1. science
2. medicine

PRIMARY INTERN MANUAL
Clinic IV, V & VI
CLE404, 412, 450
CCNM Teaching Clinics
2013-2014
NATUROPATHIC DOCTOR’S OATH
I dedicate myself to the service of humanity
as a practitioner of the art and science of naturopathic medicine.
By precept, education and example, I will assist
and encourage others to strengthen their health,
reduce risks for disease, and preserve the health of our planet
for ourselves and future generations.
I will continually endeavor to improve my abilities.
I will conduct my life and practice of naturopathic medicine
with integrity and freedom from prejudice.
I will keep confident what should not be divulged.
I will honour the principles of naturopathic medicine:
First, to do no harm.
To co-operate with the healing powers of nature.
To address the fundamental causes of disease.
To heal the whole person through individualized treatment.
To teach the principles of healthy living and preventive medicine.
With my whole heart, before these witnesses,
as a Doctor of Naturopathic Medicine,
I pledge to remain true to this oath.
2
The Canadian College of Naturopathic Medicine
Program Mission Statement
Through excellence in health education, clinical services and research that integrate
mind, body and spirit, the Canadian College of Naturopathic Medicine program
develops primary care doctors accomplished in the art and practice of naturopathic
medicine.
Graduates of the Canadian College of Naturopathic Medicine's naturopathic
medicine program will be able to:
1. Integrate naturopathic philosophy and principles with medical knowledge in the care
of patients.
2. Educate patients and the public in health promotion, and disease prevention.
3. Manage the underlying spiritual, social, mental and physical causes of disease.
4. Practice in a manner that exemplifies professionalism, strong ethics and a
commitment to the principles of naturopathic medicine.
5. Communicate effectively with patients.
6. Appraise and apply research in treating patients.
7. Integrate biomedical with clinical science knowledge in the assessment, diagnosis,
and management of patients.
8. Utilize naturopathic therapeutics in the individualized care of patients including but
not limited to:
- Asian Medicine
- Botanical Medicine
- Clinical Nutrition
- Counseling & Health Psychology
- Homeopathic Medicine
- Lifestyle Modification
- Nature Cure
- Pharmaceuticals
- Physical Medicine
9. Identify the need for urgent and emergent health care and direct appropriate
resolution.
10. Establish and manage a naturopathic practice.
11. Manage chronic disease.
12. Demonstrate leadership in health advocacy and environmental stewardship.
13. Collaborate effectively and work in partnership with other healthcare practitioners.
14. Demonstrate commitment to the advancement of the naturopathic profession.
3
Table of Contents
CLINICAL EDUCATION OVERVIEW .................................................................................................5 ADMINISTRATIVE ASSISTANCE .............................................................................................................5 COMMUNICATION .............................................................................................................................5 CONTACT LIST ............................................................................................................................7 CLE404/412/450 COURSE EVALUATIONS, 2013-14 ..................................................................10 MINIMUM SEMESTER REQUIREMENTS, 2013-14 .........................................................................11 12-MONTH SUMMARY OF 2013-14 TOTAL REQUIREMENTS FOR CLE404/412/450 .................................13 Clinic Hours ............................................................................................................................... 14 Primary Visits ............................................................................................................................. 14 Global Assessment of a Patient Interaction ........................................................................... 15 MYMOPs .................................................................................................................................... 17 Primary Health Screen ................................................................................................................ 17 Digital Rectal Prostate Examinations ............................................................................................ 18 Laboratory Rotation .................................................................................................................... 19 RSNC LABORATORY MEDICINE CLINICAL ROTATION .................................................................... 20
Acupuncture............................................................................................................................... 23 Botanical Medicine ..................................................................................................................... 23 Acute Homeopathic Prescriptions................................................................................................ 23 Constitutional Homeopathic Prescriptions .................................................................................... 24 Naturopathic Manipulations ......................................................................................................... 24 Constitutional Hydrotherapy ........................................................................................................ 24 Hydrotherapy, general ................................................................................................................ 25 CONSULTANTS .............................................................................................................................26 1) Health Psychology Consultant, David Dennis & Allison Creech, ND ............................................ 26 2) Primary Care Consultant, Dr. Michael Salsberg MD .................................................................. 26 3) Practice Management Consultants, Nadine Cyr ND & Erin Truscott-Brock ND ............................ 26 Practice Management Portfolio ............................................................................................. 27 4) Optional Consults Available ..................................................................................................... 27 CASE MANAGEMENT FORMS (CMFS) ..................................................................................................27 Case Management Rubric, 2013-14 ............................................................................................ 29 EVALUATIONS ..........................................................................................................................30 MIDTERM PICE EVALUATION ....................................................................................................... 30 FINAL PICE EVALUATION............................................................................................................. 31 PRIMARY INTERN COMPETENCY EVALUATIONS: FLOW CHART ..................................................... 32 EXTERNSHIP PROGRAM .............................................................................................................39 DEADLINES FOR APPLICATION ...........................................................................................................39 CLE100, CLE201 AND CLE310 .................................................................................................40 MONTHLY RECORD KEEPING .....................................................................................................41 POLICY ON CONVOCATION ........................................................................................................41 4
Clinical Education Overview
This curriculum is designed for students entering their final year of study at the
Canadian College of Naturopathic Medicine. The Primary Internship is comprised of 3
separate courses, CLE40, CLE412, and CLE450 each of which must be passed in
order to graduate.
Academic Clinic Committee (ACC)
The Academic Clinic Committee consists of the Dean, the Chief Naturopathic Medical
Officer (CNMO), the Associate Dean, Clinical Education (ADCE), the Associate Dean,
Academic Delivery (ADAD), the Associate Dean, Curriculum and Residency Program
(ADCR), the Associate Director, Clinic Services (ADCS), the Academic Coordinator and
the Privacy Officer.
This committee formally deals with all issues relating to clinic operations and clinical
education, including student discipline issues. All special requests outside normal
policies and procedures are subject to approval by this committee.
Administrative Assistance
All questions regarding Clinic Education courses and requirements should first be
directed to the Office of Clinical Education, Clinical Education Administrative Assistant,
ext. 241, [email protected]. All clinic paperwork is to be submitted on Moodle or in the
OCE mailbox located in the clinic Student Business Centre.
COMMUNICATION
1. Moodle is our main avenue for daily communication. Communications will be
primarily posted to the CLINIC FORMS AND RESOURCES page, and occasionally
in the CLE404, CLE412 and CLE450 course shells.
5
2. Questions regarding Clinical Education policies & procedures, important dates,
and the completion and submission of paperwork should be addresses to the
Clinical Education Administrative Assistant, ext 241, [email protected].
3. The Associate Dean, Clinical Education and the Associate Director, Clinical
Services hold weekly meetings with the 4th yr. Clinic Class Reps to address
issues brought forward by interns and to convey information to the class.
4. Appointments with the Associate Dean, Clinical Education may be made through
the Clinical Education Administrative Assistant, x241, [email protected].
