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	Translating Discoveries
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Clinical Clerkships

The required curriculum in the clinical years consists of a minimum 15.5 months of clerkships (as shown in the table below) and consists of flexible scheduling with opportunity for broad clinical experience and/or continuation of a scholarly concentration project.

NOTE: The Faculty Senate is in the process of revising the clinical curriculum. Graduation requirements for clinical training are under review and are subject to change.

For information about clerkships for visiting students, please visit the Visiting Clerkships website.

Clinical Graduation Requirements for students beginning clerkships 2004-05 and later:

CLERKSHIP#	DEPARTMENT	TITLE	UNITS
To be completed within the student's first 12 months:
*MED 300A	Medicine	General Medicine Core	12 (2 months)
*SURG 300A	Surgery	General Surgery	12 (2 months)
Two of the clerkships below (assigned by draw process) must also be completed within student's first 12 months:
**ANES 306A, N, P	Anesthesia	Critical Care Clerkship	6 (1 month)
INDE 301A	Family and Community Med	Family Medicine Core	6 (1 month)
MED 313A	Medicine	Ambulatory Medicine	6 (1 month)
NENS 301A	Neurology	Neurology Core Clerkship	6 (1 month)
*OBGYN 300A	Obstetrics & Gynecology	Basic Gynecology & Obstetrics	9 (1.5 months)
*PEDS 300A	Pediatrics	Child Health	12 (2 months)
*PSYC 300A	Psychiatry	Basic Core Psychiatry	6 (1 month)
These clerkships may be completed any time prior to graduation:
Selective I: Fundamentals of Clinical Care (chosen from approved list)			6 (1 month)
Selective II: Subinternship (chosen from approved list)			6 (1 month)
ELECTIVE			6 (1 month)
Total clinical units required for graduation			93 (15.5 months)

* Because passing of the NBME subject examination is a requirement in these clerkships, students must enroll in (i.e., begin) these clerkships at the latest by Period 7 of the final clinical year to allow time for remediation of failing scores prior to graduation.

**Anesthesia 306A, N, or P may only be scheduled in accordance with prerequisites as noted in their clerkship descriptions.

For students beginning clerkships 2003-2004 and earlier, please review this Required Clerkship table, 2003-04.

Clerkship Descriptions

Clerkships to be completed within the student's first 12 clinical months (must be completed at Stanford):

MED 300A – General Medicine Core Clerkship (SUMC, PAVAMC, SCVMC, KPMC) - Teaches the natural history, pathophysiology, diagnosis, and treatment of disease. Emphasis is placed on acquiring the understanding, skills, and attitudes desirable in a scientific and compassionate physician. Students record histories, physical examinations, and laboratory data for patients for whom they are responsible and present their findings, together with their diagnoses and treatment plans, at rounds and conferences. Developing sound clinical reasoning skills is continuously emphasized. An essential aspect of the clerkship is the students’ gradual assumption of direct responsibility for, and full-time involvement in, patient care with the house staff and faculty team. To take advantage of the differences in patient populations and teaching staffs of the four hospitals, students spend four weeks at either SUMC or PAVAMC, and four weeks at either SCVMC in San Jose or KPMC in Santa Clara. The resulting eight week experience is an integrated curriculum designed to cover the essentials of internal medicine. Students enroll in Medicine 300, and the Department of Medicine supervises a random draw-based assignment to two of the four locations shortly before the beginning of each odd-numbered clerkship period.
Director: Rex Chiu, MD

