Family Medicine

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. The curriculum will 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. The clerkship will emphasize the importance of integrity and medical knowledge in providing patients with the highest quality medical care.
4. The family medicine curriculum will promote the highest standards of professional behavior and clinical competence while preparing students for the practice of family medicine in diverse patient populations.
5. The curriculum will enhance student’s knowledge and awareness of the impact of cultural issues and family systems.

Guidelines

The family medicine curriculum will utilize the following guidelines:

1. Length:  Four to Six 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 Sakai. Students will be required to take the NBME exam.
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

A special emphasis will be placed on continuity of care, communication skills, and integration of medical care, preventive medicine and problem solving skills

Educational Objectives

The family medicine curriculum will assist students in achieving the following educational objectives

Medical Knowledge

1. Describe the normal psychosocial development of patients of all ages
2. Define the role of nutrition, exercise, life style and preventive medicine in promoting health and decreasing 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. The ability to identify and understand the principles of ethics including: i. autonomy ii. responsibilities iii. beneficence iv. nonmaleficence v. equality.

Preventative Family Medicine (FM) Assignment

Two preventative visit assignments are required for all third and fourth year students during their first Family Medicine rotation. This requirement will strengthen our health maintenance curriculum and augment students’ understanding of preventive health.

The two preventative visits can occur during any outpatient or inpatient encounter. The first preventative 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 preventative assessment and plan using the information technology software app.  A presentation of the encounter to the preceptor for instruction and feedback is required. Both preventative encounters must be documented in the Patient Encounter Log within comments.

Please see the full assignment description in Sakai under the Family Medicine syllabus.

Core Topics:

       Students are responsible for knowing the presenting signs and symptoms and management of the firecracker study topics 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

In addition, students completing this clerkship should be able to provide patient education in the areas listed below.

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

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 Sakai and complete the following assignments:

• Firecracker
• Uworld
• Communication Modules
• Ethic Modules
• AAFP website Preventative articles and the US Preventative Task Force site
•  Geriatrics

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 exams as well as Step 2. In addition, a student’s diligence in completing these assignments reflects a commitment to excellence, a component of professional behavior grade.

WEB-BASED RESOURCES

A. Recognition of the clinically relevant differences between the genders

Describe the nutritional needs of men and women.

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

B. Knowledge and application of strategies for effective learning and improvement

• http://www.ursuline.edu/stu_serv/asc/strategies.htm
• http://www.crlt.umich.edu/tstrategies/tscelc.html

C. Knowledge of development and changes across the lifespan

• http://www.nichd.nih.gov/

D. An understanding of nutrition in health and disease

• http://www.fshn.uiuc.edu/
• http://www2.swmed.edu/humannutrition/
• http://www.fcs.iastate.edu/fshn/

E. An understanding of the science and management of pain

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

F. An understanding of the concept of chronic illness.

• http://nursing.unc.edu/crci/
• http://www.pbs.org/fredfriendly/whocares/
• http://www.healingwell.com/pages/
• http://www.dartmouth.edu/dmsk/koop/resources/chronic_illness/chronic.shtml

G. An understanding of the principles of environmental medicine

• http://www.acoem.org/
• http://oem.bmjjournals.com/
• http://dmi-www.mc.duke.edu/oem/
• http://www.joem.org/

H. Comprehension of normal human sexual function and sexual  dysfunction

• http://jama.ama-assn.org/cgi/collection/womens_sexual_function (requires password)
• http://pubs.ama-assn.org/cgi/collection/mens_sexual_function (requires password)
• http://en.wikipedia.org/wiki/William_Masters_and_Virginia_Johnson

I.  Preventive Medicine Web Resources

• 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
• http://www.atpm.org/

Text books

1. Lange current Diagnosis and Treatment

Family Medicine, 2^nd Edition

South-Paul, Matheny, Lewis

2. Essentials of family medicine, 2^nd Edition

Sloan, Slatt, Curtis

Required Clinical Encounters and the Patient Encounter Log

The below list of complaints and diagnoses must be entered into your Patient Encounter Log (PEL) Program during each Core and Family Medicine Clerkship.

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

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 Skill 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.