Clinical Education

First and Second Year
Definition of OMS II eligibility for clerkshipPhysician’s Role Experiences

PROGRESSION FROM OMS-II to OMS-III

  1. Satisfactory completion (passing grades) of All OMS-I and OMS-II courses.
  2. Completion of all service-learning experience activities required for OMS-I and OMS-II.
  3. Successful compliance with all clinical training requirements such as: immunizations, orientations, proof of insurance, etc.
  4. Recommendation for promotion by the COM-SPC to the Faculty Senate. All records are reviewed by SPC to determine whether the student has fulfilled all academic requirements; has maintained the standards of ethical, moral, personal and professional conduct required for the continued study of osteopathic medicine; and is mentally and emotionally fit to become a physician.

PHYSICIAN’S ROLE EXPERIENCES (PREs)

As part of the first- and second-year student education, the Physician’s Role in Health Sciences (PRHS) courses, provide students the opportunity to participate with various healthcare organization’s public health projects. Students will attend their assigned facility, one half day a month. Students are divided into rotating groups with some groups on campus and other groups at their assigned sites.

Third Year
Didactics 'Education Days'COMATClerkship

DIDACTICS “EDUCATION DAYS”

Didactic sessions, also known as Education Days, are held on campus for third-year students on core rotations twice a month; attendance is required. Education Days are scheduled on a set half day twice a month and students are excused from their assigned clerkship.

COMPREHENSIVE OSTEOPATHIC MEDICAL ACHIEVEMENT TEST (COMAT)

The National Board of Osteopathic Medical Exam (NBOME) Subject (COMAT) exam uses an electronic format and is administered at the end of OMSIII core rotations.

Coordinators will notify the registrar’s office of enrollment report and send list to the CE exam coordinator of scheduled shelf exam, notify students of scheduled exams and reminders, enter exam scores into CE database, follow up with student test failures, report retake listing to Director of CE.

Students are expected to demonstrate appropriate respect and professionalism to all exam proctors. All students must adhere to all NBOME regulations regarding test administration and exam content confidentiality. Students may be required to return to the rotation site or participate in rotation activities after the COMAT.

Students arriving late for a COMAT will not be granted additional time to take the exam. Students who are ill on the day of a scheduled COMAT must promptly notify the CHSU-COM Clinical Education Coordinator prior to the start of the exam. With supporting documentation and approval by the Director of Clinical Education, the exam will be rescheduled.

Students scheduling their COMLEX CE and/or PE exams during clinical rotations must provide the appropriate Clinical Education Coordinator with written verification and adhere to the 30-day policy. Students are encouraged not to schedule their exams during the first week of any clinical rotation. Students must pass COMLEX Level 1 and both portions of COMLEX Level 2, CE, and PE, to graduate. For additional information regarding eligibility and procedures to take COMLEX, refer to the CHSU-COM Student Handbook and NBOME website.

POST COMAT ON-CAMPUS ACTIVITIES

After the COMAT examination, students will remain on campus for scheduled clerkship debrief sessions, residency advising as well as opportunities to interact with OPP faculty in a workshop format.

Clerkship debrief sessions will be conducted by each clerkship director, whereby student feedback and comments about clerkship experiences will be gathered to be utilized in the clerkship evaluation process by the department of clinical education.

CLERKSHIPS REQUIREMENTS

The following are requirements for student clerkships:

  1. Each clinical rotation will have an identified preceptor of record who acts as the responsible physician for the clerkship.
  2. A licensed provider must supervise students at all times.
  3. Students shall assume responsibility for and perform their assigned duties in accordance with CHSU and the training institution regulations.
  4. Students shall not be permitted to accept financial compensation or any form of gratuity for any part of their participation in the clerkships.
  5. Through their supervising preceptor, students may be assigned to specific patients. Emphasis will be placed on obtaining a history and physical examination (H&P), and palpation and structural components will play an integral part of the history and physical examination.
  6. Student H&Ps should be reviewed and signed by the supervising preceptor.
  7. Progress notes may be written by the students only under the direct supervision of the supervising preceptor. Progress notes must be signed within the time required by the rules and regulations of the training institution.
  8. Students shall not order any examinations, tests, medications, or procedures. Students shall not write prescriptions for medication, devices, or anything requiring the authority of a licensed physician.
  9. Attendance by students is required at all conferences, discussions, or study sessions, and any other programs of an educational nature designed specifically for students at the institution. Students should document their attendance at such events. In addition, students should be encouraged to attend lectures for interns, provided these do not interfere with the clinical clerk’s own program.
  10. Students shall be required to participate in the utilization of osteopathic manipulative treatment when ordered and supervised by the attending physician.
  11. Students shall learn and perform procedures under appropriate and proper supervision, in those areas where the training institution regulations permit such instruction.

