Element 11.3 – Oversight of Extramural Electives

If a medical student at a medical school is permitted to take an elective under the auspices of another medical school, institution, or organization, a centralized system exists in the dean’s office at the home school to review the proposed extramural elective prior to approval and to ensure the return of a performance assessment of the student and an evaluation of the elective by the student. Information about such issues as the following are available, as appropriate, to the student and the medical school in order to inform the student’s and the school’s review of the experience prior to its approval:

• Potential risks to the health and safety of patients, students, and the community
• The availability of emergency care
• The possibility of natural disasters, political instability, and exposure to disease
• The need for additional preparation prior to, support during, and follow-up after the elective
• The level and quality of supervision
• Any potential challenges to the code of medical ethics adopted by the home school

Hidden Curriculum

This element reflects your institution’s commitment to ensuring quality, safety, and accountability in the selection and approval of extramural electives. The LCME expects that each student’s roster of electives is individually approved by a faculty member. Extramural electives need to meet the 6 requirements listed above. If a school enrolls in VSLO, this makes the process substantially easier. International electives require an even extra layer of scrutiny. Furthermore, you are expected to have a centralized system to track evaluations your students have submitted on extramural electives and make that feedback available to future students, so they have some local information (think google/yelp review) on away rotations taken by students that preceded them.

Best Practice

If your school does not already have one, it is a best practice to establish a centralized system within the OME office to review and approve all proposed extramural electives. This process ensures that 1) the 6 bullets in this element have been addressed, 2) student performance will be assessed and, 3) students have the opportunity to evaluate the elective. In some schools, extramural electives are reviewed by the student’s Learning Community Advisor or Specialty-Specific Mentor and approved by a dean in the Office of Student Affairs. Whoever is reviewing/approving needs to have training on this element, so they know what is expected. Having a rubric/checklist for approval of extramural electives (especially international) makes your life easier and then can be Supporting Documentation for the LCME when the blessed every-8-years event occurs. Ensure that your school can clearly describe the review and approval process for both domestic and international extramural electives!

You will need to implement a robust process for collecting and reviewing student performance assessments and evaluations of extramural electives. The student evaluation of extramural electives can be part of the process to determine whether each elective meets the institution’s standards and should continue to be offered. Moreover, you are expected to share this info with other students who might consider the elective in the future. Another best practice is to establish a formal process for evaluating potential risks to student and patient safety in extramural electives. Proactively addressing identified risks is essential to maintaining a safe learning environment. While the LCME does not require a uniform training agreement for students who do an extramural elective at another school, if you are not using the AAMC affiliation agreement, your school should be prepared to describe its approach to addressing the six bullets in the element.

Continuous Quality Improvement

One of the cornerstones of CQI is making decisions based on evidence. The use of comprehensive evaluation data is critical for determining whether an extramural elective should continue to be approved. This data may include student performance assessments, student evaluations of the elective experience, and any feedback regarding safety concerns. Schools should establish a clear system for collecting, analyzing, and acting on this data in a timely manner. It is also a good idea for schools to regularly assess and update the policies and procedures related to the central review of extramural electives. Schools should set a schedule for reviewing their policies and procedures to ensure that the approval and monitoring processes for extramural electives remain effective. This may involve reviewing feedback from students, faculty, and elective sites.