Clinical Education & Clinical Education Guidelines
Throughout the University’s history, strong and valued partnerships have been established with highly regarded physicians, clinics, and hospital systems across the nation. Annually, the Office of Clinical Education conducts a clerkship match process whereby each student is assigned to an affiliated core training site for third and fourth year.
All clerkships are supported by a presentation-based curriculum, which continues the students’ foundation built during the modified systems applications-based curriculum offered during the first two years of training at KCU.
All KCU-COM students are required to follow the policies outlined in the Clinical Education Guidelines.
Download the 2023 - 2024 Clinical Education Guidelines
Clinical Clerkships
KCU-COM clinical clerkships are sometimes referred to as rotations, clinical experiences or externships, with a teaching physician who is referred to as a preceptor, attending or faculty. A clerkship may be two weeks, four weeks or one month of clinical responsibilities. Clerkships may involve inpatient, outpatient, online, telemedicine, virtual or a combination of these settings. At the conclusion of these experiences an evaluation of the student by the preceptor and an evaluation of the clerkship by the student is required.
Students should familiarize themselves with the individual syllabi for each required clerkship.
Clinical clerkships in the third and fourth years reinforce and expand on the training of the first two years of medical school and provide the opportunity to develop their clinical skills”. The third year consists of required clinical clerkships as well as some selectives at the assigned core site. Fourth-year consists of a required clerkship, three sub-internships, and elective clerkships. Required third- and fourth-year clinical clerkships are only completed at affiliated training sites. Assignment to sites is determined by a rotation match process conducted during the second year.
Students enrolled in clerkships are considered full-time students.
Clinical Clerkship Coordinators
Clinical Clerkship Coordinators are the initial point of contact for all matters pertaining to clinical education. The coordinators are primarily available to assist students in navigating clerkship logistics and. They are available to students preferably by email or by telephone during regular University business hours. Students may schedule an in-person or online meeting by appointment.
To protect students’ privacy, Clinical Education communicates information directly with the medical student, and therefore not to spouses, parents, etc.
Third-Year Curriculum
KCU-COM students must be enrolled in clinical activities throughout the entire academic year.
Students are expected to adhere to each site’s unique scheduling protocols and procedures. Some sites require more than 40 hours per week and may include working holidays, overnights and/or weekends.
Third year clerkship schedules are set by the core site coordinator. Once set, no changes will be accepted.
For more information, please review the relevant degree requirements for cohorts listed at the top of the Osteopathic Medicine (DO) program page.
Core Sites
A core site is a geographic location at which students are assigned for their third-year curriculum. The core site is the base from which all clerkships are assigned, approved and evaluated. Core site staff and faculty include a core site coordinator and a physician leader such as a Director of Medical Education (DME) or Regional Assistant Dean (RAD). The core site coordinator and the RAD will periodically meet with students to help interface between the student and the KCU clerkship coordinator. The core site personnel are responsible for assuring resources are available to deliver the curriculum at that site.
Selective Clerkships
Selective clerkships are clinical experiences completed in addition to the third-year core clerkships. The student may have some ability to choose from a list of available selective clerkships. The core site determines the selective clerkships available based on the resources at the core site. The core site personnel are responsible for the final decision for all third-year clerkships. Once a selective is confirmed, cancellations or changes are not permitted.
Selective clerkship opportunities are not allowed away from the core site during the third year. Exceptions to this policy may occur for students officially enrolled in military, global medicine or specialty honors tracks.
Emergency medicine selectives completed during the third year cannot fulfill the fourth-year EMED 401 - Emergency Medicine requirement.
Fourth-Year Curriculum
Individual start and end dates for fourth-year vary by location. Students must be enrolled in clinical activities during the entire academic year through the last business day in April.
Sub-Internships
Sub-internships (Sub-I) are clinical experiences designed to provide students with an opportunity to function at a level closer to that of an intern. Audition clerkships are designed to provide students with the opportunity to gain exposure to potential residency programs. At least three four-week or one-month sub-internship or audition clerkships must be scheduled and completed at a recognized residency training program. Splitting of these clerkships is not allowed. Additional sub-internships or audition clerkships may be completed as elective credits. Sub-internships or audition clerkships and up to three electives may be completed in the same sub-specialty without an appeal. Retroactive course changes are not allowed.
