FAMILY MEDICINE CLERKSHIP - drcolquitt.com

FAMILY MEDICINE CLERKSHIP

MACON | SAVANNAH | COLUMBUS

medicine.mercer.edu

YEAR THREE | CLASS OF 2022

WELCOME

Class of 2022,

The MUSM Department of Family Medicine welcomes you to the 8-week Family Medicine Clerkship. This manual contains essential information regarding our curriculum as well as our expectations while you are on our clerkship.

Family Medicine is an essential component of the primary care infrastructure of the US health care delivery system. This specialty provides first contact, ongoing, and preventive care to all patients re¬gardless of age, gender, culture, care setting, or type of problem. Family Medicine clinical experiences allow students to understand how context influences the diagnostic process and management decisions. Students learn the fundamentals of a problem-solving approach to the evaluation and management of frequently occurring, complex, concurrent, and ill-defined problems across a wide variety of acute and chronic presentations within diverse settings.

Your experience in the Patient Centered Medical Home pioneered by Family Medicine, with its’ focus on wellness, prevention, chronic disease management as well as acute care, will provide you with a sturdy frame of reference as you approach your own patients in years to come.

We look forward to working with you during this important learning experience in your medical education.

Directors, Faculty, Residents and Staff Department of Family Medicine

TABLE OF CONTENTS

Family Medicine Clerkship Dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Family Medicine Clerkship Competencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Family Medicine Clerkship Goals and Objectives . . . . . . . . . . . . . . . . . . . . . . . . . .3

Learning Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Family Medicine Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Objectives of Curriculum Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Curricular Expression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Ambulatory Care Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

In-Service/Call . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Patient Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Abbreviations Not to Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Mid-Rotation Standardized Patient Assessment . . . . . . . . . . . . . . . . . . . . .13

Mid-Rotation Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Gold Observation Cards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Mid-Rotation Formative Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Preventive Medicine Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Morning Report/In-Service Rounds/Conferences . . . . . . . . . . . . . . . . . . . .17

Clinical Experiences: Clinical Diagnoses/Patient Encounters, Physical Findings, Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Clinical Diagnoses/Patient Encounters Criteria . . . . . . . . . . . . . . . . . . . . . .19

Formative and Summative Evaluation Summary . . . . . . . . . . . . . . . . . . . . . . . . .20

Grade Distribution Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Remediation Policy/Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

MUSM Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Appendix A: STFM Competencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

Appendix B: Evaluation Documents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Appendix C: Site Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Appendix D: Ultrasound Pilot Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

YEAR 3 FAMILY MEDICINE CLERKSHIP | CLASS OF 2022 1

Rotation #1 | August 3 – September 25, 2020Orientation: Monday, August 3Mid-Rotation Exam: Monday, August 31SPA: Monday, August 31 (Macon & Savannah)SPA: Tuesday, September 1 (Columbus)Shelf Exam: Friday, September 25Holidays: Monday, September 7 (Labor Day)

Rotation #2 | September 28 – November 20, 2020Orientation: Monday, September 28Mid-Rotation Exam: Monday, October 26SPA: Monday, October 26 (Macon & Savannah)SPA: Tuesday, October 27 (Columbus)Shelf Exam: Friday, November 20

Rotation #3 | November 23, 2020- January 29, 2021Orientation: Monday, November 23SPA: Monday, December 14 (Macon & Savannah)SPA: Tuesday, December 15 (Columbus)Mid-Rotation Exam: Friday, December 18 Shelf Exam: Friday, January 29Holidays: November 26 - November 27 (Thanksgiving) December 19 - January 3, return January 4 (Winter Break) Monday, January 18 (Martin Luther King, Jr. Day)

Rotation #4 | February 1 – March 26, 2021Orientation: Monday, February 1Mid-Rotation Exam: Monday, March 1SPA: Monday, March 1 (Macon & Savannah)SPA: Tuesday, March 2 (Columbus)Shelf Exam: Friday, March 26

