319 Chapter 9: Directing a Clerkship Over Geographically Separated Sites Paul A. Hemmer, MD and Nancy Schindler, MD, Lead Authors Mary C. Ciotti, MD, Co-Author Introduction More than two decades ago, Irby 1 summarized the key features needed to run a clinical clerkship with geographically separated sites: "…a cohesive multi-site clinical clerkship is made possible by a core curriculum which includes a comprehensive evaluation system, faculty development activities, and administrative support." We hope this chapter helps illuminate these features. It is common for medical schools to use geographically separate sites to accomplish their educational mission. In some cases, this may mean sites across a city or state and in other cases it may mean clerkships in different states or separated by many miles. Separate sites can offer many advantages to faculty and students, including diversity of patients and practice settings, exposure to a wider scope of medical conditions, and a broader spectrum of faculty. However, maintaining comparable educational experiences and equitable, consistent evaluation for students at separate sites is a challenge. Separate sites may mean different sites within a single city or separated by hundreds (or thousands) of miles. However, many of the separate site challenges, such as maintaining consistency, also apply to different services within the same hospital! Some of these challenges are addressed in this chapter, with suggestions and potential solutions. Which solutions will work best may vary depending on the unique situation, including the structural organization of the geographic sites, the proximity of sites, the roles of the individual site directors, the allocation of resources from the medical school, and the student body. The authors hope to set forth some ideas and suggestions to help the clerkship director of a geographically diverse clerkship to address the challenges before him or her. We will begin with a review of Liaison Committee for Medical Education (LCME) standards specifically addressing geographically separate sites, then address issues of administration including selecting sites, administrative structure, and issues of curriculum. Finally, we will discuss issues of evaluation and feedback and suggestions for improving communication among sites. LCME Standards The LCME standards for accreditation of medical schools address five areas: Institutional Setting (IS), Educational Program for the MD degree (ED), Medical Students (MS), Faculty (FA), and Educational Resources (ER). 2 A number of these standards specifically relate to geographically separated sites (Table 1). Each clerkship should be in full compliance with these standards, and clerkship directors considering geographically separate sites must develop, implement, and evaluate sites with the LCME standards in mind. Perhaps the most important standards for the clerkship director that specifically relate to geographically separate sites are ED-8 and ED-41. ED-8 requires that clerkship sites must offer comparable (but not identical) educational experiences and that evaluation methods should be