Students presenting posters

Third-Year Clerkship

Breadcrumb

In Year 3, each student will have an educational experience in the core areas of internal medicine, surgery (Block A), family medicine, pediatrics, obstetrics-gynecology (Block B), psychiatry, neurology and emergency medicine (Block C) at medical centers and hospitals in Inland Southern California. Students will also spend one week of each clerkship in a community-based setting, giving them the opportunity to participate in the care of patients in diverse settings while gaining experience and understanding of the health care needs of the community.

Throughout the third year, students will continue their Longitudinal Ambulatory Clinical Experience, spending a half day each week continuing to provide care, under supervision, to the same panel of patients with whom they interacted in the second year.


All of the following must be completed prior to entry in the third year:

  1. Passing of all required second year educational activities
  2. Take the USMLE-Step 1 at least 30 days prior to first day of MS3 and receive a passing score
    • Failure of the USMLE-Step 1 will result in removal from the clerkship rotation-A safer and more prudent solution is to take the test at least 6 weeks prior to the start of clerkships.
      CAVEAT for 2020: Due to the COVID-19 crisis, the deadline to take Step 1 for the class of 2022 has been moved to the end of the third year.
  3. Participation in Clinical Foundations III
    • Attend presentations regarding clerkship policies, procedures, safety, and expectations
    • Complete all on-boarding requirements for both UCR and all UCR affiliated hospital sites

Important Dates and Deadlines

These dates and deadlines are subject to change.

Third Year Information Session
The third or fourth Tuesday in January prior to the start of MS3

Clinical Foundations III
Monday through Friday, one or two weeks prior to the start of MS3

First Day of Clerkships
Monday, June 29, 2020.


Third Year Roles and Responsibilities

Third-year medical students serve as members of the health care team and share responsibility for patients’ well-being. Students will provide patient care in a structured environment under the direct supervision of an attending physician or resident. Students often function as caregivers of patients presenting with undifferentiated medical complaints. Each patient that students encounter should receive a directed evaluation in a timely fashion.
 
Physicians must successfully combine the personal qualities of compassion and commitment (duty) with an ever-evolving knowledge base to complement sharpened academic and clinical skills (expertise). The M.D. degree confers great responsibility and implies that graduates who have earned it can function with some independence in the care of patients. Clerkships provide students with an intense opportunity to improve their current fund of knowledge, basic history-taking and diagnostic skills, and to apply these to multiple situations and settings. Although observing staff physicians and house officers at work is beneficial, experiential learning is more effective. For students, most clinical situations will be new and it is understandable to feel uncertain. During the clerkship rotations, students will find that having a willingness to challenge themselves with new experiences will be a vital aspect of their education. This is a new and more participatory learning process when compared to the first two years in the program.  The more you ask to participate, the more you will learn and develop your skills as a physician in training.  

Medical students must know their own team’s patients in necessary detail and follow these patients as if they were totally responsible for them. Students should play a proactive role in patient care. They should not remain a bystander or simply report facts. During clerkships, students must make a transition from beyond the role of a “reporter” to demonstrating some evidence of beginning to function as a reasonable “interpreter.” Demonstrate your understanding of the medical conditions that are affecting your patients as often as you can.  It is the best way to show your preceptor that you are learning and desirous of being a member of the health care team.

Working with other medical students, interns, residents, and skilled staff physicians can be challenging but is an important process for your professional growth as a physician in training. Patients and medical team members expect students to be available and actively thinking all the time. It is expected that students may feel at time that they have not gained control of the knowledge and skills that they need.  Therefore, it is important to manage time effectively and to prioritize your medical education.  Read during the day if you can, as well upon returning home from your rotation.


Third-Year Clerkship Competencies

The clinical learning outcomes for this clerkship are intended as competency expectations to help medical students achieve their potential. These competencies will be met primarily through clinical experiences and associated reading while rotating through clinical sites. Students should become familiar with these competencies.  Each supervising physician or resident will evaluate the achievement of these competencies on a regular basis.  The cumulative clinical performance for each student will serve as the basis for the summative evaluation at the conclusion of the clerkship.  These are listed in Appendix 1 at the end of this clerkship guide.