Rotation #5 | March 29 – May 21, 2021Orientation: Monday, March 26Mid-Rotation Exam: Monday, April 26SPA: Monday, April 26 (Macon & Savannah)SPA: Tuesday, April 27 (Columbus)Shelf Exam: Friday, May 21Holidays: Friday, April 2 (Good Friday)

Rotation #6 | May 24- July 16, 2021Orientation: Monday, May 24Mid-Rotation Exam: Monday, June 21SPA: Monday, June 21 (Macon & Savannah)SPA: Tuesday, June 22 (Columbus)Shelf Exam: Friday, July 16Holidays: Monday, May 31 (Memorial Day) Monday, July 5 (Independence Day)

2020-2021 FAMILY MEDICINE CLERKSHIP DATES


FAMILY MEDICINE CLERKSHIP COMPETENCIES

PATIENT CARE 1. Perform a focused history and physical exam for a patient who presents for an acute

complaint, chronic disease management, or health promotion/disease prevention. 2. Generate a differential diagnosis and initial diagnostic strategy for the most

common acute complaints that present to a family medicine office. 3. Assess a patient’s management of his/her chronic disease(s) and outline

therapeutic strategies to assist that patient in managing his/her illnesses. This includes counseling patients for behavior change.

4. Develop a preventive health plan based on the USPSTF recommendations for male and female patients of any age.

5. Perform common technical skills and office procedures under direct supervision. 6. Perform a thorough physical examination appropriate to the presenting problem.

MEDICAL KNOWLEDGE 1. Demonstrate understanding of basic medical pathophysiology and principles of

health and disease for the problems commonly encountered in a family medicine. 2. Approach clinical decision-making in an evidence-based, cost-conscious manner

that utilizes the principles of family medicine.

PRACTICE-BASED LEARNING AND IMPROVEMENT 1. Access sources of information at point of care. Interpret and use this data in real time. 2. Reflect on lessons learned from a patient seen for multiple visits.

INTERPERSONAL AND COMMUNICATION SKILLS 1. Demonstrate proper communication skills during an office patient encounter

(opening, engage, empathy, educate, enlist, closing). 2. Communicate effectively, using an interpreter when necessary, with patients of a

different culture or language. 3. Accurately present patient findings to a supervising physician. 4. Chart accurately and completely including SOAP format for current problems,

problem list, medication list, and/or prevention flow sheets.

PROFFESSIONALISM 1. Consistently behave in a manner consistent with the Student Code of Ethics and

Professional Conduct. 2. Consistently show respect for patient’s dignity and rights, including

confidentiality. 3. Consistently display honesty and ethical behavior. 4. Consistently demonstrate dependability by being punctual and reliable.5. Accept and provide constructive feedback to/from community faculty, staff,

patients, peers, and course director. 6. Recognize own limitations and seek opportunities to grow.

SYSTEMS-BASED PRACTICE 1. Identify and evaluate the psychosocial, cultural, familial and community

influences that impact a person’s health. 2. Use appropriate screening tools and protocols for health maintenance across the

age spectrum. 3. Make positive contributions to patient care by working collaboratively with office

staff, community faculty, and patients.


FAMILY MEDICINE CLERKSHIP GOALS AND OBJECTIVES

GOALSThe overall goal of the family medicine clerkship is to provide an outstanding

learning experience for all medical students.1. Our goal is that students will be able to effectively and competently evaluate a

patient and produce a competent history and physical that facilitates differential diagnosis and the development of a treatment plan.

2. Our goal is to ensure students develop the knowledge base necessary to obtain the core knowledge that is considered necessary to the practice of medicine.

3. Our goal is to socialize medical students into the best of the culture of medicine such that they develop an enduring commitment to the care of patients.

OBJECTIVESThe objectives of the Family Medicine Clerkship are to:1. Demonstrate the unequivocal value of primary care as an integral part of any

health care system.2. Teach an approach to the evaluation and initial management of acute

presentations commonly seen in the office setting.3. Teach an approach to the management of chronic illnesses that are commonly

seen in the office setting.4. Teach an approach to conducting a wellness visit for a patient of any age or

gender.5. Model the principles of family medicine care.6. Provide instruction in historical assessment, communication, physical

examination, and clinical reasoning skills.7. Provide experience in developing patient education material.

