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Family Medicine Clerkship
Orientation Presentation (4/21/17)
Overview of Syllabus (updated 6/22/2017)
Utilizing the Patient-Centered 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 the first Tuesday afternoon of Rotation 1, but subsequently most 'orientation' sessions will be on the first Tuesday of each rotation. For more details, see "Conference Call". The first session is an opportunity to address problems, concerns, or surprises regarding the student experience, but also to review the requirements and resources for the clerkship. Please be aware of the location of the interactive video equipment for your site before that first session. Those of you in the four campus communities will need to connect with campus administrative officers to get to the correct room. During the FM clerkship you will also complete presentations to your clerkship group on two other occasions - generally Tuesday afternoons of the 4th and 6th weeks of the rotation. If you have difficulty accessing the syllabus, please request a paper copy by contacting the department (addresses on "Contact Info" page). This syllabus, including hotlinks to resources, is available on-line at http://www.med.und.edu/family-medicine/clerkship/.
Because technical problems/complications can arise and we (IT) may need to connect with individuals, please provide your mobile phone number to Mona Shilling email@example.com. We will also request these numbers during orientation.
Please review the syllabus to understand the course requirements and grading structure as well as the overall expectations of the rotation. Course goals, learning objectives, educational methods, and assessment methods are further clarified on the "Goals" pages. Hypertext links to mandatory "Clerkship" and "Preceptor" evaluation forms, as well as some course resources are on-line at the above sites.
If you have not already done so, please contact your assigned preceptor 7 to 10 days before start date, to confirm starting time and location and to address special needs, including housing. This might be an appropriate time to schedule a meeting between to 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 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 reaming 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. This year, required learning objectives are identified. You will need to complete a checklist, verifying these have been encountered.
For unanswered questions, concerns, or problems, call office -(701-777-3200), fax (701-777-3849), or E-mail at addresses listed on the "Contacts" page. Have a great Family Medicine experience!
Bryan Delage, MD, FAAFP Kamille Sherman, MD, FAAFP
Conference Call (updated 6/22/2017)
Plan to attend a clerkship "Orientation" via interactive video-conference call on the first Tuesday afternoon of the clerkship, unless otherwise notified. Meeting time is from 1:30PM-3:30PM Central Time/12:30-2:30PM Mountain 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(CST)/12PM(MST). For questions, about the interactive video, contact Brandon Thorvilson firstname.lastname@example.org (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 orientation session. If laptop availability is not an option please either print the manual from the web, or contact Mona Shilling email@example.com or 701-777-3214 for a hard copy of the manual.
Dates for the meetings for each Rotation are listed on the web page and will be given during orientation.
Course References (updated 6/22/2017)
On-line <fmCASES> are available to stimulate review of patient problems/situations generally seen in Family Medicine clinics. During your clinical time for the FM clerkship you may not see all those problems, but many of those issues might be tested in the NBME Family Medicine subject exam. 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".
An additional resource and focus will be oral health. "Smiles for Life" is an on-line comprehensive oral health curriculum. At a minimum complete Course 1 and Course 7, which can be found at http://www.smilesforlifeoralhealth.org/default.aspx?tut=555&pagekey=62948&s1=1826740
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.
Healthy People 2020, available at http://web.health.gov/healthypeople/ The Guide to Clinical Preventative Services, 2nd Edition and Health People 2020 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.
We no longer require a textbook, as those quickly out date. However, a good general reference for Family Medicine is 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. 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). There is also a free pdf Essentials of Family Medicine available online.
Goals and Objectives (updated 6/22/2017)
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 (patient-Centered Medical Home); 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); and develop an awareness of your own personal strengths, interests, and limitations.
