Specialty Practice Ambulatory sub-iNternship (SPAN)

• To provide senior medical students with a longitudinal, in-depth ambulatory experience in a specialty/subspecialty of their choosing
• To develop students’ understanding of the role of ambulatory clinical practice in the SPAN specialty/subspecialty
• To build on core outpatient clinical skills developed during core clerkships and develop advanced, specialty/subspecialty-specific ambulatory skills and knowledge relevant to the next steps in the student’s training
• To develop longitudinal clinical coaching and mentoring relationships between the student and the SPAN preceptor with the goal of continuous improvement and professional development
• To ensure graduates of the UCSF School of Medicine enter residency training prepared to provide quality, compassionate, patient-centered care in the ambulatory setting in their chosen specialty/subspecialty

• Describe the specific role ambulatory care plays in the care of patients in the chosen SPAN specialty/subspecialty
• Apply understanding of the longitudinal process of workup, diagnosis, and treatment in the SPAN specialty/subspecialty to patients’ medical/surgical problems encountered in the outpatient environment
• Demonstrate the ability to conduct all elements of an ambulatory patient visit in the SPAN specialty/subspecialty with appropriate supervision. This includes pre-visit planning, agenda setting, history taking, physical examination, patient counseling, visit documentation and post-visit follow up
• Describe the role of the interprofessional team in the SPAN specialty/subspecialty and collaborate effectively with physician and non-physician members of the healthcare team in the ambulatory environment
• Reflect on feedback provided by the SPAN preceptor, create personal learning goals and monitor personal growth and improvement

• SPAN is a purely outpatient experience – SPAN sessions must occur at ambulatory sites and students must see patients during clinic visits. Procedures such as endoscopies or cardiac catheterizations or time in the OR, Emergency Department or inpatient do NOT count toward the SPAN requirement.
• SPAN students are encouraged to participate in all aspects of ambulatory patient care, including pre-visit planning, patient interviews and physical exams, determining individual treatment plans, patient counseling and shared decision making, visit documentation, relevant test and visit follow up and patient care coordination.
• SPAN students are encouraged to be involved in interprofessional care and to participate in communication and collaboration with all care team members.
• Students have the option of recruiting their own SPAN preceptor, though this is not required
• SPAN students are responsible for managing all the scheduling aspects of their SPAN sessions. SPAN students will directly coordinate scheduling with preceptor/clinic in prompt and respectful manner.
• SPAN students are responsible for monitoring and tracking completion of SPAN requirements and should communicate any concerns or challenges proactively with SPAN team.

• Host a fourth-year medical student in your outpatient clinical practice for 12 longitudinally scheduled half-day sessions spread over a 10-month period (beginning annually in May)
• Discuss student’s learning goals and self-assessments periodically
• Facilitate student involvement in patient care with appropriate supervision and graduated independence
• Directly observe students with patients
• Provide feedback and coaching on clinical skills
• Provide mentorship and support for student growth
• See this Information Sheet for Prospective SPAN Preceptors

• 12 half-day outpatient sessions
• Student-Preceptor Agreement
• 4 Bridges Brief Observation Tool (BBOT)
• 2 Self-Reflections
• MedHub midpoint and end-of-course evaluations and assessments

To receive credit for each quarter of SPAN enrollment, students must complete the following requirements by the end of that quarter:

• Summer Quarter: Students must complete and turn in their SPAN Student-Preceptor Agreement by June 1.
• Fall Quarter: Students must complete and log at least 4 SPAN sessions, at least 1 BBOT, and at least 1 self-reflection by the end of Fall Quarter.
• Winter Quarter: Students must complete and log all 12 SPAN sessions as well as 2 required self-assessments and 4 required BBOTs by March 31.

• Scheduling guidelines
  • Schedule sessions during Advanced Elective Skills & Deep Explore rotations. Students may not schedule sessions during Advanced Core Skills/Sub-I rotations.
  • Scheduling sessions during PIF weeks is acceptable– students must attend all required sessions and coach meetings.
  • Students must schedule sessions longitudinally – the equivalent of one half-day per week.   Students may not exceed 4-5 sessions per month, no more than 2 sessions per week. Students may complete full-day sessions if they adhere to these scheduling guidelines.
  • A limited number of sessions (3-4) with an alternate preceptor in the same clinic is acceptable.
  • Up to 6 sessions may be telehealth.
• Timeline
  • Mid-April– preceptor assignments distributed
  • May 1 – SPAN begins
  • June 1 – SPAN Student-Preceptor Agreement FormFile Due
  • September 1 – deadline to request change in SPAN preceptor
  • October 1 – Strongly recommend you have completed at least 1 session
  • November – mid-point evaluations
  • Mid-December (Fall Quarter end) – Deadline to complete at least 4 sessions
  • January – Recommend you have completed at least 6 sessions
  • March 31 – SPAN ends
• Session scheduling examples