Download Increasing the Quality and Years of Healthy Life

Utilizing the Patient- Centered
Medical Home* to Increase the
Quality and Years of Healthy Life
Syllabus for Family Medicine Clerkship
2011-2012
* The “Patient-Centered Medical Home” (PCMH) concept has been utilized, without label, in
most rural communities and many urban groups for some time. The availability of electronic
medical records is changing how our patients access health care.
(Each page of the manual is directly available via tabs on the left.)
Revised June 29, 2011
~1~
Table of Contents
Page #
3)
Overview of Syllabus - Read It Now
4)
Conference Call & Contacts
5)
Course References
6–8)
Goals and Objectives
9)
Course Requirements for Family Medicine Clerkship
10)
Student/Preceptor Planning Meeting
11)
Learner Contract
12-14)
Clinical Skills Inventory
15)
Case Presentation
16-17)
Group Topics
18)
Clinical Encounters Database
~2~
Utilizing the Patient-Centered Medical Home to Increase
the Quality and Years of Healthy Life
Syllabus for UNDSMHS Family Medicine Clerkship 2010-2011
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” - http://www.med.und.nodak.edu/familymedicine/clerkship/conferencecall.html 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 requirements, directs 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 expectations of
the rotation. Course goals, learning objectives, educational methods, and assessment methods are
further on the “Goals” pages. The manual and hypertext links to mandatory “Clerkship” and “Preceptor”
evaluation forms, as well as some course resources, can be found at
http://www.med.und.nodak.edu/familymedicine/clerkship/
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 infomatics 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 addresses listed on the “Contacts” page. Have a great Family Medicine
experience!
Roger W. Schauer, MD, FAAFP
~3~
Conference Call
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 from1:30-3:30 PM 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-based site. Please have the
monitor and camera switched “ON” by 1PM. For questions about the interactive video, contact Brandon
Thorvilson [email protected] (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. The access code is 7770000.
Have your laptop up and running so you will be able to access the on-line manual during the orientation
session. If laptop availability is not an option please either print the manual from the web page, or contact
Mona Shilling [email protected] or 701-777-3081 for a hard copy of the manual.
Video-conference meeting dates & times are every other Thursday afternoon, unless otherwise noted.
Dates for meetings for each Rotation are listed on the web page.
Contacts
Faculty
Roger W. Schauer, M.D., FAAFP, Course Director: [email protected]
James R. Beal, Ph.D., Director, Research & Program Development: [email protected]
Robert W. Beattie, MD, Chairman, Department of Family Medicine: [email protected]
Staff
Mona Shilling, Administrative Secretary [email protected]
(701-777-3214)
Brandon Thorvilson, Videoconferencing: [email protected]
Library of Health Sciences
Sandi Bates [email protected] (701-777-2166)
~4~
(701-777-3211)
Course References
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 “QualityAdjusted 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.
~5~
Goals and Objectives
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 health care;
develop awareness of the impact of families and culture on health problems and patient perception and
reception of health care (biopsychosocial model); develop an awareness of your own personal strengths,
interests, and limitations; and complete a research project (joint project between Family & Community
Medicine and Clinical Epidemiology).
Goal 1: Enhance and refine data collection and problem solving skills.
Learning Objectives
Educational Method
1. Demonstrate ability to
1. Collect historical data from patients and families, including
perform focused and
social, economic, religious, family, and occupational
complete physical
information that may impact patients' health status.
examinations.
2. Perform focused and/or complete physical examinations.
2. Demonstrate ability to
3. Develop and prioritize patient problem lists.
come to appropriate
4. Order appropriate investigative and supportive laboratory
conclusions regarding the
studies, record and interpret data.
patient’s presenting and
5. Record data per protocol of the system or clinic you are
underlying problems.
attending, including complete H & P records or SOAP
3. Demonstrate ability to
notes.
record appropriate patient
6. Perform diagnostic procedures and record data on clinical
data.
records.
