Utilizing the Patient-Centred Medical Home to Increase the Quality and Years of Healthy Life

The faculty and staff of the Department of Family and Community Medicine (DF&CM) extend their greetings as you prepare for your Family Medicine Clerkship experience. Clerkship orientation is scheduled for Thursday afternoon during the first week of each clerkship. For more details, see "Conference Call". The first session is primarily orientation, but also an opportunity to address problems, concerns, or surprises regarding your clerkship. Please be aware of the location of your interactive video equipment before that first Thursday.

The subtitle for your clerkship, "Utilizing the Patient-Centered Medical Home to Increase the Quality and Years of Healthy Life", highlights several of the clerkship objectives as well as the national agenda for healthcare. This manual addresses course requirementsdirects you to evaluation forms, and contains information and material pertinent to completion of course requirements. Please review the "Course Requirements" and "Evaluation and Grade Assignment" page to understand the overall expectation of the rotation. Course goals, learning objectives, educational methods, and assessment methods are further on the "Goals" tab.

If you have not already done so, please contact your assigned preceptor immediately to confirm starting time and location and to address special needs, including housing. This might be an appropriate time to schedule a meeting between the two of you early in the first week to discuss educational goals, expectations, needs, and complete the "Learner Contract". The "student/preceptor planning session" outlines items for discussion with your preceptor during your orientation meeting. The Clinical Skills Inventory (CSI) will help you assess your educational needs and goals. Because you come to this rotation with varying prior experiences in medicine it is important that you identify your learning needs. By completing the CSI and sharing this information with your preceptor early in the clerkship you can both be alert to educational needs and opportunities. At mid-clerkship (including those of you who change your preceptor and site) please review your progress toward your identified goals, and with your preceptor identify new learning goals for the remaining time of the clerkship. As you review the CSI please note the focus on being observed and receiving feedback on your skills in completing the musculoskeletal assessment and the dermatological examination.

During "Orientation we will also discuss the use of the E*Value informatics database to record patient encounters.

For unanswered questions, concerns, or problems, call (office - 701-777-3081; cell 701-740-2540), fax (701-777-3849), or E-mail at addesses listed on the Contacts. Have a great Family Medicine experience.

Roger W. Schauer, MD, FAAFP

Plan to attend a clerkship "Orientation" via interactive video-conference call on the first Thursday afternoon of the clerkship, unless otherwise notified. Meeting time is from 1:30PM-3:30PM Central Time. Your Internet Protocol (IP)-based video system will be somewhere in your hospital or clinic, or your campus offices if you are in a campus community. We will call your IP-base site. Please have the monitor and camera switched "ON" by 1PM. For questions, about the interactive video, contact Brandon Thorvilson brandon.thorvilson@med.und.edu (701-777-3211). If you do not have access to an IP site for that session please inform us in the department and call the following number to reach the conference: 1-888-809-4012 access code 7770000.

Have your laptop up and running so you will be able to access on-line manual during the orietation session. If laptop availability is not and option please either print the manual from the web, or contact Mona Shilling mona.shilling@med.und.edu or 701-777-3081 for a hard copy.

DATES:

Rotation 5

Thursday, March 1st, 1:30PM - Orientation
Thursday, March 22nd, 1:30PM - Access to Care/High Risk Populations
Thursday, April 12th, 1:30PM - The Family Connection

Rotation 6

Thursday, April 26th, 1:30PM - Orientation
Thursday, May 17th, 1:30PM - Access to care/High Risk Populations
Thursday, June 7th, 1:30PM - The Family Connection

Course References (updated 1/3/2012)

**Essentials of Family Medicine, 6th Edition, Sloane, PD, Slatt, LM, Ebell, MH, Smith, MA, Power, D, & Viera, AJ (eds), 2012 (published May 2011), Lippincott Williams & Wilkins, Philadelphia, is the only required text for the Family Medicine clerkship. This textbook focuses on evidence-based information, features discussions about prevention, addresses some community issues, discusses physician/patient relationships, and deals with problems commonly seen in Family Medicine. References for each chapter are available at on on-line website to which you will gain access when you use your log-on code (see textbook for information). The website also provides access to practice questions that are accessible by chapter. Those are available only via password (inside front cover of the textbook). Review of these questions will help prepare you for the content and general tone of your final exam in Family Medicine.