6
CONTACT LIST
Administration
x220
X232
X397
x235
Melanie Katovich
Rachel Miranda
Mitchell Zeifman, BSc, ND
Jonathan Prousky, ND, MSc
Academic Administrative Coordinator
Clinical Education Administrative Assistant [CEAA]
Associate Dean, Clinical Education [ADCE]
Chief Naturopathic Medical Officer [CNMO]
Full-time Clinic Faculty
x336
x275
x321
x284
x392
x253
x280
x227
x393
x377
x298
X303
Feature 980+494
Feature 980+492
x297
Feature 980+493
Feature 980+369
Feature 980+379
Feature 980+399
Feature 980+389
Nadia Bakir, BSc, ND, MSc
Kimberlee Blyden-Taylor, ND
Adam Gratton, ND
Alexander Hall, ND
Hal Huff, BA, ND, MSc
Afsoun Khalilli, ND
Dan Lander, ND, FABNO
Paul Saunders, PhD, ND, DHANP
Leslie Solomonian, ND
Jonathan Tokiwa, RN, ND, LAc
Zeynep Uraz, ND
Ellen Wong, ND
Melvia Agbeko
Zain Ladha
Elaine Lewis
Kristi Prince
Maria Shapoval, ND
Vanessa Youssef, ND
Mark Fontes, ND
Christopher Roberts, ND
Academic/Clinic Faculty
Academic/Clinic Faculty
Academic/Clinic Faculty
Clinic Faculty
Clinic Faculty
Clinic Faculty
Academic/Clinic Faculty
Academic/Clinic Faculty
Academic/Clinic Faculty
Academic/Clinic Faculty
Academic/Clinic Faculty
Academic/Clinic Faculty
College Resident , Second Year
College Resident , Second Year
College Research Resident , Second Year
College Resident, Second Year
College Research Resident , Outgoing Second Year
College Resident , Outgoing Second Year
College Resident , Outgoing Second Year
College Resident , Outgoing Second Year
Part-time Clinic Faculty
Kristina Brooks, ND
Shelley Burns, ND
Barbara Cowan, ND
Paul Davis, BSc (Hons), ND
Ken Dunk, DC, ND, FCAH
Kerri Fullerton, ND
Alexia Georgousis, ND
Matthew Gowan, ND
Lowell Greib, MSc, ND
Cyndi Gilbert, ND
Nicole Henry, ND
Payam Kiani, ND
Ajay Lad, ND
Carole Ma, ND
Tracy Malone, ND
Sean McConnell, ND
Louise McCrindle, ND
Cristina Meffe, ND
Caroline Meyer, BASc (Hon), ND
Rupi Mitha, ND
Sejal Parikh-Shah, ND, LAc
Poonam Patel, ND
Rita Patel, BSc, ND, FSHM, LAc
Erin Psota, ND
Rajesh Ragbir, ND
Romi Raina, ND
Pat Rennie, ND
Michelle Richea, ND
Anne Salsberg, ND
Jill Shainhouse, ND, FABNO
Onkar Singh, ND
Susan Slipacoff, ND
Tracey Teasdale, ND
Peter Tebruegge, RMT, ND
Erin Truscott-Brock, ND
Teresa Tsui, ND, MSc
Pilar Villegas, ND
Alan Vu, ND
Heidi Willms, ND
Saveria (Rena) Zambri, ND, FCAH
7
Faculty Consultants
x215
8
David Dennis, ND
Allison Creech, ND
Michael Salsberg, FCFP, MD
Neemez Kassam, ND
Lowell Greib, ND
Nadine Cyr, ND
Erin Truscott-Brock, ND
Health Psychology
Health Psychology
Primary Care
Asian Medicine
Physical Medicine
Practice Management
Practice Management
CLINICAL EDUCATION
2013-2014
CCNM Teaching Clinics
9
CLE404/412/450 COURSE EVALUATIONS, 2013-14
Each course is P/F based on:
1) Achieving a pass on 3 out of 4 Final Semester Evaluations, AND
2) Fulfilling the Minimum Semester Requirements as listed below.
Pass on at least
3 of 4
Final Semester
Evaluations
Does NOT Pass
at least 3 of 4
Final Semester
Evaluations
Pass on at least
3 of 4
Final Semester
Evaluations
+
+
+
Minimum
Semester
Requirements
Achieved
Minimum
Semester
Requirements
Achieved
Minimum
Semester
Requirements
NOT
Achieved
PASS
FAIL
INC
1) FINAL SEMESTER EVALUATIONS
Each term 3 out of 4 Final Semester Evaluations must be passed to pass the course. If more
than 1 Final Evaluation is not passed in any one term, the intern receives an F (fail) and must
repeat the entirety of the clinic course (CLE404, 412 or 450). Patient visits, hours, and
modality “numbers”, as well as case management forms submitted during a failed term, will
not be credited towards a subsequent term.
A failing evaluation in either the midterm or final evaluation, while not initiating a term fail,
remains a cause for investigation. Clinical interns with a fail on any evaluation can expect
increased attention from supervisors, advisor and Associate Dean. The ultimate goal being
the identification of the intern’s area(s) of weakness and providing support for the successful
completion of the clinical rotation.
Pgs. 28-36 of this Manual provide details on Evaluations.
2) MINIMUM SEMESTER REQUIREMENTS
Each term, the minimum semester requirements listed below must be achieved in order to
pass the course. If an intern passes 3 out of 4 Final Semester Evaluations but does not
complete the minimum semester requirements by term end, the intern will receive an INC
10
(incomplete). The intern will then have one additional month (16 clinic shifts) in which to
complete the minimum semester requirements, at which point the INC may be changed to a
Pass. If the intern does not complete the minimum semester requirements within the
extension month the intern will receive a Fail in the course. Additional remedial activity will be
required of students who are incomplete in greater than 10% of one requirement or of
multiple, different requirements. Remedial activity is set by the Associate Dean, Clinical
Education and may include focused research assignments, tutoring or a combination
activities designed to address the intern’s assessed deficiencies. Clinical interns are provided
and extra 4 weeks (16 shifts) to meet term requirements and complete remedial activity. If
the intern is unable to meet the minimum semester requirements and remedial activities
prescribed by the second extension deadline, they will be required to repeat the term failed.
All clinical activity and credits from the failed term will be erased and the student will be
assessed again by the standards of the term being repeated.
Term assignments, such as Case Management Forms (CMFs) and reflection assignments, will
not be granted the month extension beyond the term deadlines. Late assignments will not be
accepted for term credit without remediation, as determined by the Associate Dean, Clinical
Education. Further. Further, late or incomplete assignments may negatively impact the final
evaluation of the clinical intern due to poor representation of certain clinical competencies,
such as the Professionalism and Ethics competency. If a clinical intern does not apply for or
receive an extension for a late assignment, the intern will receive a fail for the assignment
and an INC for the term. This grade may be reversed once all remedial assignments are
completed within the time frame for extensions specified.