At the end of the Family Medicine Clerkship, each student should be able to:1. Discuss the principles of family medicine care.2. Gather information, formulate differential diagnoses, and propose plans for the

initial evaluation and management of patients with common presentations.3. Manage follow-up visits with patients having one or more common chronic

diseases.4. Develop evidence-based health promotion/disease prevention plans for patients

of any age or gender.5. Demonstrate competency in advanced elicitation of history, communication,

physical examination, and critical thinking skills.6. Discuss the critical role of family physicians within any health care system.


LEARNING RESOURCES

STFM NATIONAL FAMILY MEDICINE CURRICULUMThe Society of Teachers of Family Medicine (STFM) National Curriculum provides the core content to be covered by all students on the Family medicine rotation. This content is tested on the NBME Family Medicine Shelf exam. See Appendix A for the list of Common Acute and Chronic Problems covered in this curriculum. The entire core content documentation can be found at: http://www.stfm.org/Resources/STFMNationalClerkshipCurriculum

PRIMARY RESOURCESCurriculum and ResourcesThe curriculum resources are on Canvas: http://canvas.mercer.edu/

AquiferThis is your required text. You will be graded on completion of ALL 40 Family Medicine Cases. Your free Aquifer registration instructions are provided prior to Orientation. You are required to register and begin one case prior to Orientation. https://aquifer.org/

SUGGESTED TEXTS/RESOURCES FOR FURTHER READING AND REVIEWMaster Classhttp://www.radiologymasterclass.co.uk/index.html (Free for student use — do not log in!)

General TextHarrison’s Textbook of Medicine Cecil’s Textbook of Medicine

Physical Exam TextSeidel’s Guide to Physical Exam, 8th Edition (e-copy available on MUSM/Library e-books)

Review TextCase Files FM, 4th Edition (e-copy available on MUSM/Library e-books) AAFP.org (articles & questions by topic)

WebsitesUSMLE Easy DynaMedPlus

http://canvas.mercer.edu/

https://aquifer.org/

http://www.radiologymasterclass.co.uk/index.html

http://AAFP.org


FAMILY MEDICINE CASES

Cases and Content Mapping noted below:Blue text = Designated cases for mid-rotation exam

1. 45-year-old female annual exam-Mrs. Payne (prevention and wellness care for premenopause)

2. 55-year-old male annual exam-Mr. Reynolds (prevention and wellness for middle-aged adult male)

3. 65-year-old female with insomnia - Mrs. Gomez (herbal medicine risk/benefits, cultural sensitivity, metabolic syndrome)

4. 19-year-old female with sports injury-Christina Martinez (ankle sprain, Ottowa rules, UTI)

5. 30-year-old female with palpitations-Ms. Waters (hyperthyroidism, EKG)

6. 57-year-old female presents for diabetes care visit-Ms. Sanchez (htn, neuropathy, hyperlipidemia, group visits, multidisciplinary care)

7. 53-year-old male with leg swelling-Mr. Smith (Type 2 DM, htn, hyperlipidemia, smoking cessation, diabetic foot ulcer care)

8. 54-year-old male with elevated blood pressure-Mr. Martin (htn, uninsured, obesity, hyperlipidemia)

9. 50-year-old female with palpitations-Ms. Yang (hypothyroidism, GERD, stress, EKG, ECHO)

10. 45-year-old male with low back pain-Mr. Payne (radiculopathy, SLR, MRI disc herniation)

11. 74-year-old female with knee pain-Ms. Roman (GERD, OA, wrist/ hand pain, CTS, chronic pain)

12. 16-year-old female with vaginal bleeding and UCG - Savannah Bauer (preparticipation physical, adolescent health promotion visit, birth control, preconception counseling, early pregnancy, miscarriage)

