Transitioning to Clinical Training

This page was last updated August 13, 2020.

For students who are about to finish or have just finished Phase 1 of the curriculum.

Congratulations on completing Phase 1 of medical school! You’ve successfully completed your pre-clinical training. To date, you have felt like a traditional student, going to class and practicums–that all changes now. You are part of the clinical team now, a professional who comes to work each day, trying to make a difference in the lives of your patients while you learn about medicine on the job. Your clerkships will expose you to key areas of medicine that are critical to know, regardless of your ultimate career choice. It is a great time in your careers and each day will be filled with something new.

This page will connect you with mandatory logistical information to make sure you’re prepared for Phase 2. Please review all areas to ensure you’re ready for Orientation to Clerkships (OTC), Transitions 2 (T2) and Phase 2 overall.

“When I look back at what I loved most about medical school it was the clerkship years. This was the first time I felt like I was doing work that moved me closer to my goal: Becoming a physician.”

avatar

Esteban Ramirez, DO

Clinical Assistant Professor of Medicine, IU School of Medicine-West Lafayette

Explanations about Clerkship Grading

We have had multiple questions about clerkship grading and the impact of national norms and shortened clerkships. We want to address them individually, but first, some broad principles:

We are committed to your success.

We want you to remember that every single medical student in your position across this country is feeling the same way. Each of us in curriculum and student affairs, and our counterparts from different institutions, know that this year is different, and we are all making adjustments to meet your needs.

Program Directors from residencies also understand that COVID-19 has created never-before-seen circumstances and recognize that times will be different. That being said, we will continually review our data and our outcomes.

Residency programs do not compare clerkship grades between schools.

Residency programs look at a large variety of factors, and these are well-documented in the Program Director Survey published every two years by the NRMP. It is important for you to know that your MSPE letters will contain graphs that show your position compared to those in your class. Grade distributions vary significantly between schools.

There are many schools where everyone gets honors, which is displayed clearly on the MSPE. Therefore, those grades are taken with a grain of salt. When people look at your MSPE they WILL look at the internal data for your class for comparison. Although we are using set criteria to assign grades, there is no standard approach to grading between schools. For example, some schools are all pass/fail; some use A, B, C, D grading, etc. Residency programs do not, and cannot, compare grades between schools.

The shift in grading from internal comparison to national norms for exams.

We want to let you know that this change in philosophy and approach was actually made more than a year ago. Your class will be the second cohort to integrate the NBME with specific cutoffs. In the years prior to that, students were compared to each other and cutoffs determined not by criteria, but percentages (normative referenced). 20% were awarded H, up to 35% HP and the remainder pass (or, occasionally, fail if unsuccessful).

This upset many students because your performance on the NBME depended just as much as that of the other students in your cohort as on your own hard work and dedication. If you were in a “brilliant class”, students felt robbed of their opportunities to excel. The lack of set criteria for grading had created a grading system that many students perceived as opaque, confusing, and, in many cases, students expressed they felt this system was arbitrary.

In this way, by using pre-specified criteria, Honors is potentially achievable for ALL students based on clear set criteria. This move is consistent with national norms and is utilized at many medical schools across the country, and criterion grading will be used throughout your career from here on out as you take Step 2, Step 3, and eventually specialty board exams. You will also have two retake opportunities for NBME exams at the end of the year, permitting you to potentially increase your score, and thus clerkship grade.

The Length of Clerkships

Historically, Phase 2 clerkships were 18 business days. This year, Phase 2 clerkships are 15 business days. Unlike your predecessors, you have had 5 weeks of dedicated study time (KICC Start) to learn core clerkship knowledge content before starting your rotations. This material will be reviewed and enhanced during your rotations.

Additionally, the NBME is tracking the data and comparing performance this year to years past. To date, there has been no difference in performance. We, too, are doing internal reviews on an ongoing basis to ensure comparability.

Obstetrics and Gynecology

OB-GYN has been 4 weeks for years at Indiana University. We are not alone in this, and other schools do this as well. Numerous enhancements have been made to this clerkship to close learning gaps. Additionally, because of the need for longer exposure, OB received the same amount of lecture hours in KICC Start as the 8-week clerkships, specifically to allow them time to address more content in recognition of this deficit. Compared to your predecessors, you have received more women’s health and OB/GYN content than years past.

Please remember that you are well-positioned with your medical knowledge, and we encourage you to keep the lines of communication open. We will be meeting with the ACE reps regularly to ensure that all concerns can be discussed as the year progresses.

The CCSC and CCC will be monitoring the distribution of Honors/High Pass/Pass across each clerkship closely this year. Rest assured, that if there are any discrepancies in distribution, the committees will be looking at it closely and considering options as needed.