Reading & FM Case Assignments (6/22/2017)
Course Requirements for Family Medicine Clerkship (updated 6/22/2017)
Course evaluation and final grade is based on five components, including:
50% Evaluation by preceptor ("Preceptor Assessment of Student Performance" form)
30% End of clerkship NBME multiple choice exam
10% Completion of a case presentation during a faculty on-site evaluation
8% Participation in orientation and two interactive small group presentations
2% Professionalism and timely attention to detail, including recording patient encounters
into the database and contacting your sites to arrange your start time instructions.
Evaluation and Grade assignment
Final grades will be assigned on the basis of Honors (limited to 20% of class). Satisfactory, or Unsatisfactory. The following criteria will be used.
Honors(92.50-100%) - completion of all clerkship requirements by due dates, plus an average equal to or greater than 93% on all requirements. Score on NBME exam must be above the average score for your cohort of UNDSMHS students on the rotation at the same time.
Satisfactory (70-92.49%) - Based on past score data, the passing score on the NBME is currently set at 61 or as determined in Rotation 1 for Family Medicine. This is approximately the 10th percentile, nationally. UNDSMHS is moving to a computerized testing version this year, which may require adjusting the number of 61. This should be small change of just one or two points. We will set the number for the entire class after receiving the scores from those on the first rotation of this academic year. As the year progresses, the passing score set for the cohort, which will be applied to the rest of the class for the academic year, will be explained to the rest of the class during orientation.
Unsatisfactory if total score is less than 70%, or either of the two below:
(1) an unsatisfactory recommendation by the clinical preceptor, or
(2) an exam score less than 61on the NBME.
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 as follows:
(1) Preceptor Evaluation - reassignment to another preceptor, determined by the course director, for a minimum of one month;
(2) Written exam - repeat MCQ NBME exam once, at the holiday break for those in the first three rotations or after the Clinical Skills exam in med June following rotations 4-6. 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.
Student/Preceptor Planning Meeting -Learner Contract (updated 6/22/2017)
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" at 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 preceptor 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 two (if on a four week rotation) or, at least by week four (if at a site for eight weeks) it would benefit both you and your preceptor to review your progress, using both the Learner Contract and the mid-clerkship evaluation form. 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 local 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:
- 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 (preceptor may choose to allow up to one-half day per week).
7. If possible, arrange for up to two half days per rotation to spend time with a consultant or visiting physician to focus on dermatologic or musculoskeletal assessment and management.
8. Community education/presentation opportunities.
9. Set time and expectations for mid-clerkship formative evaluation.
Learner Contract (updated 6/22/2017)
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 with 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 (updated 6/22/2017)
Clinical Skills (updated 6/22/2017)
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. "Oral Health" is a new national agenda item, so please address this as well.
Preceptors know the resources and limitations of their particular practices, and have ideas about what is important for students to learn. This inventory is 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, at the beginning and mid-clerkship.
2. Identify you 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 major 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 respectfully 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.
We now require that students use a checklist to document "required clinical experiences." This should be reviewed before you start the clerkship, then weekly thereafter. If, by week six of the clerkship, you have not seen required experiences, begin completing the missing cases on fmCases and LOG THEM INTO E-VALUE by the end of the clerkship. This will also be explained during orientation. Dr. Delage and Dr. Sherman will review your checklists at site visits and audits in "E-Value" will also be done, regarding required clinical experiences. While there are mechanisms in E-Value to review the required clinical experiences, please PRINT, mark and date the level of participation for these - participated/observed/alternate method such as online case or article read. Share at site visits with Dr. Delage and Dr. Sherman. If initially a required clinical experience is completed by observation, but you participate in that required clinical experience later, please update your required clinical experiences list to "participated" and note the date.