MINIMUM SEMESTER REQUIREMENTS, 2013-14
*Numbers in excess of the minimum are applied to the subsequent term
CLE404 (1st






term): minimum requirements*
Case Management forms PASSED 4 (1 per supervisor)
General Screening Physical Exams 4
Primary Health Screen 4
Total Patient visits 65
Global Assessment of Patient Interaction 1
Advisor meeting 1
CLE412 (2nd term): minimum requirements*
 Global Assessment of Patient Interaction1
 Case Management forms PASSED 4 (1 per supervisor)
 General Screening Physical Exams 4
 Primary Health Screen 4
 Breast Exams 1
 Total Patient visits: 105
 Female Pelvic Exam 1
 DRE 1
11


Practice Management Consults 1
Advisor meeting 1
CLE450 (3rd term): minimum requirements*
 Global Assessment of Patient Interaction 1
 Case Management forms PASSED:
4 (1 per supervisor)
 General Screening Physical Exams: 4
 Primary Health Screen 4
 Breast Exams 1
 Total Patient visits: 110
 Female Pelvic Exam 1
 DRE 1
 Practice Management Portfolio 1
 Advisor Meeting 1
Requirements which may be completed anytime during CLE 404/412/450
or required for completion of program requirements.
If incomplete, the Intern will not pass CLE450 until all requirements and any
prescribed remedial work have been completed.
 Primary Care Consult 1
 Venipuncture 10
 Urinalysis 10
 B12 injections 10
 Acupuncture 35
 Botanical prescriptions 20; min. 15 must be 3-herb combos.
 Manipulations 6 cervical/ 6 thoracic/ 6 lumbar
 Acute Homeopathic Prescriptions 5
 Constitutional Homeopathic prescriptions 5
 Constitutional Hydrotherapy 6
 Hydrotherapy, general 10
 Total clinic hours 1032
 Secondary Clinical Patient Contacts 60 (min)
 Total Secondary Clinic Contacts 80
(Accumulated in clinic and CLE courses)
 Total Preceptor Hours/Contacts100/100
12
12-month SUMMARY of 2013-14 TOTAL Requirements for CLE404/412/450
Clinic Hours & Visits
RSNC, Satellite &/or Externship
hours
Primary Visits
Laboratory
1032
Urinalyses
10
280
Venipuncture
10
Physical Exams
Required Consults
General Screening Physical Exams
12
Digital Rectal Prostate Exams
2
Preventative Health Screen
12
Primary Care
1
Breast Examinations
2
Practice Management
1
Female Pelvic Examinations
2
Advisor Meetings
3
Modalities
Assignments
Acupuncture
35
Case Management Forms
12
Botanical Prescriptions
20
Botanical Dispensary Shifts
2
Acute Homeopathic Prescriptions
5
Laboratory Shifts
4
Constitutional Homeopathic pres.’s
5
Laboratory Assignment
1
Manipulations
18
Evaluations
Hydrotherapy, general
10
Midterm PICE Forms
4
Constitutional Hydrotherapy
6
Final PICE Forms
4
B12 injections
10
Practice Management Portfolio
1
Global Assessment of a Patient
Interaction
3
13
CLINIC HOURS
The minimum total number of clinic hours required is 1032*. These hours
may be accumulated throughout CLE404/412/450, and have no specific required
semester totals.
Hours are accumulated on RSNC shifts, satellite clinic shifts, and at Externship
placements. A maximum of 103 hours may be counted from an Externship
placement. If additional hours (more than 103) are accumulated at an externship
placement they will be counted as preceptor hours. (NB: you may not credit
externship hours as preceptor hours before the 103 maximum is achieved.)
Clinic hours are recorded on the “Clinic Attendance Record” and must be signed by
the Supervising doctor during the shift; hours may not be signed at a later date.
Unsigned hours will not be counted towards requirements.
*Please note that hours in excess of the minimum requirement cannot be “banked”,
i.e. applied towards additional vacation.
PRIMARY VISITS
The minimum total number of patient visits required is 280. These are divided
per semester:
 CLE350 (1st term) = 65 Visits
 CLE412 (2nd term) = 105 Visits
 CLE450 (3rd term) = 110 Visits
This includes patients seen at RSNC, satellite clinics, and at externship placements.
A maximum of 52 patient visits may be counted from an Externship placement.
Please note that student “exchanges” of treatments do not count towards this total.
SECONDARY CLINICAL CONTACTS
The minimum total number of total secondary clinical contacts from all
years is 80. It is estimated that most students will need a minimum of 60 secondary
clinical contacts in the final clinical year.
Secondary clinical contacts constitute any clinically-based interaction with a patient
that is not performed in a primate intern role. This includes secondary observation of
a full or partial visit, IV shift activity with patients, secondary activity with hydrotherapy
14
treatments (such as peat baths and saunas), venipuncture and intramuscular
injections (when not the primary clinician). Secondary clinical contacts may be
collected at any time over the three terms. It is the ultimate responsibility of each
intern to plan for secondary clinical contacts over the course of the clinical year. This
may be done by requesting to observe with a colleague or a supervisor when not
booked with patients on a regular shift or an on-call shift.
Secondary Clinical Contacts are tracked using the Secondary Clinical Contact Record
(found on Moodle). A supervisor must sign off for each patient seen as a secondary.
As with clinic hours, supervisors must sign the Clinical Contact Record during the
shift; unsigned hours or hours signed at a later date will not be counted towards
requirements.
Global Assessment of a Patient Interaction
To provide effective patient-centered care, interns are expected to focus on certain
key objectives in every patient visit. The Global Assessment of a Patient Interaction
allows for a structured assessment of key competencies expected to develop over
the course of the clinical year. Supervisors will use the assessment to provide
formative feedback on patient rapport, goal setting and other skills listed below.
Interns are expected to request at least one Global Assessment of a Patient
Interaction from at least one supervisor per term. Supervising doctors will be looking
for a progression of skills from one term to the next. This feedback will be provided
to you and the practice management consultant to assist you in building upon these
skills.
15
Global Assessment of a Patient Interaction
Completed by:_______________________________________________________________
Name (please print) Date
Student:_____________________________________________________________________
Did this student demonstrate the following clinical competencies? Base your answer on your overall
impression of the performance.
Which of the following competencies were demonstrated?
History Taking:
Focused enquiry and information
gathering method
Logical sequence of questions
Avoids leading questions/ biasing
patients response
Avoids jumping to premature
conclusions
Efficient use of time
Rapport Skills:
Listens carefully, puts patient at ease
Receptive atmosphere
Good eye contact
Appropriate posture
Conveys a sense of confidence
Is empathic and makes
affirming/legitimizing statements
Is neither rude, arrogant, nor
patronizing
Interviewing Skills:
Has an organized approach
Uses words patient can understand
Uses open-ended and closed questions appropriately
Asks one question at a time
Uses facilitation techniques, e.g. silence, repetition, etc.
