During the clinical clerkships, students focus on developing the clinical competencies required for graduation and post-graduate training. These competencies are evaluated in many different ways: by faculty observation during rotations, by examinations, by NBME Subject Examinations, and by the USMLE Step 2 Examinations. In order to develop many of these competencies and meet the objectives required for graduation, the Boonshoft School of Medicine needs to ensure that each student sees an appropriate mix of clinical encounters during their clerkships to achieve the learning objectives. For these reasons, as well as others discussed below and to meet accreditation standards, the school has developed this patient encounter log policy.
Part of our medical student learning objectives that students must achieve during their training involves documentation. Documentation is an essential and important feature of patient care and learning how and what to document is an important part of medical education. Keeping this log becomes a student training exercise in documentation. The seriousness and accuracy with which students maintain and update their patient log will be part of their evaluation during the clerkships.
In compliance with LCME Standard 6.2, each clerkship steering committee, chaired by the clerkship director, will identify the types of patient encounters/procedures that each student must complete during that particular clerkship rotation. Clerkship steering committees can look to specialty-specific national curriculum to guide the selection of these required patient encounters/procedures, but they must be derived from the BSOM learning goals and milestones. Clerkship steering committees must identify the minimum level of participation, based on student role, for each required patient encounter/procedure, with no more than 50% of required patient encounters/procedures designated as “observation” only. Clerkship steering committees must also identify acceptable alternative experiences for a student to meet the requirements of the patient logger in the case that they are unable to satisfy the requirement during their clinical rotations. This may include, but is not limited to, online case-based modules and in-class didactic topics.
Student Responsibility and Requirements:
- Document all required patient encounters (and procedures if applicable). Students must log whether or not they were observed under the “Student Role” option in the logger. Students are encouraged to log live patient encounters before using simulated encounters.
- Document information in a timely manner. The student should develop a habit of logging patient encounters frequently, with evidence of logging prior to the mid-clerkship point. Completion of the encounter log is due the last day of each clerkship. If an excused circumstance presents wherein the student is unable to complete the log during a specific clerkship, the student will be responsible to participate in a clinical elective or other remediation as determined by the clerkship, wherein the remaining items on the checklist will be completed.
Procedure for Clerkship Patient Encounter Log Review
- Mid-Clerkship/End of Clerkship Review: The Clerkship Directors and/or Clerkship Administrators must monitor the data on an ongoing basis to ensure that students are meeting clerkship objectives. Individual meetings and/or email communications will be sent to address student progress in the encounter log at the mid-point of the clerkship. At the mid-rotation point, any areas in need of supplementation will be discussed with a student. At the end of the clerkship the logs will be reviewed to ensure they are completed.
- Annual Reviews: An annual report will be prepared by the Department of Medical Education. The report will be reviewed by the Doctoring Subcommittee to determine if the specified patient encounters need to be revised in any way. This is then reported to the Faculty Curriculum Committee to ensure that the clinical experiences are meeting the objectives of the clerkship and to assess the comparability of experiences at various sites.
Patient Encounter Log Items:
The following items are required for the clerkship-specific patient encounters/procedures. Failure to complete these will be considered incomplete. The student will have to complete all items in order to receive credit for the encounter.
- Date of encounter
- Rotation: Current Clerkship
- Clinical Site: Choose the location of the encounter from the dropdown list
- Age Range (in years): <1, 1-4, 5-12, 13-19, 20-64, 65-74, 75+
- Gender: Male, Female, or Not Specified
- Clinical Tasks: See clerkship-specific list of requirements
- Selected Role:
- Observation: Student is observing encounter
- Moderate Participation/Assist in Procedure: Student completes the History and Physical (either complete or focused) and participates in the differential diagnosis.
- Full Participation/Fully Performed Procedure: Student completes History and Physical (either complete or focused), participates in the differential diagnosis, and then completes a therapeutic treatment plan, which can include documentation.
Reviewed and Approved by the Biennium II Subcommittee of the FCC on November 21, 2017