Reading & case Assignments - Exam resource

New this year is the option to work through on-line cases. The intent is to assign patient cases of problems to stimulate review of a patient situation you may not see during your clinical time for the FM clerkship. The on-line address to register and access fmCASES is http://www.med-u.org/ More details will be available during the “FM Clerkship Orientation”. Your Family Medicine Clerkship exam will be based on assigned chapters in the Essentials... text as well as selected ‘fmCASES’.

American Family Physician is an excellent on-line resource for up-to-date information and patient friendly handouts http://www.aafp.org/online/en/home/publications/journals/afp.html

You will need to enter your own AAFP membership number. Clinical preventive services information is available at http://www.aafp.org/online/en/home/clinical/exam.html

Healthy People 2010, available at http://web.health.gov/healthypeople/. The Guide to Clinical Preventative Services, 2nd Edition and Healthy People 2010 will be particularly useful as you consider appropriate health promotion/disease prevention (HP/DP) for patients you see as well as your case presentation.

The US Preventative Services Task Force Recommendations regarding prevention and screening are found at http://www.ahrq.gov/clinic/uspstfix.htm. That site also provides Electronic Preventive Services Selector (ePSS) to download the recommendations to your PDA, BlackBerry, or iPod Touch, etc at http://epss.ahrq.gov/PDA/index.jsp

Data addressing cost-effective, life-saving preventive services, sponsored by the CDC, is accessible at http://www.prevent.org/content/view/46/96/ and could be an important resource for your “Group Topic” presentation regarding “Prevention” for week three of the clerkship. Issues addressed include “Quality-Adjusted Life Years” (QALYs), an endpoint we likely will be addressing more in the near future as we look at delivering cost-effective health care services.

Health Services Technology Assessment Text (HSTAT) at http://text.nlm.nih.gov/ will link you to evidence-based medicine sites, policy and resource sites, guidelines, and NIH research. That site will provide quick access to current recommendations regarding screening.

The goals of the eight week Family Medicine Clerkship are to integrate, expand and refine clinical skills; experience the continuity, comprehensiveness, complexity, context, and coordination of care provided by Family Physicians; develop an appreciation for the role of prevention in the delivery of healthcare; develop awareness of the impact of families and culture on health problems and patient perception and reception of healthcare (biosychosocial model); develop an awareness of your own personal strengths, interests, and limitations; and complete a research project (joint project with Community Medicine and Clinical Epidemiology).

Goals and Objectives Table

Course evaluation and final grade is based on six components, including:

50% Evaluation by preceptor (Preceptor Assesment of Student Performance form)
15% Completion of an approved and acceptable research project
10% Participation in four interactive small group presentations
10% End of clerkship exam
10% Completion of a care presentation during a faculty on-site evaluation
5% Record patient encounter data on your Personal Digital Assistant (mandatory)

Evaluation and Grade assignment
Final grades will be assigned on the basis of Honors (limited to 20% of class). Satisfactory, or Unsatisfactory. The follosing criteria will be used.

Honors(90-100%) - completion of all six requirements by due dates, plus an average equal to or greater than 90% on all six requirements.

Satisfactory (70-89%) - completion of all requirements, including a minimum of a satisfactory evaluation by the clinical preceptor and a satisfactory grade for your research project, and achieving a score equal to or above 2SD of the mean on the written exam.

Unsatisfactory if total score is less than 69%, or any of the three below:
(1) an unsatisfactory recommendation by the clinical preceptor, or
(2) an unsatisfactory grade for the research project, or
(3) an exam score greater than 2 standard deviations below the mean score for your group.

If your initial case presentation to department faculty if deemed "Unsatisfactory" you will be required to complete another case presentation before the end of the clerkship.

Remediation - Failure in any portion of the total evaluation will be remediated are follows:
(1) Preceptor Evaluation - reassignment to another preceptor, determined by the course director, for am inimum of one month;
(2) Research Project - submission of an acceptable research project,
(3) Written exam - repeat mulitiple choise exam once. A second exam failure will require repeating a one month clerkship experience with a preceptor determined by the course director, then successfully passing a written exam.

