As previously stated, we expect students to spend a minimum of 30 hours per week in direct ambulatory care. During the clerkship, the students' primary clinical emphasis will be to evaluate ambulatory patients. The expectation is that over the six weeks you will increase your responsibility so that eventually you will be the first person to see patients. After you complete your evaluation, you will review each patient with your preceptor. Additional clinical responsibilities will vary by site. Opportunities to take call, work evening hours, Saturday hours, rounding on inpatients or at the nursing home, are all possible learning venues. You are required to hand in certain documents during your clerkship. Missing documents will result in a 1-2 point reduction of your final grade.
The Liaison Committee on Medical Education (LCME) , requires that students keep a daily patient log of patient encounters. You will be given a yellow log card at the beginning of the rotation and the log should be kept on hand by students at all times in the clinical setting. Log entries should be completed by the end of each day and entered into the portal WEEKLY . Your total number of problems may exceed the number of patients you have seen.
Assigned patient means patients in the clinic, (new or returns) that you are sent to interview, present to the attending and write the clinic note on.
Student Log Report By Card
Student Log Monitoring
During the Family Medicine Clerkship, we expect students to encounter a number of common outpatient procedures. Although each preceptor's office may only perform some of the listed procedures, we expect students to perform or assist in at least 10 of the procedures listed on the following pages. The teaching of a procedure may be delegated by the preceptor to a non-physician member of the health care team where appropriate, e.g., nurse, laboratory technologist. Please have the procedure supervisor sign-off and indicate yes or no as to your competency with performing the procedure. Keep the checklist with you at all times in the clinical setting. The procedural checklist is due at your final exam.
Critical incident recording is an additional way to log your experiences. Much like a diary, it provides a systemic and consistent forum to note particularly important or memorable experiences. The critical incidents log is due at your final exam.
You are required to log a minimum of two entries per week, e.g.:
Sample Critical Incidents:
This project is designed to help you appreciate health and illness from a biopsychosocial perspective. In part, the term biopsychosocial implies that peoples' health is inextricably linked to what happens in their every day lives. All too often in our practice of medicine, we gain a very limited, sometimes excessively narrow view of the problems that people are facing. This may result in less than adequate care for our patients. Perhaps you can think of some examples from your own lives: a close friend, a family member, a teacher, someone who has suffered an illness or who has died. What was it like for this person to be sick? What were her/his fears and concerns? What other factors played a role in that person's experience of illness? What impact did family have upon the experience? What impact did this experience have upon the family? What enabled that person to feel supported and get back into the swing of things again? These questions represent some ways in which we hope that this project will help you gain a larger view of what people are actually experiencing when they come to you for help. It is our objective to have you select a patient in your practice and examine that patient and her/his family to consider the following principles of Family Medicine:
In order to accomplish these goals, you will be expected to interview a patient whom you have identified together with your preceptor. Your preceptor will help you choose someone who is open to this. Ideally, it would be done at the same time the patient is in for a visit and the patient can be asked to spend just a little longer. In some cases, the patient may prefer to return on a different day when it is more convenient, or you may conduct your interview via phone. You should try to complete the interview within 45 minutes to an hour. Again, the purpose of the interview is to get a better idea of what your patients' lives are all about, what their families are like, what problems they may be facing, to whom they turn for support, and how this relates to their health in general. Inquire if your preceptor would like a copy of your write-up for the patient's chart. We expect you to use the following strategies:
This exercise is designed to provide you with experience in applying the results of medical research to clinical practice, i.e., to help you provide care for your patient that is based on the best evidence available. This is known as Evidence-Based medicine. You will continue to utilize Evidence-Based Medicine throughout your medical career.
The project is based on the articles located on the Family Medicine LUMEN website, “Users' Guides to the Medical Literature” created by the Evidence-Based Working Group from McMaster University. Carefully reading these articles will provide you with the tools you need to complete the assignment. You need to start thinking of a clinical question about one of your patients early in your clerkship. Define a question related to therapy or prevention, a diagnostic test, or the harmfulness of an intervention or treatment. If you choose to answer a different type of clinical question, or use a type of study other than the ones described in these articles, you will need to review additional guides online at http://pubs.ama-assn.org/misc/usersguides.dtl. Please be sure to apply the appropriate guides to answer the questions in the assignment. If you do not use the appropriate guides, you will not receive full credit. If you need additional help, be sure to contact one of the Research and Access Services librarians at 708-216-5305 .
Your clinical question should have three parts: 1) the patient; 2) the intervention; and 3) the outcome of interest. The patient refers to the type of patient/condition (for example, an adult postmenopausal female). The intervention refers to the test/treatment/preventive strategy of interest (for example, hormone replacement therapy). The outcome of interest refers to the medical outcome, such as improvement/cure or worsening of a condition or death. Your question should be as specific as possible without being too restrictive. For example: How effective is hormone replacement therapy in a postmenopausal Caucasian woman in preventing hip fractures?
