Common Clerkship Policies

Office of Medical Education Contacts (Third and Fourth Years)

Disability Support Services

TTUHSC EP is committed to providing equal access to learning opportunities to students with documented disabilities.  To ensure access to the educational opportunities in the clinical setting, please contact the Director of Disability Support Services (DSS) to engage in a confidential conversation about the process for requesting accommodations in the classroom and clinical setting.  Accommodations are not provided retroactively so students are encouraged to register with DSS as soon as possible.  More information can be found on the DSS website: http://elpaso.ttuhsc.edu/studentservices/disability-support-services.

Attendance Policy

Attendance at clinical duties and didactics is mandatory. Unexcused absences will not be tolerated and may result in disciplinary action, potentially including a requirement to repeat a clinical block or rotation. Students have allotted institutional holidays as stated in the student handbook and on each academic calendar. 

Students assigned to WBAMC will be excused from duty on institutional holidays.  Students will be expected to work on Military Training Days that do not coincide with institutional holidays.  If the clinic to which the student is assigned is closed, the student will be assigned duties on campus for the day.

Students are required to attend both the first and last days of the rotation.  The only excused absences will be for interviews, illnesses (with doctor’s note), or documented family emergency.  Students will not be excused in order to depart for an away or international rotation. 

Absences are only excused at the discretion of the Clerkship/Course Director. Commonly excused absences include:

• Illness/health care appointment
• Family Emergency
• Death in the Family
• Religious Holidays (please see the Religious Holy Days Policy in the Student Affairs Handbook)
• Presenting at a National Conference
• Interviews for Residency (MS4 only)

Absences in the Third Year

During the third year, a student is expected to attend all clinical and didactic activities.  If a student will be absent for any activity, they must obtain approval from the Clerkship Director.  If the Clerkship Director determines that a student’s absence(s) compromises the student’s ability to attain the necessary competencies, they may require the student to make up days or complete alternate assignments. If a student is required to make up time, this must be completed during unscheduled time and the hours worked must be in compliance with the duty hour policy.

If a student is absent more than 6 days per block or 12 days during third year (including excused absences), it will be reviewed by the Associate Dean for Student Affairs. Excessive absences could be a violation of the Student Code of Conduct and may be forwarded to the Grading and Promotions Committee.

In the event of an emergency that results in an absence from clerkship duties, the student must notify the Clerkship Coordinator AND the Office of Student Affairs as noted above as soon as possible.

If a student begins a third year clerkship block and then takes a prolonged leave (> 2weeks), then the student will be required to:

• Make up any clinical time missed in the next open clerkship block (this would be Block 1 of the next academic year for students who are “on cycle” and Block 2 of the next academic year for students who are “off cycle”)
• Once the student completes the pending clinical work, the student can then schedule the pending NBME exams and the OSCE at the next available offering.
  • The NBME dates are published in the Common Clerkship Policies. NBME exams are generally administered every 4 weeks.
  • The next available OSCE may be a remediation date or the scheduled OSCE at the end of the block
• Didactic material that is missed can be viewed through CANVAS or Elentra where videos, slides and readings are posted.
  • Students can meet with faculty to discuss any questions they have about didactic material
• There may be additional make-up assignments at the discretion of the clerkship directors.
• Make-up for the clinical time missed, coursework and testing will need to be completed before beginning year 4 clerkships. Exceptions to this can only be made with approval of both the Office of Medical Education and the Office of Student Affairs.

Absences in the Fourth Year

In the fourth year, a student may have no more than three excused absences in a 4 week block without having to make up that time. However, if the Clerkship/Course Director determines that a student’s absence(s) compromised the student’s ability to attain the necessary competencies, they may require the student to make up days or assignments, regardless of the number of days missed. It is also at the discretion of the Clerkship/Course Director to give the student an alternate assignment to satisfy all or part of the make-up time.  If a student is required to make up time, this must be completed during unscheduled time and the hours worked must be in compliance with the duty hour policy.

