Appendix 2. Clinical Encounter Table

The Clinical Encounter Table is designed to help Pediatric Clerkship Directors organize a clinical roadmap for their clerkships and help meet the requirements of LCME Standard ED-2. ¹ The table is meant to be used as a guide to help determine the types and numbers of patients and the settings in which patients should be seen during the clerkship experience. To make the process transparent, whenever possible, the language used in this Table is directly derived from the LCME document. Recognizing that most clerkships already have patient tracking tools, the table is not specifically designed as a tracking or documentation tool however it is designed so that it can easily be adapted to that purpose. For example, the column "Documentation" is included to facilitate tracking if so desired by an individual clerkship director. Importantly, the rows "monitored and verified" and "interim clinical learning plan given" are included to help meet the objectives of ED-2 if the requirement for monitoring is not addressed elsewhere. Clerkship directors may add or alter the table based on local objectives or needs. The table is designed as a framework and is meant to be both expansive and flexible. In the rows, clinical conditions are grouped into key domains that represent the minimum number of different domains that a student is expected to encounter during the clerkship experience. Other than suggesting students should meet the requirement to "see" a well child check in children of different ages in the ambulatory setting, few other constraints are proposed. Clerkship directors may decide to require students to see additional or different types of patients. Individual Clerkship Directors must decide how many patients, the level of involvement, and the setting that medical students should see patients based on local resources and curricular objectives.
The Clinical Encounter Table in its current form reflects the consensus opinion of the Curriculum Task Force of COMSEP and the Ambulatory Pediatric Association Medical Student Education Special Interest Group. These two working groups feel that a student should see at least one patient in each of the domains (patient type or core conditions) listed. For each domain, a list of presenting symptoms or concerns and diagnoses that would support having seen a patient in that domain is listed. The domains are by nature broad, e.g. upper respiratory tract, which includes many common pediatric illnesses. Some are not easily categorized, e.g. fever without localizing findings. Some do not easily also support a presenting symptom, e.g. well child visit. Nonetheless, it is hoped that Clerkship Directors will be able to use the domain, symptoms, or diagnosis to help ensure that students see the necessary types of patients.

Appendix 2. Clinical Encounter Table. This table reflects the consensus on the types of patients a student should see, the setting, and level of student involvement during the clerkship experience.

Please Click here to view the table.

^1. http://www.lcme.org/standard.htm#latestadditions

ED-2: The objectives for clinical education must include quantified criteria for the types of patients (real or simulated), the level of student responsibility, and the appropriate clinical settings needed for the objectives to be met.

ANNOTATION (Page 10): Each course or clerkship that requires interaction with real or simulated patients should specify the numbers and kinds of patients that students must see in order to achieve the objectives of the learning experience. It is not sufficient simply to supply the number of patients students will work up in the inpatient and outpatient setting. The school should specify, for those courses and clerkships the major disease states/conditions that students are all expected to encounter. They should also specify the extent of student interaction with patients and the venue(s) in which the interactions will occur. A corollary requirement of this standard is that courses and clerkships will monitor and verify, by appropriate means, the number and variety of patient encounters in which students participate, so that adjustments can be made to ensure that all students have the desired clinical experiences.