CLERKSHIP SMARTMATCH

The Clinical Education staff will establish policies and procedures to adjudicate a system whereby each student will preference their selections of various clerkship training locations and preceptors in a fair manner. As part of the process, students will be surveyed in the second year for their input into desirability of rotation locations and educated on the upcoming process.

REGISTERING FOR CLERKSHIPS

Although the Clinical Clerkship Coordinator will assign individual clerkships, students must edit/verify and submit registration/onboarding information through the CORE within five business days following the designated start date. It is imperative to submit accurate contact information for the attending physician filling out the assessment. When working with more than one physician on a clerkship, the student should e-mail their assigned CHSU Clinical Clerkship Coordinator with all necessary information.

Once submitted, any changes must be made by Clinical Clerkship Coordinators only. Any requests for changes must be e-mailed to the assigned CHSU Clinical Clerkship Coordinator.

Clinical Affairs Policy and Procedure Manual
Assessment and Comparability
Clinical Education Assessment Process

CLINICAL EDUCATION ASSESSMENT PROCESS

The purpose of this process is to ensure students have a rigorous clinical educational experience that meets the core educational learning objectives of the university and is comparable across all core educational sites, regardless of where students rotate. CHSU-COM has a rigorous and iterative process for assessment of its physician role experiences, clinical education experiences and outcomes.

There are four elements integral to this process and include:

  1. Curricular requirements:
    1. Clearly defined clinical conditions that students should see, as defined by the faculty via the clinical education subcommittee of the curriculum committee,
    2. Clerkships with the same syllabi and learning objectives, regardless of site,
    3. Consistent university global learning objectives throughout the clerkship syllabi,
    4. Opportunities for utilization of osteopathic principles and practice which are available.
  2. Standardized learner assessments and grading processes across sites:
    1. Guidelines for grading defined by the clinical education subcommittee of the curriculum committee,
    2. A standardized EPA-based evaluation form across all clerkships,
    3. Electronic tracking of patients and conditions seen on rotation,
    4. A mid-clerkship feedback communication to identify progress toward curricular requirements with a plan for addressing gaps,
    5. Available electronic cases/OSCEs as a back-up plan for selected conditions or procedures not encountered on rotation.
  3. Monthly analysis of outcomes:
    1. Reviewed by clinical education staff,
    2. Annual clerkship analysis of outcomes cumulatively and across sites by the associate dean of clinical affairs,
    3. Presentation of data to the curriculum committee and the university’s institutional effectiveness department.
  4. Infrastructure
    1. data collection and monitoring, including the student information system and learning management system.

The process involves clear communication of the expectations and required elements between the clinical education department and the site preceptors.  Communication will occur at the initial orientation meeting, semi-annually as preceptor evaluation reports are provided to preceptors, and annually as the clerkship director shares annual clerkship academic report data with preceptors.

Monthly clerkship review is conducted by the clinical education staff, with immediate action taken if necessary.  Annual clerkship analysis cumulatively and across sites occurs by the associate dean of clinical affairs with an annual report presented to the curriculum committee.  Feedback and recommendations from the curriculum committee are relayed to the associate dean and clinical education subcommittee to implement recommended clerkship modifications.

The clerkship review process is repeated annually, with data, findings, trends, and recommendations discussed at the annual clinical education retreat.  The retreat provides a forum for safe yet public discussion of critical areas that need improvement, discussing successful practices from other clerkships or sites for possible reproduction.

