Council on Medical Student Education in Pediatrics

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Pangaro L, Bachicha J, Brodkey A, Chumely-Jones H, Fincher RM, Gelb D, Morgenstern B, Sachdeva A. Expectations of and for Clerkship Directors: A Collaborative Statement from the Alliance for Clinical Education. Teaching and Learning in Medicine 2003;15(3):217-222. Reviewed by John S. Venglarcik, III, Northeastern Ohio Universities College of Medicine.


Pangaro L, Bachicha J, Brodkey A, Chumely-Jones H, Fincher RM, Gelb D, Morgenstern B, Sachdeva A. Expectations of and for Clerkship Directors: A Collaborative Statement from the Alliance for Clinical Education. Teaching and Learning in Medicine 2003;15(3):217-222.

Reviewed by John S. Venglarcik, III, Northeastern Ohio Universities College of Medicine.

Description: The Alliance for Clinical Education (ACE), a collaboration of national clerkship organizations, attempts to establish some standards "for what should be expected of a clerkship director" and to provide "guidelines for the resources and support" to be afforded the clerkship director. Their recommendations fall into five separate categories: (1) a job description and duties for the clerkship director, (2) qualifications for being a clerkship director, (3) resources necessary for the support of the clerkship, (4) career development for the clerkship director and (5) time allocations necessary for the clerkship director to fulfill their responsibilities. This is accomplished by establishing a rationale and defining essential and desirable elements for each of the above five categories.

The job description is detailed and recommends 11 specific or essential products for which the clerkship director is responsible and another five products that are desirable although not mandatory. The essentials include responsibility for the entire clinical experience from goals and objectives to performance expectations, handout materials, schedules, testing, grading, remediation, self-appraisal and assistance to students in matters of career guidance. The desirables include a defined reporting relationship as regards student performance and program effectiveness, budgetary responsibility and involvement in various educational assessments (e.g. faculty development and promotion) as well as resource allocation.

The essential qualifications of a clerkship director include nine elements: vision, knowledge of curricular goals, clinical experience, prior experience with medical students, communication skills, enthusiasm, experience in providing career guidance, and management skills and abilities. The desirables are prior clerkship experience, demonstrated teaching excellence, networking capabilities, motivational skills, feedback and advisory experience, and intellectual curiosity.

A rationale is provided for a set of essential resources available to the clerkship director which include control over resources sufficient to meet the needs of the clerkship, personnel (administrative and clerical), material resources, dedicated time, adequate space and access to new technologies. In the desirable category the most important resource is additional time; time for research, faculty development, and involvement in various committees.

The clerkship directors must be valued for their contribution to achieving curricular goals. As a consequence it is essential for career development that the clerkship directors be recognized for their educational productivity as well as given the time and resources necessary for continued development as both a clinician and an educator (including participation in faculty development). It is desirable that the clerkship director enjoys the benefits of a mentoring relationship, has the opportunity to assume other leadership positions, develop educational research expertise and serve on relevant school and national committees.

Finally, an appropriate amount of dedicated time necessary for the clerkship director to be successful is recommended. It is strongly suggested that 50% of a full-time equivalent be allocated to the clerkship director and that 25% should be considered the bare minimum.

Discussion: As someone who has been "in the trenches" as a pediatric clerkship director for 19 years and more recently, as associate dean, has assumed a supervisory role that includes budgetary oversight for five other clerkships on our campus, I was delighted to read this article. The first thing that I enjoyed was the attempt of the authors to define a raison d'être for the huddled masses of clerkship directors. Their vision of the role of the clerkship director contains elements familiar to all of us; supervision, course content, evaluation, feedback, and self-assessment. It also sees the role of the clerkship director extending to curricular reform, educational research, faculty development, and promotion as well as to assuming a greater fiscal responsibility. In elaborating this vision they have not ignored the other reality; that of personnel management, resource accrual, and allocation, faculty retention, program assessment and time commitment. Furthermore, they have attempted to delineate a set of skills, attitudes and abilities necessary for success and the attainment of personal satisfaction.

I would recommend that anyone who reads this should read the original article. I would encourage one to compare the specifics of each recommendation to their own position. The recommendations are specific enough to make sense to an old veteran like myself but general enough to be applicable to a variety of clerkships regardless of type, location and format. The time allocation recommendations appear to be based on a consideration of the available literature but 50% of an FTE seems unrealistic, especially in circumstances such as my own where there are multiple sites with multiple clerkship directors for each required clerkship and the school consequently provides some support functions. In conclusion, I think it is a laudable effort that provides a framework to which clerkship directors from a variety of settings can begin to compare themselves as it relates to job description, qualifications, support services, and personal growth opportunities. It should also serve to establish benchmarks each one of us can refer to as we continue to fight for available resources.

(Wow - I agree - we should all read this - Jon has been provocative in his comments on 50% support. Do you receive 50% support? Do you believe that less than 50% support is adequate? Do you believe this document would sway your Dean or Chair to change your support in any way? Does your institution have uniformity of resources and job descriptions across departments? Steve Miller)

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