Mandatory Compliance Tasks to Complete Before Phase 2

Students must complete various credentialing tasks before beginning clinical duties in Phase 2. It is critical that students review requirements for each component to ensure they schedule adequate time to complete all tasks before deadlines. Completing credentialing requirements is an important part of clinical duties that will continue during residency and as an attending physician.

Timeline Overview

Students should prioritize VA and BLS onboarding completion prior to Transitions 2. The other compliance tasks are due before clerkships begin; these tasks can be completed during built-in Transitions 2 time or prior to the start of Transitions 2. Please see each task’s details to determine an appropriate timeline for your schedule. Some appointments may need to be made in advance to fulfill health testing requirements etc.

VA Onboarding

Mandatory: Review Important Overview Information before beginning the steps.

Important Overview Information
  1. Timeline: Students must start this process a minimum of 30 days, but no more than 60 days before the start date of a clerkship/elective for which you are scheduled to rotate at the VA. Steps 1-8 must be completed before the start of your rotation.

Notes:

  • If you do not complete the entire VA onboarding process before you are scheduled to begin a rotation for any of the clerkships or electives that utilize the VA (listed below), the completion of your clerkships or electives may be delayed.
  • You must work with the Indianapolis VA Education Office to complete the Onboarding process. The Education Office is your primary point of contact, not the VA IT Department or VA Personnel in other departments.
  1. Who needs to complete onboarding and when:
    • Students who will be in Indianapolis during Phase 2 or 3 for any of the following rotations:
      • Phase 2: Anesthesia, Surgery, Neurology, Psychiatry, Internal Medicine
      • Phase 3: Medicine Sub-Internship, Emergency Medicine and Critical Care Selectives & Electives in Anesthesia, Surgery, Neurology, Psychiatry, Internal Medicine, and Emergency Medicine
Step 1: Email the VA
  1. Email the VA at INDVAAffiliateGroup@va.gov and provide them the following information so they are aware you are starting the process and can guide you through the steps: :
    • Name (First, Middle & Last Name). Please do not use nick names or shortened versions of your name.
    • Class year
    • Phone number
    • Have you rotated through and/or established an account at any VA facility before? If yes, where was this facility located?
    • When does your rotation start?
      • Note: You will need to complete the onboarding process even if you are only working at an outpatient clinic on occasion during your rotation.
Step 2: Complete the TMS Training Module
  1. Complete the online TMS training module
  2. Print all three certificates (listed below) to verify completion of the module. You will need to save these documents for Steps 4-6. Make note of the completion date of these modules, as you will need this information following Step 8.
    • VHA Mandatory Training for Trainees
    • Privacy and HIPAA Training
    • VHA Mandatory Training for Trainees Refresher
Step 3: Complete the following forms:

Complete the documents listed below. You are required to fill out all pages; if there is a section that does not apply to you, simply leave it blank. You will need to save these documents for Steps 4 – 6.

  1. Demographics and In-Process Checklist
  2. Declaration for Federal Employment
  3. Drug-Free Workplace Random Testing Acknowledgment for HPTs
  4. VA Form 10-2850D: Application for Health Professions Trainees
  5. Fingerprint Request Form
Step 4: Complete the following, in order to complete steps 5 &6:

A. Fingerprinting in Indianapolis: 

  1. If you are completing Step 5 & 6 (fingerprinting and background check) in Indianapolis, please skip to Step 5.
    • Note: You will bring the forms and certificates from Step 2 and 3 with you in-person to that appointment.

B. Fingerprinting outside of Indianapolis:
IMPORTANT:  Due to the COVID Pandemic, many VA facilities are not currently offering courtesy fingerprints.  It is recommended that those who are located outside of Indianapolis contact the nearest VA facility well in advance of the needed services if wanting to do courtesy prints—understanding that they may not be available.  Therefore, it is most recommended that trainees go to the Indianapolis VA to get fingerprints done

  1. If you are completing Step 5 & 6  (fingerprinting and background check) outside of Indianapolis, you will need to mail the forms and certificates from Step 2 and 3 to the Indianapolis VA at least 10 days BEFORE fingerprinting in order to ensure your documents are received before scheduling your appointment (step 5).
    • Indianapolis VA mailing address:
      • Richard L. Roudebush VA Medical Center,
        1481 West 10th Street, Indianapolis, IN 46202,
        ATTN: EDUCATION DEPARTMENT
  2. Note: Documents must be mailed to the Indianapolis VA at least 10 days BEFORE fingerprinting, even if you are completing the fingerprinting and background check at a VA facility outside of Indianapolis.
  3. IMPORTANT: If mailing in documents, please use an 8×11 envelope. DO NOT FOLD DOCUMENTS.
Step 5: Schedule an appointment for fingerprinting and a background check:

Note: It takes 15 days for an account to be created after fingerprints have been adjudicated (following Step 6). Please plan accordingly in scheduling the fingerprinting appointment. Trainees will not be allowed to begin their VA rotation until all steps of the onboarding process are complete. Failure to complete all steps of the Onboarding process may delay the start of your clerkships.