Clinical Preceptors
Your Role as a PreceptorPreceptor TrainingCredentialingClinical Faculty Appointment and Approval

YOUR ROLE AS A PRECEPTOR

Physician preceptors support third- and fourth-year clinical training. By agreeing to supervise and mentor medical students, preceptors are shaping the next generation of providers. It is through a combination of office-based and hospital experiences that most of our students realize the “essence” of becoming a physician in the 21st century. As such, they are heavily influenced by the passion, empathy and fortitude of their preceptors. Preceptors are mentors – a role which requires specific skills and functions. The following areas are provided to help clarify your roles as a CHSU COM preceptor and adjunct faculty member.

College Expectations of the Preceptor
Clerkship students are unlicensed. You must provide direct supervision of all aspects of their care. As a preceptor you’re most important work is to:

  • Set expectations for students early in their rotation
  • Provide ongoing feedback throughout the rotation
  • Fill out evaluations and discuss them with students on the last day of their rotation
  • Always be an exemplary and positive role-model (teach them about your specialty and the profession in and out of the office).

To optimize the teaching/learning encounter with a CHSU COM medical student, preceptors are asked to carry-out the following functions:

College Expectations of the Preceptor

  • Orient student to the rotation and training site. Clearly identify specific service and personal expectations.
  • Encourage office/ancillary care staff to be helpful and make student feel a part of the team.
  • Complete a formal written evaluation of the student’s performance during the rotation and give formative feedback midway through rotation.
  • Contact the Regional Assistant Dean to discuss issues of concern and poor student performance.

Teaching Duties:

  • Serve as a mentor (experienced and prudent advisor) who assists the student in applying knowledge and building skills to problem-solve patient care.
  • Provide a variety of patient cases and adequate patient volume.
  • Challenge the student with deliberate and thoughtful questions.
  • Allow the student to participate in patient management to a degree appropriate for the level of training.
  • Provide written and verbal feedback to the student in a constructive and timely manner.
  • Be available, on site, for assistance during all patient care activities.
  • Share learning resources (texts, computers and educational programs if available) sufficient to increase student knowledge and productivity.
  • Assign readings, literature searches, or medical information gathering pertinent to patient cases.
  • For preceptors who are DOs, integrate Osteopathic Manipulate Medicine into the rotation experience. As such, encourage the use of hands-on OMT as appropriate for the level of training.

If you are unclear about the scope of these duties, or would like additional materials to develop your teaching/mentoring skills, contact your Regional Assistant Dean.

Teaching Duties:
CHSU will provide extensive opportunities for professional development, including but not limited to:

  • Instruction teaching, learning and assessment in the clinical environment
  • Support for scholarship
  • The outcomes of projects assigned to the students
  • Clinical pearls
  • Access to the health professions library

For Osteopathic Physicians:
Osteopathic physicians serving as preceptors in any AOA approved osteopathic medical education program may be granted Category 1-B credit.

For Allopathic Physicians:
Preceptor credit will be issued to allopathic physicians upon request.

Become a One Minute Preceptor:
Five-Step Microskills Model of Clinical Teaching

I. The current medical environment has increased the demand on teaching physician’s valuable time. Therefore, efficient teaching strategies are critical, especially for faculty who give of their time voluntarily to teach (our) trainees. The strategy involves combining 5 teaching steps, referred to as microskills (Bowen, 1993). When used skillfully, the 5 microskills enable the teaching physician to effectively assess, instruct, and give feedback (to the trainee).

II. The five-step microskills model is designed to be used after a trainee has presented a patient to you:

  1. Get a commitment
  2. Probe for supporting evidence
  3. Provide positive feedback
  4. Teach a general rule
  5. Correct errors

Here’s a sample case from the University of Washington. It describes the application of the 5 microskills during an interaction between a student and a preceptor. Microskills are indicated in brackets.

Student: I just evaluated a 72 year old patient with three days of increasing dyspnea and cough. She has diabetes that is well controlled with medications but no other medical problems. She’s retired and lives with her husband. She reports pleuritic chest pain on the right side when she coughs. When I listen to her lungs, she has decreased breath sounds on the right side.