SURG 300A – General Surgery Clerkship (SUMC, PAVAMC, SCVMC, KPMC) - Provides students with clinical experience in the evaluation and treatment of a wide variety of surgical diseases. Emphasis is placed on teaching students to recognize and manage basic clinical problems. Students function as active members of the surgical team, and are encouraged to follow patients throughout their in-patient course. Outpatient clinics provide the student with the ability to participate in the initial work-up and care plan of pre-op patients. Didactic lectures are given by faculty during the clerkship, which cover pathophysiology of various diseases and principles of surgical management. Basic surgical skills are taught in the operating room and in the emergency department setting. The clerkship offers an opportunity for students to integrate their knowledge of anatomy, physiology and physical diagnosis into a treatment plan for patients with surgical diseases. Each student spends one four-week rotation at SHS or the PAVAMC and one four-week period at SCVMC or KPMC, Santa Clara. Rotation assignments are made on the first day of the clerkship. A one day orientation is held at the beginning of the eight week period. Director: Sherry Wren, MD

Two of the following clerkships must be completed within the student's first 12 clinical months (must be completed at Stanford, to be assigned by lottery):

MED 301A – Family Medicine Core Clerkship (SUMC, Community sites) - Teaches the assessment and management of diseases commonly encountered in the ambulatory care setting. Emphasis is placed on efficient, cost-effective medical care in a variety of settings. Prevention, behavioral aspects of care, and cultural competence will be stressed. Students will visit a variety of sites for alternative delivery of health care. Morning education sessions will also be conducted at SUMC and afternoons will be spent attending patients in a family practice office in the Bay Area. Director: Samuel LeBaron, MD

OB/GYN 300A – Basic Gynecology and Obstetrics Clerkship (SUMC, SCVMC, KPMC) - A six week core rotation divided into 3 weeks of obstetrics and 3 weeks of gynecology. The experience on the obstetric service includes inpatient and outpatient care of patients with both normal and high risk pregnancies. The gynecology service includes general gynecology as well as subspecialties including urogynecology, infertility and gynecologic oncology experiences. Directors: Kimberly Harney, MD, Cynthia DeTata, MD

PEDS 300A – Child Health Clerkship (SUMC, SCVMC) - Clerkship consists of an eight-week period divided into four weeks on an inpatient service and four weeks in an ambulatory pediatric setting. Students spend four weeks at the LPCH and four weeks at the SCVMC. In each setting, students learn the skills of history-taking, physical examination, and problem-solving appropriate for children of various ages. Students also learn assessment, become familiar with health maintenance as it applies to children, develop sensitivity to the interrelationships of children with their families and environment, and learn diagnostic and therapeutic approaches to common pediatric problems. Students also participate in diagnosis and treatment of pediatric and adolescent problems. Director: Elizabeth Stuart, MD

PSYC 300A – Psychiatry Core Clerkship - Designed to solidify the knowledge students have acquired in PSYC 201 and PSYC 204 courses, while helping students gain practical skills in the application of this knowledge to clinical situations. The core clerkship experience will focus on interviewing skills, psychiatric evaluation, on refining diagnostic skills, and give an overview of psychosocial and psychopharmacological treatment modalities for the major psychiatric disorders. The clerkship consists of work on inpatient units or in outpatient clinics under the supervision of academic and clinical faculty, a weekly lecture series by academic faculty, interviewing seminars taught by voluntary clinical faculty, and attendance at Grand Rounds. Students will be assigned to patient care settings at one of the seven affiliated sites: a comprehensive medical psychiatry unit (G2), an inpatient general psychiatry ward (H2) at SUH, an inpatient research psychiatric ward specializing in the study of schizophrenia (4B2) at the VA, an inpatient general psychiatry ward (5B3) at the VA, consult-liaison service at SUH or the VA. Although students will be given the opportunity to express their preferences regarding assignment, the final rotation assignment will be determined by the department based on availability of sites. Students will be advised of the specific clerkship requirements at the orientation offered at the start of each clerkship period. Requirements include mandatory attendance at seminars, weekly inpatient case history presentations and night-call experiences with residents/attending psychiatrists. Director: Regina Casper, MD

Other Clerkship Requirements (must be completed at Stanford):