During the first week of the rotation an orientation meeting should occur between you and the preceptor to discuss the educational needs and expectations for the rotation.

Because you come to the Family Medicine Clerkship with varied medical education experiences, plus varied prior experiences in other health professions and non-medical professions, and still others directly from an undergraduate educational institution, each student will need to identify their specific strengths and learning needs. Further, your Family Medicine experiences will also vary from site to site. The "Learner Contract" is a useful tool for planning you learning for the upcoming weeks as well as a self-assessment tool.

The initial meeting between you and your precetpro should be one of information exchange, using information about your learning needs as gleaned from the Clinical Skills Inventory. Review the Learner Contract weekly to monitor your progress and change direction if indicated. At the end of week four it would benefit both you and your preceptor to review your progress, using both the Learner Contract and the "Preceptor Evaluation of Student Performance". Other points of discussion may include, but are not limited to:

1. Expectation for case presentations, patient management, responsibilities.

2. Arrangements for the student to:

• be introduced to the functional units of the loval health care system,
• meet with the various health professionals within the system,
• meet with the business and administrative personnel of the clinic,
• be appraised of local medical/educational information resources.

3. The preceptor's approach to:

• healthcare,
• interaction with the healthcare system,
• continuing education,
• community responsibilities.

4. The daily patient schedule for the clinic and hospital.

5. The on-call schedule:

• every fourth night is the accepted norm
• a limit established by various governing bodies, and approved by UNDSMHS, is no more than an average of 80 hours per week over a four or eight week clerkship.

6. Allotted time to study and complete research (allow one-half day per week).

7. Community education/presentation opportunities.

8. Set time and expectations for mid-clerkship formative evaluation.

Please identify and discuss your learning goals for the clerkship with your preceptor by the end of week one. At mid-clerkship access your progress toward your goals and identify additional goals. Discuss additional goals witht your current preceptor or your preceptor for the final four weeks of the clerkship. The final evaluation by your preceptor will address your progress towards your goals, the preceptor(s) goals, and department goals. Issues to consider include:

• Other clerkship/clinical experiences you have completed
• Your medical interests
• Your previous life experiences
• Additional skills identified on the Clinical Skills Inventory form
• Clerkship educational goals and objectives
• Clerkship evaluation methods and forms
• Roles for preceptor and student

Learner Contract

The Clinical Skills Inventory (CSI) is a tool to help students and community faculty shape a clinical experience that is satisfying to both. As students, you know what your skills are and what you are most interested in learning. This CSI is not comprehensive of everything you will learn or experience during year 03, but is intended to reflect common problems you may address during you Family Medicine Clerkship, based on our own data and recommendations from the Family Medicine Clerkship Core Content Curriculum Task Force of the Society of Teachers of Family Medicine. This list is intended to be used as a study guide, not a document of your experiences - those should be recorded in your E-Value database. Two general problem areas, musculoskeletal and dermatological** are commonly seen in Family Medicine and are therefore focus areas of learning for you.

Preceptors know the resources and limitations of their particular practices, and have ideas about what is important for students to learn. This inventory intended to facilitate a dialogue between the student and preceptor to maximize your learning experience during this rotation. Please discuss this checklist with your preceptor during the first week of the clerkship, as you address your "Learner Contract", and again at mid-clerkship to help evaluate progress and plan further learning.

1. Identify as "Focus Area" those skills you hope to improve during this clerkship. Your preceptor may also identify focus areas, both at the beginning and mid-clerkship.
2. Identify your level of experience/comfort before clerkship, mid- and end-clerkship.

For acute presentation, by the end of the clerkship students should be able to:

1. Differentiate among common etiologies that present with that symptom.
2. Recognize dangerous conditions that may present with that symptom.
3. Perform a focused history and physical examination.
4. Appreciate the importance of a cost-effective approach to the diagnostic work-up.
5. Describe the initial management of common and dangerous diagnoses that present with the symptom.