For more information, please review:
Electives
Elective clerkships are part of the fourth year. The student typically determines the schedule, time and/or location at which elective(s) may be completed. Up to three electives may be completed in the same area of sub-specialty and may be split into two-week increments. Retroactive course changes are not allowed.
For more information, please review:
Enrollment Verification
The Office of Clinical Education uses E*Value to manage evaluations, procedures, and schedules. E*Value is available to authorized users 24 hours a day from any device with internet access.
For every clerkship, students must verify and submit registration information through E*Value within five business days following the designated start date. If the enrollment verification is not completed on time, Clinical Education cannot confirm the student is actively enrolled. This may cause a disruption in your enrollment status with the University, which may put your financial aid or graduation status in jeopardy; while not enrolled as a student, you would not be covered under the KCU malpractice liability insurance coverage. It is imperative to submit accurate contact information for the attending physician filling out the assessment (e.g. address, phone, fax, email, etc.). If the preceptor is listed incorrectly, or is unknown, please provide accurate information in the space provided and complete an Unknown Preceptor Form located on the E*Value homepage.
Once submitted, changes must be made by Clinical Education and should be emailed to the assigned KCU clinical clerkship coordinator. When working with more than one physician on a clerkship, the student should email their assigned KCU clinical clerkship coordinator with all necessary information. Retroactive changes to a course code or requirement are not allowed.
Clerkship Credit
In order to receive credit for a clerkship and coverage under KCU’s medical professional liability insurance clinical experiences must be completed at a KCU affiliated site or with a KCU-credentialed preceptor.
For sites that are not already a KCU-affiliated site, an affiliation agreement or accepted letter of good standing must be in place prior to proposed clerkship start date. For sites that are not already a KCU-affiliated site, this process can take up to six-months and KCU cannot guarantee consensus will be reached with every facility or preceptor.
Application & Other Fees
KCU pays sites for all third- and fourth-year required clerkships and associated administrative fees. Students are responsible for all out-of-pocket expenses associated with clinical education, such as transportation, housing, meals, professional attire, laboratory fees, additional drug screens, additional background checks and additional immunizations or titers.
Some clerkships require students to pay additional fees in order to rotate at their facility.
Letters of Recommendation
Preceptors are required by the Electronic Residency Application Service (ERAS) to upload letters directly to the ERAS Letter of Recommendation Portal (LoRP).
Visiting Student Learning Opportunities (VSLO) may require a letter of recommendation for some clinical experiences. Letters must be sent to the KCU clinical clerkship coordinator. The coordinator will upload these letters to VSLO.
Transportation
Travel arrangements are the sole responsibility of the student. Students are not considered agents or employees of the University and therefore are not insured for any accidents or mishaps that may occur during travel as a part of the student’s academic program. Some core clinical sites may require that assigned students have personal vehicles available.
Travel for Clinical Experiences
Students participating in the osteopathic medical curriculum are required to receive instruction in a clinical setting. As a result, it is necessary for students to make arrangements for transportation to and lodging near clinical facilities. The University does not provide for the cost of transportation or lodging.
Students are responsible for all out-of-pocket expenses associated with clinical education, such as transportation, housing, meals, professional attire, laboratory fees, etc.
Absence from Clerkships
Attendance at all clerkship related activities is mandatory; therefore, any absence requires an excuse and documentation. Students must attend the first day of any clerkship. Failure to notify Clinical Education and/or the clerkship site/preceptor of any clerkship absence, regardless of the reason or number of hours absent, may result in a meeting with the associate dean of Clinical Education regarding lack of professionalism and could result in a failing grade of the clerkship and/or referral to SPC.
An Absence Request Form and supporting documentation must be submitted directly to the KCU clinical clerkship coordinator. All submitted absence forms must include a detailed make-up plan in order for the absence to be considered. Only completed, signed forms are processed. Decisions rendered through this process are final. There are no exceptions to this policy and failure to follow the process will be considered an unexcused absence. The KCU clinical clerkship coordinator notifies the student via email when a decision has been reached. The Absence Request Forms can be found on myKCU.
