Family Medicine

1. Mission and Introduction

The clerkship in Family Medicine will:

1. Introduce students to the aspects of family medicine that are applicable to all fields of medical practice including the comprehensive and continuous care provided by family physicians to patients of all ages.
2. Enhance the students’ ability to recognize the importance of family systems and the impact of chronic illness on patients and their families. The health of individual family members, cultural issues, family systems, and their cumulative effect on health outcomes will be highlighted.
3. Emphasize the importance of integrity and medical knowledge in providing patients with the highest quality medical care.
4. Promote the highest standards of professional behavior and clinical competence while preparing students for the practice of family medicine in diverse patient populations.
5. Enhance student’s knowledge and awareness of the impact of cultural issues and family systems.

2. Guidelines

1. Length: 6 weeks.
2. Site: Hospital medical floors and Family Medicine outpatient facilities, residency programs, emergency rooms and family medicine community preceptor’s offices.
3. Before the start of the clerkship students are required to access the corresponding online family medicine course in the learning management system. Students will be required to take the NBME Clinical Subject Examination.
4. Orientation: The first day of the clerkship the student will meet with a faculty member to discuss the expectations and responsibilities of the student during the rotation. The schedule for work hours and mandatory lectures will be reviewed.
5. Schedule: Clinical faculty will work with students precepting patient visits, attending teaching rounds, and attending didactic lectures.
6. Evaluations: Each student will have a mid-rotation evaluation with feedback and an end of rotation evaluation with feedback on performance of clinical skills such as history and physical exam, communication and medical knowledge.
7. Patient Log: Students will be expected to keep an electronic log of patient encounters and be able to present these cases to clinical preceptors.
8. Two preventive visit assignments are required for all third- and fourth-year students during their first Family Medicine rotation. See section 5b below.
9. A Mid-core Examination: Students will be required to take a midcore examination on the 4th Monday of the rotation. The exam consists of 110 USMLE-style multiple-choice questions in 2 hours 45 minutes without breaks. 
10. All students must take the NBME Clinical Subject Examination in Family Medicine during the last 2 weeks of the rotation. Students must have the day off prior to the exam as well as the day of the exam
11. A special emphasis will be placed on continuity of care, communication skills, and integration of medical care, preventive medicine and problem-solving skills during this clerkship.

3. Educational Objectives

Medical Knowledge

1. Describe the normal psychosocial development of patients of all ages.
2. Define the role of nutrition, exercise, lifestyle and preventive medicine in promoting health and decreasing the risk of disease.
3. Demonstrate an approach to screen for and detect medical conditions to reduce the incidence and prevalence of disease in diverse populations.
4. Describe the role of patient education for common topics encountered in the outpatient setting.
5. Define the physiological changes that occur in the geriatric population and demonstrate the ability to develop treatment plans based on the unique aspects of geriatric patients.
6. Define the principles of end-of-life care, hospice, and palliative care.

Clinical Skills

1. Interpret evidence-based data and demonstrate the ability to utilize the information in clinical decision making.
2. Identify psychosocial issues and describe management strategies for a patient during an office visit.
3. Demonstrate the ability to perform a focused history and physical.
4. Demonstrate the ability to interpret information gained from the history and physical to develop a diagnosis and treatment plan.
5. Describe an approach to lifelong learning and identify one’s own limitations and appropriate utilization of consultation.

Professional Behavior

1. Demonstrate empathy and respect irrespective of people’s race, ethnicity, cultural background, social and economic status, sexual orientation or other unique personal characteristics.
2. Demonstrate self-accountability, dependability, responsibility, recognition of limitations and the need to seek help while continuing lifelong learning.
3. Demonstrate humility, compassion, integrity and honesty when dealing with patients, colleagues and the healthcare team.
4. Promote self-care and wellness for ourselves, our patients and colleagues.
5. Identify and understand the principles of ethics, including: i. autonomy; ii. responsibilities; iii. beneficence; iv. nonmaleficence; and v. equality.

4. Core Topics

Students are responsible for knowing the presenting signs and symptoms and management of the topics outlined in the AMBOSS study plan and the below list.