For chronic diseases, by the end of the clerkship students should be able to:

1. Find and apply diagnostic criteria.
2. Find and apply surveillance strategies.
3. Elicit a focused history that includes information about adherence, self-management, and barriers to care.
4. Perform a focused physical examination that includes identification of complications.
5. Assess improvement or progression of the chronic disease.
6. Describe majot treatment modalities.
7. Propose an evidence-based management plan that includes pharmacologic and nonpharmacologic treatments, and appropriate surveillance and tertiary prevention.
8. Communicate appropriately with other health professionals (eg. physical therapists, nutritionists, counselors).
9. Document a chronic care visit.
10. Communicate respecrfully with patients who do not fully adhere to their treatment plan.
11. Educate a patient about an aspect of his/her disease respectfully, using language that the patient understands.

Clinical Skills Inventory Checklist 

During the faculty visit you will be expected to present a patient in whose care your participated during your Family Medicine Clerkship. If possible, select a patient with whom you have had more than one encounter, be that for in-patient, ambulatory care, home visits, or all of the previous. Unusual or rare diagnoses are not the focus of this presentation rather we are lookin for your understanding fo the entire patient and their system. The presentation should be concise but include significant facets of a medical history, physical findings, treatment, and follow-up. Specifics of expectation during the presentation and subsequent discussion are noted below. Where appropriate, a portion of the presentaiton should address issues raised in context of the family. Be prepared to respond to questions regarding some of these issues if they are not addressed during your oral presentation.

1. Data Collection and Problem Solving ___/25 points

• pertinent information related to HPI
• pertinent past medical history
• pertinent positive and negative physical findings
• orderly progression of material
• problem identificaation/prioritization
• assessment & differential diagnosis supported with data
• appropriate plan for problem(s)

2. Health Promotion/Disease Prevention ___/5 points

• age & gender specific primary prevention
• age & gender specific secondary prevention
• efficacy (sensitivity/specificity/PPV, etc) of prevention activity

3. Impact of Family and Culture ___/5 points
(should include any appropriate for this patient)

• family structure and function
• life sysle issues
• impact of culture
• family/community resources
• coping mechanisms
• complementary/alternative efforts

4. Scope of Practices (where appropriate) ___/5 points

• short and long term course of problem
• assessment of resources
• consultant/referral
• patient education
• doctor/patient relationship
• physician role on team
• financial issues (may include charges/insurance/etc)

5. Learning Issues ___/5 points

• problem focused
• learning resources
• ethical issues

6. Flow, delivery of Presentation ___/5 points

TOTAL ___/50 points 

1st Session - Week 1 - Orientation
The first session, an IP-based conference call, generally occurs the first week of the clerkship and is focused on clerkship expectations and the future small group meetings. If IP-based conferencing is unavailable in your area, you will need to call 1-888-809-4012 access code 7770000#. Objectives of the first conference call are to identify problems, concerns, surprises, review course requirements, review faculty site visit, discuss examinations, and discuss group topics presentations for suture conference calls.

For subsequent sessions (Group Topics) each student will have five to eight (5-8) minutes, including discussion time, to present a topic. Provide only pertinent details, but be prepared to expand the discussion depending on questions.

2nd Session - Week 4 of clerkship
For this session each of you will discuss, in 5-8 minutes, an aspect of health care important in the community in which you are completing your Family Medicine Clerkship. The focus may be a health care isue affecting an underserved population(s) in that community, or high risk groups in your preceptor's community. The general focus of your presentation should be on the community resources (present, or needed - but absent), but the introducation could well be in context of the patient(s) you see in the clinic or hospital. The issue may have caught your attention because of a single patient encounter, or a general observation or discussion with your preceptor(s). Your presentation should be framed in terms of general learning for yourself and your colleagues, and not as an assessment of the community of interest, attempt to avoid specific identification of patients (HIPAA rules) during your presentation. Issues or questions you might address include: 

• What segment of that population is underserved or otherwise high risk?
• What social and/or cultural issues in your community affect and effect healthcare?
• What community resources are available for specific patient problems or illnesses?
• What occupational or environmental health risks are prevalent in the community?

