as part of a rotation.
- Student participation in the PLFSOM’s CME-approved events will be documented via a medical student sign-in sheet.
- Students are required to provide acceptable documentation (e.g., certificates of completion, transcript of credits, and/or photo of sign-in sheet) to Lourdes Davis in the Office of Medical Education.
- Davis will update students quarterly about their individual status in meeting the requirement.
Preamble: The PLFSOM has the responsibility to develop and implement work hour policies for medical students, especially those on clinical clerkship rotations, in accordance with LCME Element 8. These policies should promote student health and education.
- Students should not be scheduled for on-call time or patient-care activities in excess of 80 hours per week.
- Students should not be scheduled for more than 16 continuous hours (except as noted in No. 8 below).
- Students should have 10 hours free of duty between scheduled duty periods.
- Students should have at least one day off each week averaged over a one-month period.
- Students should not have more than six consecutive nights on night float duty.
- This policy applies to all clerkships/rotations in the third and fourth years at the PLFSOM.
- It is anticipated that student attendance at clerkship seminars, conferences and other didactic sessions will be facilitated by this policy and that provisions in this policy are not the basis for missing these sessions. Requests for excused absences from these sessions should be submitted to the clerkship director or his/her designee on an individual basis.
- During fourth-year required clinical rotations such as the sub-internship selectives, the clerkship director may require overnight call to prepare students for internship and residency. In this case, call rooms must be available for the student’s use at the facility and duty hours must not exceed 24 hours of continuous scheduled clinical assignments. Up to four hours of additional time may be used for activities related to patient safety, such as transitions of care. The clinical departments will determine the frequency of overnight call, but it should not be more frequent than every fourth night.
- Variances from this policy must be approved by the associate dean for student affairs.
Students must report their duty hours in the online scheduling system within 48 hours of the end of each event. Failure to enter duty hours more than three times in a clerkship will result in a concern notation on the student’s professionalism evaluation (completed by the clerkship coordinator).
There are a number of policies dictated by the Office of Student Affairs. Students are expected to be familiar with all policies in the Student Affairs Handbook (http://elpaso.ttuhsc.edu/som/studentaffairs/_documents/PLFSOM-Student-Affairs-HB.pdf) with special attention paid to the following:
- Dress Code
- Needle Stick Policy
- Standards of Behavior in the Learning Environment
- Medical Student Code of Professional and Academic Conduct
- Religious Holy Days
- Missed Graded Activities
- Evaluation Policy
Students are expected to be familiar with policies regarding the Center for Advanced Teaching and Assessment in Clinical Simulation (ATACS) and to abide by these policies when attending sessions in the ATACS Center.
Please click the button below view the Common Clerkship Policies in PDF format.