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Guidelines for Level of Responsibility for Learners

The following are guidelines on the expectation of the level of responsibility of learners at various stages. As learners progress through rotations and continue to develop their skills they should advance to higher levels of responsibility.

Med I and II Clinical Clerk or Med IV
  1. The learner observes the teacher complete a doctor-patient consultation.
  2. The learner asks questions of the patient and/or teacher during the observed consultation.
  3. The learner takes responsibility for one part of the consultation; for example, the interview, a regional examination, a management discussion, or completion of the record with direct observation* by the teacher.
  4. The learner undertakes part of the consultation with the patient without direct observation by the teacher and reviews that portion of the case with the teacher immediately afterwards.
PGY1 or PGY2
  1. The learner undertakes the complete patient consultation including history, appropriate exam, management, and discussion with direct observation by the teacher.
  2. The learner undertakes a complete patient consultation without direct observation by the teacher, immediately followed by a full discussion of the case with the teacher, and a final review to include the teacher, learner and patient.
  3. The learner undertakes a complex patient consultation with direct observation by the teacher.
  4. The learner undertakes a complex patient consultation without direct observation by the teacher, immediately followed by a discussion of the case with the teacher, and a final review with the teacher, learner and the patient.
 
  1. The learner undertakes a complete consultation without direct observation by the teacher with discussion and review at the end of the clinical session, in the absence of the patient.

*Direct observation refers to the teacher being present in the room, viewing the learner through a two-way mirror or by a video monitor.

Adapted from Dr. Cathy MacLean’s Guidelines: Level of Responsibility for Third and Fourth Year Clerks
Source: R:\Family\Undergrad\AA -Main Directory August 2006\Preceptors\Preceptor Package\2010-2011\Guidelines for Level of Responsibility.docx