Clinical Log

See Link for Patient Log in your ONE45 account

The Medicine Clerkship Log serves two purposes. First, it documents the number and kinds of patients the students encounter during the clerkship. Second, it provides information on the RIME framework and documents that the students and attendings have had mid-rotation feedback sessions. All students must submit their Clerkship Log before they can take the end of clerkship exam.

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.  Student’s progress towards this requirement is monitored through the use of the Patient Log (on one45).

UNC Medicine Clerkship Requirements

The members of the Department of Medicine Education Committee used the CDIM/SGIM set of common clinical complaints and conditions to determine the following major disease states/conditions that students are all expected to encounter during the entire Medicine Clerkship (inpatient and outpatient combined):

All students are required to have at least two (2) direct clinical encounters with patients with the following conditions (see patient/procedure log link in your one45 account):

  • Cancer Screening
  • Diabetes Mellitus
  • Hypercholesterolemia
  • Hypertension

These encounters will be assessed by completion of the computer problems during the outpatient clerkship.

All students are required to have at least one (1) clinical encounter with patients with the following conditions (see patient/procedure log in your one45 account):

  • Abdominal Pain
  • Altered Mental Status
  • Anemia
  • Atrial Fibrillation
  • Back Pain
  • Congestive Heart Failure
  • Chest Pain
  • COPD/Asthma
  • Common Cancers
  • Depression/Anxiety
  • DVT/PE
  • GI Bleeding
  • HIV infection
  • Joint pain
  • Liver disease
  • Pneumonia/URI
  • Renal insufficiency

These encounters will be assessed by completion of the patient log. At the midpoint of each of the clerkship rotations, students must review the 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 a patient with each of the conditions listed above. If, later in the clerkship, it is determined that a student might not get direct clinical experience, an indirect experience must be created. This might be having the student separately interview and examine a patient with one of the above conditions on the team (one the student is not directly following) or on another team. The student would then review the case with the resident or attending. Another option (less desirable) is to have a clinical discussion about the topic with the resident or attending (without seeing a patient individually). The extent of the interaction will be documented in the patient log.

It is highly desirable that all students will have direct clinical experiences with all the above conditions. A given student can “miss” having a direct clinical encounter with patients for only two (2) of the above conditions. They must have an indirect clinical encounter of some kind for these conditions.

Mid-rotation Feedback

The LCME mandates that all students get mid-rotation feedback. Please contact your preceptor early to schedule a feedback session. The Medicine Clerkship Log will allow a student to document that the attending and the student had a formal feedback session during which the student received an interim assessment of his/her progress. The assessment should include a formative evaluation (ideally following the RIME format) as well as a review of the number and types of patients the student has seen.