Third Year Curriculum

The third year medical school curriculum at the UCR School of Medicine includes an interdisciplinary longitudinal clinical experience emphasizing inpatient, outpatient, acute, chronic, well care and consultative medicine in the context of a single community/population.  Through this experience, each student will be exposed to:

  1. Internal Medicine
  2. Surgery
  3. Family Medicine
  4. Pediatrics
  5. Obstetrics and Gynecology
  6. Psychiatry (longitudinal over the course of the entire third year curriculum plus during transition weeks 7 and 14 of Blocks A and B)
  7. Emergency Medicine (longitudinal over the course of the entire third year curriculum)
  8. Neurology (longitudinal during transition weeks 7 and 14 of Blocks A and B)
  9. Longitudinal Ambulatory Care Experience (longitudinal over the first three years of the medical school curriculum)
  10. Community-Based Education (CBE, longitudinal during transition weeks 7 or 14 of Blocks A and B)
  11. Selectives (during weeks 22-24 of Blocks A and B) for students in good academic standing

The Third Year Schedule Preview

A Clinically Integrated Longitudinal Clerkship
Week 1-6 7 8-13 14 15-20 21 22-24
Block A - Internal Medicine/Surgery 3-week selective
Block C - Psychiatry, Emergency Medicine, Neurology
Week 1-6 7 8-13 14 15-20 21 22-24
Block B - Family Medicine, Pediatrics, OB/Gyn 3-week selective
Block C - Psychiatry, Emergency Medicine, Neurology

The academic third year is divided into two 24-week blocks. Block A includes Internal Medicine and Surgery.  Block B includes Family Medicine, Obstetrics/Gynecology and Pediatrics.  Block C runs concurrently with both Block A and Block B. It consists of Emergency Medicine, Psychiatry, and Neurology.

Blocks A and B are each subdivided into three 6-week units transected by two transition weeks (weeks 7 and 14) and finished off by one 3-week “selective” unit (weeks 22, 23, 24).   The Academic Schedule for the year will be handed out. (Students at Kaiser Sites will have different versions of longitudinal experiences).

LACE (Longitudinal Ambulatory Care Experience) continues in the third year as a half-day clinic continuation of the first and second year LACE curriculum. No LACE clinic will be held during transition and selective weeks.  

CBE (Community-Based Education) will occur during either of weeks 7 and 14 of each semester.

Transition Weeks (weeks 7 and 14):

Week 7, 14, and 21 will each begin on the Friday prior to the actual week 7, 14, or 21.

  • Weeks 7 and 14 will consist of three activities:
    1.  A formative OSCE. OSCE checklists will NOT be provided beforehand. Study all of your clinical skills exams so your performance will be superb.
    2. Evaluation, feedback and remediation sessions (the Friday of transition weeks 7 and 14)
    3. CBE activities or Psychiatry (alternating with one of the two on week 7, and the other on week 14)
  • Week 21 will consist of:
    1. Shelf Exams in the subjects completed in the prior block(s)  
    2. Compilation of preceptor performance evaluations with assignment of grades no later than 4 weeks after the end of week 21.
    3. The OSCE has been scheduled for week 24 in 2019/2020. This may change.

Selective Weeks

Weeks 22, 23, and 24 of each block will serve as a flexible foundation for the following uses:

  • Incorporation of short “Selective” experiences allowing students to explore aspects of medicine for which they might usually have to wait until the fourth year
  • remediation for students identified as “failing” the block (Advanced Clinical Elective)
  • to obtain additional experiences in areas of identified interest
  • Students are able to rotate at an affiliated site with a physician that has a current faculty appointment.
  • Student may only repeat a Selective rotation in the same subspecialty if they submit documentation that there will be a new educational outcome for the “repeated rotation”.
  • If a student wishes to do a rotation that at a non-affiliated site or for research they can request the extramural form from their clerkship coordinator. The form must be submitted for approval by block director.
  • VSLO rotations are approved for a selective option but only for the Second Selective period.
  • Selective are graded Pass/Fail/Honors

Site Preferences and the Lottery

Each student will be assigned to begin the year in either one of two blocks—Block A or Block B. The order of the clerkship rotations is set within each block and cannot be changed. Students will have the opportunity to participate in a lottery to make site requests for their clerkships. Participation in the lottery is optional. Regardless of lottery results, the students’ final rotation and site selection must be based upon UCR curricular requirements and clerkship site availability, not the desired site requested by the student.

The lottery will include the opportunity to request:

  • Which block to begin/end with (Block A – Med/Surgery or Block B – Family Med., OB/GYN, & Pediatrics),
  • Preference of clinical site,
  • Any special accommodations needed.