ANES 306A, P or N – Critical Care Clerkship - Provides experience managing patients in a critical care unit. Students learn how to optimize care for the acutely ill patient and the multidisciplinary approach to complex patients. Teaching emphasizes the review of basic organ physiology, the ability to determine the pathophysiologic mechanisms involved in critical illness, and the formulation of a physiologic based treatment plan. Students gain experience with the implementation of monitoring and therapeutic devices used in the intensive care units and begin to become adept at the evaluation, stabilization and management of the most critically ill patients expected to be encountered in today's acute care hospitals. Educational experiences include ward rounds, bedside evaluation and treatment, didactic lectures and individual interactions with attending, fellows and residents. Director: Myer Rosenthal, MD

NENS 301A – General Neurology Core Clerkship - A four-week experience in both inpatient and outpatient neurology. The clerkship emphasizes the recognition and treatment of common neurological disorders. Sites will include Stanford, the Palo Alto Veterans Administration Medical Center, and Santa Clara Valley Medical Center. Director: Paul Fisher, MD

MED 313A – Ambulatory Medicine Clerkship - The new Ambulatory Medicine clerkship combines clinic sessions in both general internal medicine and subspecialty medicine. It includes assigned readings, small group discussions, computer-assisted drills, posing and answering clinical questions with critical appraisal of the literature, and problem-based cases to reinforce principles and complexities of diagnosis and management. The didactics emphasize preventive medicine, cardiovascular, respiratory, and endocrinological disorders, and common clinical presentations in outpatient practice. Effective Period 1 (2005-06), the clerkship is a required clerkship for all students by the time of graduation. Director: Peter Rudd, MD

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Selective Clerkship Descriptions

Students will complete one month of clerkships in two categories chosen from a designated list. Qualifying clerkships are approved by the Committee on Courses and Curriculum (CCC) and may be removed from the list of approved clerkships at any time. Additions to the approved lists of clerkships take effect immediately for all students; deletions from the lists take affect for the students who begin clerkships in the next clerkship year.

Students wishing to substitute another clerkship not on the list may petition the CCC for approval prior to enrolling in the clerkship. Students should know that approval of substitutions for selective clerkships is rarely given. Retroactive approval of selective clerkship substitutions will not be granted.

Selective clerkships may be completed at another medical school through the “away” clerkship process. This means that the Stanford clerkship director must certify that a clerkship experience at another medical school is equivalent to the designated clerkship at Stanford. The student then enrolls in the clerkship with the Stanford number and the letter “W” following to indicate it was done at another location.

Selective I: Fundamentals of Clinical Care

This requirement assures that all students receive a firm grounding in general principles and practice of primary care medicine or ambulatory care medicine, according to specified goals and requisites. Students complete one month (four weeks) of clerkships chosen from the list of qualifying clerkships (see list on page 39).

Goals:

Through experiences that broaden their general professional education in areas not covered in a core clerkship, students will:

Achieve excellence in command of the fundamentals of clinical medicine with emphasis on skills required of all physicians

Gain a solid foundation in general medicine as a basis for understanding and treating disease

Requisites:

Emphasizes common problems in an area essential for a generalist

Provides knowledge, skills and attitudes that will enhance development as a well-rounded physician

OR

Goals:

Through an intensive ambulatory experience, students will:

become competent at managing problems in an ambulatory setting

strengthen ability to perform a directed history and physical examination

appreciate longitudinal management of chronic disease

develop time management skills during patient encounters

develop a sense of obligation to the health of the public

Requisites:

At least 75% of experience should be in an ambulatory/outpatient setting

Student accepts direct responsibility for patients including first to encounter patient, performs procedures, counsels patients, writes notes and orders

Provides opportunities for patient follow-up

Selective I List: Fundamentals of Clinical Care

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Selective II: Subinternship

Subinternship is an advanced clinical experience in which students assume the responsibility of and function as interns. All students must participate in at least one qualifying experience chosen from the subinternship list. Qualifying clerkships are approved by the Committee on Courses and Curriculum and may be removed from the list at any time.