Once you identify one or more questions, discuss them with your preceptor to determine the best one to “answer.” Then, follow these steps for the respective type of question. The first step is to do a literature search to identify the most helpful article. This search should be based on the principles you learned in the e-learning module “Searching for Evidence-Based Medicine” and the EBM handout distributed at the start of the school year. Based on that article, you will need to answer the following questions: 1) Are the results of the study valid? 2) What are the results? And 3) Will the results help me in caring for my patients? If the answer to question #1 is “no,” try to find a better alternative paper, if available. If not available, you can use that article, pointing out the weaknesses of the study, and go ahead and answer the remaining questions.
Make an appointment with, and obtain a Research and Access Services librarian’s signature on your search query. Call or email Liz Novak email@example.com or 708-216-5305, to schedule an appointment early in the clerkship. One point will be deducted from your EBM project grade if you fail to obtain a librarian’s signature.
Use the outline on the following page to write up your assignment. Don’t forget to attach your original article. An Internet printout can be used only if it clearly displays all tables and figures.
Hand in this project at your final exam.
Online tutorials provide easy access to practical instruction and tools to help a student learn about topics of interest. This sampling of free evidence-based medicine tutorials provides valuable info that addresses developing clinical questions, evaluating evidence, and performing efficient literature searches.
Duke University Medical Center Library and University of North Carolina-Chapel Hill Health Sciences Library: Introduction to Evidence-Based Medicine -- This site provides assistance in developing clinical questions, performing literature searches, evaluating evidence and testing knowledge. Each topic is broken down to help the beginner become proficient in EBM. http://www.hsl.unc.edu/services/tutorials/ebm/index.htm
Michigan State University, College of Human Medicine, Department of Family Practice: An Introduction to Information Mastery -- This online course was developed by family physician, Dr. Mark Ebell. It consists of modules designed to help you learn how to read and apply articles about diagnosis, therapy and prognosis; know the steps in performing a meta-analysis; and understand when it is appropriate to perform a decision analysis. Each module contains goals and tools, topic-specific curriculum and a quiz. http://www.poems.msu.edu/infomastery
University of Illinois-Chicago, Library of Health Sciences-Peoria: Evidence-Based Medicine: Finding the Best Clinical Literature -- Designed to assist health care professionals and students become effective and efficient users of the medical literature, this site helps with such things as formulating patient-centered questions, applying clinical search filters and using MEDLINE-key aspects in developing your EBM skills. http://www.uic.edu/depts/lib/lhsp/resources/ebm.shtml
Loyola Stritch School of Medicine has developed a clinical skills workshop in an effort to further objectify evaluation of clinical performance. This is part of a national trend which moves the traditional Goals and Objectives of a course, towards Competencies and Outcome Objectives. As a Third Year Family Medicine Clerk, you are required to attend a session at the SSOM Clinical Skills Lab, interviewing and counseling a standardized patient. The cases that have been developed are meant to enhance your Family Medicine educational experience, as well as evaluate your knowledge, skill, and attitude. Your performance will figure into your final grade.
Succeeding on this important exercise requires you to organize, synthesize, and demonstrate various skill sets you have acquired during your time at Stritch. Concentrating on a thorough, yet efficient, history, organizing that data into written format, as well as using that data to construct problem lists, assessments, and plans, will be critical. Feel free to review your materials from our Clerkship, as well as various tools you have used for the PCM Course.
A schedule will be emailed to you a few days after your Family Medicine orientation.
Abdominal Aortic Aneurysm
This new piece will serve as an assessment piece not only for the Family Medicine clerkship but also for SSOM's longitudinal curriculum in Prevention and Screening.
To prepare for this you should review the screening recommendation topics and information listed in the USPSTF Prevention & Screening Recommendations pamphlet. You should be familiar with the above topics.
In addition to help you study you can use the very user-friendly link below from the USPSTF that organizes your approach to screening recommendations and counseling.
As above, 15 minutes into this portion of the encounter you will hear an announcement simply to let you know that 15 minutes have gone by and that you have 5 minutes remaining. Please do not respond to the knock.
Again, if you finish the encounter before 20 minutes have gone by you may close the encounter but know that once you exit the room you will not meet again with the standardized patient until feedback.
The SP will leave the room and your classmate who has been observing the encounter will come over and give you feedback that will be filmed. During the time your peer is giving you feedback the SP is completing her paperwork in preparation for her feedback.
The standardized patient will meet with you briefly and provide feedback on your interpersonal skills through use of the Patient Perception Scale.
Patient charts are located on the door of each examination room providing basic information about your patient. You will be given time to review the chart before entering the exam room. You may take the chart into the room with you.
VIDEOTAPING OF ENCOUNTERS:
All patient encounters are videotaped and reviewed by lab staff and clerkship personnel.
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