Reasonable efforts will be made to accommodate requests. Student preferences are not guaranteed.

In order to be guaranteed a training position in the summer/fall block, students must have taken the USMLE Part I examination at least 30 days prior to the start of the Year III summer/fall block. For those few students who skip the summer/fall block and wish to enter the winter/spring block, the USMLE Part I exam must be taken prior to the first Friday in December in order to guarantee a position in the winter/spring block.

Students must make the clerkship team aware of personal events coming up during the third year (maternity leave, national presentations, etc.) and any special needs prior to scheduling their blocks.  Once site assignments and blocks are assigned, no changes will be allowed.


Clinical Sites

For each Block, students will be assigned to an inpatient service, outpatient clinic, and/or medical office of a community physician as a clerkship site.  The primary clinical sites include Riverside University Medical Services Health Center, Riverside Community Hospital, Kaiser Permanente-Riverside, Kaiser Permanente-Fontana, Desert Regional Medical Center, Riverside Community Physician Practices, St. Bernadine Medical Center, San Antonio Regional Hospital, and the Riverside County Department of Mental Health clinical facilities located throughout western Riverside County, and other sites that are joining the UCR SOM team.  

Students will be expected to travel to all clinically affiliated UCR SOM clerkship sites as assigned. Students will not be permitted to contact potential preceptors or sites to set up their own clerkships.


Clinical Structure and Duty Hours

https://somsa.ucr.edu/som-handbook#curriculum2


Clinical Expectations

Students will participate in the care of undifferentiated patients during their clerkships.  Patient care will be provided under the direct supervision of a resident or attending physician.  Students are expected to be capable of obtaining an appropriately directed (focused or complete) history, performing a physical examination, formulating an appropriate differential diagnosis and assessment, discussing the case with the supervising resident or physician, and assisting in the development and implementation of case specific patient management plans, including proper follow up and patient disposition.

Throughout their rotations, students will be expected to care for patients with specific complaints/diagnoses. All students are expected to master the content outlined for the core presentations/patient types for each specialty area and to provide direct care for those patients. The expectation is that students demonstrate patient care competencies as well as medical knowledge of these diagnoses.  This obligation to see core diagnostic presentations may include patients who present for the listed condition, for whom the condition is within the differential diagnosis for their presenting complaint, who present for other primary concerns but concurrently have the indicated condition, or who are being followed up for a previous diagnosis of the condition.  Substantial independent reading is expected and required. Additional educational material focusing on some of the core topics will be posted online. If students do not encounter a patient with one or more of the required clinical complaints/conditions, they will still be expected to review the diagnosis and treatment from standard online textbooks.  There are several diagnoses which, if not seen clinically, require completion of online educational modules.  For more information about these and other learning modules, please refer ot the specialty-specific sections of this clerkship guide.


Student Oral Case Presentations and Recording of History & Physical

When medical students are asked to present patient cases, we recommend using the guidelines below as a general framework. Your attending and resident physicians can offer additional guidelines specific to their medical specialties and individual clinical settings. For history and physical examination write-ups, please see the forms found in Appendix 3. Exceptions and alterations can be granted by the on-site attending physician.

New Patient H&P or Hospital Admit or New Consult
  1. Patient identification/introduction: “This is a X year-old [man/woman] with a history of X who presents with cc: X.”
  2. CC + HPI: OLD CARTS. Onset, location, duration, character, aggravating, relieving, temporal (pertinent positive/negative), severity
  3. “T” in carts is amplified for pertinent positives and negatives from the hx + medical records review + ROS
  4. MASH: Meds, Allergies, Surgeries, Hospital Admissions/Major Medical Diagnoses
  5. FISH; Family History. Immunizations and Preventative (Females ask LMP/contraception/GPAL; children ask development). Social (HEEADSSS as appropriate). Habits (Drugs/Tobacco/ETOH).
  6. ROS, as pertinent. There are 14 Systems.
  7. Vital Signs, followed by physical examination
  8. Laboratory and imaging studies
  9. Assessment (including problem list + supportive logic + differential diagnosis). Keep problem list numbered the same every day.
  10. Plan: Each individual assessment item gets an individual plan.
Daily Hospital Progress Note
  1. Begin with patient identification/introduction, as described above.
  2. Brief summarize the interim history, focusing on the past 24 hours.
  3. Mention pertinent positives and negatives of the history, with review of systems only as pertinent.
  4. Vital signs, followed by physical examination
  5. Updates to the laboratory and imaging studies
  6. Assessment
  7. Plan
Outpatient Progress Note
  1. Begin with patient identification/introduction, as described above.
  2. Brief summarize the interim history, focusing on what has changed since the last clinic visit.
  3. Mention pertinent positives and negatives of the history, with review of systems only as pertinent.
  4. Vital signs, followed by physical examination
  5. Updates to the laboratory and imaging studies
  6. Assessment
  7. Plan