If a student is absent more than 6 days in a semester during fourth year, it will be reviewed by the Associate Dean for Student Affairs. Excessive absences could be a violation of the Student Code of Conduct and may be forwarded to the Grading and Promotions Committee.

Notification of Absence (Third and Fourth Year)

When a student is going to be absent, they are required to notify: 1) the Clerkship Coordinator BEFORE their shift or assigned duties begin. Acceptable forms of notification are: email (preferred), phone call, or text message. Please see individual Clerkship Syllabus for Clerkship-specific contact requirements; 2) The Office of Student Affairs by emailing PLFELPClerkshipAbsence@ttuhsc.edu.

Planned Absences:

A planned absence from a clerkship phase required activity must be reported a minimum of two weeks in advance (unless deemed unavoidable by the Associate Dean for Student Affairs and the Clerkship Director). Non-compliance shall result in the absence being counted as unplanned and potentially unexcused). The same notification rules listed in the previous paragraph apply.

Documentation of Absence (Third and Fourth Year)

If a student is absent:

• Orientation Day (MS3 and MS4) is a Graded Activity. Therefore a health care provider’s note on the healthcare provider’s letterhead or printed from their electronic health record is required if Orientation is missed. The absence is subject to the institution’s Missed Graded Activities Policy. Please see the Student Affairs Handbook for more information.
• Additional graded activities include OSCE’s, NBME subject exams and all other activities that contribute to a student’s final grade (such as presentations). A health care provider’s note on the healthcare provider’s letterhead or printed from the electronic health record with signature is required.
• More than two consecutive days due to illness: a health care provider’s note on the healthcare provider’s letterhead or printed from the provider’s electronic health record is required.
• If a health care provider’s note is required as noted in the sections above, failure to obtain a health care provider’s note in a timely manner (within 48 hours) may result in a serious professionalism concern or failure of the clerkship
• When presenting at a national conference: a copy of the invitation to present and travel itinerary is required.
• When interviewing for residency (MS4 only): a copy of the invitation to interview and travel itinerary is required.

Remediation and/or Make-Up NBME Exams (Third and Fourth Year)

Students who miss an NBME exam due to an excused absence must make arrangements with the Office of Medical Education to make up the exam on the next scheduled exam date. 

Third Year students who must remediate an NBME exam will need to complete the exam before their Fourth Year coursework begins.  It is recommended that students who fail any NBME on the first attempt contact the Office of Student Affairs for any assistance needed.

Fourth Year students who must make up an NBME exam will take the exam on the next scheduled exam date, even if it falls on vacation time.  Students who are required to make up days will take the exam on the next available date following the make-up days.  Students may delay the exam if the next exam date falls during another clerkship with a required NBME.  Exceptions will also be made for approved away rotations.

During fourth year, all remediation must be completed in time for certification for graduation.

 No special arrangements (additional exam dates/times) will be made.

AY 2022-2023 NBME’s will be administered on the following dates:

Year 4 testing dates are scheduled as follows:

• Friday, July 1st
• Friday, July 29^th
• Friday, August  26^th
• Friday, September 23^rd
• Friday, October  21^st  
• Friday, November  18^th
• Friday, December  16^th
• Friday, January 27^th  
• Friday, February  24^th
• Friday, March  24^th
• Friday, April  21^st  
• Thursday, May  18^th

Third year testing dates are as follows:

Block 1

• Medicine and the Mind  OSCE - Week of October 17, 2022
• OB/Peds/Surgery/EM/FM OSCE - Week of October 17, 2022
• FM and Surgery NBME - October 21
• IM and Pediatrics NBME - October 25
• Psychiatry and OB NBME - October 28

Block 2

• IM/FM/Psychiatry OSCE - Week of April 17, 2023
• OB/Peds/Surgery OSCE - Week of April 17, 2022
• FM and Surgery NBME - April 21
• IM and Pediatrics NBME - April 25
• Psychiatry and OB NBME - April 28

Early Testing Dates during Block 1 and Block 2 TBD.