Communication skills
Establishes a clear agenda for the visit
Communication of provisional diagnosis
Communication of prognosis and short term plan
Communication of initial management plan (most patients should receive
some suggestions on how to manage their concern on their first visit)
Communication of next appointement date
PLEASE PROVIDE DETAILED COMMENTS:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
____________________________________________
16
MYMOPS
The Measure Yourself Medical Outcome Profile (MYMOP) is a standardized tracking
questionnaire that is employed in the RSNC to track and measure patient outcomes.
MYMOPs are not an absolute clinic requirement; however, they represent a main
tracking tool and are recommended to be used with every patient. MYMOP tracking
(at least three data points) will be required for every CMF submitted. For
more information on this measurement tool, visit the website at
http://sites.pcmd.ac.uk/mymop/index.php?c=intro.
MYMOPs may be done at every patient visit. There are no restrictions to use.
This tool for measuring treatment outcomes does not become clinically useful until a
minimum of 5 are done on any one case. Interns are encouraged to consistently
apply this tracking tool with patients and to utilize the results over time to assess
patient outcomes.
General Screening Physical Examinations
The minimum total number of General Screening Physical exams required is
12.
These are divided per semester:
 CLE404 (1st term) = 4
 CLE412 (2nd term) = 4
 CLE450 (3rd term) = 4
Primary Health Screen
The primary health screen is a tool created to assist in tracking and informing
patients of age-specific health screening for preventative health. To complete the
Primary Health Screen the intern must complete all relevant points of the General
Screening Physical Examination & Required Testing Form and update the Cumulative
Patient Profile form for the patient. Demonstrating the completion of these elements
to your clinic supervisor will qualify for a Primary Health Screen credit.
The minimum total number of Patient Health Screens required is 12.
These are divided per semester:
 CLE404 (1st term) = 4
 CLE412 (2nd term) = 4
 CLE450 (3rd term) = 4
17
Breast Examinations
The total number of breast exams required is 2. These are divided per
semester:
 CLE412 (2nd term) = 1
 CLE450 (3rd term) = 1
All breast examinations must be performed entirely under supervision. Successful
breast examinations are based on competency of examination, patient
communication, assessment of examination findings and patient recommendations
provided based on findings.
Female Pelvic Examinations
The total number of gynecological exams required is 2. These are divided per
semester:
 CLE412 (2nd term) = 1
 CLE450 (3rd term) = 1
All gynecological examinations must be performed entirely under supervision.
Successful female pelvic examinations are based on competency of examination,
patient communication, assessment of examination findings and patient
recommendations provided based on findings.
If the exam has not been accomplished with a patient one month prior to the
requirement due date, you will have the option of performing the exam with a
standardized model.
Digital Rectal Prostate Examinations
The total number of digital rectal prostate exams required is 2. These are
divided per semester:
 CLE412 (2nd term) = 1
 CLE450 (3rd term) = 1
All male genital & prostate examinations must be performed entirely under
supervision. Successful digital rectal prostate examinations are based on
competency of examination, patient communication, assessment of examination
findings and patient recommendations provided based on findings.
If the exam has not been accomplished with a patient one month prior to the
requirement due date, you will have the option of performing the exam with a
standardized model.
18
Laboratory Rotation
The total number of Urinalyses required is 10.
The total number of Venipunctures required is 10.
Urinalyses and venipunctures may be accumulated throughout CLE404/412/450,
Laboratory Shifts
Interns are scheduled for a minimum of 4 Lab DI (Duty Intern) shifts during
CLE404/412/450. The Duty Intern (DI) Schedule is posted on Moodle (On the
Clinic Forms and Resources page) as well as on the 4th Year Clinic Bulletin Board by
the File Room.
Interns are expected to attend all scheduled Lab DI shifts, regardless of whether
the minimum number of shifts and/or the Laboratory Assignment have been
completed.
and have no specific required semester totals.

Prior to attending your initial Laboratory Rotation, interns are expected to have
read and be familiar with the RSNC Lab Manual. Interns that are not prepared
for the laboratory shift will be given remedial work to complete.

Laboratory Assignment
Over the course of your Lab DI shifts, you will complete the Laboratory
Assignment with the Medical Lab Technologist. To pass the Laboratory
Assignment, you must achieve competency in all sections of the assignment
by the end of your assigned Lab shifts. If you have not passed this
assignment by that time, additional remediation shift(s) may be assigned.
19
RSNC LABORATORY MEDICINE CLINICAL ROTATION
Checklist of Competencies
Student name: _______________________________________ (please print)
Student ID #: _________________________
Date: ______________.
I have read the Health and Safety and Specimen Collection chapters in the RSNC
Laboratory Manual
_____________________________________
(Student signature)
Requirement
Lab Supervisor name (print) & signature
Can describe Universal Precautions
Can describe RSNC Needlestick Injury Protocol
Can describe OSHA regulations for spill clean-up
In order to complete and pass the RSNC Laboratory Clinical Rotation, the intern must
Achieve Competency in all sections of the checklist.
IHL ROTATION
Time
Clinical Reception name (print) &
signature
Time in
Time out
IHL
Indications
Procedure
Interpretation
Case
Management
Overall
Blood glucose
test(glucometer)
A /C
P/C
F
Blood typing
ESR
Zinc tally
Spirometry test
Nebulizer treatment
Hair analysis
A /C
A /C
A /C
A /C
A /C
A /C
P/C
P/C
P/C
P/C
P/C
P/C
F
F
F
F
F
F
Urinalysis
1
A/C : Achieved Competency
20
No
Performed dipstick proficiently Yes
Described patient instructions for 24-hour urine collection
No
Yes
P/C : Partial Competency
F: Fail
1
RSNC LABORATORY MEDICINE CLINICAL ROTATION
Checklist of Competencies (cont’d)
Described sample preparation for:
Skin scrape
Throat swab
Sputum
Vaginal swab
Yes
Yes
Yes
Yes
Completion of IHL checklist
Yes
No
Lab Supervisor signature:
No
No
No
No
(to be signed at the end of the clinical shift)
GDL ROTATION
Clinic Reception name (print) &signature
Time
Time in
Time out
GDL
CBC
Thyroid panel
Creatinine (serum)
eGFR
Zinc
Fasting glucose
Hemoglobin A1C
INR
Cholesterol panel
Ova and Parasites
(no stool collection
required only a
discussion with Clinic
Faculty)
Urea breath test
Pap Smear
Homocysteine
HIV
Microalbumin and
Creatinine ratio
Indications
Procedure
Interpretation
Case
Management
Overall
A /C
A /C
A /C
A /C
A /C
A /C
A /C
A /C
A /C
A /C
P/C
P/C
P/C
P/C
P/C
P/C
P/C
P/C
P/C
P/C
F
F
F
F
F
F
F
F
F
F
A /C
A /C
A /C
A /C
A /C
P/C
P/C
P/C
P/C
P/C
F
F
F
F
F
21
RSNC LABORATORY MEDICINE CLINICAL ROTATION
Checklist of Competencies (cont’d)
Venipuncture proficiency:
Good selection of vein
Professional manner
Correct order of removal
(Tourniquet, tube, needle)
Butterfly draw (one draw)
Completion of GDL checklist
A/C
A/C
A/C
A/C
Yes
P/C
P/C
P/C
F
F
F
P/C
F
No
Lab Supervisor signature: _____________________________________________
(To be signed at the end of the clinical shift)
RSNC Laboratory Medicine Clinical Rotation
Complete
Student signature: ___________________________________________
Laboratory Supervisor signature: _______________________________________
Date: ______________________
22
Incomplete
ACUPUNCTURE
The minimum total number of acupuncture treatments required is 35.