13. 40-year-old male with a persistent cough-Mr. Dennison (allergic rhinitis, atopy, sinusitis)

14. 35-year-old female with missed period-Ms. Rios (pregnancy, abnormal prenatal testing, placenta previa, Down syndrome, postpartum depression, breastfeeding)

15. 42-year-old male with right upper quadrant pain-Mr. Keenan (GERD, PPI use, biliary colic, Etoh use, detox)

16. 68-year-old male with skin lesion-Mr. Fitzgerald (seizure disorder, squamous cell ca, BPH)

17. 55-year-old post-menopausal female with vaginal bleeding-Mrs. Parker (menopause, breast health, htn, obesity, hormone therapy, osteoporosis, hypothyroidism, mammography)


18. 24-year-old female with headaches-Ms. Payne (neuro exam, functional goal setting, chronic pain, testing/management negotiation)

19. 39-year-old male with epigastric pain-Mr. Rodriguez (H pylori, cultural issues, immigrant health)

20. 28-year-old female with abdominal pain - Ms. Bell (ASCUS, PAP, Trichomonas, domestic violence and safety)

21. 12 year-old female with fever–Marissa Payne (sore throat, influenza, vaccination, 2nd hand smoking, obesity)

22. 70-year-old male with new-onset unilateral weakness-Mr. Wright (htn, fall, syncope, CVA, afib, thrombolysis, anticoagulation)

23. 5-year-old female with sore throat-Althea Newman (strep, ADHD, immunizations)

24. 4-week-old female with fussiness-Amelia Arlington (colic, postpartum depression, infant feeding)

25. 38-year-old male with shoulder pain-Mr. Chen (rotator cuff tendinopathy, chronic pain vs acute pain)

26. 55-year-old male with fatigue-Mr. Cunha (dyspnea, palpitation, rectal bleeding, iron deficiency anemia, colonoscopy)

27. 17-year-old male with groin pain-Andrew Hailey (STI, adolescent wellness exam)

28. 58-year-old male with shortness of breath-Mr. Barley (smoking cessation, Motivational interviewing, COPD< inhaler use, vaccination)

29. 72-year-old male with dementia-Mr. Marshall (htn, COPD, delirium, depression, UTI, caregiver stress)

30. 27-year-old female - Labor and delivery-Mrs. Gold (group prenatal visits, birth plan, fetal monitoring, cultural preferences (no blood transfusion), breastfeeding, normal newborn exam and care)

31. 66-year-old female with shortness of breath-Mrs. Hernandez (T2DM, stress, EKG, CHF, ECHO)

32. 33-year-old female with painful periods-Ms. Tomlin (fibroids, contraception, IUD)

33. 28-year-old female with dizziness-Mrs. Saleh (vertigo, URI, Neuro exam)

Pediatric Cases (5) (required for FM Cases completion)PEDIATRIC Case 1: Evaluation & Care of the Newborn Infant (APGAR scoring, IUGR, breastfeeding, teen pregnancy) PEDIATRIC Case 2: Infant well child (2, 6, 9 mo exam, dietary anticipatory guidance, sleep, growth, immunization, abdominal mass) PEDIATRIC Case 3: 3 year-old well child visit (atopic dermatitis, Fe def anemia, dental health, nutrition) PEDIATRIC Case 4: 8 year-old well child check (overweight, T2DM, htn, ADHD) PEDIATRIC Case 13: 6 year-old chronic cough (eczema, asthma)

Internal Medicine (2) (required for FM Cases completion) INTERNAL MEDICINE CASE 2: 60 year-old women with chest pain (htn, CAD, hyperlipidemia, obesity, metabolic syndrome, mitral stenosis, LAD stent ”TLD” diet) INTERNAL MEDICINE CASE 16: 45 year-old man with obesity (hyperlipidemia, lifestyle intervention)

FAMILY MEDICINE CASES


OBJECTIVES OF CURRICULUM COMPONENTS

AMBULATORY CARE EXPERIENCE1. Demonstrate effective communication skills, with patients, staff and faculty.2. Recognize and treat Common Problems in Family Medicine in different

outpatient settings.3. Demonstrate competency in the acquisition, recording, and interpretation of

clinical data.4. Recognize common pathological conditions/findings using diagnostic imaging

studies.5. Document clinical encounters in a SOAP format.6. Utilize currently approved preventive measures in the care of patients.7. Perform a thorough physical examination appropriate for each problem and at all

age levels. 8. Integrate the concepts of behavioral medicine into patient care.