3rd Session - week 7 of clerkship
As you prepare for this presentation first read a brief editorial "Family Oriented Medical care", by MC Newman and JJ Lawless in the Am Fam Physician.2007 May 1;75(9):1306-1310 (the editorial should be directly available at http://www.aafp.org/afp/2007/0501/p1306.html). I will suggest that the authors did not address another important element in our relationships with our patients and their families - namely, what we bring to the encounter. Each of us brings our own past and past experiences into out encounters with patients and their families, whether or not we are aware of our own learning from our experiences. Consciously or unconsciously, our own values - our own belief systems, may have an effect on our relationships with the patient and their family or families.

The focus of this "Family Connection" presentation might be a patient and their family or it might be about your own reaction to the patient and/or their family. Thinking about the family Connection provides an opportunity to explore, with the patient, the meaning of their illness for themselves and their family, rather than limiting the discussion to the allopathic medicine understanding of the disease. Thinking about and understanding the family connection may help health care providers:

• ...understand how differences in culture can be a barrier or an asset to providing primary care, (i.e., the impact of cultural/family healthcare beliefs on health care seeking and adherence behavior, as well as the impact of different beliefs of the healthcare provider).
• ...identify alternative techniques for data collection and procesing when the patient's culture differs from yours.
• ...understand when and how to perform a family assessment.
• ...match community resources with patient and family needs.
• ...integrate findings from assessment of the family into patient management.
• ...incorporate family issues into patient education.
• ...appreciapte the influence of person upbringing and lifestyle on how the medical student or physician views disease, patients, and patient families.

The following provides "rules", terms, or definitions that may help define the family/patient dynamics - The Family Connection . This document is a compilation of thoughts I and others have observed regarding how individuals and families interact. A genogram or family map may aid your discussion about interactional pattern in the patient's system, and how those patterns will affect and effect ultimate health outcomes. As you collect and consider patient-centered information, consider issues like family rules (expressed or enexpressed), interdependence, boundaries, and triangulation, and how those issues impact the patient's health and health seeking behaviors.

One additional potential resource is "Essentials of Family Medicine", 5th edition, eds Sloane, et al. The material covered in chapter 2 of the 5th edition, "The Challenging Patient Encounter", is regrettably absent in this updated edition. Current 4th year students might still have an available copy of the 5th edition. 

The Family Connection

The E-Value database is designed to assist your documentation of your patient encounters, both for diagnoses and for proocedures. The purpose of the database is twofold:

1. To collect accurate information on student clinical experience thus promoting better evaluation of the curriculum, and regarding student clinical experience.

2. To act as a clinical tool for the student=s own use and future reference.

Clinical encounters that lead to learning should be entered into the database. Sufficient time should be allowed between patients to permit this. Entries that are extremely useful for the "Problem" database for the DF&CM include "Age, Gender, Problem List, Involvement, Setting, and Attending Faculty". Because the practice of your preceptor might not include your base Campus, discipline of Family Medicine, and the Date & Time. For the "Procedure" entries include "Procedure List" in place of "Problem List". Only by logging all pertinent material can the full scope of the student=s experience be evaluated. Providing this data allows the Department to respond to the rare instance where the clerkship site lacks the necessary scope of practice or where the student=s role needs to be addressed.

Scheduling time for necessary housekeeping, including accessing needed resources and data collection during patient care, is simply a good habit that is acquired by practice and will be respected by your preceptor. Hot synch frequently - preferably at least weekly. Check remaining battery power frequently. If batteries discharge, your data will be lost. If you do not submit electronic data you will be required to submit paper documentation of the scope of your experience.

The Health Insurance Portability and Accountability Act (HIPAA) is directing the implementation of specific requirements to protect privacy of individuals. The Privacy Rule generally requires covered entities to take reasonable steps to limit the use or disclosure of, and requests for, protected health information (PHI) to the minimum necessary to accomplish the intended purpose. For example, because the "old" elderly might be more easily identified by problem and age in this population. "Patient Age" for those over 90 years old should simply be entered as "90". You have already successfully completed the HIPSS orientation exam. If you have additional questions or need clarification aboutHIPAA issues that are not adequately addressed at http://www.ncvha.hhs.gov./ , please contact DF&CM faculty.

