Element 5.5 – Resources for Clinical Instruction
A medical school has, or is assured the use of, appropriate resources for the clinical instruction of its medical students in ambulatory and inpatient settings that have adequate numbers and types of patients (e.g., acuity, case mix, age, gender).
Hidden Curriculum
At its core, this element emphasizes ensuring an adequate number and mix of patients in both inpatient and outpatient settings to support the learning needs of your medical students. Table 5.5-2 in the DCI for full accreditation surveys is the money table! Note that you must list:
| Facility Name/Campus (if applicable) | Clerkship | Average Daily Inpatient Census | Average # of Students per Rotation (range) | |
| MD Students From This School | Medical Students (MD/DO) from Other Schools | |||
So – the team is looking at that average daily inpatient census and then how many overall students are sharing those patients. You best have enough patients for your students!
Best Practice
Ensuring that medical students have consistent and meaningful access to patients during their clinical training is a critical responsibility and one that requires proactive coordination. One of the biggest challenges schools face is balancing the number of learners with the number of available patients at clinical sites. This means looking beyond just your own medical students and considering other learners who may be sharing those same opportunities such as physician assistant and nurse practitioner students, or students from other medical schools. If you have students rotating from other medical schools on core clerkships (MD OR DO) that’s a whole other topic that will deserve a lot of attention.
In some cases, the competition comes from within: multiple programs from the same institution may be sending students to the same clinical site. That’s why it’s so important to take a broad view assessing how many total learners are at each site, not just from your program but from others as well. It’s also key to understand the patient census at each site, taking into account any seasonal variations that could affect availability.
Communication with clinical sites is essential. Work with site leadership to determine whether there are enough patient encounters and clinical shifts to accommodate all students. Make sure there’s a clear understanding of how learners are prioritized and scheduled.
Monitoring how students are progressing through their required clinical experiences is equally vital. Clerkship directors should review this data regularly ideally after each rotation block and follow up on any concerns. Student feedback also plays a big role here even if the data shows they’re technically meeting requirements, are students struggling to get those experiences? Surveys can help identify issues that numbers alone might miss.
Lastly, keep an eye on any changes in the healthcare system or within specific clinical sites that could impact patient volume or mix. These changes might affect your affiliation agreements or your students’ ability to meet core educational goals. Staying in close communication with site partners ensures you’re ahead of any disruptions and helps maintain strong, sustainable clinical learning environments.
Continuous Quality Improvement
Regular monitoring of clinical capacity is essential. Schools should track the number of learners assigned to each clinical site at least annually or more frequently, such as each semester or block, if needed. In addition, it’s important to monitor patient volumes at each site, broken down by specialty or service, to ensure that students have access to adequate clinical experiences. Affiliation agreements and any changes at clinical sites such as operational shifts or organizational restructuring should also be reviewed regularly, ideally on a quarterly basis, to identify potential impacts on student training and site capacity.