IN-SERVICE PATIENT CARE 1. Assume (supervised) responsibility for care of hospitalized family medicine

patients.2. Demonstrate competency in the acquisition, recording, and interpretation of

clinical data.3. Recognize common pathological conditions/findings using diagnostic imaging

studies.4. Communicate effectively with members of the inpatient team, consulting faculty,

and outpatient/referring family physician about patient progress, thus ensuring ideal disease management and continuity of care.

5. Document clinical encounters in a History and Physical format.

SOAP NOTES AND HISTORY AND PHYSICAL NOTES 1. Document a patient encounter utilizing the SOAP (Subjective, Objective,

Assessment, Plan) method as well as a complete History and Physical note.2. Discuss the purpose of clear, organized and accurate documentation of patient

encounters to include continuity of care and medical-legal issues. 3. Document a minimum of one patient encounter using the Soap Note Guidelines

and one patient encounter using the History and Physical Guidelines.

CLINICAL ENCOUNTERS: DIAGNOSES, PROCEDURES, AND PHYSICAL FINDINGS1. Experience the breadth of family medicine diagnoses, physical findings and

procedures.2. Document electronically all required clinical diagnoses and procedures , and

complete Physical Findings in Family Medicine and Pathways to Safer Opioid Use materials in Canvas during the rotation.

STANDARDIZED PATIENT ASSESSMENT1. Identify some of the strengths and weaknesses of their own patient interview and

physical examination skills. 2. Document encounters for the medical record by writing appropriate notes,

including differential diagnoses.3. Incorporate standardized patient feedback about bedside skills and mannerisms


that may build or erode trust and confidence between doctor and patient.4. Discuss performance on the SP Assessment with the Clerkship Director or other

faculty member at Campus/Site using written feedback and video of assessment as basic evaluation tools.

5. Design and implement a plan for remediation of identified weaknesses discovered in the assessment.

MID-ROTATION FORMATIVE EVALUATION1. Review progress on the rotation with the Director.2. Take an active role in receiving and responding to provided feedback, and in

developing an Individualized Learning Plan.

MID-ROTATION EXAM1. Complete Aquifer Family Medicine Cases exam.2. Identify focused areas of study for the Family Medicine National Board Shelf Test.

PREVENTIVE MEDICINE PROJECT PRESENTATION1. Develop skills in reading the medical literature critically, particularly as it relates

to best practices in preventive medicine. 2. Discuss the costs of primary or secondary interventions and contrast these with

the benefits to large populations.3. Present to others, clearly and concisely, a summary of the literature reviewed,

and make recommendations about best practices.

MORNING REPORT/IN-SERVICE/CONFERENCES1. Enhance curricular content acquisition in all competencies by attending required

conferences and workshops.

OBJECTIVES OF CURRICULUM COMPONENTS


CURRICULAR EXPRESSION

A variety of activities are used to reach the competencies, goals, and objectives outlined above. The campus or site daily schedule may vary, but our core curriculum remains the same and as follows:

AMBULATORY CARE EXPERIENCEOur discipline emphasis is on the outpatient management of common problems. Specific clinical assignments will be provided during orientation to each campus or site.

Your supervising physicians will be faculty physicians or upper level Family Medicine residents. At the beginning of each clinic session, present yourself to your supervising physician and review their performance expectations for that session. You are expected to stay in the assigned clinic setting until the end of the scheduled clinic session. You may stay until the last patient is seen but only if this does not interfere with other scheduled activities or compromise your ability to comply with the Student Work Rules. If the last patient is seen prior to the close of the session, then you may use this time to review your performance with the supervising faculty member or resident.