Scheduled absences are not and should not be considered approved until the official Absence Request Form is signed by the associate dean of Clinical Education.
The Clinical Education Guidelines document on myKCU outlines additional guidance for students taking board examinations, discretionary days, sick days, family emergencies, flex time, and time off needed for residency. Students must follow the Clinical Education Guidelines to avoid unexcused absences.
Canceling/Changing a Fourth-Year Clerkship
It may be necessary to cancel or change a fourth-year clerkship; however, retroactive changes to a course code or requirement are not allowed. (Cancelling or changing a third-year clerkship is not allowed.) Cancellation/change requests must be received, at a minimum, 60 days prior to the confirmed start date. Requests are considered on a case-by-case basis and approval is not guaranteed. Students are required to attend the scheduled clerkship if requests to change or cancel are received after the deadline, or denied. For consideration, requests should include the following:
- A cancellation/change request must be submitted in writing to the KCU clinical clerkship coordinator.
- A Scheduling Request for an alternative clerkship must be submitted for review via E*Value.
Graduation Requirements
Each student must successfully complete and receive credit for all clerkships to qualify for graduation. This is in addition to meeting other graduation requirements as set forth under Osteopathic Medicine (DO) .
Assessment
To pass each clerkship, students must pass the Preceptor Evaluation of Student Performance and any applicable Subject Exam. Students must also complete an End of Clerkship Reflection. Grades will not be assigned until the End of Clerkship Reflection is completed.
Clinical Competency Assessment
Preceptors complete a Clinical Competency Assessment at the end of clerkship. The purpose is to provide feedback to guide both clinical and professional development. The preceptor documents performance of expected competencies as compared to other students at the same educational level. Assessments submitted by interns or residents must be cosigned by an attending physician or the DME.
If a student works with more than one attending, more than one assessment will be accepted. Paper copies may be returned by the student directly to Clinical Education or their KCU clinical clerkship coordinator.
The University recommends that students request an informal mid-clerkship assessment to allow the student to determine whether there is consistency between the preceptor’s and student’s performance perceptions. In addition, should a student be experiencing difficulty on a clerkship, a mid-clerkship assessment allows time for improvement prior to the end of the experience. This may help avoid surprises at the end of a clerkship and allows the student to proactively address any problems.
Preceptor approaches vary widely in providing students with feedback on performance. Preceptors may or may not review their assessment with the student; it is appropriate for the student to request such a review prior to completion of the clerkship. If the preceptor is not available to review the assessment with the student and the student has questions or concerns, the student should contact their KCU clinical clerkship coordinator to discuss the most constructive way to obtain the desired feedback.
At no time is it appropriate for a student to request a preceptor to change a rating, revise comments or challenge a preceptor regarding an assessment. If significant performance issues arise, an appropriate University official will notify the student. Students failing to maintain the utmost level of professionalism in dealing with any part of the assessment process may be referred to the appropriate University official.
Mid-Rotation Feedback
The Mid-Rotation Feedback form is designed to alert the student and preceptor to issues which can be addressed during the remainder of the clerkship. While this is not a graded or required form, students are encouraged to use this tool and seek informative feedback from the preceptor.
End of Clerkship Subject Exam
Students are required to pass the NBOME Comprehensive Osteopathic Medical Achievement Test (COMAT) Subject Exam (End of Clerkship Exam) upon completion of each core discipline:
- Emergency medicine (year 4)
- Family medicine
- Internal medicine
- Obstetrics and Gynecology
- Pediatrics
- Psychiatry/Behavioral health
- Surgery
- Osteopathic Principles & Practice (OPP).
Students are expected to study for these exams with similar rigor as all other high-stakes examinations and are required to utilize the course syllabi located in Canvas as a guide. A student is only allowed to retake a COMAT exam to achieve a passing score.
Students may be awarded Honors (H) for excellent performance on a Subject Exam. Passing (P) and Honors (H) are benchmarked against the NBOME academic-year norms for all students in that discipline. Students may be awarded Honors (H) for excellent performance on a Subject Exam. Passing (P) and Honors (H) are benchmarked against the NBOME academic-year norms for all students in that discipline.
