Element 8.8 – Monitoring Student Time

The medical school faculty committee responsible for the medical curriculum and the program’s administration and leadership ensure the development and implementation of effective policies and procedures regarding the amount of time medical students spend in required activities, including the total number of hours medical students are required to spend in clinical and educational activities throughout the curriculum.

Hidden Curriculum

The curriculum committee (CC) and the medical education program leadership team share the responsibility of ensuring that your school has implemented effective policies and procedures around this element.  As such, your curriculum committee minutes MUST show that not only has the CC approved this policy but that they ALSO review and approve the hours for your pre clerkship courses/blocks etc. AHEAD of time. For example, let’s say your first year is organized into 4 blocks. Each block needs to demonstrate how much in-class time, free time and self-directed learning time they will have BEFORE they start. An “easy” way to do this is:

• At the end of course review, the course/block submits any changes in schedule/work hours for the CC to review and approve, or,
• The appropriate subcommittee reviews prior to the start of the course/block AND submits the info to the CC for review and approval

Here’s something else – a schedule with 60 hours of work time in the pre-clinical curriculum is not going to be looked on favorably. Trust us. So, pipe down about how many hours you had when you went to school, walking there barefoot in the snow.

Best Practice

Create formal policies, such as an Academic Workload Policy and a Duty Hours Policy, to define expectations for pre-clerkship and clerkship students.

The Academic Workload Policy should provide guidelines for balancing students’ academic workloads and time spent on educational activities both in-class and outside of scheduled class time.  If possible, include a standardized metric to calculate the out-of-class activities (e.g. 2 hours for each active learning session) Notably, Element 8.8 now includes the evaluation of sufficient unscheduled time for self-directed learning (SDL) activities, which was previously part of Element 6.3.

The Duty Hours Policy should set limits on maximum weekly hours, additional hours allowed, minimum time off between duties, and required hours off per seven-day work period.

Establish systems that allow students and faculty to report time and duty hour violations confidentially (e.g. thru course evaluations) and anonymously through a secure reporting system, ensuring they feel protected from retaliation. Define clear procedures for how reported violations are investigated and addressed. This should include steps for gathering information, assessing the severity of the violation, and determining appropriate actions or corrective measures. Students should be able to contact the course director immediately with any concerns related to duty hour violations or scheduling questions. Clerkship Directors should also inquire about potential duty hour violations during mid-term feedback meetings. Implement a system for providing feedback to students and faculty about reported violations and actions taken both in “real time” and on a regular basis as part of overall curriculum management. This type of feedback loop is critical for student satisfaction.

Finally – when you provide a calendar as a supporting document, be sure that it represents ONE student’s experience. Have hours blocked off clearly as “Independent Time off” and “Self-Directed Learning Time” etc.

Continuous Quality Improvement

It’s important to have procedures for collecting and monitoring data on the time medical students spend in required activities during the pre-clerkship and clerkship phases. This includes:

1. Your curriculum committee, possibly through your pre-clerkship/clerkship subcommittees, proactively reviewing the proposed pre-clerkship curriculum and syllabus for each course to ensure that the out-of-class required activities are in line with your policy.   In addition, if you have longitudinal courses, their out-of-class assignments must be calculated in the total out-of-class requirements.
2. Once the course is completed, schools must regularly gather feedback from students to ensure that these policies align with the actual time students spend on required outside-of-classroom activities. This can be done in a variety of ways including face-to-face interactions between faculty and students, by reviewing time logs, conducting end-of-course evaluations and end of year evaluations with questions specific to the workload to ensure that the workload is manageable and conducive to effective learning.

By continuously monitoring and adjusting the curriculum based on this data (student input)your school can enhance the educational experience and ensure compliance within this element. Finally ensure these policies are effectively communicated to students, faculty, residents, and other health professionals at all instructional sites. You will want to have attestations that these groups have seen all your schools important policies.