Clinical Log

Background

The Liaison Committee on Medical Education (LCME) is the agency that accredits medical schools in the United States. The LCME mandates that “an institution that offers a medical education program must have in place a system with central oversight to ensure that the faculty define the types of patients and clinical conditions that medical students must encounter, the appropriate clinical setting for the educational experiences, and the expected level of medical student responsibility. The faculty must monitor medical student experiences and modify them as necessary to ensure that the objectives of the medical education program are met.”

To ensure adherence to this mandate, UNC SOM created the UNC96, a list of conditions and symptoms reflective of the most important medical conditions in North Carolina (based on mortality, morbidity, prevalence, cost of care data, and faculty opinion).  Before graduating, all students must observe or participate in the care of patients with each of these conditions and symptoms.  Students progress towards this requirement is monitored through the use of the Clinical Log (on one45).

UNC Inpatient Medicine Clerkship Requirements

During the Inpatient Medicine Clerkship, all students are required to have at least one clinical encounter with patients with the following conditions (from the UNC96 list):

• Abdominal Pain
• Altered Mental Status (acute or chronic)
• Anemia
• Atrial Fibrillation or Flutter
• Congestive Heart Failure
• Chest Pain
• Gastrointestinal Bleeding (upper or lower)
• HIV Infection
• Liver Disease/Cirrhosis
• Obstructive Lung Disease (COPD or Asthma)
• Pneumonia
• Renal Insufficiency (acute or chronic)
• Venous Thromboembolism (DVT, PE)

Monitoring

As noted above, patient encounters will be monitored by completion of the Clinical Log (on one45).  At the midpoint of each of the four week rotations (i.e., near the end of week 2 and end of week 6), students will review the Clinical Log with their residents and attendings.  This will allow students to focus subsequent clinical encounters to maximize the chance of a direct clinical experience with patients with the conditions listed above.  All students will also have an individual mid-clerkship meeting with the clerkship director sometime during week 4 or week 5 of the clerkship.  During that meeting each student’s overall clinical experiences will be discussed, including a review of the Clinical Log.  If needed, a student’s subsequent clinical rotation will be modified to the extent possible to maximize the chance of direct clinical experiences with patients with the conditions listed above.  If despite these efforts it is determined later in the clerkship that a student might not get a direct clinical experience with a patient with one of the above conditions, an indirect experience will be created.  For example, a student might be asked to interview and examine a patient with one of the above conditions on a different ward service.  The student would then review the case with his/her resident and/or attending.  Another option (much less desirable) is to have a clinical discussion about the topic with the resident or attending or the clerkship director (without the student seeing a patient individually).  A given student can “miss” having a direct clinical encounter with patients for only two of the above conditions.  They must have an indirect clinical encounter of some kind for these conditions.  The extent of the interaction will be documented in the Clinical Log.