Exams are currently administered online as self-proctored and scheduled on a testing date and time designated by the Office of Clinical Education. For examinations taken at a Prometric testing center, a voucher will be issued and students will be responsible for scheduling a testing date and time within a designated testing window. All subject exams must be taken as once scheduled.
Subject Exam scores and Examinee Performance Profiles (EPP) will be are made available to students through the NBOME website on KCU 360. KCU reserves the right to change the method of subject exam administration as well as testing location and is based upon the options provided by the NBOME.
Example of how grades will show on transcript:
| Clinical Clerkship |
Grade |
| Pediatrics |
P |
| Family Medicine |
F/P |
| Internal Medicine |
H |
Grading for IMED 301/302 and SURG 301/302
The final grades in the sequential 301/302 courses are dependent on the score earned on the Subject Exam. A grade for the 301 course will be assigned based on evaluations alone and is subject to change based on the outcome of the Subject Exam. A student may sit for this exam only after the 302 course has been completed. If the student subsequently earns Honors on the exam, the 301 grade will be updated to reflect H for both 301 and 302. If the student subsequently fails the 302 course, the 301 grade will be updated to reflect F for both 301 and 302.
End of Clerkship Reflection (ECR)
Students are responsible for completing End of Clerkship Reflections through E*Value at the end of every clinical experience to include:
- Evaluation of self and the clerkship
- Evaluation of the preceptor
End of Clerkship Comprehensive Osteopathic Medical Achievement Tests (COMAT) Subject Exam Failure
Students may be allowed to remediate one Subject Exam without it being considered a failed clerkship. The highest Subject Exam score and clerkship grade that can be achieved after remediation is Pass.
First failure: Student receives failure notification from Director of Clinical Education Operations Student meets with the associate dean for Clinical Education
Student contacts KCU clinical clerkship coordinator to reschedule exam
Honors track students may be removed from the assigned track All subsequent failures:
Student may be referred to Student Progress Committee (COM-SPC) where the student will be required to present their case. COM-SPC evaluates and makes a decision which could include, but is not limited to remediation, repeating the academic year, or possible dismissal.
Students who are provided with the opportunity to remediate a failed clerkship or an NBOME COMLEX-USA -USA examination will do so at the discretion of Clinical Education and/or the COM-SPC.
If a student receives a preceptor evaluation with recommend fail for a clerkship, the student will receive a final grade of F. In the event of failure, the student will be required to repeat the clerkship as scheduled by the Department of Clinical Education.
If a clerkship is successfully repeated, the student will receive a grade of F/P.
Osteopathic Principles and Practices Comprehensive Osteopathic Medical Achievement Test (OPP COMAT)
The Osteopathic Principles and Practices Comprehensive Osteopathic Medical Achievement Test (OPP COMAT) will be administered beginning October 1st or after, during IMED 301 , SURG 301 or a selective, whichever occurs first. Students are required to pass the OPP COMAT. Students are expected to study for these exams with similar rigor as all other high-stakes examinations. Exact exam dates will be set by the individual core clerkship sites. If a grade of Honors (H) is achieved, this will be noted in the student’s Medical Student Performance Evaluation (MSPE), but not on the transcript.
A passing score on the OPP COMAT is required as a prerequisite before taking the COMLEX-USA Level 2-CE exam. Examinations will be administered during OPP 321 - Osteopathic Principles & Practice II . Third-year students must pass the OPP COMAT during the second semester of the third year. Exact exam dates are set by the KCU Clinical Education Department in collaboration with individual core clerkship sites. If a grade of Honors (H) is achieved, this will be is noted in the student’s Medical Student Performance Evaluation (MSPE), but not on the transcript.
Clinical Skills Assessment
In this course, the fourth year osteopathic medical student will review, either independently or with a group of peers, the following: patient-physician communication skills, physical examination techniques, forming differential diagnoses of a presenting problem and documentation skills. Following the review phase, the student will complete formal standardized patient encounters to assess clinical skills as required for completion of the student’s medical education.
Students may be required to travel to KCU Kansas City or KCU Joplin.
Osteopathic Principles & Practice
Osteopathic Principles & Practice (OPP) is a required longitudinal three-semester online and hands-on course that runs during the third and fourth years of osteopathic medical school. The course focuses on the integration of OPP, including osteopathic manipulative treatment (OMT), into problem solving and patient care. The clinical conditions covered each semester will be based on the top diagnoses coded nationally for each covered organ system or specialty.