Patient/Procedure Logs

All students are required to document patient encounters/ procedures using the New Innovations system.  This is a mandatory requirement to successfully complete the rotation and required for grade submission.  Students are expected to complete the logs within one week of the patient encounter. Failure to complete the patient log appropriately is considered an issue of professionalism.  The Clerkship Coordinator/Director will review the patient encounter/procedure logs at certain points of the block and provide feedback to the students to assure that clinical expectations are being met.

Clerkship students will see patients with numerous diagnoses. As a subset of all of the diagnoses of all of the patients that are seen by the student, selected CORE patient presentations are mandatory (see the Disclipline/Patient Type charts below). These required core clinical presentations serve as educational and situational opportunities that allow the students, with faculty oversight and evaluation, to engage actual patients with the underlying goal of attainment of the UCR SOM competencies, which are listed in Appendix 1.

It is imperative that the student will have independently read enough background material to have mastered each mandatory core presentation in order that it be logged as completed. In the event a required core patient type (diagnosis) is not seen by the student, the student should communicate with the faculty to attempt to broaden the exposure to patient pathology. Additionally, several diagnoses have case modules available that can be completed to compensate for a missed diagnostic opportunity. In either case, independent reading is a requirement to properly master each of the required patient types.


Commercial Board Review Programs

Commercially-available programs that promise to prepare you for USMLE examinations are ubiquitous and their advertisements are enticing. Students are advised to use their best judgment when evaluating these claims.  There is no substitute for attending scheduled sessions of the medical school curriculum, thoroughly reading and completing learning assignments, and mastering all of these materials.  

How can test questions help? The literature suggests that students who obtain a deep mastery of the material presented in the medical school, and then use test questions to confirm their learning, improve their USMLE scores.


Objective Structured Clinical Examinations (OSCEs)

Students will be required to perform an Objective Structured Clinical Examinations (OSCE) during weeks 7, 14, and 21 of each semester during their 3rd year.  These exams are designed to test clinical skill performance and competence in skills such as communication, clinical examination, assessment, differential diagnosis, the clinical plan. Weeks 7 and 14 OSCE are formative (feedback is provided but scores do not count towards the final grade) and week 21 is summative (it counts as 30% of the final grade and feedback is not provided). The OSCE and SOAP note will be graded using a variation of the History, Physical, Assessment, and Plan format listed above under the heading “Student Case Presentation and Recording of History & Physical.” The written SOAP note will be graded on a rubric similar to the sample shown in Appendix #11 of this Guide to Clerkships. Passing the final OSCE on the second block of the third year with 70% or more is a requirement for graduation to the 4th year.


Clinical Advisors, Mentors, and Interest Groups

Each student will be assigned a Careers in Medicine (CiM) physician advisor to help with the process of selecting and working towards entry into an area of specialty training of the student’s choosing. It helps to know what you want. By joining specific Medical Student Interest Groups (Family Medicine Interest Group, Psychiatry Student Interest Group, etc.) you can explore your potential pathway more thoroughly. When an advisor is assigned, students should meet with their advisors with specific goals in mind. The following times are important:

  1. Prior to beginning the 3rd year: Consider your goals and specialties that interest you. You can join an interest group beginning your first year.
  2. August of the 3rd year: Think of one or more viable residencies with reference to your USMLE-1 scores. Consider a “Selectives” course that explores or advances knowledge within your distinct fields of interest.
  3. January of the 3rd year: Submit a draft of your proposed year 4 block schedule to your advisor, including electives.
  4. February of the 3rd year: Prepare the VSAS and non-VSAS applications for year 4 away electives. After March it may be too late to change your mind without repercussions. Stay in touch with your advisor during the entire process.

Liability Insurance

All UCR students on approved clinical clerkships occurring in the United States are covered by the medical liability insurance of the UCR SOM during their 3rd and 4th year of medical school.


