Clinical Affiliate Agreements and Preceptor Records: Keeping CAAHEP Clinical-Site Evidence Current

If your program's clinical-site file looks like a shoebox — three signed agreements, a stack of preceptor orientation forms, and a spreadsheet you're pretty sure is two years out of date — you're not alone. For most CAAHEP-accredited programs, the clinical affiliate agreement and the preceptor records are the two documents a site-visit team opens first. They're also the two most likely to be stale, because they live in different places, get updated by different people, and don't have a single owner who checks them on a schedule.

This post covers what CAAHEP's standards require for clinical affiliate agreements and preceptor documentation, where your CoA adds expectations, and a simple annual routine to keep the file current. It's for program directors and accreditation coordinators at CAAHEP-accredited programs — respiratory care, diagnostic medical sonography, or any of the 31 professions CAAHEP covers through its 25 CoAs [1].

The Shared Standard: A Formal Agreement with Every Clinical Entity

CAAHEP's standards template is explicit. Section V.F (Agreements) requires "a formal affiliation agreement or memorandum of understanding between the program sponsor and all other entities that participate in the education of the students describing the relationship, roles, and responsibilities of the program sponsor and that entity." [2]

That's the floor. Every entity where your students do clinical work — hospital, clinic, community health center, correctional facility — needs a signed agreement on file describing the relationship, roles, and responsibilities. A handshake with the site's education coordinator doesn't count, even if the site has hosted your students for twenty years.

Clinical affiliates are also listed as a required resource. Section III.A names them as item nine in the list of resources that "must be sufficient to ensure the achievement of the program's goals and outcomes." [2] That means the annual resource assessment (more on that below) has to include your clinical sites, not just your faculty headcount and lab equipment.

The Diagnostic Medical Sonography CoA (JRC-DMS) goes further. Beyond the basic relationship/roles/responsibilities language, its guideline says the delineation of responsibilities should include "student supervision, benefits, liability and financial arrangements, if any," and that the agreement should include "a clause to protect students and to ensure due process" [3]. JRC-DMS also defines an affiliate as "an institution having adequate resources to provide a broad range of appropriate clinical education opportunities for students" and distinguishes it from a clinical education center — a department, division, or other designated part of a clinical affiliate [3]. Check that your agreement uses those terms the way your CoA does.

What Your CoA's Standards Add Beyond the Template

The template sets the floor; each CoA builds on it. Two examples show how much variation there is.

In respiratory care (JRCRC), the program director's responsibilities explicitly include "orientation/training and supervision of didactic faculty and clinical instructors/preceptors" [4]. The full-time Clinical Coordinator has five named duties, and two of them are about preceptor records: ensuring "orientation to the program's requirements of the personnel who supervise or instruct clinical students at clinical sites" and ensuring "that clinical instructors/preceptors are trained in student evaluation, including inter-rater reliability" [4]. That last phrase is a specific expectation. It means your preceptors need to be calibrated on how they score students, not just handed a rubric and told to fill it in.

In diagnostic medical sonography (JRC-DMS), the requirement is more granular about who supervises: "A clinical instructor must be identified for each clinical affiliate." That's one named instructor per site, not a pool of available staff. The instructor must hold the appropriate credential in the concentration(s) they evaluate, and the program director's own responsibilities include "ensuring the effectiveness of all clinical affiliates is maintained" — a guideline clarifies that this can be demonstrated "through overseeing, monitoring, and communicating with the Clinical Coordinator regarding student clinical rotations, the number of cases, and completion of required competencies by all students" [3].

Pull your CoA's standards, find the clinical-instruction and agreements sections, and write down every named responsibility. The template sets the floor; your CoA's document sets your ceiling.

Preceptor Records: What the Standards Expect You to Document

The standards don't use the phrase "preceptor file," but the requirements add up to one. Section III.B (Faculty/Instructional Staff) requires that for all clinical instruction, "a qualified individual(s) clearly designated by the program to provide instruction, supervision, and timely assessments of the student's progress" must be in place [2]. Section IV.A.2 requires that student evaluations "be maintained in sufficient detail to document learning progress" [2].

The Clinical Coordinator role (Attachment 2 of the template) [2] makes the documentation duties explicit. The coordinator must:

• coordinate clinical education;
• ensure documentation of the evaluation and progression of clinical performance;
• ensure orientation to the program's requirements of the personnel who supervise or instruct students at clinical sites; and
• coordinate the assignment of students to clinical sites.

In practice, that means your file for each clinical site should contain:

• The signed affiliation agreement or MOU (V.F).
• The name and credential of the designated clinical instructor or preceptor for that site (III.B; DMS III.B.6).
• Evidence of preceptor orientation to your program's requirements — a signed acknowledgment, a training log, or a calendar invite with attendance (Attachment 2, duty 3).
• For respiratory care: evidence of inter-rater reliability training (JRCRC III.B.2.a.5).
• Student evaluation records maintained in sufficient detail (IV.A.2).
• Your program's policies on assignment of clinical experiences, made known to applicants and students (V.A.2.k).

If a site-visit team asks to see the preceptor records for Site B, you should be able to produce that file in under ten minutes — not an afternoon of digging through email threads and a shared drive.