Remediations for MS3’s and MS4’s are available on any scheduled testing date (Year 3 or 4).  Once the student decides on a date to remediate, please contact Mrs. Janssen at least one week in advance to make arrangements.

Credentialing of Medical Students

All medical students must maintain compliance with occupational health requirements in order to participate in clinical rotations. This is monitored by the Office of Student Affairs.

In addition, many health care facilities and offices require students to be credentialed to attend procedures and/or care for patients. The Office of Medical Education will work closely with Student Affairs and the individual clerkships to file the paperwork necessary for each facility. It is each student’s responsibility to answer emails and comply with required appointments (such as for fingerprinting at WBAMC) and to complete all required paperwork in a timely manner. If students fail to comply with deadlines and are unable to attend a rotation as a consequence, it may be reflected in the student’s final assessment as a professionalism issue. Please note that the Office of Medical Education and the appropriate clerkship will notify students if there are facilities that are not approved for medical student rotations. The students should not perform clinical duties or procedures at any facility that is not approved even if their community preceptor goes to that facility. 

If a student does not complete the required credentialing process, then they may NOT enter that facility and work as a medical student.

Clinical Grading Policy

Student clerkship performance is based on the clerkship director’s judgment as to whether the student honors, passes, or needs improvement on each of 8 competencies described by the PLFSOM discipline performance rubric.  The final clerkship performance assessment is conducted at the end of the rotation based on the student’s level of performance at that point in time.  Students are not penalized for lower levels of performance early in their rotation.  It is expected that over the course of the block, student performance will have improved in many or all categories, based on constructive feedback and growing familiarity with the clinical discipline and patient care. In other words, the final assessment is not an average of the student’s performance over the entire rotation but represents their final level of achievement.  

Possible Final Grades are Honors, Pass, Fails, and In Progress.  There is no cap or quota on the number of students eligible for Honors designation.  The overall grade is based on the 8 competency scores as described below, the NBME score and the OSCE score.  No student who “needs improvement” in any competency on the final clerkship evaluation is eligible for honors. 

A student who fails Professionalism may receive a Pass or a Fail overall at the discretion of the course director, regardless of the scores on all other items. 

Third and Fourth Year

Overall grade is based on the assessment in each of the 8 competencies, NBME score (See Table 1 for clerkship designated thresholds for pass and honors), OSCE performance (if applicable), and professionalism

• Honors, if all of the following are true:
  • Passes NBME exam, if applicable, at or above the clerkship designated score for honors on first attempt
  • Passes OSCE, if applicable, on first attempt
  • Minimum of 4 of the 8 individual competencies rated as “Honors” on the final clerkship evaluation
  • No individual competency rated as “needs improvement” on the final assessment.
• Pass if all of the following are true: 
  • Passes NBME exam, if applicable, at or above the clerkship designated score for pass on the first or second attempt
  • Passes OSCE, if applicable, on first or second attempt
  • Minimum of 6 of the 8 individual competencies rated as pass or better on the final clerkship evaluation
  • No more than 2 individual competencies rated as “needs improvement” on the final clerkship assessment
  • Professionalism concerns are, in the judgment of the course director, not significant enough to warrant a Fail on the final clerkship evaluation.
• A failing clinical assessment is assigned if any of the following are true.
  • 3 or more individual competencies rated as “needs improvement” on the final clerkship assessment
  • NBME Exam, if applicable, below the designated clerkship score for pass after 2 attempts
  • Failure on final exam (other than NBME), if applicable, after 2 attempts
  • Fail on OSCE, if applicable, after 2 attempts
  • Professionalism concern deemed by the course director significant enough to warrant a Fail on the final evaluation.
• If a student receives a final grade of “needs improvement” in 3 or more competencies in any of the clerkships, they will be referred to the Grading and Promotions Committee (GPC).
• If a student fails 3 NBME’s or 2 OSCE’s within the third year, they will be referred to the Grading and Promotion Committee and a notation will be made on the MSPE (Medical Student Performance Evaluation)

An In Progress grade will be assigned any student who has not completed required assignments or examinations or who has not fulfilled all clinical experience obligations, pending completion of the required work.

