Ambulatory Experience in Clinical Training

MedNet File Link

Download the MedNet File


Full Policy Contents

Policy Statement
Reason for Policy

Additional Contacts

Effective: Immediately
Last Updated: 1/27/2017

Responsible University Office:
Medical Student Education

Responsible University Administrator
Senior associate dean for medical student education

Policy Contact:
Phase 2 and 3 assistant deans

RESPONSIBLE Phase 2 and 3 assistant deans
ACCOUNTABLE Curriculum Council Steering Committee
SUPPORT Medical Student Education
CONSULT Continuous Quality Improvement
INFORM Learning Technology, Medical Student Education

LCME Standards

6.4 Inpatient/outpatient experiences


Students, clinical faculty and educational staff/administrators.

Policy Statement

Within the core clinical instruction phase of medical education at the IU School of Medicine, a student should achieve a minimum threshold for instructional time in ambulatory care settings at 20%, inpatient settings at 40%, and emergency department at 5% of the required clerkship experiences.

Reason for Policy

A student’s medical education should include a composite of experiences in inpatient and ambulatory settings. While certain disciplines may dictate that patient care experiences occur in either an inpatient or an ambulatory setting, for many disciplines, a variety of experiences in either venue may meet the core requirements of instruction.

Training at an academic institution affiliated with an academic health center allows for a broad sampling of experiences in clinical medicine. These experiences may inadvertently over-represent an inpatient setting for clinical experiences throughout the curriculum at a single site of instruction. The school must ensure a well-rounded educational experience for medical students that enables patient encounters that are representative of common medical practice outside of advanced, tertiary or quaternary care models.

LCME element 6.4 requires a school’s curricular committee to “ensure that medical students spend sufficient time in inpatient and ambulatory settings to meet the objectives for clinical education.”

A minimum standard for training in ambulatory settings during the core clinical instruction phase of education is essential.


Approved by the Curriculum Council Steering Committee 01/17/2017.


The platform for tracking student duty hours during core clinical instruction is programmed to allow for ‘Setting designations’ within an instructional day so that ambulatory settings of education may be logged. Cumulative tracking toward the policy goal will be reviewed as part of the student’s educational portfolio within the academic advising and mentoring process to identify any difficulties the student is having in meeting this goal. Clerkship directors or associated clerkship management teams are apprised of student training requirements to ensure that training settings allow compliance in these goals.

The Clinical Component Committee will annually review the outcomes of the tracking process to understand school-level noncompliance and will review data for the appropriateness and determination of the threshold level of ambulatory instruction.


Ambulatory clinical experiences take place in settings in which direct patient encounters occur in an outpatient setting, usually through outpatient clinic settings.

Emergency Medicine encounters in a standard emergency department/room are designated as ambulatory clinical experiences.

Clinical experiences in Radiology will not be tabulated for either ambulatory of inpatient clinical encounters unless direct patient contact and care are provided as part of the experience.



Specific factors or limited issues not in compliance require a formal report from the respective clerkship director to the Curriculum Council Steering Committee outlining an exact process/plan to achieve compliance.

Additional Contacts

Subject Contact Phone Email
Phase 2 assistant dean Jen Schwartz (317) 948-7576


Approved 9/13/2016 by the Curriculum Council Steering Committee.
Revised 01/17/2017 by the Curriculum Council Steering Committee.