Optional Subject Exams
An optional, non-required NBME subject exam may be taken in either Emergency Medicine or Neurology at a cost to the student (approximately $101). These exams must be are administered at a Prometric testing center. Students should contact must email their KCU Clinical Education Department clinical clerkship coordinator a minimum of 60 days in advance to make arrangements and remit payment. The exam is not scheduled until payment is received by the Office of Finance. Scores for these exams are not reflected upon written request to the KCU GME Department for inclusion in the student’s MSPE and not on the transcript, but may be included in the student’s MSPE.
Deficiencies
The student will be notified of a poor assessment by their KCU clinical clerkship coordinator. All deficiencies or concerning comments are reviewed and the student will be asked to provide feedback. Deficiencies relating to poor preceptor evaluations, professionalism or other concerns deemed necessary can be referred to the appropriate University official. Additional assessments submitted following official review will be accepted but may not impact the outcome.
Subsequent to the review process, any student identified as having failed a clerkship may be required to meet with the COM-SPC. Final disposition of the assessment in question is pending completion of this process.
*At any time and for any reason, KCU reserves the right to require additional methods for assessing students. Students may be required to return to the KCU campus for a formal review.
Physical Examinations
During clinical clerkships, students are routinely required to see and examine patients. It is necessary that all examinations of patients be appropriately structured, supervised and consented in the interests of all parties, including the patient, student and attending physician.
Students must wear their KCU picture identification badge and introduce themselves to patients as a medical student. Patient consent for a student to perform an intimate examination must always be voluntary. Consent for an intimate examination must be either verbal and/or written.
Regardless of the gender of the student performing the exam and the patient being examined, a chaperone (defined as another medical professional, preferably the preceptor) is required during all intimate examinations. A chaperone is not an accompanying person (e.g., friend, relative of the patient, another medical student). Students are highly encouraged to record the date, time and the results of the examination as well as the name of the chaperone in the medical record.
Performing Osteopathic Manipulative Medicine & Osteopathic Manipulative Treatment
Students may perform their learned manual skills for diagnosis and therapy on patients while on any clerkship, provided the preceptor (or other supervising physician) has given their permission and provides direct supervision at all times.
Reporting Clerkship Issues
At times, concerns or issues may arise during a clerkship. General concerns should be addressed directly to the preceptor, core site coordinator, director of medical education or KCU regional assistant dean, when appropriate. The utmost degree of professionalism is encouraged when discussing these concerns. If an effective resolution cannot be reached, or if the student is not comfortable addressing the issue themselves, the student should contact his/her KCU clinical clerkship coordinator.
Immediate concerns (harassment, patient safety, etc.) should be reported directly to Clinical Education.
Dress Code for Clinical Activities
On clinical rotations, students must wear professional attire and maintain professional appearance. White coats and closed-toed shoes are required. Training sites may designate other prescribed professional dress code requirements including scrubs and/or comfortable shoes. Students may be asked to change their appearance to conform to the dress code of preceptors as well as clerkship sites.
Student identification badges should be worn above the waist and made clearly viewable at all times. ID badges must be presented when requested by any member of KCU administration, staff or faculty. Badges are not transferable and must be returned to the KCU Safety & Security Management (SEM) upon termination of student status. Badges are issued to first-year students free of charge during orientation week. Students are expected to keep their ID badges during their entire educational career at KCU. For all lost, stolen or misplaced ID badges/access cards, students can receive a free replacement at the SEM dispatch desk.
Didactic Conferences & Reading Assignments
While the focus of the clinical years is hands-on experience, didactic conferences and reading assignments are often provided as an aide to this learning process. Completion of reading assignments and attendance at didactic conferences scheduled by KCU, the regional assistant deans, directors of medical education, the core site hospital, clerkship service or preceptor is required without exception.
Duty Hours
Scheduling is determined solely at the discretion of the core site hospital, service, or preceptor, and must be followed without exception. Responsibilities may be required on overnights, weekends or holidays. Laws mandating restrictions on intern and resident work hours do not apply to medical students.