4. Demonstrate ability to
7. Recognize medical emergencies and establish health care
present pertinent
priorities.
information to patients,
8. Initiate patient care in an orderly and appropriate manner.
preceptor(s) and faculty.
9. Write problem-oriented progress notes which address
5. Demonstrate ability to
acute and chronic health care needs.
keep accurate and concise 10. Document patient encounters in the E-Value database.
records.
11. Demonstrate competence in critical thinking skills.
Assessment Method
1. Preceptor Evaluation (written and oral)
2. Department of Family & Community Medicine
(DF&CM) faculty evaluation (oral)
3. Clinical Encounters Database (E-Value)
Goal 2: Learn principles and interventions for Health Promotion and Disease Prevention that are
maximally conducive to good health.
Learning Objectives
Educational Method
1. Define wellness as a concept 1. Use "Healthy People 2010" as a resource for patient
that is more than “not being
care.
sick.”
2. Address primary or secondary prevention opportunities
2. Define primary, secondary,
for most clinical encounters. Many prevention activities
and tertiary prevention.
are age, gender, and environment specific, and must be
3. Identify risks for specific
individualized to the patient and community.)
illnesses that affect screening
3. Establish priorities for health promotion and disease
and treatment strategies.
prevention (HP/DP) appropriate to the community,
4. Apply the stages of change
population served, or practice of your preceptor.
model and use motivational
4. Develop strategies to implement HP/DP.
interviewing to encourage
5. Identify barriers and challenges to implementation of
lifestyle changes to support
health promotion and disease prevention in general, and
wellness (weight loss, smoking
in the practice of your preceptor.
cessation, safe sexual
6. Develop evidence-based health promotion/disease
practices,
prevention plans for patients of any age or gender.
~6~
exercise/activity/nutrition/diet).
5. Provide counseling related to
health promotion and disease
prevention.
6. Discuss an evidence-based,
stepwise approach to
counseling for tobacco
cessation.
7. Find and apply the current
guidelines for adult
immunizations.
8. For each core health
maintenance condition listed in
Table 1, discuss who should be
screened and methods of
screening.
Assessment Method
7.
Prepare a presentation for your colleagues that address
health priorities in the practice or community in which
you are completing your Family Medicine clerkship.
Address any barriers or challenges to implementing that
HP/DP in your community.
1.
2.
3.
4.
Clinical preceptor
Group topic presentation
Written exam
Address during presentation to DF&CM faculty
Goal 3: Recognize the reciprocal impact, on patients and their families, of family, community, and
culture on perception and reception of health care.
Learning Objective
Educational Method
1. Develop an understanding
1. Identify the social/economic factors that impact health
how the patient’s health
care delivery for your patient.
problem(s) impact the rest
2. Identify family, community, and cultural issues that might
of the family, and how
have an impact on how the patient interprets the cause
family history, beliefs, and
of the disease, illness, or problem.
culture affect health care.
3. Use a genogram or family map to identify relationships
2. Learn how differences in a
that influence the patient’s environment and health care.
community or cultural
4. Identify family traditions and history and that impact on
beliefs can be a barrier or
health care for your patient.
an asset to providing
5. Identify important life events in the family and the impact
primary care (i.e, health
that those events have on the health of the individual
care seeking and
and family.
adherence behavior.)
6. Prepare a presentation for your colleagues that
3. Become aware of your own
addresses social, community, economic, environmental,
health care beliefs, and
or cultural barriers to health care in your preceptor’s
how those beliefs might
community that affect and effect health care, or define a
have evolved.
high risk population (see “Access to Care/High Risk
Populations) a. might include community resources that may be
available for specific patient problems or illnesses.
b. might include occupational or environmental
health risks that are prevalent in the community.
7. Prepare a presentation for your colleagues that
addresses family, community, cultural or personal issues
that may impact health-care provider and patient/family
relationships (see “The Family Connection”.)
