Clerkship Policies

Supervision of TUSM Students in the Clinical Setting

During the core clerkships and all clinical rotations students must be under the supervision of a faculty physician who is working within the scope of their practice. Student supervision may directly occur via a resident physician (intern, resident, fellow) who is under the supervision of a faculty physician.

Prior to starting the core clerkships ALL students have successfully completed the Interviewing, Physical Diagnosis and Competency-based Apprenticeship in Primary Care (CAP) Courses. In so doing, each has been deemed competent to conduct a history and physical examination in the clinical setting without direct supervision (e.g. in the room), with the exception of breast and pelvic examinations where in-room supervision is expected.

Prior to starting the core clerkships ALL students have successfully completed the Core Clerkships Orientation that includes training in simple bedside procedures. Students may perform phlebotomy and insertion of peripheral intravenous catheters, in the clinical setting, without direct (e.g. in the room) supervision (by completing the Orientation experience they have been deemed competent in these procedures. For all other procedures, students must be directly observed by a resident or faculty member who is working within the scope of their practice.

Policy on Conflict of Interest in Core Clerkships and Advanced Electives

In order to avoid a conflict of interest in the evaluation of students as well as to promote a fair and positive learning environment, students may not be assigned to a clinical rotation where they will be directly supervised or otherwise evaluated by a physician (or other medical provider) with whom they have a current or prior medical relationship.  If a student requires emergency medical attention during a clerkship and the best (or available) provider is their direct supervisor or evaluator, the student will have the option to be reassigned to another site after recovery from illness. This will be accomplished through the Dean of Student Affairs with strict confidentiality.

In addition to the above policy, students may not be supervised or otherwise evaluated by any family member or close friend (inclusive of close friends of family members).  Students are expected to disclose such relationships prior to the Clerkship Lottery process (this includes prior personal physicians as above) and will be excluded from such rotations.

Clerkship Directors as well as those who directly supervise students will attest to the fact that no such COI exists by a signature on the student’s evaluation form.

Student Work Hours Policy

Tufts University School of Medicine recognizes that education is the primary goal for medical students during the third- and fourth-year clinical clerkships. The following work hour policy developed by the Core Collaborators subcommittee of the Curriculum Committee outlines student work hour limitations that maximize the educational value of clinical training while limiting fatigue that may impair a student’s ability to aid in patient care or achieve the learning objectives of the rotation. The Core Collaborators recognize that didactic teaching sessions are an essential part of the third-year core curriculum. For this reason, each clerkship is encouraged to implement this policy in a way that interferes least with didactic and case-based learning. Under the rubric of TUSM’s Honor Code, students are accountable for tracking their own efforts.

1. Medical students engaged in clinical activity will be on duty no more than 80 hours per week (averaged over a four week period). For the purposes of this policy, duty hours are defined as time spent in the hospital directly related to patient care or educational requirements such as in-hospital conferences, and on-call time (even if spent sleeping). Preparation for patient care, conferences, or exams is not considered “duty” time and may be done outside of the clinical setting.

2. Medical students shall not spend beyond 30 consecutive hours in the clinical setting while on duty. This allows students to remain in the hospital post-call for a few hours in order to complete on-call notes, patient care, and for the educational experience related to their on-call activities that may take place during the morning post-call.

Suggested ways to implement this policy include (but are not limited to):

  • Schedule all third-year didactic sessions on a specific day of the week and avoid any overnight call the evening prior.
  • If didactic sessions occur daily, schedule all overnight call on Friday or Saturday nights with no didactic sessions the following day.
  • Regular weekday “on-call” activities on rotations with daily didactic sessions can end at 10 or 11 p.m. thereby allowing students to return the following day for didactics and patient-care activities.
  • Fourth-year ward rotations may have students follow intern or resident schedules.

Clerkship directors are required to share this policy as well as their specific implementation plan with all residents and attending physicians as well as medical students.