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RequiredClinicalExperiencesDataCollectionSheetAECOM

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					                                                          MSPCE-EPERC
                             Required Palliative Care Experiential Training

                                 Data Collection and Request for Submissions for EPERC Posting
1 School Name
2 Contact Name
3 Contact Email

4 If the student experience is coordinated by more than one clerkship working collaboratively (check all tha
             Internal Medicine
  x          Family Medicine
  x          Pediatrics
             Surgery
             Anesthesia
             Curriculum office/central school administration
             Other:
5 Name of other clerkship involved
6 Duration of required student clinical activity (time allocated for students to see real patients under superv
  X          1/2 - 1 day
             2-5 days
             > 5 days
             # of days
7 Location of clinical activities (where students see patients) (check all that apply:
  X          home hospice
  X          residential or other inpatient hospice beds
  X          hospital palliative care consultation service or inpatient unit
             palliative care outpatient clinic
             long term care facility
  x          pain clinic
  X          other pediatrics inpatient ward and oncology day hospital
8 Name of other location (s)
9 Other than required direct patient care activities (check all that apply)
             OSCE or similar communication skill simulation(s)
             narrative (reflective) essay or journaling
  X          on-line didactic modules
             interdisciplinary team meeting (IDT)
  X          face:face didactic training (lecture or small group)
          X         self-directed learning (find literature in support of clinical problem)
      10 Other activity(s)
      11 How are students evaluated? (Check all that apply)
                    global rating form
          X         multiple choice examination
                    communication simulation (OSCE)
                    narrative essay review
          X         other palliative care specialist evaluates students' performance at clinical site
      12 Additional evaluation tools used
      13 Student grades
          X         Student evaluations for palliative care experience ARE used in determining clerkship grade?
                    Student evaluations for palliative care experience ARE NOT used in determining clerkship gra
      14 Which of the ACGME competencies are included as part of student training?
          X         Patient Care
          X         Medical Knowledge
          X         Professionalism
          X         Interpersonal and Communication Skills
          X         Practice-based Learning and Improvement
                    Systems Based Practice




If possible, please attach one (only one) Microsoft Word file containing additional details of your student ro
curriculum syllabus distributed to students or faculty. Limit to file to less than 10 pages. Please include a
for the student experience.
                            MSPCE-EPERC
Required Palliative Care Experiential Training

  Data Collection and Request for Submissions for EPERC Posting
            Albert Einstein College of Medicine
            Pablo Joo
            pablo.joo@einstein.yu.edu

 coordinated by more than one clerkship working collaboratively (check all that apply)




 /central school administration




 t clinical activity (time allocated for students to see real patients under supervision




 (where students see patients) (check all that apply:


 her inpatient hospice beds
ve care consultation service or inpatient unit
 utpatient clinic
 acility


 inpatient ward and oncology day hospital


 atient care activities (check all that apply)
 r communication skill simulation(s)
 tive) essay or journaling
 modules
 team meeting (IDT)
tic training (lecture or small group)
arning (find literature in support of clinical problem)
            lecture
d? (Check all that apply)
m
examination
 simulation (OSCE)
 review
care specialist evaluates students' performance at clinical site




ons for palliative care experience ARE used in determining clerkship grade?
ons for palliative care experience ARE NOT used in determining clerkship grade?
 etencies are included as part of student training?


ge


d Communication Skills
earning and Improvement
Practice




 one) Microsoft Word file containing additional details of your student rotation, such as the
 udents or faculty. Limit to file to less than 10 pages. Please include a list of learning objectives


                                                      Thank You

				
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