The overall objective of the third year is to integrate all that you have learned into the basic skills needed to be a successful physician. Physicians are lifelong learners who must always reach for the next level. In order to reach that goal, the clerkship directors are providing you with a list of expectations to assist you during this next year.

1. You are expected to be present and participate fully in all activities involved in the clerkship, including orientation, seminars, and the final exam.
2. You are expected to make decisions, defend them, and understand the consequences of a poor decision.
3. You are expected to give 100% effort while on a clerkship and you should expect the same from your classmates.
4. You are expected to be respectful of your classmates, residents, faculty and other staff at all times. Do not undermine your colleagues.
5. You are expected to be current with all your patients and you are encouraged to do advanced reading on those patients. You should feel free to bring relevant articles to the team.
6. You should expect the residents and attendings to provide constructive criticism, so that you can improve throughout the clerkship. A formal midterm feedback session is required at week 3 of the rotation and week 5 of the Medicine rotation.
7. You are expected to be present daily unless you are ill or have a family emergency. You must seek approval for this time off by contacting the clerkship director for permission. There are no scheduled holidays during required third year clerkships.
8. You will be assigned to specific sites and team by the Clerkship Director.
9. You should expect that you will receive your final evaluation within 6 weeks of completing your rotation.
10. Remember that patient is the focus of the patient care experience, not you.

1. The process must include evaluation of students, faculty, curricular content, and curricular methodology
2. 2. All required rotations must submit a final grade and comments to the Dean’s Office no later than 6 weeks after the completion of a clerkship.
3. Accountability to the standards for distribution of feedback must be monitored.
4. Midterm formative feedback of students must be completed in week 3 of a 5 week rotation and week 5 of a 10 week rotation.
5. The midterm formative feedback form will be common for all 3rd year required clerkships and be in a checklist format.
6. A common set of skills and attitudes pertaining to professionalism will be assessed by each clerkship director for 3rd and 4th year required clerkships. If a student receives an overall evaluation of below expectation, they will be required to remediate. The clerkship director will recommend a remediation plan that is submitted to the Student Progress Board for implementation. A clerkship director can also determine if to use professionalism as part of overall final assessment.
7. The class grade distribution expectation will be 20-25% Honors, 40-45% Near Honors, 30-35% Satisfactory. The grade distribution will be reviewed annually by the clerkship directors.
8. The students must be evaluated based on the instructional objectives that have been developed by each clerkship director.
9. Evaluation of students must include direct monitoring by faculty of patient care skills, including history taking, physical examination, and procedural skills, appropriate for each clerkship.
10. Summative feedback must be obtained regarding student performance, faculty teaching effectiveness, and effectiveness of educational methodology at the end of each rotation.
11. The ACGME Core Competencies should serve as a guide to general areas of evaluation of students.
    1. The Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
    2. Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.
    3. Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.
    4. Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals.
    5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
    6. Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Approved by Clinical Sciences Subcommittee May 17, 2004
Approved by the Curriculum Committee on June 10, 2004

Third and fourth year students are expected to be available for clerkship duties on all university holidays except the following:

• Thanksgiving Day
• Winter Break

Third & fourth year students will not have the five one day holidays observed by the University unless specified by the attending physician or the clerkship director.

OHSU, as a health care system, must always remain open during inclement weather. However, adverse weather conditions may present travel problems or other unsafe situations, causing classes to be delayed or canceled, as well as alterations in some office, clinic and lab schedules. Outlined below are guidelines for medical students concerning inclement weather.

First and Second Year Students
Announcements and decisions regarding OHSU class schedules will be made by the OHSU President's Office. Classes may be on a normal schedule, delayed or canceled. Please contact the Weather Hot Line at 494-9021 or listen to the local radio and television stations for the status of classes at OHSU. Decisions are to be made by 6:00AM.

If classes are to be held or delayed you are expected to make a reasonable effort to attend class. If conditions make it impossible for you to travel safely to the OHSU for a scheduled activity requiring attendance (e.g. examination), please contact TSO at 494-8428 or by email (lehmannd@ohsu.edu) and indicate your absence.

If you are scheduled for a preceptorship, follow the procedures above for classes. You are responsible for contacting your preceptor regarding your attendance for that day.

Third and Fourth year Students
If you are assigned to a ward/inpatient clerkship, then you are expected to meet your clinical responsibilities since OHSU Hospital remains open in inclement weather. Students should contact their attending physician or resident in the morning regarding your clinical responsibilities. If conditions make it impossible for you to travel safely, contact your attending or resident regarding your circumstance.

If you are assigned to an outpatient clerkship, then follow the OHSU announcements regarding the status of your clinic. Clinics may be on a normal schedule, delayed or canceled. Contact the Weather Hot Line at 494-9021 or listen to the local radio and television stations for the status report from the OHSU. The report should be given by 6:00AM.

If clinics are to be open or delayed in opening you are expected to make a reasonable effort to meet your clinic responsibilities. However, if conditions make it impossible for you to travel safely, contact your attending or resident regarding your absence.

If you are scheduled to participate in clerkship orientation and/or the Continuity Curriculum, then follow the OHSU announcements regarding the status for classes. See policy above for first and second year students.

• Away Elective Form

1. Name of person(s) or institution offering the elective
2. Subject matter of the elective and course content
3. Duration
4. Immediate supervision
5. Justification for the elective
6. Must be in good academic standing

This information must be submitted in writing to the appropriate OHSU department chairman together with the Away Elective Form, to be endorsed by the chairman’s signature. These documents are then to be submitted to the Education and Student Affairs office at least six (6) weeks prior to the experience.