[Step 1 – Get a commitment]

Preceptor: What do you think is going on?
Student: Well, I’m worried about pneumonia. She looks pretty sick.

[Step 2 – Probe for supporting evidence]

Preceptor: What led you to that conclusion?
Student: She has a temperature of 39.0 c, a respiratory rate of 24, and a cough productive of rusty brown sputum. When I percussed her chest, there is dullness on the right side. Those signs along with her symptoms of dyspnea and cough seem most diagnostic of pneumonia.

[Additional probing]

Preceptor: What else did you consider?
Student: I asked her about recent travel or change in her activity, wondering about a DVT and a pulmonary embolus. She’s pretty active and hasn’t traveled any place that required prolonged immobilization. And since she is diabetic, I thought about an atypical presentation of angina or acute myocardial infarction. So, I got an EKG and it was normal.

[Additional probing]

Preceptor: What would you like to do for her?
Student: I’d like to obtain a sputum gram stain and culture. Then, I’d like to start her on antibiotics. I’ll call tomorrow to check on her and have her come back in three days to see me in clinic to make sure she’s getting better. The sputum culture should be back by then and I can change her antibiotics if I need to.

[Step 3 – Provide positive feedback]

Preceptor: I liked the way you put this case of pneumonia together. The symptoms and signs certainly point in that direction.
You considered two other very important diagnostic possibilities in this patient and used information appropriately to decrease the likelihood her symptoms represent myocardial ischemia.

[Step 4 – Teach a general rule]

Preceptor: In patients with the symptoms you describe, it is important to distinguish between bronchitis and pneumonia. Sometime patients with pneumonia are hypoxemic and older patients with pneumonia often experience cardiopulmonary failure.

[Step 5 – Correct errors]

Preceptor: She may respond to out-patient therapy. But first, you need to decide if she’s too sick to go home. An older patient with a respiratory rate of 24 and a temperature of 39.0 c should have a chest x-ray and her oxygen saturation measured. And, in diabetic patients that you suspect are infected, you should always check their blood sugar. Let’s go see her together and then decide about ordering more tests.

III. References

Bowen, J. (July-August 1993). Journal of the American Board of Family Practice.


Integrating the Learner into the Busy Office Practice

If one thing is certain in life, it is that your office or clinic is a busy place. Managed care and other changes are making it even busier. At the same time, your office is an increasingly valuable site for training health professionals. With sicker patients in the hospital for shorter stays, and a mandate for medical schools to produce more primary care physicians, learners are spending more of their clinical training in outpatient settings. How can you integrate these learners into your practice while maintaining your sanity and your bottom line?

The best source of practical answers to this question is community-based preceptors like you. The purpose of the monograph below is to promote the exchange of these ideas and helpful hints. We will explore five steps that are important in integrating learners into the practice and provide examples from other preceptors’ experiences. Some of these ideas may be very helpful for your particular precepting circumstances; others may not. We hope that you find at least a few new suggestions that you can use. As you read this monograph, we encourage you to think about your own tips for teaching learners in a busy practice. The ideas that you provide in the post-test will, with your permission, be shared with other preceptors in future preceptor development activities.

Download “Integrating the Learner into the Busy Office Practice” monograph


Title IX Training for COM Preceptors

CREDENTIALING PRECEPTORS

All physicians who serve as preceptors for CHSU COM student must be board-certified (BC) or board eligible (BE) by ABMS or AOA. Physicians not BC/BE are not eligible to serve as preceptors record for CHSU COM students. In addition, to the BC/BE requirement, all preceptors must be credentialed with CHSU COM.

REQUIREMENTS FOR PRECEPTOR CREDENTIALING

Credentialing a preceptor requires:

  1. Current Affiliation agreement
  2. Personal Information and W9
  3. Verification of the medical license and board certification

CLINICAL FACULTY APPOINTMENT AND APPROVAL

Additional Required Documentation: Current CV and Faculty Recommendation

When the box for clinical faculty appointment is checked on the affiliation agreement a current CV and faculty recommendation form is required. Once credentialing documents have been submitted, the Associate Dean of Clinical Affairs will review.  Approvals will be forwarded to the CHSU COM Dean with recommendation for initial rank.