Assessment Method
1. Clinical preceptor
2. Self assessment
3. Group topic presentations
4. Case presentation to DF&CM faculty
~7~
Goal 4: Experience the comprehensiveness of Family Medicine and scope of care
provided by Family Physicians.
Learning Objective
Educational Method
1. Develop an awareness of
1. With the aid of your preceptor, identify and follow several
being a physician of first
patients who are chronically ill.
contact.
2. Observe the patient’s clinic course for short and long2. Become aware of the role
term care, and modify the care as necessary.
of the physician as an
3. Provide appropriate patient education.
integral member of the
4. Become aware of health-care needs for underserved,
interdisciplinary health care
vulnerable, and/or at-risk populations in your clerkship
team.
community.
3. Develop an awareness of
5. Contact the financial personal in the practice to
cost effectiveness in
determine costs of a patient visit, tests or procedures,
evaluation and treatment of
and reimbursement issues for at least one private pay,
patients.
one Medicare, and one Medicaid or Welfare patient.
4. Understand appropriate
consultation and referral of
patients.
Assessment Method
1. Clinical preceptor
2. Group topic presentation
3. Case presentation to DF&CM faculty
Goal 5: Develop an awareness of personal strengths, interests, and limitations.
Learning Objective
Educational Method
1. Identify your level of clinical 1. Assess your level of competence and comfort
skills in assessing patient
addressing medical problems noted in the Clinical Skills
problems.
Inventory.
2. Demonstrate maturity in
2. Develop a Learner Contract (LC) with your preceptor.
interpersonal relationships
3. Review the LC at mid-clerkship, and re-evaluate and reand personal values.
state your goals.
3. Adhere to medical ethics.
4. Assume initiative and responsibility in caring for patients,
4. Respect the rights of
to the extent expected by your preceptor.
patients
5. Become a patient advocate when it will be beneficial to
5. Be able to discuss the role
the patient or family.
of family physicians within
6. Devote appropriate time and energy to all duties.
any health care system.
Assessment Method
1. Self evaluation; Learner Contract; CSI
2. Clinical preceptor
Goal 6: Develop and understanding of clinical research.
Learning Objective
Educational Method
1. Develop and understanding 1. Identify a topic that has a personal interest and curiosity.
of the research process and 2. Complete a literature search using available databases
measurement of outcomes.
such as Pubmed, Cochrane, or
InfoPOEMs/Retriever. (You are encouraged to identify a
topic for which "evidence-based" guidelines are available.)
3. Develop a research question(s) which is limited in focus,
but adequately addresses your topic.
4. Conduct a chart review or analyze a secondary dataset
based on a research question(s).
5. Use appropriate analysis to answer the research
question(s).
6. Complete a well-written project report.
Assessment Method
1. Submit a completed and acceptable research project, as
determined by faculty of DF&CM
~8~
Course Requirements for Family Medicine Clerkship
Course evaluation and final grade is based on six components, including:
50%
Evaluation by preceptor ("Preceptor Assessment 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 case 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 following 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 as follows:
(1) Preceptor Evaluation - reassignment to another preceptor, determined by the course director, for a
minimum of one month;
(2) Research Project - submission of an acceptable research project;
(3) Written exam – repeat multiple choice 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.
~9~
Student/Preceptor Planning Meeting
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 prior 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
http://www.med.und.nodak.edu/depts/fammed/Clerkship/learnercontract.htm , is a useful tool for
planning your 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 (found at
http://www.med.und.nodak.edu/depts/fammed/Clerkship/clinicalskills.htm ). 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” form found at
https://survey.med.nodak.edu/ome/Clerk/stuassessfm.asp . Other points of discussion may
include, but are not limited to:
1. Expectations 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.




The preceptor's approach to:
health care,
interaction with the health care system,
continuing education,
community responsibilities.
3.
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 during 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.
~ 10 ~
Learner Contract
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:
1.
2.
3.
4.
5.
6.
7.
Other clerkships/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
Learning Objectives
Student goals: List two to five learning objectives and specific strategies for accomplishing them.
