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The overall purpose of the third year Family Medicine Clerkship is to foster student knowledge of and familiarity with the family practice method of health care delivery and the role of the family physician in both the local and medical communities.
The major vehicle for this education is exposure to practicing family physicians and their patients. The clerkship experience has been designed to assist each student in refining proficiencies necessary for life-long learning. Areas targeted for skill building include verbal communication, physical examination, targeted clinical problem solving, differential diagnosis, data collection, supportive patient relationships, logical problem solving, and ethical decision-making.
GOAL I: Understand the nature of the patient-physician relationship and its impact upon the management of the patient's illness
OBJECTIVES
1. Describe the dynamics of the physician-patient relationship in Family Medicine settings.
2. Contrast the dynamics of the physician-patient relationship in Family Medicine settings with the dynamics of another medical specialty setting.
3. Identify five ways in which these relationship dynamics may impact management of a patient's illness.
GOAL II: Assess the patient and the family in the context of the biopsychosocial model
OBJECTIVES
1. List the steps used to assess patients according to the biopsychosocial model.
2. Compare and contrast three patients with the same disease process.
3. Discuss how the approach to the diagnosis and management of two medical problems common to family physicians differ biologically, socially, and psychologically.
GOAL III: Apply problem solving skills to ambulatory patients who have undifferentiated, early-disease state problems
OBJECTIVES
1. Describe the steps used to develop a differential diagnosis, diagnostic plans, and a preliminary treatment for a given patient with common symptoms but no definitive diagnosis.
2. Verbally differentiate between ambulatory patients with early disease and those with late chronic disease in terms of management plans and patient education.
GOAL IV: Develop long term treatment plans and goals for patients with chronic illnesses
OBJECTIVES
1. Explain why treatment plans and goals differ from patient to patient with the same complaint.
2. Given a patient in early stages of a chronic illness, devise goals and a long-term treatment plan for the patient to minimize suffering and maximize benefits.
GOAL V: Formulate differential diagnoses and treatment plans based on limited information gathered in a typical office visit.
OBJECTIVES
1. Verbally evaluate a given treatment plan on the basis of outcome for the patient, likelihood of being implemented successfully, and the cost effectiveness of the treatment.
2. Compare and contrast the information gleaned regarding a specific disease process in the varied environments of a limited-time office visit and a prolonged-time hospital stay.
3. In relation to a specific patient contact, describe a likely scenario of how follow up office visits may affect information gathering, diagnoses clarification, treatment, and treatment evaluation.
GOAL VI: Refine time management skills.
OBJECTIVES
1. Given a list of tasks and priorities for each task, develop a working schedule flexible enough to allow sufficient time to complete each task.
2. Classify tasks according to their importance, resource cost, time cost, and potential benefits.
3. Contrast the costs and benefits of delegating tasks.
GOAL VII: Understand patient problems in a community and family
OBJECTIVES
1. Compare and contrast the community’s, the family’s, the patient’s, and the physician’s perceptions of three different types of patient problems.
2. Describe one community’s response to and support of patients with a specific medical disorder.
3. Exemplify three ways in which two different families might deal with similar patient problems.
4. Explain the effects of differing community and family expectations on patient’s problems and the resolution of those problems.
GOAL VIII: Recognize how interpersonal relationships, social characteristics, and cultural norms can alter the presentation and management of an illness.
OBJECTIVES
1. Outline three ways in which a patient’s interpersonal relationships can impact the presentation, diagnosis and management of an illness.
2. List three ways in which the patient’s personality (e.g. shyness, obsessive-compulsivity) and social position (e.g. white-collar worker, homeless) can impact the diagnosis and management of an illness.
3. Name three ways in which cultural background (e.g. African-American, Appalachian) can impact the diagnosis and management of an illness, including the impact of variance between the patient and the physician.
GOAL IX: Record and synthesize data in an organized clinical fashion.
OBJECTIVES
1. Record patient information collected in an office setting according to standards set forth in the SOAPP (Subjective, Objective, Assessment, Plan, Prevention) format.
2. Complete problem and medication lists for each patient.
3. Record prevention protocols for patients.
4. Record family history, past history, review of systems, and physical exams in appropriate places in the chart.
GOAL X: Interact in a positive, productive manner with other professionals and staff.
OBJECTIVES
1. Develop a list of Do's and Don'ts for interacting with other professionals and support staff.
2. Describe the role each staff member played in the team approach to treatment and indicate how the contributions of each were or could have been maximized.
3. In a simulated conflict role-play, demonstrate positive and supportive behaviors used to resolve conflicts.
GOAL XI: Refine ways to exhibit a caring and empathic attitude toward patients and your ability to display professional values and attitudes.
OBJECTIVES
1. List two new behaviors learned during your Family Medicine Clerkship that demonstrate care and empathy towards patients.
2. Describe the spectrum of appropriate professional values, attitudes, attire, and demeanor.
3. Describe the confidentiality procedures used most often in your preceptor's office.
4. State several key behaviors associated with professional values and attitudes.
GOAL XII: Perform common office practice procedures
OBJECTIVES
1. Demonstrate appropriate skill in performing urinalysis, KOH preps, wet preps, venipunctures, throat cultures, IM and sub Q injections, EKGs, skin testing, tympanometry, suturing, incision and drainage, casting and splinting, and stool guiacs.
2. Describe the conditions under which each procedure above is used.
GOAL XIII: Develop an appreciation for the basic core concepts of Family Medicine
OBJECTIVES
1. Describe three cases you were involved in where continuity of care was a major contributor to good outcome.
2. Identify the key disease prevention strategies common in family medicine
3. Explain a case where anticipatory guidance might have helped contribute to a better outcome if it had been given.
4. Identify and track the financial costs of a specific patient with a specific illness.
5. Define the basic core concepts of Family Medicine in terms of their usefulness to family practitioners.
6. For each core value, identify a case that demonstrates how you or your preceptor used it in practice.
GOAL XIV: Refine development of professional role and career decision-making.
OBJECTIVES
- Compare the lifestyles and values of family medicine and three other specialties in terms of your own needs and future desires.
- Compile the key aspects of a curriculum vitae for yourself today and a hypothetical one you hope to have in 20 years.
- Outline the steps needed to transform the first into the second.
- Describe your learning skill strengths and the learning skills you need to further develop in order to remain competent over the lifetime of your practice.
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