Medical Conditions

1. Abdominal pain
2. Allergic rhinitis
3. Altered mental status
4. Asthma
5. Anxiety
6. Back pain
7. Chest pain
8. Depression
9. Dermatitis (including acne)
10. Diabetes mellitus
11. Ear infection
12. Headache
13. Hypertension
14. Osteoarthritis
15. Respiratory tract infection (including bronchitis, sinusitis, pharyngitis)
16. Somatoform disorder
17. Urinary tract infection
18. Vaginitis
19. Well adult exam
20. Well child exam

Patient Education Topics

1.  Adult health maintenance
2. Hypertension, patient control
3. Asthma management                                
4. Nutrition guidelines, including
5. Diabetes mellitus, new & cholesterol and weight loss-controlled diagnosis
6. Safe sex and contraceptive choices
7. Depression
8. Smoking cessation
9. Exercise
10. Stress management

5a. Required Clinical Encounters and the Patient Encounter Log

The faculty in each specialty have identified specific clinical experiences that are a requirement for the clerkship. The PEL program is designed to track each student’s patient encounters, clinical setting in which the encounter occurs, and level of responsibility. This program allows the school to standardize the curriculum. All patient’s complaints and/or diagnosis encountered during clinical rotations must be entered into the PEL program. Entering the required clinical encounters “Must See List” is required during clinical rotations and will be displayed to the clerkship director for review on the final clerkship evaluation. Whenever possible incorporate the Communication Skills course topic for each required encounter. Never place patients’ names or any patient identifying information in this program, this would be a HIPPA violation.

If students are unable to see a required clinical encounter, they must view the virtual visit link and watch the video. Once the encounter video is viewed, add the virtual encounter in the PEL as a Virtual visit. 

The entries for the list of complaints and diagnoses below must be entered into your Patient Encounter Log (PEL) application during this clerkship. 

PEL Link: https://myapps.sgu.edu/PEL/Admin/Account/Login?ReturnUrl=%2fPEL

5b. Preventive Family Medicine Assignment

Two preventive visit assignments are required for all third- and fourth-year students during their first Family Medicine rotation. This requirement strengthens the health maintenance curriculum and augments students’ understanding of preventive health.

The two preventive visits can occur during any outpatient or inpatient encounter. The first preventive visit should occur before a student’s midcore evaluation. The second must occur before the end of the rotation. A student will conduct a focused history and physical exam and review pertinent laboratory studies. Based on this information gathering, the student will develop a preventive assessment and plan using the information technology software app. A presentation of the encounter to the preceptor for instruction and feedback is required. Both preventive encounters must be documented in the Patient Encounter Log within comments.

6. Web-based Educational Assignments for Independent Learning

The School requires the successful completion of web-based assignments in order to receive credit for this clerkship. Students should log into the learning management system and complete the following assignments:

• SGUSOM's Curriculum on AMBOSS
• UWorld
• Communication Modules
• Ethic Modules
• Geriatrics
• American Academy of Family Physicians (AAFP) website: Preventive articles and the US Preventive Task Force site

The Office of the Dean monitors student performance on these assignments. The completion of these assignments will be sent to the clerkship directors for incorporation into the final clerkship grade. The clinical faculty feels these assignments are excellent preparation for the NBME Clinical Subject Examinations as well as USMLE Step 2. In addition, a student’s diligence in completing these assignments reflects a commitment to excellence, a component of professional behavior grade.

7. Reading

Textbooks

Current editions of the following books: 

• Current Diagnosis and Treatment in Family Medicine, South-Paul, Matheny, Lewis
• Essentials of Family Medicine, Sloan, Slatt, and Curtis

Web Resources

Clinically relevant differences between the genders

• http://www.mcw.edu/gradschool/
• http://www.umassmed.edu/gsbs/
• https://www.utmb.edu/gsbs
• https://medicine.buffalo.edu

 Strategies for effective learning and improvement

• https://www.ursuline.edu/academics/academic-support-svcs

Development and changes across the lifespan

• http://www.nichd.nih.gov/

 Nutrition in health and disease

• https://fshn.illinois.edu
• https://www.utsouthwestern.edu/education/school-of-health-professions/programs/clinical-nutrition-coordinated-program/
• https://fshn.hs.iastate.edu

Science and management of pain

• http://www.aapainmanage.org/
• http://www.painmed.org/
• http://www.aspmn.org/
• http://www.ampainsoc.org/

Chronic illness

• https://nursing.unc.edu/areas-of-expertise/chronic-conditions
• http://www.pbs.org/fredfriendly/whocares/
• http://www.healingwell.com/pages/
• https://www.cdc.gov/chronic-disease/about/index.html

Principles of environmental medicine

• http://www.acoem.org/
• http://oem.bmjjournals.com/
• https://www.dukehealth.org/treatments/occupational-and-environmental-medicine
• http://www.joem.org/

Normal human sexual function and sexual dysfunction

• https://edhub.ama-assn.org/collections/46495/sexual-health
• http://en.wikipedia.org/wiki/William_Masters_and_Virginia_Johnson

Preventive Medicine

• https://epss.ahrq.gov/PDA/index.jsp
• http://www.ahcpr.gov/clinic/uspstfix.htm
• http://www.acpm.org/
• http://www.elsevier.com/locate/issn/0091-7435
• https://www.aptrweb.org/