Table 1: Clerkship-Designated Scores for Pass and Honors

Please note: 

1. Third year students in Class of 2024 who complete the requirement for EM and Neurology during their 3^rd year will not be required to take these subject exams. Students who did not complete these requirements during their 3^rd year will need to take EM and Neurology during their 4^th year and will be required to take the subject exams.
2. Each Fourth Year Elective has its own specific grading assessment forms. Final grades possible are Honors, Pass, and Fail. Please refer to the syllabus for each elective for more information on the specific grading policy.

Class Ranking Formula

Class rank will be calculated at the completion of third year clerkships and will be included in the student’s MSPE prepared by the Office of Student Affairs. The ranking will be based on competency grades, professionalism, NBME scores and OSCE performance. Contribution of each element will be as follows:

• 30 % based on competency grades from 8 third year clerkships in Knowledge for Practice, Patient Care, Interpersonal and Communication Skills, Practice Based Learning and Improvement, System-based Practice, Interprofessional Collaboration and Personal and Professional Development.
• 30% based on performance in the end of block OSCEs
• 30 % based on NMBE subject exam scores from the 6 third year clerkships. Note that NBME exams are not required in Emergency Medicine and Neurology during third year,
• 10% based on competency grades in Professionalism from all 8 third year clerkships

Referral to Grading and Promotion

Third year students will be referred to the GPC if they receive “Needs Improvement” in 3 or more competencies on any Clerkship final assessments or if they fail a Clerkship. Fourth year students will be referred to GPC if they receive “Needs Improvement” in 2 or more competencies on any required fourth year rotations (including Emergency Medicine, Neurology, Sub-Internship and Critical Care, and Bootcamp) or if they fail a clerkship or elective.

Progress of all students will be reviewed by the GPC twice per year in the context of all course work, student’s professionalism, evidence of progressive improvement and personal circumstances. Performance in other blocks or clerkships will be taken into consideration by the GPC.

***Please note that the GPAS Policy is currently under full review and the Common Clerkship Policies will be updated once this is complete.

For the Third Year:

The committee will consider all Year 3 students after the end of each 3rd year clerkship block. Students considered at-risk will be placed on academic warning or probation and reviewed by the GPC according to the following rules:

Grading and Promotion Committee Review for Year 4

The committee will consider all Year 4 students on a rolling basis following each 4th year block. Students considered at-risk will be placed on academic warning or probation and reviewed by the GPC according to the following rules

* Students cannot earn clerkship phase elective credit for GPC-required remediation(s)

Op-Log Policy

1. Students are required to complete Op-Log entries on all patients with whom they have direct, “hands-on” clinical contact-e.g., take all, or significant part of the patient’s history, conduct a physical examination, perform or assist in diagnostic or treatment procedure, write orders, participate in treatment decisions, etc.  A student will also be expected to complete Op-Log entries on patients seen with an attending or resident where clinical teaching and learning through observation is an explicit goal of the encounter.
2. Students will document each problem/diagnosis addressed by the student at the time of the encounter e.g., if a patient has the following diagnoses listed on his/her record-DM type 2, Hypertension, and Osteoarthritis, but the student only addresses the OA during the encounter, OA is the only problem that would be recorded in Op-Log for that encounter. If the student addresses more than one problem in a given encounter, then they should list the diagnosis primarily addressed at the visit first, and then the others diagnoses in order following this.
3. Students are expected to record their encounters in OP-Log on at least a weekly basis.  Regardless of where the assessment falls in a week, students must have their Op-Log recordings up-to-date at least 24 hours prior to scheduled mid-block of clerkship formative assessment and by 5:00 pm the Monday of NBME week. 
4. For hospitalized patients, a student will complete an entry at the time they assume care of the patient and each day that they have direct “hands on” contact.
5. Timely, complete, and accurate clinical encounter Op-Log entries will be a component of the clerkship assessment.  Students who do not meet expectations in the documentation of their clinical experiences will not be eligible for “Honors” designation. 
6. Students will not document “incidental” patient-encounters. Each clerkship will operationally define “incidental encounters for its purposes. 
7. Each clerkship has identified mandatory conditions that students must encounter during the clerkship. If a student does not see a patient with the mandatory condition or procedure at the designated level of involvement, then an alternate assignment must be completed to fulfill the requirement. Please see the Op Log sections in each syllabus.