Preceptor goals: List two to five most important areas on which the student should focus, and strategies
for addressing these areas.
Your (student) summary of progress toward goals and expectations at mid- & end of clerkship. Review
with preceptor and department faculty as an opportunity to discuss your progress.
Preceptor's Signature / Date
Student's Signature / Date
~ 11 ~
Clinical Skills Inventory
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 your 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 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 midclerkship 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 that
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.
~ 12 ~
Clinical Skill
Focus No
Observed Limited
Area
Experience Only
Experience
Health Promotion & Disease Prevention (HP/DP)
Primary Prevention – for age & gender
Secondary Prev. – for age & gender
Occupational safety and health
Tobacco use/cessation
Substance use/abuse
Weight management & nutrition
Self-screening techniques
Infant development milestone
Disorders of behavior & development
Pregnancy prevention/contraception
Prenatal care
Acute Problems Managed by Family Physicians
**Musculoskeletal problems
Low back pain
Joint pain & injury
XXXX
**Dermatological problems
Common skin rashes
Common skin lesions
Skin wounds
XXXX
Adverse drug reactions
Fever
Cough
Upper respiratory symptoms
Ear pain
Sore throat
Eye pain/redness/drainage
Dyspnea
Wheezing
Allergies & Asthma
Dizziness/vertigo
Headache
Depression
Anxiety
Fatigue or sleep problems
Chest Pain
Leg swelling
Abdominal pain/dyspepsia
Liver disease
Lower intestinal problems
Dysuria
Vaginitis/vaginal discharge
Urinary tract infections
Sexually transmitted diseases
Menstrual disorders
Abnormal vaginal bleeding
Male urinary symptoms
Breast diseases
~ 13 ~
Feel
Comfortable
Chronic Problems Managed by Family Physicians
Multiple chronic diseases (simultaneous)
Obesity
Hypertension
Hyperlipidemia
Diabetes mellitus (Type 2)
Thyroid disease
Asthma/COPD
Arthritis
Back pain (chronic)
Cardiovascular disease (chronic)
Depression (chronic)
Anxiety (chronic)
Dementia
Osteoporosis/osteopenia
Menopause
Geriatric function assessment
Palliative and end-of-life care
Procedures (Optional – not graded)
Pap & Pelvic exam
Vaginal Delivery
Splinting or casting
Joint aspiration/injection
Venipuncture/starting IVs
Suturing
Excision (skin lesions)
Cryocautery
~ 14 ~
Case Presentation for DF&CM Faculty Visit
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 expectations 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 pts
 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 pts
 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 pts
(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 pts
 short and long term course of problem
 assessment of resources
 consultation/referral
 patient education
 doctor/patient relationship
 physician role on team
 financial issues (may include charges/insurance/etc)
5. Learning Issues ___/5 pts
 problem focused
 learning resources
 ethical issues
6. Presentation flow ___/5 pts
TOTAL ___/50 pts:
~ 15 ~
Group Topics
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 future 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 you Family Medicine Clerkship. 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. 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 health care?
 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 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 relationship 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
~ 16 ~
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 health care beliefs on health care seeking and
adherence behavior, as well as the impact of different beliefs of the health care
provider).
…identify alternative techniques for data collection and processing 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.
…appreciate the influence of personal 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 to define the family/patient
dynamics http://www.med.und.nodak.edu/familymedicine/clerkship/documents/TheFamilyConnection.doc
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 patterns 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 unexpressed), 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.
~ 17 ~
E-Value Clinical Encounters Database
The E-Value database is designed to assist your documentation of your patient encounters, both for
diagnoses and for procedures. The purpose of the database is twofold:
 To collect accurate information on student clinical experience thus promoting better evaluation of
the curriculum, and
 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. 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 simple be entered as “90”.You have already successfully completed the HIPAA
orientation exam. If you have additional questions or need clarification about HIPAA issues that are not
adequately addressed at http://www.ncvhs.hhs.gov/ , please contact DF&CM faculty.
~ 18 ~