Acupuncture treatments may be accumulated throughout CLE404/412/450, and
have no specific required semester totals.
Once an intern has performed a minimum total of 5 acupuncture treatments, your
supervisors have the option of not being present in the treatment room for the
insertion of acupuncture needles. This is at the discretion of each individual
supervisor and requires “sign-off” by each supervisor on the appropriate form (found
in the supervisor’s shift binder).
Botanical Medicine
The total number of Botanical Prescriptions required is 20. Botanical
prescriptions may be accumulated CLE404/412/450, and have no specific
required semester totals.
A minimum of 15 (of 20) prescriptions must contain 3 or more botanical herbs
(liquid or dried) and be filled at the RSNC Dispensary (or equivalent compounding
pharmacy). A maximum of 5 (of 20) botanical prescriptions may be solid extracts,
single or 2 herb prescriptions, ready-made combinations, teas or powders (these are
identified as “other botanical prescriptions”).
Please Note: Repeats of botanical prescriptions (with the same patient) will not be
credited towards requirement numbers.
Botanical Compounding Shifts
All Interns are scheduled for a minimum of 2 “Compounding DI” (Duty Intern) shifts
during CLE404/412/450. The Duty Intern (DI) Schedule is posted on Moodle (on
the “Clinic Forms and Resources” page) as well as on the 4th Year Clinic Bulletin
Board.
Interns are expected to attend all scheduled Compounding DI shifts, regardless of
whether the minimum number of shifts have been completed.
Acute Homeopathic Prescriptions
The total number of acute homeopathic prescriptions required is 5.
These prescriptions may be accumulated throughout CLE404/412/450, and have no
specific required semester totals.
23
To be credited for an acute homeopathic prescription the prescribing intern must
demonstrate a reasonable differential list of remedies based on the signs and
symptoms presented, selected through repertorization and/or clinically appropriate
reference material. Rationalization for final prescription, potency and posology must
be presented for credit to be awarded.
Please Note: An acute homeopathic credit is not given for re-dosing an acute
prescription, with or without a change of potency.
Constitutional Homeopathic Prescriptions
The total number of constitutional homeopathic prescriptions required is 5.
These prescriptions may be accumulated throughout CLE404/412/450, and have no
specific required semester totals.
To be credited for a constitutional homeopathic prescription, the following must be
included in the patient file: Credit cannot be granted without this supporting material.
 Detailed patient intake
 Rubrics, print-out of repertorization, determination of miasm, family, series,
stage, etc. as appropriate to the case
 DDX of top remedies (3-5), with pros & cons for each
 Rationalization for final prescription, potency, and posology
Please Note: A constitutional homeopathic credit is not given for re-dosing a
constitutional prescription, with or without a change of potency, or for a previous
constitutional prescription dosed acutely.
Naturopathic Manipulations
The minimum total number of manipulations required is 18 = 6 cervical, 6
thoracic, and 6 lumbar. These adjustments may be accumulated throughout
CLE404/412/450 and have no specific required semester totals.
Constitutional Hydrotherapy
The minimum total number of Constitutional Hydrotherapy prescriptions
required is 6. One constitutional hydrotherapy treatment is considered a
“prescription”. These prescriptions may be accumulated throughout
CLE404/412/450 and have no specific required semester totals.
24
Constitutional hydrotherapy is generally prescribed as a series of treatments. A
Constitutional Hydrotherapy Patient Treatment Record should be completed for each
series of treatments and placed in the patient’s file. For more details, see the
Hydrotherapy Manual on the Moodle Clinic Forms and Resources page.
Hydrotherapy, general
The minimum total number of Hydrotherapy prescriptions required is 10.
These prescriptions may be accumulated throughout CLE04/412/450 and have no
specific required semester totals.
Examples include, but are not limited to:
Sauna
Nasal lavage
Full or partial immersion peat baths
Sitz bath
Poultices
Steam inhalations
Peat peloid pack
Warming socks
25
Consultants
1) Health Psychology Consultant, David Dennis, ND
Consults with the Health Psychology Consultant are optional, but highly
recommended. Examples of appropriate issues on which to consult include (but are
not limited to) cases with a psychological or counseling component; cases of trauma,
abuse, or addiction; cases involving psychiatric diagnosis, developmental delay,
and/or dual diagnosis, etc.
The Counseling Consult form (available on Moodle, Clinic Forms and Resources) must be
completed and brought to your appointment. The Consultant will not see you
without this completed form and the patient file.
Interns are responsible to sign up for these consults. Sign-up will be available through
the Moodle Clinic Forms and Resources page.
2) Primary Care Consultant, Dr. Michael Salsberg MD
Each student is required to complete two consults with Dr. Salsberg, MD. One
consult should focus on primary medical care questions while the second consult
should focus on the use of lab tests in the diagnosis of illness. Examples of
appropriate issues on which to consult include (but are not limited to) differential
diagnosis of symptoms, pharmaceutical side effects and interactions, conventional
treatment protocols in advanced and/or complicated disease.
The minimum total number of Primary Care consults required is 2.
This is due by the end of your third semester:
 CLE450 (3rd term) = 2
Interns are responsible to sign up for these consults by the date indicated on the sign
up schedule. Students who fail to sign up by the deadline will be placed in the
remaining available spots. Sign-up procedures will be announced through the Moodle
course shell.
3) Practice Management Consultants, Nadine Cyr ND & Erin Truscott-Brock
ND
Each student is required to complete one consult with their assigned practice
management consultant. The Practice Management Consult form (available on
Moodle, Clinic Forms and Resources) must be completed and brought to your first
appointment. The Consultant will not be able to meet with you without this
completed form.
26
The minimum total number of Practice Management consults required is 1.
This is due by the end of your second semester:
 CLE412 (2nd term) = 1
You will be scheduled for these consults by the OCE. The schedule will be posted on
Moodle (Clinic Forms and Resources).
Practice Management Portfolio
Practice Management Portfolio: CLE450
In consultation with their Practice Management Consultant, Interns will build a
portfolio of practice management and marketing techniques. This is a P/F
assignment that is a requirement for CLE450. The due date for submitting the
completed Practice Management Portfolio will be announced with the Practice
Management consult schedule. Late submissions will be deducted 10% each
day past the submission date, which will reflect on P/F grading. Full details to
be posted on Moodle (Clinic Forms and Resources).
4) Optional Consults Available

Traditional Asian Medicine/Acupuncture consults are available throughout the
year with Neemez Kassam, ND. Sign-up will be available through Moodle.

