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Assessment and Student Supervision

The University of Iowa Carver College of Medicine hereby establishes guidelines regarding the levels of supervision required by all undergraduate medical educators. The type and level of supervision required for each student will vary based on the student's level of training and experience as well as by the complexity of a patient's care. While rotating on clerkships, medical students should function as an integral part of the team:  permitted to participate in team care of the patient, and expected to demonstrate individual responsibility for patient care activities.

Expectations for clerkship directors (9.3)

Individual course/clerkship directors will provide specific guidance to students regarding the student's level of responsibility and the scope of approved activities or procedures that will be expected. This information will be shared with all teaching faculty, residents and staff annually.

Additional requirements

  • Supervision of all students is provided by qualified faculty, residents, and non-faculty instructors at all times that a student is on duty or on call. Students are provided with rapid, reliable systems for communicating with faculty and resident physicians.
  • Supervision is designed to foster progressive responsibility.
  • Supervision is based on a student's demonstrated ability, level of training and demonstrated competence, as well as the objectives for the rotation.
  • Supervision is designed to provide constructive feedback in any problem areas encountered during the rotation and to facilitate mid-clerkship assessment and feedback.
  • Supervision is designed to verify student-generated reports in a timely manner. Any major changes made to a report are discussed' with students to enhance education.

Expectations of attending physicians and resident physicians (9.3)

Clinical educators, residents, and students will be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects.

Faculty and residents will provide opportunities for students to demonstrate responsibility and ownership for the following patient care responsibilities:

  • Take patient histories, perform complete and/or focused physical examinations and enter findings in the medical record of the patient with the approval of the patient's supervising attending physician and under the supervision of the attending physician or designated house staff.
  • Students will write the patient's daily note, enter orders, and coordinate care in a fashion commensurate with their training level. Students must clearly sign all entries in the medical record, along with the designation that they are medical students. Supervising attending physicians or graduate medical trainees are to review student notes and all order entries.
  • Provide patient care services under the direct supervision of the attending physician or designated house staff. In all patient care contacts the patient shall be made aware that the individual providing the care and/or performing the procedure is a student.
  • Review focused topics related to patients on the service and report information back to the team to demonstrate self-directed, clinical learning and application of knowledge to the care of patients.

Expectations of non-faculty instructors (9.3)

Non-faculty instructors will provide opportunities for students to demonstrate responsibility and ownership for the following patient care responsibilities:

  • Take patient histories, perform complete and/or focused physical examinations and enter findings in the medical record of the patient with the approval of the patient's supervising non-faculty instructor and under the supervision of the non-faculty instructor.
  • Provide patient care services under the direct supervision of the non-faculty instructor. In all patient care contacts the patient shall be made aware that the individual providing the care and/or performing the procedure is a student.
  • Review focused topics related to patients on the service and report information back to the team to demonstrate self-directed, clinical learning and application of knowledge to the care of patients.

Narrative assessment requirement (9.5)

Faculty will provide written comments (narrative assessment) on each student’s performance or achievement in meeting the goals of courses or clerkships, wherever such assessment is feasible.

Narrative assessment will be provided in all required courses if a student has one or more sessions with the same instructor in settings of 10 or fewer students (10:1 student/faculty ratio) and total contact of at least 12 hours. In situations where a pair of faculty members are allowed to share one instructor role, they will provide narrative assessment. For preclinical courses, narrative (written) comments can be formative or summative. Narrative summative assessment will be provided for each student from all required clerkships.  Comments will be submitted through the forms designated by the course or clerkship and approved by the college.

Required Clinical Experiences (6.2, 8.6)

The Medical Education Council shall have final authority over the entirety of required clinical experiences (RCEs) chosen for all required clinical rotations for medical students. The Council shall review, at least annually, the required clinical experiences of all required clerkships. The timing of this review will be determined by the Council but scheduled in advance of the start of a new clinical year.  All required clerkships will participate in the methods established by the Council to centrally monitor student experiences with patients.

All clinical departments will review the list of required clinical experiences with faculty, residents, and non-faculty instructors at least annually and encourage them to assist the students they supervise to gain access to the patients they need to see. Students will receive instruction about the required clinical experiences at orientation to the clerkship and RCEs will be posted to the clerkship ICON site. The clerkship director or supervising faculty member, as appropriate, will review each student’s progress in meeting the RCEs so that adjustments may be made in time to allow the student to complete them prior to the end of the clerkship. This review will occur during mid-clerkship feedback sessions and more often as needed.

Feedback requirements (9.7)

  • Students will write one note per week on all clerkships and receive feedback about their write-ups in a timely fashion.
  • Students will receive mid-course or mid-clerkship feedback in all courses and clerkships, including the two-week selectives.

Grades (9.8)

  • Final grades will be available within six weeks after the conclusion of a course or clerkship.

Healthcare providers involvement in student assessment (12.5)

It is the responsibility of the CCOM to ensure health care providers have no influence on the academic assessment or progress of a student they have treated.

  • Residents, faculty, and non-faculty instructors should not supervise or evaluate the academic performance of any student for whom they have provided health care, including psychological care.
  • Faculty members on the promotions committee should recuse themselves from a vote regarding promotion of a student for which they have provided health care.
  • If a medical/PA student is hospitalized or being seen in the emergency room, or other clinic settings, other medical/PA students should not be involved in the student’s care.
  • Therefore students should not be working with a faculty member, resident, or non-faculty instructor that will evaluate them if the student has ever been their patient, and in addition, students should not be participating as a member of a health care team taking care of a fellow medical or PA student.