  1. For students coming to the Indianapolis VA:
    • Please email INDVAAffiliateGroup@va.gov to set up an appointment. 
      • Appointments are scheduled Monday-Friday 7:30 am-3:30 pm.
        • Although appointments are available throughout the day, it is preferred and recommended that these appointments be scheduled in the morning to lessen the interference with clinical duties.
  1. For students outside of Indianapolis:
    • Students outside of Indianapolis may go to another VA Facility.
      • Please refer to this document that includes a list of VA facilities that offer fingerprinting services. PLEASE NOTE THAT DUE TO COVID, MOST LOCATIONS ARE NOT OFFERING COURTESY FINGERPRINTS AT THIS TIME.
      • Students must provide the SOI and SON codes below to the VA facility to ensure prints are digitally sent to the VA in Indianapolis.
        • SOI #VAB8
        • SON #1315
        • NOTE:  Be sure to complete the bottom of the Fingerprint Request Form. List the Facility name as Richard L. Roudebush VA Medical Center.
      • After fingerprinting, students should email the VA at INDVAAffiliateGroup@va.gov and provide the following information:
        • Full Name (first, middle, last)
        • Fingerprinting date
        • Where you completed the fingerprinting
        • Phone number for the VA to reach you.
Step 6: Fingerprinting and background check:

This step will take approximately 30 minutes. Consider bringing phones/study material in case there are multiple trainees onboarding. (Note:  To avoid delays, arrive 15 minutes prior to your appointment.)

A. Email the following:

  1. Email current Clerkship/Elective coordinator to ensure proper absence permissions to onboard at the VA.  Make sure to include your appointment time and Step that you are completing in the process. You should not need to take an entire day off from a Clerkship/Elective to onboard at the VA.
  2. Email the Indianapolis VA Education Office (INDVAAffiliateGroup@va.gov)
    1. If you encounter any problems during the process, the Education Office should be your primary point of contact, not the VA IT Department or VA Personnel in other departments, as there may be certain legal or process considerations that only the Education Department is aware of.

B. You must bring the following documents to the appointment: 

  1. The three TMS online training completion certificates that were completed with Step 2:
    • VHA Mandatory Training for Trainees
    • Privacy and HIPAA Training
    • VHA Mandatory Training for Trainees Refresher
  2. The five forms that were completed with Step 3:
  3. Two forms of unexpired government-issued ID. (School-issued ID’s are no longer a valid form of ID). 

C. Location for fingerprinting appointment at the VA:

  1. Indianapolis: Education Department located in the basement of the C-wing; Room C-B094 in the Richard L. Roudebush VA Medical Center, 1481 West 10th Street, Indianapolis, IN 46202
    • Note: Do not report more than 15 minutes prior to your scheduled appointment time
    • Parking instructions for the Indianapolis VA
    • IMPORTANT: The VA Shuttles are not currently operating due to COVID. You may use the patient/visitor parking onsite for your onboarding appointment. Students will need to secure a parking permit from Police Services when they go to get their PIV badge done. This permit will allow free parking in the ESKENAZI D-LOT – NOT THE VA. Students may opt to park at IU and walk over if they have parking permits there.
  2. Outside of Indianapolis: See Step 5 for location recommendations.

D. After appointments in Indianapolis, students receive instructions for the next steps, along with a list of sponsors.

Step 7: Receive email notification confirming background check is clear:

Once you receive an email notification from the VA confirming that your background check is clear, proceed with Step 8 within 1 week of receiving the email notification.

