6.0 Guidelines for Relationships in the Clinic Environment

6.1 The Intern-Patient Relationship

The following are guidelines and regulations regarding the relationship between the intern and clinic patient to which the intern must adhere.

1. All required forms and records in a case must be kept current, including a complete record of examination findings, report of findings and progress notes.
2. Discretion and respect for the confidentiality of the doctor-patient relationship must be observed at all times, both inside and outside the clinic.
3. A due regard for patient privacy must always be observed. Specifically, no patient may be used in demonstration to other interns, and no one may be brought in to observe a treatment visit or evaluation of a patient in examination unless approval has been obtained from the patient's faculty clinician and from the patient.

   Additionally, no patient will be unnecessarily disrobed. Patients will be properly draped during examination, xray, and treatment procedures. Interns wishing to enter a room must knock and wait for a reply before entering.

4. All patients are to be examined or treated in accordance with the faculty clinician-approved plan, and the patient's case record must be present and all findings recorded.
5. No intern may leave the clinic at the end of a shift until his or her case records for the day are completed and available for review.
6. Patient's records and imaging studies are not to be taken from the clinic.
7. No intern will make a house call to treat any clinic patient without a faculty clinician’s authorization. A faculty clinician must accompany an intern making a house call.
8. Patient contact for any reason, such as missed appointment, follow-up on care, etc., will be at the discretion of the faculty clinician, who must be on-site when this occurs.
9. An intern may not represent himself/herself as a Doctor of Chiropractic or licensed doctor during the internship. This includes the use of unauthorized professional cards, printed checks and letterheads, as well as verbal self-representations.
10. At the end of each shift, each intern should complete their monthly adjustment record for services rendered that day in eMedley, the NWHSU documentation software. This record is to be maintained in a current and accurate manner. The clinic staff does carry out a random monitoring of intern service reports. Deliberate misrepresentation may minimally result in a failing grade for the internship.
11. Patient records are randomly monitored for quality assurance and must be kept current and complete.

6.2 Business Card Policy

Business cards for use during clinical internship may be used by students. The following procedures must be adhered to for interns who wish to use business cards.

There are two options for generating business cards:

1. Create your own.
   1. The card may contain your name and the clinic address.
   2. You must indicate you are an intern. Using a designation indicating you are a doctor is prohibited (ex: DC, Dr., Chiropractor, etc.).
   3. No personal communication information is allowed (ex: home phone, cell phone, email, Facebook, Twitter addresses, etc.).
   4. Indicating any approach to health care is prohibited (ex: patient-centered approach, chiropractic care, nutrition, neurology, functional medicine, etc.).
   5. Use of the University or college logo is prohibited.
   6. After the final printing and prior to distributing the business cards, you must submit your business card to, and obtain approval from, Clinical Education.

      To minimize the possibility of having to reprint your business cards, you are welcome to submit a proof of the business card to Clinical Education prior to printing.

2. Use your faculty clinician’s business card
   1. Must have their permission.
   2. Write your name on the back.
   3. You must indicate you are an intern. Using a designation indicating you are a doctor is prohibited (ex: DC, Dr., Chiropractor, etc.).
   4. No personal communication information is allowed (ex: home phone, cell phone, email, Facebook, Twitter addresses, etc.).

6.3 The Intern–Clinic Faculty Relationship

Clinical internship requires a contract between a specific intern and faculty clinician. This faculty clinician needs to be physically on-site and immediately available to the intern during the internship. Alternative arrangements need to be made if the faculty clinician is not physically on- site and available to the intern. To receive credit for clinical hours and activities, the alternative arrangements must be approved by Clinical Education in advance of the primary doctor’s absence.