Student Health Insurance

https://somsa.ucr.edu/som-handbook#gship
Students must be covered by health insurance for the duration of their clerkships in their 3rd and 4th year of medical school.


Clerkship Feedback and Grading Guidelines

see Appendix #8 - Grading and Evaluations for Pediatrics, OB/GYN, Psychiatry, Internal Medicine, and Surgery

Medical School Grading and Promotions Procedures

During the third and fourth clinical years, students may receive an Honors grade for exceptional work or High Pass for above average work, in addition to the Pass/Fail designation.  Students will be provided both written and verbal feedback at week seven and fourteen of the clerkships and additional feedback will be provided in the case of suboptimal performance. Students will be allowed to remediate any minor deficiencies at the end of each clerkship block.  Students who do not meet satisfactory performance criteria will be remediated prior to advancing to the next year.  No student who requires remediation for performance, time off for any reason within a core clinical course, or who enters the course late enough to require remediation time that supplants a third year selective will be eligible for Honors in that course.

Clerkship grades consist of a clinical evaluation, an end-of-block OSCE and a shelf examination (if applicable).  A passing score is 70% of the total available points for individually weighted components. The minimum acceptable shelf exam score is the 6th percentile (nationally normed).  If a student does not achieve a global passing score for a clerkship (70%) they will be required to remediate the component(s) failed.

Failure of the Shelf

Failure of the shelf examination will require a satisfactory repeat of the shelf examination.  The repeat is expected to occur within three weeks following the completion of the 21st week of the block; however the timing may be modified with prior approval of the Block Director and Associate Dean for Education.  If the remediation is unsuccessful, the student will fail the clerkship.  Clerkship failures will be remediated with a 6-week clerkship remediation.

Failure of the OSCE

Failure of the OSCE will require a satisfactory repeat of the OSCE.  The repeat is expected to occur within three weeks following the completion of the 21st week of the block; however the timing may be modified with prior approval of the Block Director and Associate Dean for Education.  If the remediation is unsuccessful, the student will fail the clerkship.  Clerkship failures will be remediated with a 6-week clerkship remediation.

Failure of Clerkship Performance

Failure of the clerkship performance will require a satisfactory repeat of the clinical rotation for 3 weeks.  The repeat is expected to occur within three weeks following the completion of the 21st week of the block; however the timing may be modified with prior approval of the Block Director and Associate Dean for Education.  If the remediation is unsuccessful, the student will fail the clerkship.  Clerkship failures will be remediated with a 6-week clerkship remediation.  

Students who fail more than one component of the clerkship (OSCE, Shelf, Evaluation) may be assessed a clerkship failure and may be required to complete a 6-week remediation of the clerkship.  Students who globally fail two clerkships during third year will be required to repeat the six-month clerkships.

Remediation Notation on Academic Record

Any and all remediated educational activities will result in the most recent score (including narrative evaluations) being recorded on the transcript and reported on the Medical Student Performance Evaluation (MSPE).  Successful first attempt remediation of individual clerkship components will be recorded as pass and will generally not be noted on the transcript or the MSPE.  However, multiple clerkship component remediation work that necessitates additional time outside of the clerkship schedule that place a student off track will be reported.  Clerkship failures will be recorded as incomplete grades on the transcript until successfully remediated.  Six-week clerkship remediation for global clerkship failures will have notations in the MSPE.

The weight of the final grade in Medicine, Surgery, Pediatrics, Psychiatry, and OB/Gyn is:

  • 50% course evaluation
  • 30% OSCE
  • 20% Shelf Exam

The weight of the final grade in Family Medicine, and Emergency Medicine is:

  • 5/8ths course evaluation
  • 3/8ths OSCE.

Students who have less than the minimum faculty evaluations in the Year 3 longitudinal clerkships will not be eligible for a grade of High Pass or Honors. Grades are also reduced for students with issues of professionalism, and of those who are late/absent in doing their required weekly coursework. If a student fails a Shelf Exam, they become ineligible for honors in Family Medicine and Emergency Medicine.

Grades are assigned as:

  • Honors: students in top 20% of overall grade
    • Students who delay the start of a block will not be eligible for Honors. Off-cycle students beginning a block at the expected start date will be eligible for Honors.
    • Students who fail any shelf will be ineligible for Honors in Family Medicine and Emergency Medicine
  • High pass: students in top 30% below Honors
  • Fail: Less than 70% of final grade total

Percentages are approximate and are dependent upon objective student performance criteria rather than simply giving 20% and 30% of students Honors and High Pass. No student who starts the third year late will be eligible for Honors in any course that semester. Any Professionalism issues reduce the final grade.

