A clerkship rotation is a 4-8 week period of time (depending on the specialty field) in the 3rd and 4th year of medical school, during which a student gains clinical education, experience and mentorship in working with licensed physicians and other independent health care providers. The medical school will provide reading/course materials, evaluation tools and other academic support, including a 24 hour help line. The medical students will be covered by liability and health insurance. Clinical preceptors will receive faculty appointments, CME credit and honoraria for their time and expertise on a per student/per month basis.

Additional Information

I hereby certify that the information on this application and all other information that I receive otherwise provided is true and correct. I understand that any misrepresentation or omission will be sufficient cause for cancellation of this application or removal from the clinical faculty roster.

I Agree to notify the Saint Padre Pio Institute for the Relief of Suffering School of Osteopathic Medicine credentialing department of any changes to my license or employment status.
The Saint Padre Pio Institute for the Relief of Suffering, School of Osteopathic Medicine is a Catholic institution, under the Archdiocese of Kansas City in Kansas and adherent to Ex Corde Ecclesiae. As preceptor faculty, it is intended that you shall qualify as a “religious minister” under the First Amendment to the U.S. Constitution to the maximum extent of the law as contemplated by applicable Supreme Court precedent, including Hosanna-Tabor Evangelical Lutheran Church & School v. EEOC, its progeny, and state law-equivalents. As preceptor faculty, you acknowledge and accept the following:

1. You will sign and maintain a mandatum of fealty to the bioethical and other principles of the Catholic Church in all teaching and interactions with medical students. (attached/link)

2. You will not participate in the provision of care that is in contradiction to the bioethical principles of the Catholic Church, including, but not limited to: elective abortion, provision of abortifacient contraception, euthanasia and/or withholding of basic, ordinary care for the purpose of hastening death, gender reassignment or transition care, including surgery and hormonal therapy.

3. In your hospital and clinic practice, you will similarly indemnify and protect medical students in your charge from any requirement by others to provide care in contradiction to Catholic bioethical principles, as described in #2, above and that any such refusal to participate in such care shall not adversely affect the medical students’ academic evaluation, progress or participation in other patient care activities.

4. You will abide by the Code of Conduct of the Saint Padre Pio Institute for the Relief of Suffering, School of Osteopathic Medicine.

Preceptors must be able to support the mission and vision of SPPSOM and adhere to Catholic principles, as specified under “mandatum” above.

By completing this form and becoming a preceptor for the Saint Padre Pio Institute for the Relief of Suffering School of Osteopathic Medicine (proposed), you agree to complete in good faith the duties listed below:

* Provide ongoing and timely feedback regarding clinical performance, knowledge base, and critical thinking skills

* Supervise, demonstrate, teach, and observe clinical activities in order to aid in the development of clinical skills and ensure proper patient care

* Delegate to the student increasing levels of responsibility for clinical assessment and management as appropriate to the student’s experience and expertise

* Participate in the evaluation of clinical skills and medical knowledge base through direct supervision and evaluation

* Evaluate the student’s ability to write appropriate and complete progress notes, histories, physical examinations, assessments, and treatment plans

* Promptly notify the medical school of any circumstances that might diminish the overall training experience

* Maintain an ethical approach to the care of patients by serving as a role model for the student

* Complete the following required program documents:

– Updating the mandatum, licensure, insurance, and credentialing information when requested by the program

– End of Rotation Evaluation of student