Goals:

Through an intensive inpatient experience, students will:

Assume a high level of patient care responsibility in preparation for residency.

Strengthen their clinical and procedural skills.

Improve their ability to manage complex, acutely ill patients.

Learn to work as a team member.

Requisites:

Student is responsible for direct management and care of patients with significantly higher level of responsibility than the core clerkship.

Builds upon knowledge and skills learned during the core clerkship.

Internship-like responsibilities, e.g., primary workup of new patients, writes orders, performs procedures, participates in daily care, takes night call, writes notes and dictates discharge summary.

Selective II List: Subinternship

For students entering 2003-2004 and earlier, please review these Selective Requirements.

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Clinical Performance Examination (CPX)

Demonstration of competency on the Clinical Performance Examination (CPX), taken in the final clinical year, is a requirement for graduation. The CPX is conducted in the afternoons over a 10-day period in August and can accommodate about eight students each afternoon. Students will be given the opportunity to schedule themselves into the examination on a first-come, first served basis. Students who do not schedule themselves into the examination before the deadline will be placed in remaining open slots.

The CPX is an eight-station standardized patient examination lasting from 1:00 to 6:00 p.m. The examination assesses students in five skill areas:

History taking

Physical examination

Information sharing

Clinical courtesy

Patient/physician interaction

Each student’s exercise is videotaped and made available to the student for review. Following the exam, students watch the recording of their performances and complete a self-assessment exercise. Once the self-assessment has been submitted, the student receives access to their CPX score report.

Students who do not demonstrate minimum competency in each skill area, or who do not meet the passing mark for overall score, will receive mentoring from a faculty member. Mentoring sessions will be confidential one-on-one tutorials with a supportive faculty member who has demonstrated excellence in clinical teaching. The student will be expected to work with the faculty member to improve their skills until the faculty member certifies that the student has met the standards.

The examination is meant to ensure that all students receiving the M.D. degree from Stanford have demonstrated competency in fundamental clinical skills. It identifies students who are struggling so they can get the help they need in a discreet, positive learning environment.

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NBME Subject Examinations in Required Clerkships

Standards for performance on NBME subject examinations apply in the following required clerkships:

Internal Medicine

Obstetrics and Gynecology

Pediatrics

Psychiatry

Surgery

Examination must be passed with minimum score in the 23 rd percentile

Students who do not pass receive “N” (continuing grade) in the clerkship and must retake exam (does not result in any statement in Summative section of evaluation)

Failure on retake results in statement to this effect appearing in Summative section

Third attempt is oral examination – “N” grade is converted to either a “pass” or “fail”

Failure results in focused remediation with enrollment in a 390 clerkship

To assure that remediation is accomplished prior to graduation, students must enroll in (i.e., begin) all of the above clerkships at the latest by Period 7 of the student’s final clinical year.

Students with documented disabilities may require special examination accommodations. The Office of Accessible Education determines if and what accommodations to recommend. The MD Advising Office receives the recommendation and conveys the request to the clerkship director prior to the examination.

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Advanced Cardiac Life Support (ACLS) - MED 295

Certification in ACLS (Advanced Cardiac Life Support) is a requirement for graduation. Students may register for ACLS in the first or second clinical year. Training courses are offered at the Palo Alto VA Medical Center under the direction of Dr. John Giacomini. All training sessions (up to four) will be held on Friday/Saturday. Each session can accommodate a maximum of 25 students. Registration is on a first come, first served basis. Because advance planning is necessary to arrange instructors, registration will be cut off two weeks before each session. When the training is completed, students will be given a certification card that will be good for two years.

To sign up, register for MED 295 on Axess. An information packet with training materials will be placed in your student mailbox two weeks before the course begins. Be prepared to do some reading before the first session.