Musculoskeletal Examination

http://at.uwa.edu/CurrHome/AH323/skillsshoulder.asp

Dermatology

www.logicalimages.com/resourcesDerm.htm

http://www.logicalimages.com/educationalTools/learnDerm.htm

Dermis

http://www.dermis.net/dermisroot/en/home/index.htm

The Electronic Textbook of dermatology

http://telemedicine.org/stamfor1.htm

Procedures

http://www.nejm.org/multimedia/videosinclinicalmedicine

Eric L. Johnson, MD

Podcasts: www.med.und.edu/familymedicine/slidedecks/

Faculty:

Roger Schauer, MD
roger.schauer@med.und.edu
701-777-3081

James R. Beal, PhD. Director, Research & Program Development
james.beal@med.und.edu

Robert W. Beattie, MD, Chairman, Department of Family & Community Medicine
robert.beattie@med.und.edu

Staff:

Mona Shilling
mona.shilling@med.und.edu
701-777-3214

Brandon Thorvilson, Videoconferencing
brandon.thorvilson@med.und.edu
701-777-3211

Library of Health Sciences
Sandi Bates
sandi.bates@med.und.edu
701-777-2166

Utilizing the Patient-Centered Medical Home to Increase the Quality and Years of Health Life

Preceptor Overview of FM Clerkship Requirements & Changes

Thank you for hosting and teaching out Family Medicine (FM) clerks for the 2011-12 term.

Changes for the 2011-12 term include an updated textbook and access to on-line case studies for the FM clerks. The on-line cases (fmCASES) were developed by FM faculty from across the country, with the intent of providing supplementary learning opportunities for clerkship students spending clerkship time with a preceptor whose scope of practice is more limited. The required textbook is the revised and updated 6th edition of “Essentials of Family Medicine” by Sloane, Slatt, Ebell, Smith, Power, and Viera (copyright 2012, published May 2011 by Wolters-Kluwer Health, Lippincott Williams & Wilkens). The clerkship exam will be based on assigned readings in the textbook and selected cases.

As noted last year, the Medical Curriculum Committee approved the recommendation of the Clinical Education Committee that students be provided the option to spend up to two ½ day sessions with other specialists during each clerkship, pending approval of the clerkship director. The recommended specialties for FM are Sports Medicine and Geriatrics. Making those arrangements is up to the students, but you should be aware that the administrative decision has been approved. At most of the rural facilities students may be able to arrange experiences with sports medicine or orthopedic physicians who may regularly visit that community for consultation. Or, if you or one of your colleagues provides sports medicine services for your local high school, consider involving your student. Many of you likely either have a large geriatric practice yourselves, or work with a colleague whose focus is on geriatric care.

We ask that you and your student review the “Learner Contract” early in the first week of the clerkship, either during their ‘Orientation’ to your practice, or soon thereafter. That review should again occur by mid-rotation, to assess student progress in both their learning expectations and your teaching goals. Another valuable discussion item is the ‘Preceptor Assessment of Student Performance’, found at http://www.med.und.nodak.edu/familymedicine/clerkship/.

The “Core Curriculum” endorsed by the Society of Teachers of Family Medicine, American Academy of Family Physicians, and other Councils of Academic Family Medicine Organizations is reflected in the "Clinical Skills Inventory" (CSI). Your scope of practice may be different compared to other preceptors, so a discussion about what the student can expect to learn from your practice should occur early in the clerkship. The CSI can be a useful resource for this discussion. The student should have already defined their past experiences and learning expectations in the “Learner Contract”. A focus area for FM students is to gain substantial experience in evaluating musculoskeletal problems and dermatological problems, and that they document that they have been observed completing both the musculoskeletal and dermatological examination. This focus does not minimize the need for students to be observed completing other parts of the evaluation of the total patient, although various clinical departments have mandates for documenting observation of other parts of the exam. For a number of years UNDSMHS has required that all medical students spend at least four weeks at a rural facility. Most students complete this requirement during their FM clerkship, which to some extent impacts continuity-of-care opportunities for those students. Others meet that requirement with a rural 4th year elective.

Preparation for their “Group Topic” presentations is more of a challenge for students with split clerkships. These meetings occur during the 3rd, 5th, and 7th week of the clerkship. For students in split rotations only the first presentation, addressing “Prevention” will be completed during those first four weeks. The second presentation, addressing an “At Risk Population/Access to Care” issue will be during the first week at their second FM site, so students are generally better served if they define their “at-risk population” based on their first clinic assignment. The final presentation, which addresses a family dynamic issue for “The Family Connection”, could focus on a patient problem or family issue identified by either preceptor. You are invited to observe or participate in any and all “Group Topic” sessions during these interactive video conferences.