• Note that the required diagnosis must be listed first in the Op Log in order to fulfill the requirement.
• Each encounter logged can only be used to satisfy one requirement. For example, if a student sees a patient with chest pain who has DM and HTN, this entry will only satisfy the chest pain requirement. It will not satisfy 3 requirements.
• For specific diagnoses (such as colic or child abuse), this can be adjusted at the discretion of the clerkship director.

    8. We expect that students will document a minimum number of encounters per clerkship.  Please note that these are minimum expectations, and as such a student may not          qualify for Honors if they only meet the minimum expectation (Honors designation indicates a student went above and beyond).

    9. Deliberate falsification of Op-Log entries is an honor code violation.

Common Requirements

Year 3

1.Intersessions

a. There will be three intersessions in the third year

1. One week prior to the start of Block 1
2. One week prior to the start of Block 2
3. Two weeks at the end of the academic year after the conclusion of Block 2
4. . The entire class will participate in the activities. Content will integrate the experiences in the clinical rotations during Year 3 with concepts from the Year 1 &2 coursework.

b. This is a 4 credit course required for graduation.

c. Dates for Class of 2023

1. May 16 to 20, 2022
2. October 31 to November 3, 2022
3. May 5 to 12, 2023

d. Attendance and participation in the intersession activities is mandatory.

e. Please refer to the Intersession Syllabus for complete details and to review the objectives, a sample calendar and assessments.

2. End of Block OSCE grading

a. Students at the end of each block are required to take and pass on OSCE exam.

1. The exam typically consists of 5 to 6 cases. The cases combine clinical skills/reasoning from the block clerkships.
2. The OSCE may also include skill demonstration stations (see specific clerkship/block syllabi)
3. Grading of the OSCE Standardized Patient cases
   1. The student will receive two sub-scores
      1. Integrated clinical encounter- consisting of:
         1. Standardized Patient Checklist covering  key elements of history and physical examination
         2. SOAP note in the standard format with a focus on the assessment and plan and organization of the note
         3. Additional elements, such as oral case presentations to assess clinical reasoning
      2. Communication and Interpersonal Skills
         1. Uniform checklist across all cases with focus on fostering the relationship, gathering the information, providing information, helping the patient make decisions, and supporting emotions
   2. Must pass each category (Integrated clinical encounter AND Communication and Interpersonal Skills) averaged across the 5 cases.
   3. Minimum passing score 70% each for CIS and ICE component for each case
4. Remediation
   1. If a passing score in either category or both (CIS and ICE) is not achieved , the student will be required to repeat the case/cases that not meet the minimum passing score
   2. If a passing score on either category or both is not achieved on the second attempt, the student will be referred to Grading and Promotions for failure of the clerkship as noted on page 8 &9.

3.End of Year 3 OSCE

a. Background

1. Cases are designed to elicit a process of history taking and physical examination that demonstrates the examinee’s ability to list and pursue various plausible diagnoses. Clinical reasoning will be evaluated.

b. The EOY OSCE is scheduled during the May Intersession.

c. Objective

1. Demonstrate  competency in history, physical examination skills, and diagnostic reasoning appropriate to the level of the student
2. Accurately document a focused history, physical examination, assessment and corresponding clinical reasoning in the record.
3. Make informed decisions about the initial diagnostic work-up for each scenario and document in the record.
4. Demonstrate communication skills in providing patient education and counselling when appropriate to the situation.
5. Demonstrate sensitivity, compassion, integrity, and respect for all people.