Course

Number of Weeks of  Required
Feedback Events (FE’s)


With submission of the 6th and 8th FE’s, the lowest FE’s will be discarded and not count for grading. Submissions of Feedback Events for credit cannot exceed 2/week (Rules are different for EM & Psychiatry*)

Minimum # of  FE’s every 7 weeks, “3-week Trimesters” or 21-week blocks
Emergency Medicine 6 during the 3rd year; min. 1/shift n/a
Family Medicine minimum of 3 weeks of feedback events 1 per 7-week block
Internal Medicine minimum of 3 weeks     “ 1 per “3 week” trimester
OB/Gyn minimum of 3 weeks     “ 1 per “3 week” trimester
Pediatrics minimum of 3 weeks     “ 1 per “3 week” trimester
Psychiatry Minimum of 2 weeks each semester during the 3rd year plus 1 during each “Psych Week” (The 6th and 8th evaluations in psych supplant the lowest FE‘s*) 1 per psych week + 2 for each 21-week semester for a grade >PASS
Surgery minimum 3 weeks of  Feedback events 1 per “3 week” trimester

The grading template is PAPER, and will be handed to the faculty (residents are acceptable as well) by the student. These forms will contain the UCR SOM competencies with a 5-point Likert scale for check marks and comments. These forms are to be returned to the coordinator, either in paper, or the student can take a photo of the form and email it to the coordinator. Forms will be available online and from your coordinators. A generic copy is present in appendix #8. Scoring from feedback forms (FE’s) and New Innovations Faculty Evaluations will be used for final grades.

The performance of Weekly Readings/Modules/Submissions is also a factor in grading (1% of the total grade will be deducted for each late or absent Theme. A 1% penalty is usually enough to eliminate Honors). Performance of 100% of the weekly coursework on-time also leaves students eligible for Honors in “Selectives.”

All students are required to submit a course evaluation and supervisor evaluation at the end of the block using the New Innovations evaluation system.  This is a mandatory requirement to successfully complete the block rotation and is required for grade submission.  Students’ comments are anonymous.

Students should attempt to be evaluated in some manner weekly. For now, faculty will use New Innovations for formal evaluations, but can also use forms submitted directly from students. Some rotations have faculty that rotate off-service after less than one week, so students may find it useful to hand a paper form of the approved evaluation to the faculty member. In this event, the completed form from the faculty must be placed into a sealed envelope for hand delivery to the clerkship coordinator, or a photo taken and emailed to the coordinator.

Each block rotation uses a criterion based or fixed standard evaluation and grading system in addition to a “360 degree” evaluation. This system allows for comparison of a particular student’s performance to a predetermined standard of proficiency and additionally values all 8 competencies, not just test scores.  Regarding clinical grade distribution: Rigid cut off percentages are not used and year to year, the percentage of students receiving a particular clinical grade (Honors, High Pass, Pass, and Fail) may vary.

It is expected that, in an average year, 20% of the students within each of the 7 courses will receive a grade of honors and 30% will receive a grade of High Pass. Grades will be released no later than four weeks after the end of week 21. Students who feel their final grade was recorded in error may challenge their grade by submitting a request for review of their scores within 14 calendar days of the release date of grades. This form is found in this Guide as appendix #5. A more detailed explanation of the grading methodology and examples are found in appendices #7 and #8.

Each of the blocks have associated Weekly Themes with required online readings and modules that must be completed. Students who do not complete 100% of the modules will receive an incomplete for the course and become ineligible for a grade of honors. Completion of Weekly Themes is mandatory. Failure to complete the readings, modules, and themes on time will reduce the course grade by 1% per delinquent week and significantly reduce the probability of receiving a grade of Honors in “Selectives.” This 1% grading reduction will apply to all core subjects for the affected block.


Receiving Feedback

Faculty and residents involved with medical student education are expected to provide timely feedback to medical students regarding their clinical and academic performance. By definition, "formative" assessment is feedback designed to help the student improve his or her performance, and is not to be used to determine a student’s grade or to influence decisions about academic progress or promotions. Toward the midpoint of each clinical clerkship, every UCR third-year medical student is scheduled during a transition week for a one-to-one meeting with the clerkship director or block director for a mid-clerkship feedback discussion. The Liaison Committee on Medical Education (LCME) requires United States medical schools to provide mid-clerkship feedback to all medical students.