Required Clinical Experiences(updated 6/28/2016)
The below attachment is a list of the required clinical experiences expected to be had by students in the Family Medicine Clerkship. With the number of clinical sites that the Family Medicine Clerkship is taught at; by volunteer faculty with variations in Practice maturity and patient mix; every experience may not be available for participation. If a certain experience is not available by the 5th week of the rotation or unlikely given the patient mix, then the remedial case should be finished and documented in E-Value or other databases for that encounter. Please see the list at the end; for this remediation of required clinical experiences. There will be overlap and complimentary experiences in other Clerkships; and where applicable, these were not repeated here but may will be performed on the Family Medicine Clerkships. The Core Competencies assigned for Family Medicine include Dermatologic and Musculoskeletal Exams and disease processes; and Health Promotion and Disease Prevention. Awareness and applications of standards for addressing health promotion and disease prevention, as well as management of acute and chronic disease processes, is part of this clerkship experience. This is a Clinic based Clerkship with opportunity for inpatient and ER at some location. The setting may at times be "outpatient only."
Case Presentations to Faculty Member (updated 6/22/2017)
During the faculty visit you will be expected to present a patient in whose care you 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 looking for your understanding of 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 presentation 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 identification/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
- evidence based medicine (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 cycle issues
- impact of culture
- family/community resources
- coping mechanisms
- complementary/alternative efforts
4. Scope of Practice (where appropriate) ___/5 points
- short and long term course of problem
- assessment of resources
- 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
Group Topics: Social Determinants of Health(updated 6/22/2017)
Professor Rounds: For professor rounds in Family Medicine, you will be assigned to present a case with your topic used in the video conferencing. Plan to present in SOAP note fashion, as you would to your attending physician. Dr. Sherman and Dr. Delage will provide you with formative feedback, utilizing the OPCRS form designed to give formative feedback on your presentation. This activity does not affect your grade.
1st Session - Week 1 - Orientation
The orientation, 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, or if you cannot utilize 'Skype', contact Brandon Thorvilson at 701.777.3211 for instructions or email Brandon at firstname.lastname@example.org. 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 future conference calls.
Group Topics: Social Determinants of Health:
As with the orientation, these will be video conferences that will be using the Video network at your facility and you will need to be at your video connection and ready at 1:00PM for a 1:30PM start time. For the Group Topics we will have you explore the Social Determinants of Health. Our health is impacted by our access and availability of care. The social structure, as well as out culture and family dynamics, impact our perception and reception of healthcare.
For your Group Topics; each student will have five (5) minutes, to present a topic. This will be followed by discussion for 3 to 5 minutes. Points will be deducted if presentation time exceeds 7 minutes. Provide only pertinent details, but be prepared to expand the discussion depending on questions. If you are presenting for "Professor Rounds", more time is allowed. Your case will be presented before focusing on the "social determinant of health" topic.
1st Session - Week 4 of Clerkship - Access to Care and cultural competence
For this session each of you will discuss, in 5 minutes, an aspect of health care important in the community in which you are completing your Family Medicine Clerkship. This will be followed by 3 to 5 minutes of discussion. The focus may be a health care issue affecting an underserved population(s) in that community, or high risk groups in your preceptor's community. One resource you might fine useful is the "Community Health Needs Assessment" for the hospital in your community. These should be available on the internet (requirement of the Affordable Care Act), but you may need to connect with someone in the administrative office of your hospital.
The general focus of your presentation should be on the community resources (present, or needed - but absent), but the introduction 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, the practice, or individual patients. Because we will know your 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?
2nd Session - Week 6 of clerkship - Family Connection and Healthcare Disparities
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). Note that 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 our 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. Identify a "stressor" to find your topic. 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:The Family Connection
Clinical Encounters Database aka "E-Value" (updated 6/28/2016)
The database is designed to assist your documentation of your patient encounters, both for diagnoses and for procedures. The purpose of the database is twofold:
1. To collect accurate information on student clinical experience thus promoting better evaluation of the curriculum, and
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 the general broad scope, some on-line "fmCASES" may appropriately be documented as "on-line". Default entries for this clerkship 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. Upload the data frequently. We expect entries logged every 2 to 3 days, as Dr. Delage and Dr. Sherman monitor this frequently. If you do not keep up and try to enter extensive amounts of encounters at the end of the rotation, your study time is decreased. We have seen this negatively affect student scores on the NBME exam. We will deduct up to 2 points of your overall score if inadequate or delayed data entry occurs. This needs to be entered electronically in E-Value and must be done electronically via your laptop, or mobile device. Please contact Dr. Sherman, Dr. Delage and Tracy Uhlir immediately if you have any problems accomplishing this requirement due to access issues, WI-FI availability or technical problems.
