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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.

Clinical supervision policy (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.

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 their supervising provider(s). Supervision is designed to foster progressive responsibility, based on 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.

While rotating on clerkships, medical students should be permitted to participate in team care of the patient and are expected to demonstrate individual responsibility for patient care activities. Supervising faculty, instructors and residents will provide opportunities for students to demonstrate the following responsibilities:

  • Take patient histories, perform complete and/or focused physical examinations and enter findings in the medical record.
  • Students will write at least 1 patient note per week, 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. The supervising provider will review student notes and all order entries.
  • Constructive feedback on at least 1 clinical note will be provided during the clerkship.
  • 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.

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, and for at least one note per clerkship receive feedback from an attending, resident, or fellow. Feedback to students is to be either written (such as annotations to a printed note, or an email) or provided verbally in-person, and provided 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 four 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.

Health care providers (faculty, fellows, residents and non-physician providers) will have no involvement or influence on the academic assessment or promotion of a student for whom they have provided health care, including psychological care.  Exceptions to this policy include emergency treatment, patient safety, or sole expertise to provide care.

All instructors, including non-providers, will have no involvement or influence on academic assessment or promotion of a student with whom they have a conflict of interest.  Examples of conflict of interest may include a prior or existing significant personal relationship, family relationship, or business relationship; and situations in which a student has previously lodged a complaint against the instructor.

Instructors who may have a conflict of interest, including health care providers, may not participate in assessment in any way that may affect the student’s academic progress.  Examples of involvement in academic assessment may include assessing a student’s clinical performance, professional performance or small-group performance; assigning a course or clerkship grade; and involvement in decisions about the student on promotions committee.

In addition, students may not participate as a member of a health care team taking care of another medical or PA student.

 

Responsibilities:

Course and clerkship directors must ensure that faculty, residents and other instructors are aware of this policy. They must re-assign students as necessary to avoid all conflicts of interest. They must refer to a co-director or proxy in assigning a student’s grade if they have a conflict of interest themselves.

Students must notify their course/clerkship director if they identify a situation that would conflict with any part of this policy. Students are not required to divulge the nature of the conflict of interest. They must not ask for a clinical performance assessment from an instructor with whom they have a conflict of interest. They must not evaluate an instructor with whom they have a conflict of interest. They must inform their team or attending if they have been inadvertently assigned to care of another student.

Instructors must contact the course/clerkship director immediately upon discovering that they are assigned to an evaluative role of a student for whom they have provided health care or with whom they have a prior or existing conflict of interest. They need not divulge the nature of the conflict of interest and must not divulge the reason for recusing themselves from the assessment without student consent.  Clinical instructors must not assign a student to the care of another student.

Faculty members on the promotions committee should recuse themselves from a vote regarding promotion of a student for whom they have provided health care or with whom they have a prior or existing conflict of interest.