Element 6.2 – Required Clinical Experiences

The faculty of a medical school define the types of patients and clinical conditions that medical students are required to encounter, the skills to be performed by medical students, the appropriate clinical settings for these experiences, and the expected levels of medical student responsibility.

Hidden Curriculum

This is another frequently cited element. Element 6.2 forms the basis for Element 8.6 in which it asks to describe how students document completed experiences and how this will be monitored. You can read more about Element 8.6 right here! The LCME doesn’t state this, but absolutely expects that most of the required clinical encounters (RCE) are ones that student can take an active role in. They are not going to want to see a lot of “observes” in this section. Another issue is that they typically don’t like it when they see the setting for the RCE can be both inpatient and outpatient. As much as possible, pick one location. Many schools have far too many RCEs per clerkship. A general rule of thumb is to have the number of RCEs match the number of weeks in your clerkship – so if you have a 6-week clerkship – have 6-8 max RCEs. This does NOT mean that these are the only diagnoses you expect your student to learn about! It just means these are ones that you are going to have them document! Finally, while the DCI does not ask for Alternative Experiences any longer – we can tell you that one school was indeed still asked for this information at their official survey visit – so you best still have it ready.

Best Practice

Element 6.2 involves implicit expectations about patient care, role modeling by faculty, institutional priorities reflected in clinical settings, and social norms within the medical community. These elements shape students’ professional identities and approach to patient care beyond the official curriculum. Table 6.2-1 requires you to list the levels of student responsibilities. Create different levels of responsibility and assign each one to a specific experience, using terms/definitions approved by your curriculum committee. Ensure you can define these levels in your narrative. For example, you might use terms like Perform, Assist, or Observe.

Ensure that alternative experiences are provided to address gaps in patient encounters or skills. Clerkship Directors should be responsible for developing a list of alternatives for students who are unable to access a required encounter or perform a required skill. These alternatives can include simulation experiences, online modules, case studies, literature, and videos/podcasts. Make sure these lists are reviewed and approved either at a sub-internship or subcommittee level and then by your curriculum committee. A helpful tip is to have your list of clinical experiences and alternatives reviewed and approved annually during the clinical phase review, clerkship, and sub-internship review process.

When performing a phase review of the curriculum, you will want to have the entire list of all RCEs across all clerkships in ONE document. This way the Curriculum Committee can decide if there are too many of one RCE (e.g. diabetes in 6 of 8 required clerkships) and remove some of the redundancy or if there is a diagnosis they feel should be added to a clerkship.

Use multiple methods to inform students, faculty, and residents about the list of required clinical encounters and skills. Clerkship directors can inform medical students through mandatory orientation sessions, clerkship course overview documents, and mid-term feedback. They can review the required clinical experiences with teaching faculty during orientation, departmental meetings, or through regular emails. Additionally, clerkship directors can email the list of required encounters and skills to residents before they supervise medical students, include it in online modules, and address it during annual department resident meetings. Ensure that whichever modality you choose, students, faculty, and residents can attest to having received the information.

Continuous Quality Improvement

Continuously monitor the completion rate of RCEs and how often alternative experiences to address gaps in patient encounters or skills is used. You should also regularly make adjustments as needed to ensure the RCEs meet the intended learning objectives. Establish a system for annually reviewing and approving lists of clinical experiences and alternative experiences during key review processes such as clinical phase reviews, clerkship reviews, and sub-internship reviews.