  • You should have already received instructions for Step 8, as well as a list of sponsors, at your “Fingerprinting and Background Check” appointment.
  • Note: This verification only applies to the individual student receiving it, and cannot be used by other students completing the VA Onboarding process. All students must start with Step 1 and complete all steps.
Step 8: Obtain PIV badge and computer access

PLEASE DO NOT PROCEED WITH THE STEPS BELOW UNTIL YOU’VE BEEN NOTIFIED via an Email from THE ONBOARDING TEAM

A. Timing and location considerations:

  1. This step must be completed within 30 days of fingerprinting otherwise, the fingerprinting step must be repeated. DOES NOT REQUIRE AN APPOINTMENT – YOU GO ON YOUR OWN TIME.
  2. This step must be completed at the VA in Indianapolis.
  3. This step takes approximately 1-3 hours to complete.
  4. Call your sponsor the DAY BEFORE you decide to return to the VA to complete the final steps, to let them know when you’ll be coming. Here is the Sponsor Contact List.  Inform the Sponsor that you will be in the building the following day to complete your onboarding and would like to meet for sponsorship.
    • Calling your sponsor ahead of time will save you time on the day of your appointment
  5. Email current Clerkship/Elective coordinator to ensure proper absence permissions to onboard at the VA.  Make sure to include the time you will go to the VA and the Step that you are completing in the process. You should not need to take an entire day off from a Clerkship/Elective to onboard at the VA.

B. Bring two forms of unexpired government-issued ID with you to complete this step.  (School-issued ID’s are no longer a valid form of ID)

C. You must do the following steps (in this order).

  1. Ensure you have two forms of unexpired government-issued ID with you.  (School-issued ID’s are no longer a valid form of ID)
  2. Go to the Sponsor whom you called the day before.  Their office location is listed on the document you received at the end of your fingerprint appointment.
  3. Report to Police Services to take your picture for your VA PIV badge (Building 21 behind the main building).  If not available the same day, the PIV rep will inform you of when to return to pick up the badge.  Please proceed with Step 4 IMMEDIATELY after receiving your badge.  (Hours are 7:00am-4:00pm) YOU MUST PICK UP YOUR BADGE TO BE AT THE VA.
    1. After you have your badge, you MUST walk over to the main hospital and log into the computer system and CPRS using your PIV badge. Once you log into the system using your PIV badge then your account should be valid for 90 days. If you do not log back into the system after receiving your PIV badge then you run the risk of having to start the ENTIRE badging process again.
  4. Go to the IT Help Desk to set up your VA computer account first (Room C-B056). Receive your Computer login sheet and Signature Block Instructions. This step should not take longer than 45 minutes to complete. This step must be completed in the following order:
    1. Arrive at the IT Department at 7:45 AM. The IT Department opens at 8 AM.
    • You will need to log into the system (including DHCP and CPRS), using your new PIV badge.  Note:  DUE TO COVID PRECAUTIONS, IT IS QUITE POSSIBLE THAT YOU MAY NOT BE ABLE TO LOG ON IN THE HELP DESK OFFICE.  PLEASE PROCEED (WITH YOUR SHEET) TO THE EDUCATION DEPARTMENT AND USE THE COMPUTERS THERE TO COMPLETE THIS STEP.  The staff in Education are there to help if needed.

Note:

Note: Once all steps are completed your access will be valid for one year from the date of the completion of the TMS modules; however, if you complete a rotation, but are returning later within that 365-day window, YOU MUST CONTACT THE VA EDUCATION DEPARTMENT 20 DAYS PRIOR TO RETURNING TO ENSURE ACCOUNT ACCESS. Students must take note of the completion date of their TMS Training modules because they will complete these modules every year, otherwise, their VA access will be terminated until modules are completed.


Basic Life Support

Details

Students are encouraged to keep their Basic Life Support certification active and can complete this task at any time. Students do not need to wait to receive AY 19-20 compliance notifications from MedHub to go ahead and get it taken care of.

BLS certification typically lasts two years. Because many students first complete BLS training at the beginning of medical school, many students’ certifications will be expiring around the start of Phase 2.


TB Test

Details

Coordinate getting a TB test by contacting Campus Health.

TB tests are typically valid for one year.


Fit Test

Details

Due to COVID-19, hospitals are running low on N95 masks and fit testing is on hold for now. (Updated March 13, 2020.

FIT-testing is a procedure that determines what respirator model and size is appropriate to provide protection from tuberculosis (TB). Trainees should get annual fit tests when working in clinical environments.

Set up an appointment: Contact Campus Health to set up a time for test time. Fit-testing typically takes about 15 minutes.

Fit tests are typically valid for one year.


OSHA

Details

Complete the OSHA training.

Training is typically valid for one year.


HIPAA

Details

Complete the 2019 HIPAA training.

Training is typically valid for one year.


IU Health Modules (Including Cerner)

Details

Complete the modules on IU Health’s website.

Training is typically valid for one year.


FAQs

Will I have to complete additional requirements to the mandatory requirements above?

Yes. You may have to complete additional EMR modules for any clinical sites you work in. Additionally, each clinical site may have unique requirements. The clerkship coordinator will provide all students this information prior to the start of rotation.

How will I know who my clerkship coordinator is?

This information can be found in the syllabus for the clerkship.  This document is located on the home page of the Canvas site.