Physical Medicine consults are available throughout the year with Lowell Greib,
ND. Sign-up will be available through Moodle.
Case Management Forms (CMFs)
The minimum total number of CMFs required is 12.
These are divided per semester:
 CLE404 (1st term) = 4 CMFs (1 per supervisor, chosen by supervisor)
 CLE412 (2nd term) = 4 CMFs (1 per supervisor, chosen by supervisor)
 CLE450 (3rd term) = 4 CMFs (1 per supervisor, chosen by supervisor)
 Case Management Forms may be completed for any new patients of CCNM
Teaching Clinics with 3 or more visits. The CMF template in the Moodle
CLE404/412/450 course shell should be used.
 CMFs should be completed soon after the patient’s third visit.
27
 MYMOPs (at least 3) are a requirement of each CMF.
 CMFs must be submitted electronically to the Moodle CLE404/412/450
course dropboxes.
 Marked CMFs may be returned by the Supervisor to the intern for revision.
o An intern is allowed a maximum of 2 revisions for each CMF. If the CMF
is still not adequate after 2 revisions, it will be considered a fail and will
not be counted towards requirements.
 Any paper copies must be shredded, as no patient information may legally be
kept outside of the patient file.
 Once a CMF is passed, your supervisor enters a Pass into the Moodle
CLE404/412/450 course shell.
2013-14 Deadlines for submission of CASE MANAGEMENT FORMS



Summer Term:
o Upload CMFs to Moodle course shell for marking by: August 10, 2013
Fall Term:
o Upload CMFs to Moodle course shell for marking by: November 30, 2013
Winter Term:
o Upload CMFs to Moodle course shell for marking by: April 12, 2014
Please Note: These submission dates represent the last date for Case Management Forms to be
submitted for marking as revision may be necessary prior to a passing grade being granted. Late
submissions that are not submitted by the printed deadlines will be subject to the policy governing
late course assignments: late submissions will be deducted 10% each day after the deadline to a
maximum of 35%. A failing grade will be given to any submission that is more than 3 days late, as a
grade below 65% constitutes the threshold for failure.
28
CASE MANAGEMENT RUBRIC, 2013-14
To receive a Pass, each section of the CMF must be adequately completed
based on the rubric provided below.
SUBJECTIVE
COMPLETE
INC
COMPLETE
INC
COMPLETE
INC
COMPLETE
INC
Chief concerns – clear and concise description that includes only
the most vital information. (Additional details may be discussed in
“Clinical Impression”.)
OBJECTIVE
Physical exam – only the most relevant negative & positive
findings
Laboratory values or other diagnostic studies - only the most
relevant negative & positive findings
MYMOPs – must be performed before treatment is started and
ideally at each subsequent visit until the problem resolves.
ASSESSMENT
Clinical Impression – Well-supported hypothesis as to major
contributors & root cause of the case. Should include differential
diagnoses, including rule in/rule out criteria. All differential
diagnoses are well supported by subjective and objective findings.
Includes short & long term prognoses.
Working dx –Includes clearly stated rationale. All working
diagnoses are well supported by subjective and objective findings.
ICD-10 codes for all working diagnoses.
PLAN
Treatment Goals – Clear rationale for treatment plans. Treatment
goals supported by subjective and objective findings Short-term and
long-term goals concisely & clearly articulated.
Other Treatments & prescriptions from other healthcare
practitioners (including posology & duration)
Self-prescribed treatments - supplements, treatments, etc.
(including posology & duration)
Intern Treatments – In-office treatments. Clear & complete
treatment plan instructions, including posology and duration.
Follow–up plan including timing & plans for subsequent visits.
OTHER
COMPLETE
INC
Written style is succinct and easy to follow
Tone is neutral and professional
CMF submitted in a timely fashion (i.e. within a reasonable time after
the 3rd visit)
29
EVALUATIONS
PRIMARY INTERN COMPETENCIES EVALUATION FORMS (“PICE Forms”)
Using the Primary Intern Competencies Evaluation Form or PICE Form, Interns will be
evaluated throughout the term on 12 clinical competency areas. These competency
areas are:
1. Clinical/Medical Knowledge
2. Interviewing Skills
3. Physical Exam Skills
4. Diagnostic Acumen
5. Research Skills
6. Charting Technique
7. Patient Management & Treatment Skills
8. Communication & Collaboration Skills
9. Patient Rapport
10. Knowledge of Naturopathic Therapies and their Proper Application
11. Professionalism & Ethics
12. Practice Management
The PICE form allows for specific feedback to each intern on areas of strength,
weakness, and little/no activity.
MIDTERM PICE EVALUATION
Interns will receive a completed PICE form from each of their 4 Supervisors at the
midterm of the semester (see Midterm Evaluation dates listed below). This PICE form
will be your Midterm Evaluation and will represent a summary of all activity observed
by the supervisor up until the Midterm date. The intern will be given a numerical mark
to represent their level of achievement to date; this is a formative grade used only for
feedback.
A list of Clinic Advisor assignments is posted in the Moodle Clinic Forms and
Resources page. Interns are required to sign up for a mandatory Advisor meeting in
each term, to discuss the results of the midterm evaluations. Sign-up sheets will be
posted on the 4th Yr. Clinic Bulletin Board around the Midterm Evaluation dates.
Interns identified on the Midterm Evaluations as requiring improvement in specific
areas are advised to discuss strategies with both their Advisor and supervising
faculty to improve in these areas before the Final Semester Evaluations.
30
The Midterm Evaluation dates for 2013-2014 are:
July 6, 2013
October 26, 2013
March 1, 2014
FINAL PICE EVALUATION
Interns will receive a second completed PICE Form from each of their 4 supervisors
during the last month of the semester. This PICE Form will be your Final Semester
Evaluation and will represent a summary of all activity observed by the supervisor
from the Midterm date until the Final Semester Evaluation date. The intern will be
given a numerical mark to represent their level of achievement to date; this is a
summative grade and will be used to determine whether an intern passes the Final
Semester Evaluation.
Please keep in mind that performance expectations increase with each subsequent
semester.
The Final Semester Evaluation dates for 2013-2014 are:
August 24, 2013
December 14, 2013
April 26, 2014
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PRIMARY INTERN COMPETENCY EVALUATIONS: FLOW CHART
MIDTERM SEMESTER EVALUATION
Supervisors fill out PICE Form (ratings scales)
based on student activity from beginning of
semester until the Midterm Eval date & upload
to Moodle.
FINAL SEMESTER EVALUATION
Supervisors fill out PICE Form (ratings scales)
based on student activity from Midterm Eval
date to the Final Eval date & upload to Moodle.
See pg. 28 of Manual for due dates
See pg. 28 of Manual for due dates
OAA notifies interns to sign up for mandatory
Advisor meetings on posted sign-up sheets on
the 4th Year Clinic Bulletin Board beside the
OAA.
Supervisors are required to notify ADCE if
any student has not passed Final
Semester Evaluation.