Ambulatory clinics may include Patient Centered Medical Homes, home visits, volunteer health clinics, Hospice, private practice clinics, nursing home visits. You are required to log all encounters during these sessions — be sure to follow HIPAA requirements.

IN-SERVICE/CALLAll students are required to participate in the care of in-patients 2-3 weeks during the rotation to experience the continuity of care offered in Family Medicine.

You are required to take overnight call for a minimum of two (2) calls or a maximum of six (6) calls (or Night Float). You will be off the afternoon on the day following call or Night Float to ensure compliance with the work restrictions of the Student Work Rules. There is no call during the final week of the rotation.

PATIENT NOTESYou will write many patient notes during the rotation. However, you will have two (2) formal patient notes graded by the Clerkship Director and these should be turned in to the director within one week of the in-patient duty. Your notes will be credited for three (3) pts (Hx and PE) and two (2) pts (SOAP note) if they are submitted on time and meet the standard for the third year student; otherwise, you will be asked to re-write them or lose credit.

History and Physical NoteIn the in-patient settings, you will evaluate patients requiring a complete History and Physical, present your case to the supervising physician, and negotiate a management plan. You are required to complete one (1) History and Physical while on in-service to be submitted to the Clerkship Director for formative and summative feedback. This will count up to three (3) points.


History and Physical Note Guidelines

• CC: (Chief Complaint) This is required on every note or H&P. It is a one sentence or less description, preferably in the patient’s own words, that states the reason for this patient encounter (i.e., “chest pain”, “I have a cold”, “fall with knee injury”).

• HPI: This section contains the subjective data (what the patient tells you during the interview). It should be documented in a chronological fashion, detailing events leading up to the hospitalization or emergency room visit. It should include the patient identifiers such as age, race and gender. It may also include relevant past medical surgical history, relevant family and social history, and pertinent review of systems. All documentation should be grammatically correct and in the form of complete sentences.

• PMH: List all illnesses or injuries, and dates of onset when they are available. List pregnancies, menstrual history and developmental history if applicable.

• PSH: List all surgeries or procedures. Include dates and pathology uncovered, if available.

• MEDICATIONS: List all medications, dosages and how they are taken including all over-the-counter, herbal, vitamin and supplemental medications. May need to ask specifically about eye drops, birth control and OTCs.

• ALLERGIES: Should include all known medication allergies and the specific reaction as well as allergies to other known substances.

• FH: Should include history of cancers, DM-2, cardiac disease. Also, health status of mother and the father, siblings and children, with cause of death in deceased.

• SH: Social history should include occupation, education level, religious preferences, marital status, and use of tobacco/alcohol/drugs.

• ROS: Should include all pertinent positive and negative findings in the review of systems but is more comprehensive than a ROS for a SOAP note as you are ‘screening’ for unidentified problems.

• Physical data includes the vital signs, physical examination (complete), laboratory findings, radiology, and pathology reports. Generally, the physical examination is documented from head to toe, beginning with HEENT and finishing with Neurologic System (Cranial Nerves, Deep Tendon Reflexes, Sensory, Motor and Cerebellar testing) or Integument. Remember this is a complete Physical Examination.

• Assessment is the diagnosis and should be as complete as possible given the current data. If the most specific diagnosis is ‘cough’ then that should be the first diagnosis, but this should be followed by a differential diagnosis that should include the most likely etiologies for the cough. If the patient has other related or contributory illnesses like COPD or HTN, then these should be listed as well. Faculty would like to see some discussion about the differential diagnosis in order to verify that you are reasoning at the level of your peer group. If your diagnosis is cough or dyspnea, explain what you think the leading cause for that symptom might be, and then the second and third possibilities that you have considered.



• Plan is the final portion of the History and Physical and should mirror the orders if the patient is being admitted. The plan should include further diagnostic evaluations planned, the therapeutic interventions, and any educational materials given or discussed. Any future evaluations, lab tests, radiology tests or immunizations should be listed. Specify each medication, the dose, the number given, and the number of refills allowed. Lastly, document any referrals made and the reason for each referral.