• International Away Elective Form

There are three methods for students to seek an international educational experience as specified below:

A. Authorized by the School of Medicine to receive academic credit and scholarship support
B. Authorized by the School of Medicine to receive academic credit
C. Non sponsored by the School of Medicine and receive no academic credit.

A. Scholarship Support for International Education Experiences Earning Academic Credit
The School of Medicine Committee for International Medical Education provides endowed scholarship support for students to pursue opportunities for international clinical experiences. Eligibility for funding requires that the student must meet the criteria and follow the procedures outlined below. Prior to submission of the application, the student should contact Dr. Jay Kravitz, Assistant Professor of Public Health, for assistance in identifying international educational opportunities.

1. Students requesting scholarship funds in support of an international experience are required to submit an application for funding during the next academic year commencing in July. The SOM Committee for International Medical Education will review applications, interview applicants, and make final recommendations for funding to the Associate Dean for Medical Education who will make a final decision regarding the awarding of funds. The Committee meets in April and makes awards in early May.
   
   
2. Eligibility criteria for a competitive scholarship application are as follows:
   1. Successful completion of the required first, second and the third year curriculum.
   2. Passed USMLE Step 1.
   3. Previous preparation for international experience will make an application more competitive. (Examples: International health coursework such as JCON 705A, previous international healthcare, education or service experience, foreign language course, etc)
   4. Submit the following information by the deadline to Office of Education and Student Affairs:
      
      • Indicate the name and location of a person or agency that is supervising/responsible for your experience at each site.
      • Submit a letter from the supervisor at the site indicating the objectives you plan to accomplish during this visit.
      • Indicate the length of stay (dates) for each experience.
      • Describe the learning experience expected to be achieved during these experiences.
      • Explain basis by which this experience will enhance your medical education.
        
   5. Experiences of at least 2 months and preferably 3 or more months.
      
      
3. Upon completion of the international experience, students receiving funding are required to submit a written report (limited to 5 pages double spaced) about their experience(s) and to make a presentation on the experience(s) to the SOM Committee for International Medical Education and other interested faculty and students. Upon completion of the written report and presentation the student will receive the final one third portion of approved funding.
   
   
4. Students approved for an international education experience, are required to be registered and pay University tuition ( if due) and fees while away on an international experience. Students can earn up to a total of 9 clinical elective academic credits which apply to graduation requirements. The remaining academic credits may be applied to qualify as a full time student for financial aid purposes and will be represented on the academic transcript. Students are required to meet with the Financial Aid staff prior to departure regarding financial aid regulations. Students need to meet with the Administrative Director for Education and Student Affairs to arrange for academic credits.
   
   
5. Students are responsible for requesting a final grade from their sponsor, who submits it to Office of the Dean.
   
   
6. Prior to departure, students are required to obtain consultation from a travel clinic regarding appropriate immunization and prophylactic medications.
   
   
7. Students are required to secure medical insurance as well as emergency medical assistance insurance prior to departure and this coverage should be in place for the duration of the international experience. It is suggested that students contact AEA-SOS International or a comparable organization to purchase insurance. AEA-SOS, Inc. can be reached at P.O. Box 11568, Philadelphia, PA 19116 or 1-800-767-1403.

B. Authorized International Education Experience for Earning Academic Credit
The following are the guidelines for medical students wishing to earn academic credit, receive financial aid or be granted an extension of their curriculum in order to pursue an international educational experience(s). Eligibility for an international educational experience requires that the following criteria must be met at least 12 weeks prior to departure.

1. Successful completion of the required first, second and third year curriculum. Passed USMLE Step 1.
   
   
2. Submission of an application to the SOM Committee for International Medical Education by the deadline. The following is the required information to be submitted in writing for approval:
   
   • Indicate the name and location of a person or agency that is supervising/ responsible for your experience at each site.
   • Indicate the length of stay (dates) for each experience.
   • Describe the learning experience expected to be achieved during these experiences.
   • If this experience extends your medical curriculum beyond four years, explain why this experience will enhance your education
   • Meet with the Administrative Director for Education and Student Affairs to arrange academic credits and financial aid for the period you are away.
   • Meet with the University Financial Aid Office staff prior to departure regarding financial aid regulations.
     
     

3. Students approved for an international education experience, are required to register and pay University tuition (if due) and fees while away on an international experience. Students can earn up to a total of 9 clinical elective academic credits which apply to graduation. The remaining academic credits may be applied to qualify as a full time student for financial aid purposes and will be represented on the academic transcript.

4. Students are responsible for requesting a final grade from their sponsor, who submits it to Office of the Dean.

5. Prior to departure, students are required to obtain consultation from a travel clinic regarding appropriate immunization and prophylactic medications.

6. Students are required to secure medical insurance as well as emergency medical assistance insurance prior to departure and this coverage should be in place for the duration of the international experience. It is suggested that students contact AEA-SOS International or a comparable organization to purchase insurance. AEA-SOS, Inc. can be reached at P.O. Box 11568, Philadelphia, PA 19116 or 1-800-767-1403 or online at www.internationalsos.com.

C.  Non Sponsored International Education Experiences without Academic Credit
Medical students may also pursue international experience(s) during the summer term between years one and two. Successful completion of the year one curriculum is required. Students earn no academic credit toward graduation requirements and are considered not sponsored by the School of Medicine. Non sponsored students pursuing education experiences are encouraged to obtain medical insurance as well as emergency medical assistance insurance in this circumstance. In this regard, students should contact AEA-SOS International or a comparable organization. AEA-SOS, Inc. can be reached at P.O.Box 11568, Philadelphia, PA 19116 or 1-800-767-1403 or online at www.internationalsos.com.