Students generally follow the same schedule as their preceptor; however, if the preceptor is on vacation or scheduled away from the office or hospital, additional arrangements must be made for completion of the clerkship. If this occurs, the student must contact the KCU clinical clerkship coordinator immediately. Students must be enrolled in clinical activities throughout the entire academic year up to graduation. Unreported absences or chronic absenteeism may lead to referral to an appropriate University official.
Safety & Compliance
Hospital Rules & Regulations/Financial Responsibilities
Each hospital/health care system has individual rules and regulations. Medical students must familiarize themselves with and adhere to these protocols during training. Students must respect and follow all policies regarding the use of hospital facilities, housing and equipment.
Students are financially responsible for any damage to or loss of hospital or training site-related property, including but not limited to library materials, pagers and keys. Final grades may be withheld pending return of all hospital or training site property.
Emergency Plan Procedures
Students who are on rotations should follow the emergency procedures and protocols at their specific clinical site at all time. In the event that a rotation schedule is interrupted due to hazardous weather conditions or another emergency situation, students should notify CE as soon as possible.
In the case of inclement weather, students on clerkships are expected to follow the schedule of the site where they are rotating. If the site is closing due to inclement weather, the student is excused until the site reopens. If the student is at a site that remains open during inclement weather, the student is to report and remain on-service until the end of his/her shift. Students should use caution and allow plenty of time for travel to their destination.
In the case of an emergent situation outside normal business hours that requires you to evacuate the location, relocate for a period of time, or any other emergency, please contact the KCU Safety & Emergency Management office at 816.654.7911.
KCU Exposure Policy
If a KCU medical student is exposed to bloodborne pathogens either by direct contact with blood or other bodily fluids via the eyes, mucous membranes, human bite, or sharps (e.g., needle stick, lancet stick, scalpel cut) while on a clerkship, it is to be handled as an emergency situation.
In the event of an exposure, students are to adhere to the following and any additional on-site procedures.
Clean
Immediately wash exposed region with soap and water for five minutes. If the exposure occurred in the eyes, nose or mouth, use copious amounts of water to irrigate the mucus membranes. Students should know where stations to irrigate eyes are located.
Communicate
Let the preceptor, DME, core site coordinator and Clinical Education know about the exposure as soon as possible. Students should ask for the following information:
- Patient information (name, date of birth, medical record number, address, phone number) and any prior testing for HIV, Hepatitis B, Hepatitis C, RPR, or other risk factors.
- If patient is known to be HIV positive, obtain information on CD4 count, history and current opportunistic infections, prior and current regimen and resistance.
- Baseline labs for student and patient (e.g., HIV, Hepatitis B, Hepatitis C).
- If he/she is not able to do lab work, present to the closest emergency room.
Chemoprophylaxis
If the patient is HIV positive, or if his/her HIV status is unknown, begin post-exposure prophylaxis (PEP) with a multidrug regimen within a few hours of the exposure. Students should not delay in seeking care. If unable to obtain a prescription for medication from the preceptor, students should go to the nearest emergency room for a prescription.
Students can visit the Clinician Consultation Center for additional PEP guidelines.
Post-Exposure Protocol:
- Immediately wash exposed areas with soap and water.
- If splashed in eyes or mouth, flush with large amounts of water.
- It is critical that students be treated within the first two hours after injury.
- Notify supervisor and follow clerkship site exposure protocols.
- If facility is not equipped to handle exposure, contact an occupational health clinic, appropriate site location, or go to the nearest emergency department with your current health insurance information.
- Notify Clinical Education of any care received.
Counseling
Students who were exposed to a blood borne pathogen, bodily fluids, or needle sticks will receive counseling and instructions for follow-up from Clinical Education. Student should contact Clinical Education within 24 hours of the incident vis email, [email protected], or phone 816.654.7330. The student should send a copy of the incident report to Clinical Education.
Research
Research being conducted on or off campus requires written approval from the Office of Research & Sponsored Programs (ORSP) as well as the Office of Clinical Education prior to starting the project. Questions regarding whether or not a project is considered research should be directed to ORSP. Students should contact their KCU clinical clerkship coordinator for information.
Please review the Research Clerkships section for polices and procedures related to pursuing an elective research clerkship:
|