*See Pass criteria below.
Advisors receive all 4 Supervisors’ PICE forms
for each advisee from the OAA, for discussion
during Advisor mtgs.
Advisors complete “Advisor Summary” sheet for
each advisee and upload to Moodle.
Advisors are required to notify ADCE if any
students not passing at this time.
Interns identified on the Midterm
Evaluations as requiring improvement are
advised to discuss specific strategies with
both their Advisor and supervising faculty to
improve these areas before the Final
Semester Evaluations.
32
To achieve a PASS on Final Semester Evaluation:



CLE404: an overall rating of “good performer”
must be achieved in 10 of 12 categories.
CLE412 an overall rating of “good performer”
must be achieved in 10 of 12 categories.
CLE450: an overall rating of “good performer”
must be achieved in ALL categories.
PRIMARY INTERN COMPETENCY EVALUATIONS
INTERN: ___________SUPERVISOR:____________COURSE:
____ Mid Final ADVISOR:___________
Please circle an overall rating in each category:
1 = poor; 2 = marginal performer; 3 = good performer; 4 = strong performer; 5 = exceptional
Clinical/Medical Knowledge
1
2
3
Evidence:
4
5
Evidence:
Interviewing Skills
1
2
3
4
5
Evidence:
Physical Exam Skills
1
2
3
4
5
Evidence:
Diagnostic Skills
1
2
3
4
5
Research Skills
1
2
Evidence:
3
4
5
Evidence:
Charting Technique
1
2
3
4
5
Evidence:
Therapeutic Management
1
2
3
4
5
Communication & Collaboration
1
2
3
4
Evidence:
5
Evidence:
Patient Rapport
1
2
3
4
5
Evidence:
Knowledge of Naturopathic Therapies
1
2
3
4
5
Evidence:
Professionalism & Ethics
1
2
3
4
5
Practice Management
1
2
Evidence:
3
4
5
*To achieve a PASS on a Final Semester Evaluation:
 CLE404: an overall rating of “good” must be achieved in 10 of 12 categories.
 CLE412 an overall rating of “good” must be achieved in 10 of 12 categories.
 CLE450: an overall rating of “good” must be achieved in ALL categories.
33
PRIMARY INTERN COMPETENCIES
1. Clinical/Medical Knowledge
Examples of skills in this competency area:
A.) Demonstrates an understanding of how anatomy, biochemistry and pathophysiology relate to patient
complaints, assessment and diagnosis.
B.) Well prepared for patient visits. Able to triage acute patient presentations.
C.) Identifies interactions and potential interactions between therapies.
D.) Able to assess and apply current medical information in the care of patients.
E.) Demonstrates knowledge of the contributing factors to disease and the ways in which they
impact health.
F.) Demonstrates knowledge of indications for and interpretation of results of commonly used
diagnostics. G.)Demonstrates knowledge of the most frequent clinical, laboratory, and pathologic manifestations of
common diseases.
H.) Demonstrates knowledge of the epidemiology of common diseases and the systematic approaches to
reduce incidence and prevalence of the disease.
I.) Identifies factors that place individuals at risk for disease or injury, select appropriate tests for
detecting patients at risk, and determine strategies for response.
2. Interviewing Skills
Examples of skills in this competency area:
A.) Obtains an accurate and thorough medical/case history in a timely manner.
B.) Integrates a patient’s verbal and written information. Recognizes concerns not clearly stated by
patient.
C.) Conducts focused inquiry for all age groups.
D.) Ascertains safety risk to self and others, as indicated.
E.) Documents all medical correspondence.
F.) Is thoroughly familiar with current and past treatment plans and outcomes.
34
3. Physical Exam Skills
Examples of skills in this competency area:
A.) Performs complete health exams in a timely manner, including asking supervisor to confirm findings.
B.) Performs organ system-specific and/or hypothesis-driven examinations
C.) Medical equipment in working order. Obtains vitals on a regular basis.
D.)
Able to conduct focused inquiry for all age groups.
E.) Adapts exams to individual patient circumstances and comfort.
F.) Ensures faculty supervision before performing any male or female genital or breast exams.
G.)Differentiates and accurately interprets normal and abnormal findings on physical exam.
4. Diagnostic Skills
Examples of skills in this competency area:
A) Creates reasonable differential diagnosis lists.
B) Creates plans for ruling out/in possible conditions, detailing steps necessary to arrive at working
diagnoses.
C) Recognizes patients with immediately life-threatening conditions.
D) Interprets laboratory tests, demonstrating the ability to integrate clinical and laboratory findings.
E) Able to incorporate uncertainty explicitly into clinical decision making, demonstrating the ability to
identify missing clinical information and determine when it is appropriate to act on incomplete
information.
F.) Demonstrates the ability to use information technology to locate existing data sources.
F)
Reasons deductively in solving clinical problems
5. Research Skills
Examples of skills in this competency area:
A.) Able to retrieve, manage, and utilize biomedical information for solving clinical problems and making
therapeutic decisions.
B.) Demonstrates critical assessment of the quality and validity of all information.
C.) Makes decisions based on evidence, when such is available, rather than opinion.
D.) Employs skepticism, curiosity, and humility in the face of the unknown.
35
6. Charting technique
Examples of skills in this competency area:
A.) Chart is presented in proper format, and organized properly in the file folder, according to the RSNC
charting guidelines.
B.) Consent to treatment form signed by the patient or the patient’s designated signatory prior to any treatment.
C.) Privacy Consent Form signed prior to any treatment.
D.) Chart is legible and completed in blue or black ink. Each page is dated and identified with patient name.
Accurate medical terminology in all sections of chart.
E.) Completed treatment summary for each visit, including any changes in supplements/medications and lab
results.
F.) Charting includes rationale of therapies suggested. Treatment plan reflects all suggested activities and all
ongoing treatment.
7. Therapeutic management
Examples of skills in this competency area:
A.) Understands the implications of the patient’s illness.
B.) Plans for appropriate follow-up, including referrals, diagnostic testing, bloodwork, etc.
C.) Constructs appropriate management strategies for patients with common conditions.
D.) Formulates treatment plans that reflect the relative certainties of the differential diagnosis.
E.) Monitors patient progress and appropriately modifies treatment plan to improve treatment outcomes.
F.) Formulates treatment plans that reflect the relative risks/benefits of treatment options and outcomes.
G.) Educates healthy patients about prevention of future illness (primary prevention).
H.) Educates patients with common illnesses about prevention of further illness (secondary prevention)
I.) Educates patients about their use of common naturopathic therapies and expected side effects.
36
8. Communication and Collaboration
Examples of skills in this competency area:
A.) Contributes actively to shift preview and review.
B.) Works effectively as an individual, in inter-professional groups, and as a member of the health care system.
C.) Able to orally summarize a patient’s case in a complete, coherent and concise manner.
D.) Completes referral letters, release of record forms and other necessary paperwork, in a timely fashion.
E.) Able to employ effective oral & written communication with patients, patients’ families, colleagues, and
others with whom the intern must exchange information.