NOTE : Occasionally a student who is preparing to graduate is unable to attend one of the ACLS training sessions offered at the Palo Alto VA Medical Center because he or she is out of town, interviewing for residency, or for other reasons. If this is the case, the student may make arrangements to complete ACLS training at another facility. The student would then need to bring his/her certificate of completion to the Office of Student Affairs to verify participation in the course. For ACLS training outside Stanford, contact Kathy Dyble, Hoover Pavilion (650-723-3450) or the American Heart Association. There will be a charge to take this training outside the medical school.

Contact Gay Wittenberg, VA Medical Center, 650-493-5000, ext. 65153.

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Translating Discoveries

Part One: Translating Discoveries in the Clinical Clerkships is designed to extend students' acquisition of basic science knowledge throughout medical school by integrating relevant basic science instruction into clinical clerkships.

Part Two: Translating Discoveries series (INDE 297) underscores the value of understanding basic science principles, translating them into the evidence-based, patient-centered practice of medicine, and gaining awareness cognizant of their broader social and ethical implications. The perspective of patients is emphasized, through their frequent participation as course instructors.

Academic Policies Related to Clinical Clerkships

Expectations of Student Performance

Academic Performance Policy

A description of the academic performance policy will be provided soon (dated 12/01/05).

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General Policies Related to Clinical Clerkships

Contractual Agreement for Participation in Clinical Clerkships

The clerkships scheduled in the Office of Student Affairs represent a professional commitment to fulfill a clinical responsibility. The following regulations apply:

Each student’s clinical clerkship schedule is listed online in the Fishbowl System. Students are able to make changes to their schedule using their Fishbowl username and password. Students are expected to attend each clerkship to which they are assigned. Students wishing to add or drop a clerkship must adhere to the restrictions on adding or dropping clerkships. If the student is unable to meet the deadlines for dropping or adding clerkships, permission must be obtained from the clerkship director and the clerkship office.

Scheduling a clinical clerkship represents a multilateral agreement among the student, patients, faculty, the Office of Student Affairs (which ensures that tuition is paid for the period of instruction and that the student is legally covered under the University’s malpractice policy for medical students), and fellow students with whom the allocation of clinical clerkship slots is shared. To protect all of the above parties, the penalty for not respecting this multilateral agreement is a formal failure of the clerkship. Graduation is contingent upon correcting any such failures.

Definition of Medical Student Practice Role

The Medical Board of California requests that medical students be carefully instructed about what they may and may not do in terms of writing orders or prescriptions for patients. Thus, the Office of Student Affairs, in collaboration with clinical department chairs, the Stanford-affiliated hospitals, and the nursing offices, has prepared the following description of the appropriate role of the Stanford medical student on a patient care team:

California state law allows specific exceptions for medical students to the general code, which requires that all medical acts must be performed by licensed physicians. The exception specifies that a student may do all things that a physician may do with the following two provisos:

That any medically-related activity performed by students be part of the course of study of an approved medical school.

That any medically-related activity performed by students be under the proper direction and supervision of the faculty of an approved medical school.

Medical students may write orders for drugs, treatments, etc., providing:

The provisions of number 2 above are observed.

The students are assigned to or are consultants to the service on which the order pertains.

A licensed physician countersigns all orders before the orders are executed. Telephone orders of counter-signatures will be accepted from licensed physicians (including licensed housestaff). Medical students may locate and solicit the licensed physician’s verification by telephone, but the licensed physician must speak directly to the registered nurse and must actually sign the order before going off duty. The counter-signature is recorded as a telephone order. Routine admission orders are not exempted from the above provisions.

Medical students may act as subinterns, but they are still subject to the above provisions.

Medical students will identify their signatures with CC (Clinical Clerk), just as licensed physicians identify their signatures with MD. Medical students will also wear badges identifying them as medical students.

Students functioning in a preceptorship away from the Stanford University Hospital and its affiliates are subject to the above limitations. If a preceptorship is an out-of-state one, other state regulations may govern the role of the student in the preceptorship, and students should ascertain the provisions of these regulations.

