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.
The Liaison Committee on Medical Education is the agency that accredits medical schools in the United States. The LCME mandates that “each clerkship that requires interaction with real or simulated patients should specify the number and kinds of patients that students must see in order to achieve the objectives of the learning experience….The school should specify the major disease states/conditions that students are all expected to encounter. They should also specify the extent of student interaction with patients and the venue(s) in which the interactions will occur. A corollary requirement of this standard is that clerkships will monitor and verify, by appropriate means, the number and variety of patient encounters in which students participate, so that adjustments can be made to ensure that all students have the desired clinical experiences.”
As stated elsewhere, the overall goal of the UNC Medicine Clerkship (inpatient and outpatient) is to have all students develop a comprehensive approach to the evaluation and care of the adult medical patient. During the clerkship, students will continue to improve their ability to obtain, record, analyze and communicate clinical information. The patients the students meet on the wards and in the clinics should be the focus for the development of these skills; the students' contact with the patients is the center of the curriculum.
It is clearly not possible during 12 weeks of clinical experiences (8 inpatient + 4 outpatient) to see, learn or teach all that comprises internal medicine. There are, however, some core clinical competencies that all students must master. A select group of members of the Clerkship Directors in Internal Medicine and the Society of General Internal Medicine created a list of major core clinical competencies. Within each topic, the pertinent learning objectives (knowledge, skills and attitudes) are enumerated. Students are expected to be well along the path to mastering these core clinical competencies by the end of the combined clerkship experiences. Students are strongly encouraged to peruse this information.
Students will learn most of the core competencies during their participation in clinical care (including contact with their patients and the medical providers) and by supplementing these experiences with appropriate educational materials. When they are learning about specific topics, students often ask "What do I need to know about this?" Again, while it is impossible for educators to tell students everything they must learn, it is possible to offer some guidance. To this end, the CDIM/SGIM group also created a set of common clinical complaints and conditions. Within each topic, specific learning objectives are listed. While there are many topics that are not listed, students can use these outlines to get a sense of the depth and breadth of knowledge they are expected to acquire during the clerkship. Again, students are strongly encouraged to peruse this information.
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
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
- Atrial Fibrillation
- Back Pain
- Congestive Heart Failure
- Chest Pain
- Common Cancers
- GI Bleeding
- HIV infection
- Joint pain
- Liver disease
- 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.
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.