d. Scoring and Grading

1. The student will receive two sub-scores
   1. Integrated clinical encounter- consisting of:
      1. Standardized Patient Checklist covering  key elements of history and physical examination
      2. SOAP note in the standard format with a focus on the assessment and plan and organization of the note
      3. Additional elements, such as oral presentation, may be added to assess clinical reasoning
   2. Communication and Interpersonal Skills
      1. Uniform checklist across all cases with focus on fostering the relationship, gathering the information, providing information, helping the patient make decisions, and supporting emotions.
         1. Note: there will be modifications for pediatric cases and telephone encounters

e. Must pass each category (Integrated clinical encounter AND Communication and Interpersonal Skills) across all 6 cases

1. Minimum passing score 75%

f. Remediation

1. If a passing score in either category or both is not achieved, the student will be required to repeat all stations of the examination.
2. If a passing score on either category or both is not achieved on the second attempt, the student will be referred to Grading and Promotions.

g. Successful completion of remediation is required to begin Year 4 coursework.

4. Comprehensive Clinical Sciences Examination (CCSE)

a. Each student is required to take the CCSE at the end of Year 3 during the May Intersession to determine readiness to take USMLE Step 2 CK.

b. The Associate Dean for Student Affairs or their designee will discuss with the student if the score is of concern and decide on a plan of action.

c. COMPLETION OF YEAR 3 is highly encouraged before taking USMLE STEP 2 CK.

1. Please note that missing time to take Step 2 CK during Block 3 will result in an unexcused absence. Please see the attendance policy on page 2.
2. Unexcused absences may result in disciplinary action, potentially requiring a student to repeat a clinical block or rotation.

5. Q Stream participation

a. Participation in the assigned Q Stream modules is required.

b. Q stream is an electronic platform for spaced learning. Concepts that are important across all clerkships will be covered in a series of Q Stream modules. Examples include infection control and patient safety concepts.

c. Reports regarding participation will be forwarded to the clerkships directors at the midpoint of the block and at the end of the block.  Failure to participate may affect the student’s final grade in the related competency, such as system-based practice, practice-based learning and improvement, and/or professionalism.

Year 4

6. Critical Care Core Curriculum

a. This is a series of online interactive modules available through the Society for Critical Care Medicine that address core topics that represent foundational knowledge and apply across critical care settings. Examples of topics addressed include: airway management, and interpretation of arterial blood gases, and common causes of shock. (See specific syllabi)

b. Completion of assigned modules and quizzes is required.

c. If modules are not completed by the end of the rotation, the student will receive a grade of In Progress until all modules are completed in a satisfactory manner. Failure to complete these modules by the assigned deadline could result in a “needs improvement” in the professionalism competency on the final assessment.

Year 3 and Year 4

1. Documentation in the Electronic Medical Record

a. It is a privilege for our medical students to document in the electronic record at Texas Tech Health Sciences Center El Paso and our affiliated hospitals and clinics.

b. Student notes entered in any electronic health record as part of a clerkship experience or requirement must be completed by the student in a timely fashion and routed to the appropriate resident and faculty.

c. Delinquent notes in all electronic health records, including EHRs at our affiliated institutions, must be resolved prior to clearance for graduation. The student’s diploma will not be released until all delinquent records are cleared,

2. Reminder of Important Dates

a. USMLE Step 1

1. Students must take Step 1 prior to the start of third year orientation and clerkships.
   1. If a student receives their score and does not pass, please refer to the GPAS policy available at: https://elpaso.ttuhsc.edu/som/ome/CEPC/_documents/secure/GPAS_policy_2019MARCH.pdf  
2. Students returning from a Leave of Absence must take and receive a passing score on Step 1 prior to the start of the clerkships. Please see the GPAS Policy and the Student Handbook.

b. USMLE Step 2 CK

1. Students must take their first attempt at Step 2CK before October 31 of their 4^th year. Students who do not meet the deadline will be suspended from 4^th year clerkships/courses until they take the examination.
2. Obtaining a passing score on Step 2 CK is a graduation requirement. Please refer to the GPAS policy for additional details, available at: https://elpaso.ttuhsc.edu/som/ome/CEPC/_documents/secure/GPAS_policy_2019MARCH.pdf

CME Requirement

The CME requirement is a prerequisite for graduation!

