Required clinical experiences in the core clerkship rotations - responsibilities of students, faculty, and MD Program curriculum leaders

A. Principles

  1. Educational value

    The logging of clinical procedures and encounters in core clerkship rotations has important educational value for students, teachers, and course directors

    1. Students benefit from logging because it allows them to confirm that they have in fact encountered all of the core problems and performed all of the core procedures that the program has deemed essential for completion of the MD degree.
    2. Every participant in the clerkship education process benefits from logging because it allows the program to confirm that all clinical sites provide equivalent experiences and that all students meet the minimum expectations with regard to patients seen and procedures performed
  2. Real patients

    The MD Program emphasizes the importance of student interaction with real patients to help support achievement and assessment of the program’s key and enabling competencies. For this reason, the required encounters and procedures lists are designed to be achievable exclusively through experiences with real patients. However, simulated experiences may be permitted in some cases to remedy gaps, as described below

  3. Course component

    Logging of clinical encounters and procedures is a mandatory, Credit/Non-credit component of every core clerkship rotation that is greater than or equal to one week in length. A student will not receive credit in a course until such time as the list is completed

  4. Academic integrity

    The principle of academic integrity applies to logging just as it applies to all other course components. Therefore, any falsification of data will be considered a a breach of academic integrity, subject to disciplinary action according to University and MD Program policies and procedures

B. Description of the course lists of required encounters and procedures

Every core clerkship course maintains and publishes a list of required encounters and procedures. These lists are reviewed annually by each course and updated as required, with central oversight by the Clerkship Director. Updates must be reviewed/approved by the Clerkship Committee and Curriculum Committee

The lists are publicized on the course websites on Elentra and on the Case Logs tab on MedSIS. At the start of each rotation, students are expected to familiarize themselves with the list of required encounters and procedures for that course, including the required number of each encounter and procedure and the level of student involvement required, as described below.

  1. Encounters

    Encounters are defined as meaningful involvement in a patient’s care. For example, taking a history, performing relevant physical examination manoeuvres, and taking part in discussion of investigation and management are considered encounters

  2. Procedures

    Procedures have a pre-specified level of minimum involvement that must be achieved in order to be logged. These expectations are clearly articulated as part of the list of required procedures. The levels are

    1. The student observed the procedure
    2. The student performed the procedure with assistance or assisted someone else
    3. The student performed the procedure independently
  3. Number

    In most but not all cases, only one encounter or procedure per item listed is required. Students are not expected to log every patient, but must meet the requirements for logging (including quantity) specified by each course

  4. Settings

    The expected setting for each procedure and encounter is generally implicit, given that the lists are course-based and courses typically have specific settings. In cases where more specificity is required, it is included in the name of the procedure or encounter. Where context specificity is not important, encounters/ procedures are annotated on the case logs list as achievable in more than one course (e.g. Well care of the newborn in Pediatrics or Family Medicine

C. Process for reporting and review

  1. Mid-rotation

    As part of the formal interim feedback conversation, it is mandatory for students to review their Case Logs Student Activity Report with their preceptor/site-supervisor, except in the case of courses with a duration of one week or less. (Courses of one week or less are deemed too short to require mid-rotation meetings.) It is a student’s responsibility to present the report to their preceptor/site supervisor

    Students are expected to have a dialogue with their preceptor/supervisor regarding the report. This portion of the mid-rotation feedback conversation has two main purposes

    • To discuss the key learning points of the experiences that have been logged by the students to date
    • To establish a plan for subsequent clinical experiences to remedy any gaps in order to complete all the required encounters and procedures by the end of the rotation. This is documented on the Interim Feedback Form
  2. End-of-rotation

    The Course Director reviews each student’s record to ensure all encounters/procedures have been completed, and assigns a grade of Credit/No credit.

  3. Incomplete requirements

    As stated above in A. Principles, the expectation is that the required clinical encounters and procedures are preferentially experienced through interaction with real patients. Some encounters and procedures will be identified in each course as “Must be real” because they are critical common patient encounters that cannot be adequately replaced by simulation. Even for other required encounters and procedures, simulations should only be used to remedy gaps, such as when a given experience with a real patient is unavailable (e.g., in the case of seasonal illness or certain less common presentations)

    In the event of an incomplete Case Logs Activity Report, students will be required to work with the course director expeditiously to make an action plan, with follow-up from the course director, to remedy any remaining gaps. In some cases, an encounter/procedure may be achieved on a future rotation and left blank until achieved. Upon completion of a Case Logs Activity Report, Credit for the component will be awarded. Note: All gaps in all courses must be completed within six weeks of the end of the Year 3 clerkship in order for all clerkship courses to be considered complete with credit earned

  4. Central monitoring

    The Clerkship Director will monitor overall completion rates in every course at regular intervals to identify any trends of concern requiring action

    Individual students who are persistently unable to complete the required lists in multiple courses may be considered to exhibit academic difficulty, in which case the appropriate interventions will be applied, in accordance with the Guidelines for the assessment of MD students in academic difficulty – Clerkship

Date of original adoption: 12 September 2011 

Date of last amendment: 09 July 2019