Preparing for Your Mid-Clerkship Feedback Meeting

As is true for many other aspects of your future professional career, you will find with your mid-clerkship feedback process that you tend to get out of it what you put into it. In other words, if you approach the process as a self-directed medical learner, you will likely derive substantially greater value from the experience. We recommend that you take an active role in eliciting feedback during your clinical clerkships so that you can get the most out of these invaluable learning experiences. To help our students take a more active role in their own feedback, the clinical education team develop the following feedback forms:

  • Mid-Clerkship Mini-Feedback Form
    This is an optional one-page form designed for students to give out to any clinical teachers/supervisors/staff at their affiliate clerkship sites in order to improve the quality and quantity of formative feedback that students receive. We do, however, strongly encourage students to use this form as a mechanism for eliciting valuable feedback from their clinical teachers. It is to your advantage to distribute these forms to your clinical supervisors, ask the supervisors to fill out the forms – and preferably, to meet with you to discuss the content – then give the completed forms to your clerkship coordinator prior to your one-to-one mid-clerkship feedback meeting scheduled on campus. This additional input will enhance the value of the feedback meeting. Like the other mid-clerkship assessment tools, this one does not count toward the student’s grade. Rather, it is designed to elicit informal feedback that we hope students will find timely and constructive.

  • Mid-Clerkship Formative Assessment by Student and Faculty Form
    Based on the Association of American Medical Colleges’ core entrustable professional activities (EPAs) this optional self-assessment tool is designed to help you reflect on your professional development as a physician-in-training. Your self-assessment is for constructive feedback only and is not incorporated in your clerkship grade. We strongly encourage you to complete the self-assessment component of this form before your scheduled mid-clerkship feedback session so that you can go over it with your clerkship or block director during the meeting. You can opt not to complete it, but the clerkship or block director is still required to complete an alternate version of the form that excludes your input. This is your assessment, and although it is not a graded exercise, taking a proactive approach is to your advantage.

  • Clerkship H&P Observation by Faculty
    This is a required form for every third-year medical student in every clerkship, because observing medical students completing a history and physical examination during each clinical clerkship is an LCME requirement for every U.S. medical school. The purpose of this assessment form is to ensure that the H&P observation gets done, and to improve the educational value of the process by asking both mentor and protégé to review the Association of American Medical College’s entrustable professional activity (EPA) checklist, which for this skill set is EPA 1. All clerkship students should ensure that a clerkship faculty member observes them completing a full H&P, fills out the form, and reviews it with them before the student and faculty member both sign the form to indicate that formative feedback was given and received. The H&P observation can occur at any time during the clerkship, and does not necessarily need to be done prior to the mid-clerkship feedback meeting with the block/clerkship director. However, students should make sure they leave enough time to get this exercise scheduled and documented before the end of the clerkship. While it is not a graded exercise, it is a required “check-off” exercise for successful completion of the clerkship.


Student Mistreatment

The UCR School of Medicine is committed to a positive learning environment to educate and support our medical students. An important component of this commitment is to address and prevent mistreatment of students. Every medical student has the right to a respectful learning environment free of all forms of mistreatment. We strongly encourage medical students and all other members of our educational community to review the School of Medicine’s published mistreatment policy.

The School of Medicine has a Student Grievance Committee that is charged with monitoring and preventing maltreatment in the classroom and clinical setting. Comprised of medical student representatives, residents, faculty and staff members across all of our affiliated clinical training sites, this committee maintains the integrity of our students’ learning environment by (1) ensuring that students, residents, fellows, faculty and staff members all receive effective education to prevent mistreatment, (2) providing a secure mechanism to report alleged violations, and (3) maintaining and enforcing comprehensive guidelines for responding to any incidents of student mistreatment.

There are multiple mechanisms for reporting perceived mistreatment. Any member of our campus community may report concerns about potential mistreatment of a medical student through:

  • The Student Grievance Committee (Email: Grievance@medsch.ucr.edu, (951) 827-7826)
  • New Innovations (confidential reporting through a secured web site)
  • The Student Affairs Office
  • Medical student class representatives
  • Or by contacting a faculty or staff member of the student’s choice.

Within 72 hours of receiving a report of alleged mistreatment, the chair of the Student Grievance Committee will contact the student by secure UCR email. The UCR School of Medicine is committed to a policy of non-retaliation and will take appropriate steps to protect individuals who raise concerns in good faith.