Preceptors will be appointed as Clinical Faculty.  Preceptors will be notified by letter with Dean’s signature.

Clinical Rotation Sites
Map of SitesClerkship EvaluationContingency Plan

Number of Affiliation Agreements by Category

CLERKSHIP EVALUATION

Preceptors of record complete student performance evaluations at the end of the clerkship rotation. Students will complete preceptor evaluations. Coordinators will generate evaluation link through CORE-ELMS and notifications will be sent to preceptors and students.

CONTINGENCY PLAN

In the event that a clinical education experience becomes unavailable for a student, the following process will be followed:

Communication with the site/preceptor by clinical education team member: a) Does the change involve a single preceptor or an entire site?; b) Anticipated length of the change: Temporary or Permanent; c) Are there any substitute willing preceptors available at the site?

Clinical education team will examine the feasibility of the following solutions:

When a single preceptor affected at a site with multiple preceptors

Current student: a) Second preceptor takes involved student; b) Remaining preceptors at that site rotate taking the involved student; c) If site has students on shifts, ascertain if student could be assigned to a different shift; d) Assign student to any available preceptor in that specialty with a vacancy; e) Assign student to a preceptor in that specialty at another site willing to take additional student; f) Communicate with preceptors from contingency list willing to take students: 1) When preceptor identified, credential preceptor if not already done; 2) Assign student to preceptor from contingency list; g) If student past week two of rotation, assign virtual curriculum for remainder of rotation.

Future students: a) Remaining preceptors at that site assigned additional students; b) Remaining preceptors at that site rotate having time with additional students; c) Shift compression or modification to accommodate additional students; d) Assign students to available preceptors in that specialty with vacancies; e) Assign students to preceptors at another site willing to take multiple students; f) Communicate with preceptors/sites from contingency list willing to take students: 1) When preceptor identified, credential preceptor if not already done; 2) Assign student to preceptor from contingency list; g) Evaluate student and preceptor schedules for next few blocks to identify any potential movement of student rotations to switch to available preceptors; h) Consider available elective rotation for students.

When a single preceptor is affected at a site where they are the solo preceptor

Current student: a) Assign student to any available preceptor in that specialty with a vacancy; b) Assign students to preceptors willing to take multiple students; c) Communicate with preceptors/sites from contingency list willing to take students: 1) When preceptor identified, credential preceptor if not already done; 2) Assign student to preceptor from contingency list; d) If student past week two of rotation, assign virtual curriculum for remainder of rotation.

Future students: a) Assign students to available preceptors in that specialty who have vacancies: b) Assign students to preceptors who are willing to take multiple students; c) Communicate with preceptors/sites from contingency list willing to take students: 1) When preceptors identified, credential preceptor if not already done; 2) Assign student to preceptor from contingency list; d) Evaluate student and preceptor schedules for next few blocks to identify any potential movement of student rotations to switch to available preceptors.

Lastly, consider available elective rotation for students.

Fourth Year

AAMC VISITING STUDENT LEARNING OPPORTUNITIES (VSLO) PROGRAM

The VSLO program enables medical students to pursue short-term learning opportunities in the United States and Globally. The program supports students through the process of searching for electives, submitting applications, and completing their resulting educational experience(s). The VSLO program includes:

  • Educational opportunities, including pre-clinical, community-based global health, research, and clinical opportunities.
  • The application service called the Visiting Student Application Service (VSAS) which allows students to search and apply for opportunities

Visiting Student Learning Opportunities (VSLO) is sometimes referred to as VASA. The AAMC will email students with the subject line titles VSAS: New User Instructions. The email will include an access code along with further instructions. VASA is designed to allow students to apply to 4th-year (Allopathic) elective rotations. Third-year students will begin to plan for the 4th-year schedule in December of 3rd -year.