9. Patient rapport
Examples of skills in this competency area:
A.) Demonstrates active listening in interviewing the patient.
B.) Demonstrates empathy with the patient.
C.) Is present and conscientious in patient care.
D.) Addresses all stated concerns of the patient.
10. Knowledge of Naturopathic Therapies & their Application
Examples of skills in this competency area:
A.) Provides well-researched rationale for patient’s therapeutic plan.
B.) Creates therapeutic plans that take into consideration the patient’s circumstance and ability to implement
the plan.
C.) Able to prepare treatment plans in acute situations within the given time constraints.
D.) Demonstrates knowledge of the safe and effective dosage ranges of naturopathic remedies.
E.) Able to discuss how the naturopathic principles are integrated into the individual patient’s treatment plan.
F.) Demonstrates the technical ability to apply modalities.
G.) Communicates accurate prognosis based on therapeutic intervention.
37
11. Professionalism and Ethics
Examples of skills in this competency area:
A.) Arrives at preview and review on time. Starts and ends patient visits on time.
B.) Communicates with all clinic staff, faculty and colleagues in a courteous and respectful manner.
C.) Does not make treatment suggestions to the patient without the prior approval of the supervisor.
D.) Shows compassionate treatment of patients, and respect for their privacy and dignity.
E.) Respects patient confidentiality, demonstrating knowledge of the legal, ethical, and medical issues
surrounding patient documentation, including confidentiality and data security.
F.) Demonstrates respect for cultural and socioeconomic diversity.
G.) Recognizes and accepts limitations in their own knowledge and clinical skills, and demonstrates a
commitment to continuously improve their knowledge and ability.
H.) Meets the professional standards of the BDDT-N.
12. Practice Management
Examples of skills in this competency area:
1. Exhibit strong planning and time management skills.
 Starts and ends scheduled appointment on time.
 Prepares for and has clear agenda for each patient visit.
 Adapts visit agenda, ensuring visit does not end abruptly.
 Meets requirements’ timelines (i.e. CMF’s, PICE’s)
2. Communicate with patients short and long-term plans, projected timelines, and follow-up
expectations.
 Schedule the follow-up(s) accordingly
 Create reasonable time-lines for management of chronic disease patients.
 Closes every appointment by confirming timing of subsequent appointment(s) and patient
understanding of prescriptions.
3. Actively support long-term case management.
4. Utilizes a variety of techniques for increasing patient base, including but not limited to public
presentations, community and/or corporate health fairs, social networking, etc.
38
EXTERNSHIP PROGRAM
Externship refers to an intern conducting a portion of their clinical education at a
site external to RSNC. The Intern is expected to engage in clinical patient interactions
in a similar manner as they would at RSNC, under the supervision of the licensed
naturopath who oversees that external clinic. Interns are expected to be given a high
level of autonomy with the Supervising ND providing guidance. The Externship may
not exceed 20% of the intern’s total graduation requirements in regards to modalities,
physical examinations and patient visits, and 10% of the intern’s total requirements in
regards to hours. This program is an optional component of the naturopathic
medicine program, and each application is subject to the approval of the Associate
Dean, Clinical Education and/or Dean.
For the 2013-14 academic year the Externship Program is offering 3 month-long
options and 3 weekly options:
Month long Externship options:
 August 2013 month long externship
 November 2013 month long externship
 February 2014 month long externship
One day per week Externship options:
 September - December 2013 weekly externship
 January - April 2014 weekly externship
 May - Aug 2014 weekly externship (only for students in CLE450 during
that time)
Applications are assessed based on the quality of the Externship site, and the host’s
ability to fulfill obligatory supervisory criteria.
DEADLINES FOR APPLICATION
Externship forms may be submitted to the Office of Clinical Education for approval by
the following deadlines:
August Month Externship: June 15, 2013
September - December Weekly Externship: June 15, 2013
November Month Externship September 15, 2013
January - April Weekly Externship: November 15, 2013
February Month Externship: November 15, 2013
39
May - August Weekly Externship: March 15, 2014
For further information, please refer to the Externship Program Package 2013-2014,
available on Moodle (Student Resources> Forms & Resources>Clinic).
CLE100, CLE201 and CLE310
You will encounter students from all other years shadowing supervisors and
observing with 4th Yr. interns at the RSNC and satellite clinics. Here is a summary of
their activity and your involvement with first, second & third year students:
CLE100:
 First year students shadow supervisors on Saturdays only, during the fall and
winter semesters.
 First year students do not shadow 4th yr. interns.
o 4th yr. interns have no activities or requirements associated with
CLE100.
CLE201:
 Second year students shadow supervisors from 2-8pm on Thursdays and
Fridays during the fall semester only.
 Second year students also shadow 4th yr. interns from 4-8pm on Wednesdays,
Thursdays and Fridays during the fall semester only.
o 4th yr. interns with shifts on Wed, Thurs and/or Friday 2-8pm will be
shadowed by 2nd yr. students, and will provide these students with
critical feedback on 15 minute physical exam and intake activities.
o If you have shifts Wed, Thurs and/or Friday 2-8pm, you may have a 2nd
yr. student with you on more than one of your shifts. However, you are
never required to have more than one observer sit in during any patient
visit.
CLE310:
 Third year students do not shadow supervisors.
 Third year students are paired with 4th yr. interns and function as secondary
interns from 2-8pm on Tuesdays, Wednesdays, Thursdays and Fridays, as well
as 8-2pm and 10-4pm on Saturdays during the winter semester only.
o 4th yr. interns with shifts at these times will be paired with a 3rd yr.
student who will participate in decision making and provision of
treatment for patients.
40
CLE310IMG:
The International Medical Graduate program at CCNM will allow these students to
observe and participate in the clinical setting through a series of graduated
observations and interactions. Students will follow a similar schedule and activity
requirement as is programmed throughout the Clinical Education Courses, CLE100,
CLE201 and CLE310.
MONTHLY RECORD KEEPING
The following original documents should be included with the Monthly Summary:






Monthly Summary Cover Page
Monthly Open Work Order
Attendance Sheet with all supervisor signatures
Secondary Clinical Contacts Record with all supervisor signatures
Timesheet for Preceptorship Hours
Seminar Hours (only applies to students who entered CCNM before
Sept. 2008)
All documents are available on Moodle (Clinic Forms and Resources). Interns are
advised to keep copies of all submitted paperwork. Originals are kept in your
student file in the OCE.
POLICY ON CONVOCATION
CCNM recognizes that Interns may want to participate in the graduation ceremonies
even if they have not have achieved all clinical requirements necessary to graduate.
At the discretion of the Dean, Interns may be permitted to participate in graduation
ceremonies provided they have achieved 65% of their total clinical requirements by
May of that year. The Dean must be satisfied that the Intern is making satisfactory
progress in achieving clinical competency and will complete all requirements before
August 31 of that year. A diploma will not be granted until the Intern meets all
requirements necessary for graduation.
41