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. If you have additional questions or need clarification about HIPAA issues that are not adequately addressed at http://www.ncvha.hhs.gov./ , please contact Department faculty.
Targeted Rural Health Education (TRHE)/Medical Student as "SCRIBE" Training
Targeted Rural Health Education (TRHE)
Opportunity to work with personnel at the Center for Rural Health to identify and write about a public health concern from a community's Health Needs Assessment. Goal would be publication of an article in a local newspaper. If you wish to participate, please contact the Clerkship Director's as well as Mona Shilling and Melissa Gardner int he Dept to help coordinate this optional activity.
Medical Student as "SCRIBE" Training
This is available for students if their preceptor wishes to participate. The preceptor and student need to complete extra training to allow this increased access to training in the electronic medical record.
Hot Links (updated 6/11/2014)
The Electronic Textbook of dermatology
http://undmedlibrary.org/resources/list/go/204635 (if off campus you will need to log in)
http://undmedlibrary.org/resources/list/go/204635 (if off campus you will need to log in)
Eric L. Johnson, MD
Contact Info (updated 6/22/17)
Bryan, Delage, MD, CO-Clerkship Director
David F. Schmitz, Chair, Family & Community Medicine
Mona Shilling, Administrative Secretary
Melissa Gardner, Administrative Assistant
Brandon Thorvilson, Videoconferencing
Library of Health Sciences
Preceptor Overview (6/22/2017)
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 our Family Medicine (FM) clerks for the 2016-17 academic year.
Access to on-line case studies for the FM clerks are available. The online (<fmCASES> http://www.med-u.org/) were developed by FM faculty from across the country, with the intent of providing supplementary learning opportunities for clerkship students spending time with a preceptor whose scope of practice is more limited. Information about "Oral Health", available through "Smiles for Life" www.smilesforlifeoralhelth.org/default.aspx?tut=555&pagekey=62948&s1=1855605 has been added as an additional focus. At this time, these are resources that are not used for grading purposes.
As noted previously, 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 clerkship's. These meetings occur during the 4th and 6th weeks of the clerkship. For students in split rotations only the first presentation, addressing “At Risk Population/Access to Care” will be presented week 4. 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. The final presentation is week 6 of the clerkship, which would be week 2 of the second portion of a "split" clerkship.
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. Know that preceptor evaluations are worth 50% of the student's grade. Timely completion is needed to give students their clerkship score.
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, Dr. Delage, Dr. Sherman and/or Dr. Schmitz 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 Dr. Delage or Dr. Sherman. Mona Shilling, Administrative Secretary, can also direct your concern to us.
Thank you for your time and energy commitment to teach Family Medicine to our students.
Bryan Delage, MD, FM Clerkship Co-Director - Eastern Student Sites
Kamille Sherman, MD, FM Clerkship Co-Director - Western Student Sites
Mona Shilling, Administrative Secretary
Melissa Gardner, Administrative Assistant
Brandon Thorvilson, Video Conference Coordinator, Computer Services
Library of Health Sciences
Duty Hour Policy for Students
The participation of medical students in third and fourth year clerkship's 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 clerkship's must also provide students with adequate time for individual study, sleep, and relaxation. Accordingly, the following policies set forth the maximum acceptable amount of time that clerkship's and electives may require of students.
Duty Hour Policy
1. Duty hours are defined as all required educational activities in clerkship's 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 preparation 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 holidays 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.
The primary responsibility for monitoring and enforcing these duty hour policies rests with the clerkship 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.