Remediation

see Appendix #6

A remediation plan is needed in the following general circumstances: a pattern of below expected level performance, unprofessional behavior, performance that does NOT meet acceptable standards, a Shelf Exam score less than the 6th percentile of the national average, or a recommended failing grade.  Remediation is individualized and will be implemented on a case by case basis. If a remediation plan is required, a written plan of remediation should be developed by the UCR Clerkship Director in conjunction with the site, discussed with the student, and implemented by the clinical site director within 10 days of failed exam.  Clinical site directors should contact the Clerkship Director or the Senior Associate Dean for Education if they anticipate the need to implement an amended remediation plan for a particular student. Remediation form will be found in Appendix 6.


The NBME Shelf Exams

In addition to clinical performance, the standardized shelf exam prepared by the National Board of Medical Examiners (NBME) is another measure of medical knowledge acquisition. The shelf exam has the virtue of consistency and validity across institutions. These exams also predictive of students’ ability to pass the mandatory licensing exams. Finally, the exams may identify students with learning or testing disabilities. For these reasons, the SOM will give a Mandatory Practice Shelf assessment at week 7. This exam does not count towards ANY aspect of the course grade. It is very useful for student self-reflective feedback and to give experience on USMLE-style questions.

  • Clerkship Directors will use the week-21 shelf exam as a component of the final grade for their course. The exam will account for 20% of the final grade (except Fam Med & Emerg Med).
  • If a student does not achieve an exam score greater than or equal to the 6th percentile on any given exam, the student will be required to retake the exam. Scheduling shelf exam re-takes after remediation will be determined following discussion with the Clerkship Director.
  • Students are responsible for paying for any exams ordered and scheduled that were not administered (due to student cancellation or no show).
  • A second failed Shelf Exam will require that the course be repeated prior to allowing entry into the 4th year.

 The clerkships that require the shelf exams are: Medicine, Pediatrics, Obstetrics and Gynecology, Surgery, and Psychiatry.


SOM Student Blood and Needle stick Policy

All students will receive an orientation to blood-borne pathogens and infectious and environmental diseases and how to safely avoid their exposure during orientation week and during the first block of instruction. Students will also be required to complete the corresponding online UC Health training modules.  In the unlikely event an exposure occurs on the UCR campus, the campus protocol will be followed.

An exposure incident is defined as a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral (through the skin) contact with blood or “other potentially infectious materials.”

Those airborne, blood and body fluid exposures and needle stick injuries that occur while a student is completing an off-campus clinical activity will follow a protocol consistent with the clinical affiliate’s policies.  In the event of an exposure, the student will, after reducing the exposure (as described in the next paragraph), immediately notify his or her supervising resident and/or attending and proceed immediately to the on-site emergency room at the facility in which the incident occurred.  Students may also seek immediate treatment at the UCR Campus Health Center (during business hours). It is important to note that treatment for HIV prophylaxis needs to be initiated within two hours for optimal effectiveness.  Students will not be penalized for leaving the service after notification of the supervising resident/faculty and Clerkship Coordinator. Students will also be required to notify the Office of Student Affairs within 12 (twelve) hours of all exposures. Good references are: https://www.cdc.gov/niosh/topics/bbp/emergnedl.html and https://www.hivguidelines.org/.

If an exposure incident occurs on the UCR SOM campus, the student is instructed to wash the exposed area immediately with soap and water.  If there is a cut, the area should be washed with soap and water and the area should be allowed to bleed. If blood or other potentially infectious body fluids enter the eye, nose or mouth, the area should be flushed with water for at least 15 minutes. Then the student should seek immediate medical/nursing care, either from the Campus Health Center (during office hours) or at a local emergency or urgent care center.  Students must follow the Environmental Health and Safety biosafety exposure control plan found at https://ehs.ucr.edu/laboratory/biosafety.  Students must also notify their supervising faculty at the time of the incident who should in turn notify the Office of Student Affairs within 24 hours. See the algorithm that follows.

For all exposure incidents, the route(s) of exposure and the circumstances under which the exposure incident occurred are to be documented. The source individual is identified and documented, unless identification is not feasible or prohibited by state or local law.  After consent is obtained, the source individual's blood is tested for HBV, HCV and HIV status.  If the exposed student gives consent, a baseline blood sample is collected immediately following the incident with subsequent periodic samples taken at a later date.