Purpose/Goals of Requirement:

• Expose students to the full continuum of medical education including Continuing Medical Education;
• Provide students opportunities to broaden their clinical training by participating in approved Type 1 CME events;
• Reinforce the fact that all physicians are expected to be active, life-long learners and to take responsibility for maintaining and expanding their knowledge base.

Requirement:

• A minimum of 10 documented Type 1 credits must be completed by March 1 of the MS 4 year;
• Credits must be earned in at least three (3) different disciplines (e.g., Internal Medicine and IM sub-specialties, Surgery and surgical subspecialties, OB-GYN, Pediatrics and pediatric sub-specialties, Psychiatry, Family Medicine, etc.);
• At least 5 of the credits must involve “live” sessions;
• Clerkship required learning activities that “happen” to carry CME credit (e.g., the Lactation Curriculum in OB-GYN) will not count toward meeting the CME requirement except for Grand Rounds Sessions that have been approved for Type 1 credit by the CME office that students are required to attend as part of a rotation.

Documentation:

• Student participation in PLFSOM CME approved events will be documented via medical student sign-in sheet;
• Students are required to provide acceptable documentation (e.g., certificates of completion, transcript of credits, and/or photo of sign-in sheet) to Christy Graham in the Office of Medical Education;
• Mrs. Graham will update students quarterly about their individual status in meeting requirement

Duty Hours Policy

Preamble: The School of Medicine has the responsibility to develop and implement work hour policies for medical students, especially those on clinical clerkship rotations, in accordance with LCME Element 8. These policies should promote student health and education.

1. Students should not be scheduled for on-call time or patient-care activities in excess of 80 hours per week.
2. Students should not be scheduled for more than 16 continuous hours (except as noted in #8 below).
3. Students should have 10 hours free of duty between scheduled duty periods.
4. Students should have at least one day off each week averaged over a one-month period.
5. Students should not have more than 6 consecutive nights on night float duty.
6. This policy applies to all clerkships/rotations in the third and fourth year at Paul L. Foster School of Medicine.
7. It is anticipated that student attendance at clerkship seminars, conferences, and other didactic sessions will be facilitated by this policy and that provisions in this policy are not the basis for missing these sessions. Requests for excused absences from these sessions should be submitted to the clerkship director or his/her designees on an individual basis.
8. During 4th year required clinical rotations, such as the Sub-Internship selectives, the clerkship director may require overnight call to prepare students for internship and residency. In this case, call rooms must be available for the student’s use at the facility and duty hours must not exceed 24 hours of continuous scheduled clinical assignments. Up to 4 hours of additional time may be used for activities related to patient safety, such as transitions of care. The clinical departments will determine the frequency of overnight call, but it should not be more frequent than every 4th night.
9. Variances from this policy must be approved by the Associate Dean for Student Affairs.

Clerkship Requirements for Reporting Duty Hours

Students must report their duty hours in the online scheduling system within 48 hours of the end of each event. Failure to enter duty hours more than 3 times in a Clerkship will result in a concern notation on the student’s professionalism evaluation (completed by the Clerkship Coordinator).

Additional Policies

There are a number of policies dictated by the Office of Student Affairs. Students are expected to be familiar with all policies in the Student Affairs Handbook (https://ttuhscep.edu/som/studentaffairs/student-handbook/) with special attention paid to the following:

• Dress Code
• Needle Stick Policy
• Standards of Behavior in the Learning Environment
• Medical Student Code of Professional and Academic Conduct
• Religious Holy Days
• Missed Graded Activities
• Evaluation Policy
• Off Cycle Policy

Students are expected to be familiar with policies regarding the Training and Educational Center for Healthcare Simulation  (TECHS) and to abide by these policies when attending sessions in the TECHS Center.