What the Design is

The design of the Clinical Distinction course simply describes both the time you will spend on your project.

There are two design options:



All tracks other than the specialty track are always the basic design.

Selecting a design determines variations in paperwork and due dates.

  • For all rotations, including both designs for Clinical Distinction, the rotation request form is due 60 days in advance of the start date of the course.
  • For all designs the contract is due on the first day.
  • For all designs a contract and a narrative are due for each course in which a student is registered.

The differences are outlined below.

The Basic Design

The basic design is simple and most students will choose this. The course starts on the first Monday of the rotation block and ends on the last Friday. It is a four week course.

  • The contract of learning is due on the first day of the rotation.
  • The narrative evaluation is due on the last day of the rotation.*
  • The course (NI) evaluation is due on the last day of the rotation.

*CED recognizes that while a student may be prompt about completing his/her work on time, it may be challenging to get faculty signatures on the contract, have an exit interview and get faculty evaluations on time. Reasonable leeway is given and CED will do as much as possible to assist the student in this process. Ultimately, it is up to the student to plan ahead and communicate with their course faculty sponsor so that the faculty member is available in a timely fashion to sign contracts, do exit interviews and complete evaluations.

The Longitudinal Design

The longitudinal design allows more freedom to create an expansive project.

  • The contract of learning is due on the first day of the rotation.
  • The narrative is due at a date, determined by the student and agreed upon by the faculty member later than the last day of the course.
  • The course (NI) evaluation is due on the last day of the rotation.

There are several reasons to choose a longitudinal design:

  • Allows collection of patient information or procedure opportunities during core rotations or the selective rotation.
  • Allows for extended participation or data collection in a research project.
  • Allows attendance at medical conferences not available during registered four week block.

There are two important restrictions for students hoping to do a Longitudinal specialty track.

  1. Longitudinal design is allowed only if it is specified at the time of course registration. The end date of the course must be listed in the rotation request form or it will be assumed that the end date is the last day of the rotation block.
  2. In some instances, because of the longitudinal design there will be an overlap in time between CD I and II.
    • In the event that the topics of study of both CD one and two are identical, the student should ensure that the longitudinal end date of CD I is before the start date of CD II.
    • Even if the topics of study of CD I and CD II are identical, the student is still required to complete all paperwork for both courses separately. They will have two rotation requests two contracts and two narrative evaluations.

If the topic of study you choose for CD I and CD II are different you can stop reading here. If they’re the same read on…..

Using the Same Topic of Study for CD I and II

There is no restriction on doing the same project or using  same topic of study for both Clinical Distinction I and II. This can take various forms depending on the project design and the students interest.

Here some examples:

  1. For both CD I and II the student signs up to participate in a research project on Alzheimer’s in an existing lab.
  2. For CD I a student does a clinical clerkship in a diabetes clinic and for CD II the student does independent study on diabetes
  3. For CD I a student does the longitudinal medical Spanish curriculum, collecting data during their core rotations and writing up a new curriculum which they can teach their fellow students on rotation. For CD II the student joins the global health program and travels to a Spanish-speaking country.
  4. For CD I and II a student develops a elective course which they deliver to second-year students.

As stated above in each and every one of these cases the student needs to complete two rotation request forms, one for CD I and one for CD II, two contracts one for CD I and one for CD II, and two narrative evaluations one for CD I and one for CD II.

It’s helpful if you understand that this is not meant to be busywork, and you can use some of the work you put in for CD I paperwork for your second contract and narrative as well as your rotation request form.

Let’s go back to the previous examples so you can understand better how to make the most of this experience.

In the first example the student is doing the exact same study in both the first and second CD projects. When they get approval to work in the lab it’s a good idea to get approval for both CD courses in the same email. Then when they fill out the rotation request form twice, they can simply copy the same email into the form each time. In fact, the only difference on each form will be the dates of the rotation and the CLIN number, which will be 717 for for the first time period, and 718 for the second set of dates. They can be submitted one after the other and the approval process for both can take place simultaneously.

When the student completes their first contract it’s important they think about the big picture – what they hope to complete over the course of both clinical distinction courses. They should also think about how much of that work they can get done in the first four weeks.

Their contract can reflect the goals of the whole project but it should clearly specify what they expect to finish in a four week period. When they complete the narrative evaluation at the end of this, they should discuss whether not they met those goals. It’s perfectly reasonable to say “I have another four weeks that I’ll be working on this project, so my hope is that I’ll complete anything I wasn’t able to do in the first four weeks.”

The second contract is pretty straightforward- it will list what they hope to do in the next four weeks of the project.

In the second narrative evaluation they will include information from the first four weeks of the project- this is strongly recommended.  You’re MSPE or Dean’s letter will be a compilation of both of your narratives with a focus on your second narrative evaluation. What stands out about this type of project is a developmental process that you can describe based on both your contracts and narrative. It’s possible to show not only an increase in the amount of work that was accomplished but that there was a more rich developmental growth in the competencies in entrustable professional activities.

The second example is essentially two basic courses. The only thing I have to say about this is that in the second narrative evaluation, it’s useful if the student references their first clinical distinction experience to explain their interest and the depth that are implicit in focusing on a single specialty area.

In the third example, note the longitudinal project for CD I. Because just like in the second example these are essentially two separate courses the end date of CD I is not dependent on CD II in any way.

Finally in the fourth example,  the student is developing and delivering the elective for both CD I and CD II, so CD I even if its longitudinal must end before CD II starts. This is a situation like the first where the student should differentiate the amount of work they expect to finish in CD I from what they hope to accomplish in CD II.

We’ll talk more about the competencies and EPA’s in another section however it’s important to understand that even if CD I and CD II are on the same topic, the student does not have to use the same competencies or entrustable professional activities for both courses– in fact it would be a more robust demonstration of learning if they were different.

If you are in co2020 you can stop reading here.

CO2021The Progressive Design – A Retired Language

The progressive design is being retired now, because it was simply too confusing. If you selected this design in a prior rotation request form, don’t worry I explain below how you will have no trouble with your grade or completion of this project.

In fact following and all of the instructions below which are unchanged, a student who has chosen a progressive design should be successful.

This design describes a project plan which spans multiple courses. It can include:

  • One or both CD courses in either basic or longitudinal designs
  • A selective course of four weeks or one or 2 two-week selectives
  • A vacation block
  • Core Rotation time

Regardless of which courses are included in the progressive design, the requirements for each course are unchanged – for example, if both CD courses are part of a progressive design and both are following the basic design, two specialty contracts and two narrative evaluations are required and must be completed by the dates specified as start and end dates of each respective block. If a selective is included with a CD course, a CPE is required for the selective and the specialty contract and narrative are required for the CD.

So why do a progressive design?

Progressive design allows a deep exploration of a topic, competencies and extended time to work on specific entrustable professional activities. It may be just the specialty area that is the same across all courses, and different competency areas or EPAs are explored, or it may be that two contracts have significantly overlapping plans of study and simply describe the portion of work that will be done in each block of time.

To understand the requirements of a progressive design, students need to be sure they are meeting all the requirements for the courses included in their progressive project. If you have questions feel free to reach out to a course director, the curriculum coordinator or your CD advisor.