Practices and perspectives on clerkship absence policies: a national survey of internal medicine clerkship directors.

PURPOSE: Within a competency-based medical education (CBME) framework, absences limit opportunities for hands-on learning, observation, and accrual of valuable experiences. Internal medicine (IM) clerkship student absences pose challenges for clerkship directors (CDs) to manage, track, and create equitable make-up opportunities. This study surveyed CDs on absence policies, management, and effect on assessment. Authors aimed to identify best practices in developing absence policies to guide CDs and support students. METHOD: An annual, multi-thematic survey of IM CDs at 140 U.S. medical schools with Liaison Committee on Medical Education accreditation was fielded from September to December 2023. One thematic section included 18 questions on understanding student absences in the clerkship. RESULTS: The survey response rate was 83.0% (116/140 schools). Among CDs, 70.7% (82/116) reported being responsible for handling absences. Eighty-one percent (94/116) reported a specific list of events/situations considered approvable absences. CDs (n = 115; one non-respondent) reported important issues to consider when developing an absence policy were meeting clerkship goals/objectives (90/115; 78.3%), creating equitable learning experiences (90/115; 78.3%), and planning make-up (73/115; 63.5%). Over half (61/115; 53.0%) identified administrative burden as another important policy consideration. Perceived barriers to creating a make-up plan included absence timing (77/116; 66.4%) and limited site capacity (76/116; 65.5%). Reported barriers to assessing students with absences included interrupted clinical experiences, fewer evaluations of students, and increased administrative burden. CONCLUSIONS: In CBME, participation in experiential learning is essential for progression from novice to proficient. Cumulative absences are educationally meaningful as they limit access to learning opportunities required for growth. This survey's results support transparent absence policies and tracking across clerkships. Simplifying approvable absences may reduce systemic bias and decrease administrative burden on IM CDs. In-person learning should be prioritized as the primary modality for make-up to regain key experiences and preserve opportunities for direct observation and assessment.