Clerkship Committee Minutes 04/25/16

Clerkship Directors Meeting: April 25, 2016

Attendees: Casey, Cheng, Gusic, Heald, Herrington, McDaniel, McGahren, Schroen, Solorzano, Sudhir, Wilson, Wispelwey, Ward

Agenda and Discussion

Phronesis Group. Students in the Phronesis Group are now on clerkships. If they have the opportunity to attend a visit or procedure with their patients (longitudinal experience) they may be excused from clinical duties on the clerkship.

PLEWS-OGAN CPD GROUP: Walker Redd, Ambika Babbar, Jensie Harley, John Heller, Charlotte Heppner, Takairo Nakamura

SCHORLING CPD GROUP: Thuy Ho, Catherine Jansch, Takairo Nakamura, David Noble, Caroline Ruminski, Sarah Seifu

Entrustable Professional Activities. Maryellen Gusic made a presentation on EPA’s. There was discussion from the entire group as the EPAs for medical students will need to be integrated in the clerkship.

  • EPAs require direct observation
  • There will need to be assessment during clerkships to determine the competency of each student
  • General comments and themes
    • The number of procedures that students get to do is low, mostly because residents and fellows may need to do the procedures
    • The number of procedures in the EPA document are are only venipuncture, inserting an intravenous line, basic cardiopulmonary resuscitation and bag mask ventilation, and
    • There is a disconnect between the EPAs and billing and coding requirements
    • Level of supervision for medical students would be 3A or 3B (direct supervision and repeat key findings) which would allow for billing by the attending
    • Assessment is difficult with less time for attendings on the wards and less continuity with any one student
    • Consideration should be made for having teaching faculty who are responsible for direct observation and assessment of EPAs
    • Ability to perform EPAs with same level of entrustment will lapse and so, students may need to be observed after a lapse for reaffirmation of entrustment
    • Clinical skills are general, the clinical scenario will differ
    • Remediation for those who don’t meet expectation: how many students can we do this for? When in 4th year? Will this delay ACE?
    • Do residents have the skills to be assessors?
    • Things to consider: medical students should always take history independently, what if patients come “packaged?” Is it OK that residents coach the students?
    • For the recognition of quality or safety issues: we need to consider having students attend unit UBLs or learn how to do med rec
    • How will this affect elective selection and timing?

Reports of Unprofessional Behavior. clerkship directors are receiving more comments from the MSAC committee. Some of the comments are related to unprofessional behavior as it is commonly understood. A growing proportion of the comments are related to patient comments or general observations of how “medicine” is practiced that does not include breeches of professional conduct. The clerkship directors commented on who determines what is “unprofessional” and the difficulty of addressing the comments. The directors were concerned about the automatic distribution to the Dean for such comments. The directors see themselves as advocates for the students and take all comments seriously, noting that some of the recent ones are not necessarily unprofessional behaviors but comments on the complex  and stressful medical environment.

Action Item: Dr. McDaniel will meet with Dr. Chen and Ms. Thomas and report back to this committee at the next meeting.

Meeting Adjourned at 6:10 PM

Nancy McDaniel