Expectations for Clerks and Clinical Teachers
The following outlines expectations for both clerks and clinical teachers during the Family Medicine rotation:
- Contacting Preceptor: Clerks are expected to contact their preceptors prior to the start of their rotations to introduce themselves and to determine when and where they should meet on the start date of the rotation.
- Attendance: Clerks are expected to work with their preceptors for approximately 4½ days per week doing whatever work their preceptor is doing—seeing patients in the clinic, in hospital, on housecalls, emergency room visits or shifts, deliveries, etc. If required, clerks can be assigned to work with a colleague to ensure objectives are completed, for example, work a half day during the rotation with a colleague who does prenatal care, etc.
Clerks should aim to see three to six patients per half day. - Webinars: orientation and curriculum will be delivered Tuesdays from approximately 1:00-5:00 p.m. There will also be a pre-recorded orientation for clerks to watch prior to the start of this clerkship rotation. These are mandatory sessions.
- Community Half Days (Optional): The clerk has the option to arrange up to three community half days over the 6 week rotation, if this helps them fulfill individual learning needs. Possible suggestions are available to the clerks on Brightspace and preceptors may help organize these experiences.
- Call: As per the UGME On Call Policy clerks are expected to do call when their preceptors are doing call, to a maximum of 5 nights out of any 21-day peirod. If a clerk is engaged in active on-call duties between the hours of midnight and 6:00 am, they should be excused from clinical duties after appropriate handover.
Clerks should not be on call on the final night of the rotation.
The method of contact will need to be determined by the clerk and preceptor, i.e. cell phone or borrowing a pager through the community hospital, etc.
- Level of Responsibility: Please refer to the Guidelines for Level of Responsibility. Clerks are generally provided as much responsibility as they and their preceptor feel comfortable with. Students at the clerkship level may benefit from observing their preceptor on the first day to become familiar with the office routine or in complex or urgent clinical situations, however they should be capable of working more independently—taking histories and doing physical exams on their own. We would encourage clerks to take some time after seeing a patient to develop their differential diagnosis and management plan before presenting the case to their preceptors. They should be documenting their encounters in patient charts. All prescriptions or hospital orders must be co-signed by their preceptor.
- Logbooks: Clerks are responsible for completing their One45 Logbooks. It is recommended that this be done on a daily basis. This should be reviewed periodically with the preceptor, particularly at the midpoint and final ITERs, to ensure that the objectives are being completed. The three logbooks for Family Medicine are:
- Clinical Encounter log
- Procedure/Physical Examination Log
- Community Half Day log (optional)
- Feedback: Frequent feedback is important for clerks. This may occur at the time that the clerk presents each case or at the end of the day. It is also helpful for preceptors to occasionally observe clerks take a history and do a physical examination—this can be done with the preceptor in the room, or by listening in as the clerk takes a history in the ER room, etc. Preceptors can refer to the Providing Constructive Feedback handout for some suggestions on how to provide feedback.
- Evaluations: There are 4 types of assessments for this unit. Clerks are responsible for ensuring that these are completed.
- Mini-Clinical Evaluation Exercises (Mini-CEXs): 2-3 forms per 6-week rotation. Please refer to the Mini-CEX information sheet on how to use this form. THIS FORM HAS REPLACED THE FAMILY MEDICINE FIELD NOTES.
- Formative In-Training Evaluation Report (ITER): The Formative ITER is mandatory and is to be completed after each 3-week period in the clerkship rotation. It will be completed on-line on the One45 system. Please also review the Logbooks at this time—if there are any objectives that have not been completed this will allow both the clerk and the preceptor to plan how these objectives can be completed during the remainder of the rotation. Please ensure the timely completion of the ITER.
Preceptors and clerks should contact the Clerkship Director at this point if there is a risk of a failing grade so that we can provide clerks in difficulty with assistance and remediation during the second half of the rotation. - Project Presentation: Clerks must complete a 10-minute Power Point presentation, which they present to their peers during their rotation. Clerks will select a peer-reviewed journal article (based on family medicine objectives) to critically appraise and provide discussion on its relevance to family medicine. Students will be assigned to present on either the 3rd, 4th, 5th week by webinar and will be evaluated by one of the faculty. Clerks will send a final copy of their presentation to dfm.undergrad@dal.ca prior to their presentation day.
- Summary In-Training Evaluation Report (ITER): The Summary ITER will be completed at the end of the 6-week rotation by the Clerkship Director. The Summary ITER indicates that the Clerkship Director has reviewed the Formative ITERs, the logs listed above, the project presentation and any remediation plan, if applicable, and assigns the student a grade of Pass or Fail.
- Mini-Clinical Evaluation Exercises (Mini-CEXs): 2-3 forms per 6-week rotation. Please refer to the Mini-CEX information sheet on how to use this form. THIS FORM HAS REPLACED THE FAMILY MEDICINE FIELD NOTES.
- Examination Evaluations
- End of Unit Examination: At the end of the 12-week Family Medicine/Psychiatry block, clerks will complete an (approximately) 80-question MCQ/Short answer examination. The LMCC Part I uses “one best answer” MCQs. We have tried to model our questions using this format in order to give clerks more experience with these types of questions.
- Observed Structured Clinical Exam: In September, all clerks will complete an integrated OSCE. Stations cover all areas of medicine and stations are not specific to any single specialty, however, will include objectives covered in the Family Medicine rotation.
- Preceptor Evaluation: Clerks are asked to complete the on-line evaluation of their preceptor(s) at the end of their rotation. Once three evaluations have been completed on a given preceptor, this information will be summarized and anonymous feedback will be provided to the preceptor.
- Missed Time: Clerks must comply with the Undergraduate Medical Education Policies and Regulations Absences due to Illness and Clerkship Time Off Protocol. All student requests for time away must be submitted to the UGME/DMNB offices. If the request meets the UGME/DMNB policy they will then forward the request to the Family Medicine Medical Education Office. Preceptors will be copied on the responding email either approving or denying the request. Students are then encouraged to contact their preceptors for final approval.
- Insurance and Privileges: All clerks from Dalhousie University are registered with the College of Physicians and Surgeons of Nova Scotia and are insured under the University’s liability policy while they are registered as students. In some cases we have been forwarding the names of clerks to hospitals in order to arrange hospital privileges. If preceptors have been experiencing problems with this process in their community they are asked to contact the Department so that we can further assist in this process.