Malpractice Liability for Medical Students

Stanford assumes the financial responsibility for medical malpractice liability incurred by registered medical students when participating in any clinical activities as part of their formal educational program at the Stanford University Medical Center, or at other Stanford-approved medical facilities. However, it is very important that Stanford medical students be certain they are protected when participating in clinical work in special situations. Therefore, students should consult the Medical School Registrar’s Office if they will be:

taking a clinical clerkship at another hospital or medical school in the United States while not paying tuition and not registered as a medical student at Stanford.

taking a clinical experience in a foreign country while not paying tuition and not registered at Stanford.

participating in any volunteer clinical work away from Stanford.

working in a private physician’s office.

participating in any clinical activities not at Stanford that are not covered in (1) through (4) above.

Stanford reserves the right without prior notice to modify its practices with regard to financial responsibility for medical malpractice liability.

Student Participation in Clinical Activities Involving Personal Risk

(endorsed by the Medical School Faculty Senate on May 17, 2000)

The Stanford University School of Medicine has long had the policy that medical students learn to be physicians by participating in the care of patients under faculty supervision. Some of these patients may have an infectious or other disease that provides some risk to caretakers, including students. While every effort will be made to provide appropriate training and safeguards for students so that these risks are minimized, they cannot be totally eliminated.

Students are required to participate in patient care as one of their fundamental responsibilities during a clinical clerkship. Students are expected at all times to follow universal safety precautions in order to safeguard their own health. Under certain rare and extenuating circumstances where the risk to the student significantly outweighs either the educational benefit to the student or the health-care benefit to the patient, a supervising physician may suggest that a student be exempted from, or a student may ask permission from the supervising physician to be excused from, participation in certain aspects of patient care. The clerkship director is responsible for providing clarification of this statement and resolving any disputes. In the event a dispute is unsatisfactorily resolved from the standpoint of either the student or the supervising physician, the matter may be referred to an Associate or Assistant Dean of Medical Student Advising for final review.

Student Duty Hours and the Working Environment

Providing students with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and student well-being.

Supervision of students

All patient care must be supervised by qualified residents or faculty.

Faculty, residents and students must be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects.

Duty Hours

Duty hours are defined as all clinical and academic activities related to the students, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.

Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.

Students must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call. One day is defined as one continuous 24 hour period free from all clinical, educational, and administrative activities.

On call activities

The objective of all call activities is to provide students with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal workday when students are required to be immediately available in the assigned institution.

In-house call must occur no more frequently than every third night, averaged over a four-week period.

Continuous on-site duty, including in-house call, must not exceed 30 consecutive hours.

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Information for Students

Policy on Dropping Clerkships

The Office of Student Affairs requires students to make clerkship scheduling changes a minimum of two weeks prior to the beginning of the clerkship period. This ensures that students on the waitlist for that period can be accommodated and that clerkship directors can plan patient care and educational activities. Failure to adhere to this policy raises concerns about the professional conduct of a student.

There have been occasions when a Stanford medical student enrolled in a clerkship fails to report for the first day of that clerkship, or provides late notification to the clerkship director that they plan to drop the clerkship.

Students who have a valid reason for wishing to drop a clerkship within two weeks of the beginning of the clerkship period may do so only by contacting their academic advisor. The advisor will review the reason and, if permission to drop is granted, will contact the clerkship director and the Assistant Director of Clerkship Administration in the Office of Student Affairs to finalize the request.

Students who fail to report for the first day of a clerkship, or drop a clerkship within two weeks prior to the start date without permission, will be asked to appear before the Committee on Student Performance to explain their reason for this action. If there is a second occurrence of a late drop or other evidence of unprofessional conduct, a notation to that effect will be included in the student’s Medical School Performance Evaluation (MSPE, or Dean’s Letter).