Visit the AAMC website to find more information about VSLO including how it works, things to know, and fees for the service. AAMC links:

Glossary

Glossary of Terms

TermDefinition
AACOMAmerican Association of Colleges of Osteopathic Medicine
ACGMEAccreditation Council for Graduate Medical Education
ACLSAmerican Heart Association's Advanced Cardiac Life Support
AHAAmerican Heart Association
AOAAmerican Osteopathic Association
ARCAmerican Red Cross
ATSUA.T. Still University; visiting third- and fourth-year students for clerkship
BLS American Heart Association's Basic Life Support (Healthcare Provider)
CHEA
Council for Higher Education Accreditation
CHMGCommunity Hospitalist Medical Group
CHMG HospitalistContracted Internal Medicine Preceptor (DR)
CHSUCalifornia Health Sciences University
ClerkshipClinical clerkships encompass a period of medical education in which medical students train in a teaching hospital
CMCCommunity Medical Centers
COCACommission on Osteopathic College Accreditation
COMCollege of Osteopathic Medicine
COMATDistinctive subject examinations designed to assess core osteopathic medical knowledge. currently tests on eight core clinical disciplines: Emergency Medicine, Family Medicine, Internal Medicine, OB/GYN, Osteopathic Principles and Practice, Pediatrics, Psychiatry, and Surgery. 2.5-hour exam consisting of 125 questions
COMLEX Level 2 CECOMLEX-USA Level 2-Cognitive Evaluation (CE) is a problem-based and symptoms-based assessment related to clinical care. Broken up into two 4-hour sessions in the same day. 400 questions, the exam covers a wide array of topics including: emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic principles and neuromusculoskeletal medicine, pediatrics, psychiatry, surgery, and other relevant areas
CORE ELMSExperiential Learning Management System
CRMCCommunity Regional Medical Center
D.O.Doctor of Osteopathic Medicine
Direct Supervision of a Medical StudentDirect supervision of a medical student by a licensed provider who is available in the facility at the time the student is providing care to any patient. For a procedure, the licensed provider must be credentialed to perform the procedure and in the room with the student throughout.
Education DaysThird-year osteopathic medical students will be presented with didactic and small group discussion content covering clinical content, topics of the community health center movement, health systems science, and the Central Valley. The students will be presenting patient case presentations and facilitating journal clubs.
EMRElectronic medical records
FBUFresno Barrios Unidos
FQHCFederally Qualified Health Center
·  Omni
·  Golden Valley"
GMEGraduate Medical Education
GVHGolden Valley Hospital
HospitalistCRMC contracted preceptors
ID/DLIdentification/Driver’s License
ILPIndividualized Learning Plan
IPEInterprofessional Education
KCUMB (KCU)Kanas City University Medicine and Biosciences; visiting third- and fourth-year students for clerkship
LIGSLetters in Good Standing- A letter of good standing is used to verify the character and academic status of a student
M.D.Medical Doctor
MCHMadera Community Hospital
NACIQINational Advisory Committee on Institutional Quality and Integrity
NBOMENational Board of Osteopathic Medicine Examiners
NPNurse Practitioner
OCCOsteopathic Core Competencies
OMM"Osteopathic Manipulative Medicine

Third-year osteopathic medical students will be provided the opportunity to complete training in osteopathic manipulation medicine; OMM day is held the last day of clerkship following COMAT exams."
OMS-l, ll, lll, lVOsteopathic Medical Student in academic year 1, 2, 3, or 4
OPPOsteopathic Principles and Practice
PALSAmerican Heart Association's Pediatric Advanced Life Support
PGY-1Post Graduate Year One; residency or intern rotations
PreceptorThe preceptor guides the student's clinical learning experience, facilitates student autonomy, and acts as a role model.
PRHS I, II, III, IVPhysician Role in Health Science Courses 1, 2, 3, 4
QuantiFERON Gold test(QFT) is a simple blood test that aids in the detection of Mycobacterium tuberculosis, the bacteria which causes tuberculosis (TB)
SLOService-Learning Opportunity
Student CredentialingVerification documents required for clinical rotation
SUB-ISub-internship
· 2022 Visiting students
·  Three residency rotations (in hospital)"
Title IVTitle IV of the Higher Education Act
USDEUnited States Department of Education and the Secretary of Education
VSASVisiting Students Application System
VSLOVisiting Students Learning Opportunities
WASCWestern Association of Schools and Colleges
WILPWellness Individualized Learning Plan