1. The following Doctor/Intern Contract Procedures have been formulated to provide both the faculty and the intern with clear expectations for the Clinical Internship learning experience.
   1. The doctor and intern will complete a Clinical Internship Contract (T7–9) prior to the beginning of the internship that specifies the internship starting and ending dates, the daily schedule, and the number and types of patient contacts needed by the intern to complete the program.
   2. The doctor and staff will provide a thorough orientation to the clinic that will include an overview of office procedures, personnel, practice philosophy, scheduling of hours/time-off, and the intern’s role in the clinic. (See the “Orientation” module – Week 1 Assignment in Moodle).
   3. In keeping with the Clinical Mentor model of teaching, the intern is to spend most of the 6-8 hours per week (T7), 18-21 hours per week (T8) or 21-25 hours per week (T9) at the doctor's side, learning through observation and participation in the shared care of the patient. It is appropriate for the intern to spend time with other personnel in the clinic on assigned tasks or to achieve specific learning objectives. However, the student is in the office to learn as much as they can, and are developing their perspective as a chiropractor from their mentor. The intern should not be expected to function in the capacity of a CA or other paid staff member, nor should the day-to-day function of the clinic completely depend on the presence of the intern.
   4. The doctor needs to actively incorporate the intern into their clinical patient care. There is limited educational value in passive observation. The more a doctor is able to involve the intern in the course and process of providing care to the patient, the better prepared the student will be. A good mentor will find ways to “treat and teach” simultaneously, and may do so in a way that does not undermine the quality of care or trust of the patient. Over the course of the internship, the student should expect to gain experience in the evaluation, treatment, and physical adjustment of actual patients.
   5. The doctor will provide regular, ongoing feedback and instruction to the intern through scheduled weekly supervision/case review meetings, daily “check-in” sessions, and spontaneous contact. Faculty Liaison are available to visit the site to meet with the student and doctor to process how the internship is going, to offer assistance for improving the training, and to help resolve any problems.
   6. The doctor must conduct a formal evaluation (AMCO/CEX) of the student's progress and performance at the end of the term. After reviewing this with the student the evaluation is to be submitted to Clinical Education in Examsoft/Zoho. We request that the doctor verify the types of experience the intern is having by approving the adjustment records, case managements, x-ray report forms and time logs.
   7. The doctor must be present at all times within the environment when the student is interning. The supervision of the intern’s chiropractic training must be provided by the approved, licensed Doctor of Chiropractic to whom the intern is assigned. If the faculty clinician is absent from the office for any expected or unexpected reason, follow the procedures in section 7.5.1.
2. It is the responsibility of the faculty clinician to manage care and to help the intern learn patient care skills by involving them in all phases of that care whenever possible. It is also the faculty's responsibility to determine the readiness of interns to proceed with the various phases of patient care and to assess and verify interns’ competence.
3. Learning each aspect of the office is important, and as the doctor becomes comfortable with the intern’s abilities they can be incorporated into different areas within the office. The intern should not be expected to function in the capacity of a CA or other paid staff member, nor should the day-to-day function of the clinic depend on the presence of the intern.
4. Any clinical decisions in a case are to be made by the patient's faculty clinician. It is the intern's responsibility to consult with the patient's faculty clinician regarding any and all of the following:
   1. Patient discharge
   2. Report of findings, which will normally be led by the faculty clinician with the intern participating
   3. Patient work discontinuance or return to work order or any correspondence regarding a patient's case
   4. Patient insurance or legal reports
   5. Change or cancellation of a patient appointment or change of plan for treatment frequency
   6. Decision to do laboratory testing, take xrays, give nutritional supplements, or perform any procedure or give any treatment which would involve any additional expense to the patient, or one that would constitute a deviation from an approved treatment plan
   7. Any change in treatment plan
5. The signature of the patient's faculty clinician is required on the following documents upon their completion:
   1. Treatment plan
   2. Daily progress notes
   3. Xray request forms
   4. Laboratory report forms
   5. Notes for telephone consultation
6. Any clinic or patient-related problem must be brought to the attention of the faculty clinician. Maintaining communication with the faculty clinician about problems that exist is the intern's responsibility. If satisfaction is not obtained, the intern may bring the problem to the attention of Clinical Education or, if necessary, the Clinics Administrator.

6.4 The Intern-Front Desk Staff Relationship

The general principle of the intern-front desk staff relationship must be that of mutual respect and awareness of the responsibilities and domain of each.

It is the basic duty of a front desk staff member to greet patients, answer phones, schedule appointments, file, make payment arrangements, receive payment for services, maintain a professional reception room environment, and see that the flow of patient "traffic" into treatment rooms is smooth and efficient so that patients will not be kept waiting excessively. Additional duties include record keeping, typing, and certain cleaning duties. No intern should interfere with or attempt to usurp these duties unless requested by the faculty clinician.

Interns should not occupy the lobby or detain the front desk staff with unnecessary questions or conversation, as this will interfere with the front desk staff's ability to perform their duties.

Any conflicts or problems that arise between an intern and front desk staff should be brought to the attention of the faculty clinician if not settled by the individuals involved.