Clinical Clerks at the University of Calgary are final year medical students (year III) who, as part of their education, are assigned to medical teams at the teaching hospitals in the Faculty of Medicine. As part of the medical team, our Clerks are expected to gain experience in clinical medicine. This entails assuming primary patient care responsibilities as well as being a member of the medical team

Expectations of Clinical Clerks on the MTUs:

1. Prepare off-service notes on his/her patients and discharge summary if requested

2. Provide primary care for 4 to 6 patients, including daily visit and progress note

3. "Read around" team patients

4. Attend all MTU rounds and activities as well as Grand Rounds and CPC. (N.B. When on the MTUs, Clerks have no off ward obligations).

5. Call is one night in four (average). The 28 hour rule applies to clinical clerks with respect to patient care but not teaching rounds.

A detailed description of the Clerk's role is contained in the hand-out which has been distributed to the Clinical Clerk

Expectations of Residents Regarding Clinical Clerks:

1. Review all Clerk history and physical examinations

2. Oversee and ultimately be responsible for Clinical Clerk care of patients

3. Accommodate transfer of stable patients or those with diminishing educational value from the Clinical Clerk's care to that of the resident

4. Teaching - physical examination skills

   • technical skills

   • emergency management e.g. asthma, pulmonary edema
     

   • common medical problems e.g. hypertension, CHF, diabetes 
     

5. Contribute to evaluation of Clerks including assessment of reliability, dependability, honesty, availability, conscientiousness, and (improving) medical knowledge.

Morning report occurs Monday and Wednesday mornings from 8:00am to 9:00am at both sites (as well as Friday mornings at FMC).  The goal of morning report is to learn from a case that was admitted the day or night before.  Format for Morning Rounds

1. The team is expected to be prompt (start time 0800) and to display appropriate professional interactions with the visiting professor and colleagues.

2. A visiting professor will be present for the Monday and Wednesday sessions and the MTU preceptor will be present on Friday am (see schedule).

3. The visiting professor should be introduced to the team by the senior resident.

4. The team will present a case admitted from the night before.

5. The visiting professor or MTU preceptor will lead the session by modeling interactive hypothesis testing (Details of the case are released in small packets of information to the group of peers and students who form appropriate hypotheses and justify the need for further specific data on this basis. The preceptor directs interactions, injecting where necessary the knowledge base of experience to reject some directions of inquiry and to reinforce others).

6. The team is expected to initiate the session by presenting the chief complaint, with discussion, led by the visiting professor or MTU preceptor, to classify the problem, develop differential diagnosis, identify cardinal features as the case evolves.

7. The team will have available for review the chart, EKG, CXR, lab investigations and/or other pertinent materials.

8. The team is NOT expected to prepare anything in advance.

9. The team is NOT expected to lead the session.

10. The team is NOT expected to know all outcomes of the case.

11. AT THE DISCRETION OF THE VISITING PROFESSOR, discussion may surround a case related to their subspecialty already admitted to the team, or a case the professor has seen recently in the outpatient or inpatient setting.

12. Part of the discussion may occur at the bedside, or by having a patient attend in the conference room.

Objectives
Postgraduate and Undergraduate trainees will:

1. Improve clinical reasoning by observing an experienced clinician demonstrate an approach to common clinical presentations during an interactive learning session.

2. Practice under expert guidance the acquisition of relevant historical, examination, and laboratory data needed to effectively and efficiently assess the presenting problems of patients.

   • Practice the use of diagnostic schemes.

   • Obtain data required to develop a differential diagnosis and a management plan.

   • Demonstrate critical thinking and flexibility in their interpretation of these days

3. Recognize the learning potential in every case, no matter how simple, common or mundane.

4. NOT produce an exhaustive differential diagnosis, review of the literature or discussion of management