How to Take Clerkships at Other Institutions

Students wishing to take clerkships in the United States or Canada should apply about six months in advance. Students who wish to take clinical clerkships abroad should apply to the international hospital or medical school one year in advance. Catalogues of elective clerkships available at U.S. medical schools and information about electives in International Health are located in the Lane Library. Additional information is available from individual departments at Stanford. Correspondence should include the following information:

Your name and address

Expected graduation date from Stanford University School of Medicine

The clerkships you are interested in taking, including alternates if possible

Approximate dates available (be as flexible as possible)

A statement that the Associate Dean for Academic Advising will be pleased to write a letter of recommendation if required

A request for housing information

If the away institution requires a letter of good standing, with proof of malpractice coverage, the student should see the Assistant Director of Clerkship Administration (Caroline Cheang) in the Office of Student Affairs. She will provide the letter, have the application signed, and return these documents to the student for mailing to the away institution along with any application fees, transcripts, or proof of immunization.

It is recommended that away clerkships be taken for credit. When the elective with the away institution is confirmed, credits can be requested by filling out a Faculty Authorization Form, which can be obtained from Caroline Cheang. When Caroline receives from Dr. Terrance Blaschke both the approved Faculty Authorization Form and an acceptance notification from the other institution, the away clerkship will be added to the student’s Fishbowl schedule. The student should register the away clerkship on Axess with the suffix “W.” An evaluation of clerkship work done at the away institution is required. The student should take to the away institution a Clerkship Evaluation Form to be filled out by the attending at the end of the clerkship and mailed back to the Medical School Registrar.

Students who choose to take the away clerkship for no credit should check with the Medical School Registrar to ensure malpractice insurance coverage.

Students who wish to take a core or required clerkship away from Stanford and use it to satisfy the core or the required clerkship graduation requirement (a request which is not encouraged) must get approval from Dr. Terrence Blaschke, Associate Dean for Medical Student Advising.

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Information for Clerkship Directors

Guidelines for Optimal Resident Interactions

Residents should:

Introduce students and provide a description of their role to patients, families, and other health care staff.

Inform students of expectations and their role in the group at the beginning of a rotation.

Include students so they feel like active members of the team.

Encourage students to take "ownership" of their patients.

Give students an appropriate amount of responsibility in caring for patients.

Discuss with students how to present themselves professionally; this includes dress, demeanor, language, punctuality, etc.

Provide appropriate and constructive feedback based on observed student interactions with patients and other members of the health care team.

Be patient with students.

Encourage questions.

Be accessible to students.

Give specific feedback frequently.

Give praise and thanks liberally.

Make sure tasks assigned to students have learning value.

Focus on teaching pertinent physical findings.

Lead by example. Residents are important role models for students.

Treat all health care providers (nurses, therapists, administrative assistants, techs) with respect at all times.

Observe patient confidentiality at all times.

Show empathy and compassion for patients and families, both in their presence and when discussnig patients with colleagues.

Always behave in a respectful manner with honor and integrity.

Teach cultural sensitivity and follow ethical principles.

Share a "pearl" daily.

Explain the purpose behind ordering labs, studies, or consults.

Admit when they don't know the answer.

Teach something about each patient everyday.

Guidelines for Resident Interactions to be Avoided

Residents should not:

Take credit for students' work.

Talk disrespectfully about other healthcare providers (i.e., ancillary staff, other medical specialties).

Use inappropriate language.

Introduce students as "Doctors."

Make negative or disparaging comments about students in front of other students or patients.

Interrupt or joke during student presentations.

Have confrontations in front of patients and families.

Reprimand students in a publicly humiliating fashion.

Say "You should know that by now."

Compare different students' knowledge in front of other students.

Ask questions in a belittling manner.

Have unfair expectations of students' medical knowledge or ask questions beyond the scope of students' knowledge.

Send students on menial errands that have no learning value.

Allow interactions with pharmaceutical representatives to defer from practicing evidence-based medicine.

Make sexual advances or references to students.

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