Why "Current" Is the Hard Part

The standards aren't just about having the documents; they're about keeping them current. Three requirements make this a living file, not a one-time setup.

First, the annual resource assessment. Section III.D requires the program to "at least annually, assess the appropriateness and effectiveness of the resources described in these Standards," and to develop an action plan when improvements are needed [2]. Clinical affiliates are on that resource list. If you added two new sites last year, lost one, or if a preceptor at your main hospital retired, the assessment has to reflect that.

Second, substantive change reporting. Section V.E requires the sponsor to "report substantive change(s) as described in Appendix A to [CoA] in a timely manner" [2]. Your CoA defines what counts. JRCRC's list includes curriculum changes of 10% or more of program credits, changes in the degree awarded, and changes in the sponsoring institution's organizational structure [4]. If a site change triggers a substantive-change report, the agreement file has to be updated in the same cycle.

Third, the safeguards standard. Section V.C requires that "the health and safety of patients/clients, students, faculty, and other participants" be "adequately safeguarded," that students be "readily identifiable as students," and that "students must not be substituted for staff" [2]. That's a policy question that belongs in the agreement or in a standing policy document tied to it. If your agreement was signed five years ago and your site's safety protocols have changed since, the agreement may not reflect current practice.

The common thread: personnel turn over, sites open and close, and policies evolve. The file has to track all of that, or it's a historical artifact, not a compliance document.

A Simple Annual Routine for the Clinical-Site File

You don't need a new system to keep this file current. You need a schedule and a single owner. Here's a routine that works:

1. Pick an anchor date. Tie the review to something you already do — the start of the clinical rotation cycle, the annual resource assessment, or the self-study calendar. One day, every year, the file gets opened.
2. Walk the site list. For each active clinical affiliate: is the agreement signed and unexpired? Is the designated preceptor or clinical instructor still at that site? Has anyone new been added? Is the credential current?
3. Check the preceptor records. Orientation done this cycle? Inter-rater reliability training, if your CoA requires it? Evaluation forms complete and filed?
4. Flag changes for substantive-change reporting. If a site was added, dropped, or materially changed, note it for the CoA report.
5. Update the resource assessment. Clinical affiliates are item nine on the list. The assessment should name each site and note its role.
6. Archive, don't delete. Old agreements and departed preceptor records stay in the file, marked as superseded. A reviewer may ask for the history.

Assign this to your clinical coordinator or program director. The key is that someone owns it and does it on a date, not "when things slow down."

Where MapOutcomes Fits In

MapOutcomes' CAAHEP vertical is built for this kind of multi-entity evidence. Each clinical affiliate becomes a node in the evidence map, with its agreement, designated preceptor, orientation records, and student evaluations linked to it. When the annual resource assessment rolls around, the file is already organized by site — you're reviewing, not reconstructing.

MapOutcomes keeps that evidence connected across the cycle, so the annual report and the self-study draw from the same current file rather than a folder of PDFs that may or may not match.

Where to Go Next

If you're new to the CAAHEP process, our first CAAHEP post walks through the nine steps from self-study to site visit, and the site-visit preparation guide covers what to expect on visit day. Clinical affiliate agreements and preceptor records sit in the middle of that cycle — the evidence that has to be current every year, not just in the year of the visit.

Two things to do this week:

1. Open your clinical-site file and count. How many active affiliates do you have? How many signed, unexpired agreements are in the file? If the numbers don't match, that's your first gap.
2. Find your CoA's preceptor-specific requirements. The template gives you the floor. Your CoA's standards document — JRCRC, JRC-DMS, CoAEMSP, or whichever one accredits your program — adds the specifics: inter-rater reliability training, per-site clinical instructor identification, delineation of liability. Write those down next to the template requirements so you know exactly what "current" means for your program.

Until then: one file, one owner, one date a year. The site visit will be a form, not a fire drill.

References

1. CAAHEP, "Committees on Accreditation," CAAHEP. [Online]. Available: https://www.caahep.org/program-directors/committees-on-accreditation
2. CAAHEP, "Standards and Guidelines Template for the Accreditation of Educational Programs" (approved 1/15/2021; revised 3/17/23, 7/15/26), CAAHEP. [Online]. Available: https://cdn.prod.website-files.com/5f466098a462432df91fef63/6abaa60623697b022f1632fb_StandardsTemplate_Approved1-15-21_Update7-15-26.pdf
3. CAAHEP / JRC-DMS, "Standards and Guidelines for the Accreditation of Educational Programs in Diagnostic Medical Sonography" (revised 2020), CAAHEP. [Online]. Available: https://cdn.prod.website-files.com/5f466098572bfe97f28d59df/66d868f5efaed6e08a5176ba_DMSStandardsApproved9-18-20_Update2024-09-03.pdf
4. CAAHEP / JRCRC, "Standards and Guidelines for the Accreditation of Educational Programs in Respiratory Care" (effective 2/1/2022; technical updates 10/2023, 1/2025), CAAHEP. [Online]. Available: https://cdn.prod.website-files.com/5f466098572bfe97f28d59df/67a10d55f57c59254c43ff7a_RCStandardsApproved1-20-22_update1-27-25.pdf