Feedback to students is an important part of their learning. You do that on a daily basis when students present patient evaluations and proposed plans, whether you agree with the student or teach them alternative or correct options or approaches. The “Preceptor Assessment of Student Performance” is an important tool for evaluation but also for providing feedback about progress. Students want and need formative feedback about their learning and progress, so provide that teaching with the on-the-spot patient-care discussions throughout the clerkship.

You should have received a letter from the Office of Academic Affairs defining benefits available to you to both assist and recognize your teaching and mentoring efforts. If you would like to learn more about how to access some of the electronic benefits, like e-mail, electronic databases, and full text journal articles I encourage you to ask your medical student for assistance. Alternatively, below you will find the e-mail address and telephone number of resource people in the Harley E French Library of Health Sciences.

Finally, I will make arrangements to meet with you and your student during the clerkship, to review student progress and any concerns. If there are concerns or problems prior to that visit, please contact me.

Thank you for your time and energy commitment to teach Family Medicine to our students.

Roger W. Schauer, MD, FAAFP

Faculty

Roger W. Schauer, M.D., FAAFP, Course Director:
roger.schauer@med.und.edu
(office - 701-777-3081, cell 701-740-2540)

James R. Beal, Ph.D., Director, Research & Program Development:
james.beal@med.und.edu
(701-777-3272)

Robert W. Beattie, MD, Chairman, Department of Family Medicine:
robert.beattie@med.und.edu

Staff

Mona Shilling, Administrative Secretary: mona.shilling@med.und.edu
(701-777-3214)

Brandon Thorvilson, Coordinator, Computer Services: brandon.thorvilson@med.und.edu
(701-777-3211)

Library of Health Sciences

Sandi Bates, MLIS, sandi.bates@med.und.edu
(701-777-2166)

The participation of medical students in third and fourth year clerkships and electives involves two important responsibilities that at times may make conflicting demands on the students' time. These two responsibilities are:
1. The development of the student's clinical skills and professional attributes.
2. Student contribution to medical teams and care of patients.

In balancing these two potentially competing needs, it is recognized that the third and fourth year clerkships must also provvide students with adequate time for individual study, sleep, and relaxation. Accordingly, the following policies set forth the maximum acceptable amount of time that clerkships and electives may require of students.

Duty Hour Policy
1. Duty hours are defined as all required educational activities in clerkships and electives during the third and fourth years of the medical school curriculum, including inpatient and outpatient care, administrative activities related to patient care (charting, discharge planning, transfer planning, etc.), and scheduled educational activities such as conferences, rounds, lectures, etc. Duty hours do not include reading and prepatation time spent away from the duty site.
2. Duty hours shall not exceed 80 hours per week. These 80 hours include in-house (but not out-of-house) call activities.
3. Students shall be provided with one 24 hour period off each week, free from all educational and clinical responsibilities. School holicays that occur during a rotation may be included as days off for the time period during which they fall.
4. Adequate time for rest and recreational activities shall be provided. This will include a minimum 10 hour time period free of student responsibilities between all daily duty periods and after in-house call.
5. In-house call shall not occur more frequently than every third night, averaged over a rotation (four or eight week period).
6. Duty hours in the hospital or clinic setting shall not exceed 30 consecutive hours, including hours spent sleeping while on call if less than four hours.
7. Students shall not be expected to use duty hours on tasks that are not directly related to learning activities (e.g., performing personal favors or services for other medical personnel), nor should they be expected to do tasks unrelated to their learning activities (such as covering for residents who must leave due to work hour restrictions).
8. Clerkship directors and elective preceptors may promulgate duty hour restriction that are more (but not less) stringent than those outlined herein.

Responsibility

The primary responsibility for monitoring and enforcing these duty hour policies rests with the clerkships directors and elective preceptors. The clerkship director and elective preceptor are responsible for forwarding details regarding any perceived or actual problem with the implementation with this policy to the Clinical Education Committee and the appropriate departmental chair.