Soap NotesYou will take a directed history, perform a pertinent physical examination, and then present the case to your supervisor. Together, you will negotiate a management plan with the patient. You are required to complete one (1) SOAP note in your choice of clinical settings to be submitted to the Clerkship Director for formative and summative feedback. This will count up to two (2) points.

SOAP Note Guidelines

• CC: (Chief Complaint) This is required on every note or H&P. It is a one sentence or less description, preferably in the patient’s own words, that states the reason for this patient encounter (i.e., “chest pain”, “I have a cold”, “fall with knee injury”).

• Subjective Data includes what the patient tells you during the interview. It should be documented in a brief but logical and complete fashion. It should include the patient identifiers such as age, race and gender. This should be followed by the current symptoms, interval history, relevant past medical and surgical history, relevant family and social history and pertinent review of systems. All documentation should be grammatically correct and in the form of complete sentences.

• Objective data includes the vital signs, physical examination relevant to the complaints, laboratory findings and radiology and pathology reports.

• Assessment is the diagnosis and should be as complete as possible given the current data. If the most specific diagnosis is ‘cough’, then that should be the first diagnosis but this should be followed by a differential diagnosis that should include the most likely etiologies for the cough. If the patient has other related or contributory illnesses like COPD or HTN, then these should be listed as well.

• Plan is the final portion of the SOAP note and should include further testing or evaluations planned, the therapeutic interventions, and any educational materials given or discussed and the plan for a return visit. Any future evaluations, lab tests, radiology tests or immunizations should be listed. Do not write ‘continue current medication’ or ‘refilled current medications’ as this is inadequate for continuity of care. Specify each medication, the dose, the number given, and the number of refills allowed. Lastly, document any referrals made and the reason for each referral.




PATIENT SAFETY: DO NOT USE LIST FOR PATIENT NOTES

DO NOT USE POTENTIAL PROBLEM USE INSTEADU (unit) Mistaken for:

• 0 (zero) • 4 (four) • cc

Instead write: • unit

IU (international unit) Mistaken for: • IV (intravenous) • 10 (ten)

Instead write: • international unit

Q.D., QD, q.d., qd (daily)

Q.O.D., QOD, q.o.d., qod (every other day)

Mistaken for each other

Period after “Q” and the “O” mistaken for “I”

Instead write: • daily

Instead write: • every other day

Trailing zero (X.0 mg)*

Lack of leading zero (.X mg)

Decimal point is missed Instead write: • X mg

Instead write: • 0.X mg

MS Can mean: • morphine sulfate or • magnesium sulfate

Instead write: • morphine sulfate

MSO4and MgSO4 Confused for one another Instead write: • magnesium sulfate

Apothecary Units Unfamiliar to many practitioners

Confused with metric units

Instead use: • metric units

@ Mistaken for: • 2 (two)

Instead write: • at

Cc Mistaken for: • U (units)

Instead write: • ml or milliliters

µg Mistaken for: • mg (milligrams)

Can result in one thousand-fold overdose

Instead write: • mcg or micrograms

*Note: A “trailing zero” may be used only for laboratory results, imaging studies that report size of legions, or catheter/tube sizes. It may not be used in medication orders or other medication-related documentation.


STANDARDIZED PATIENT ASSESSMENT – DIRECT FEEDBACKA formative Standardized Patient Assessment is required at mid-rotation. This provides feedback for clinical skills and preparation for the CS exam.

The SP Assessment uses two (2) or three (3) cases that are based on common problems encountered by Family Medicine physicians. It generally occurs during Week 5 of the rotation. It may be in real or telehealth format. Students should be prepared to evaluate patients with any of the following complaints:

Abdominal Pain Hypertension

Alcoholism Medical Ethics

Alzheimers Menopause

Back Pain Metabolic Syndrome

Carpal Tunnel Syndrome Obesity

Chest Pain Osteoarthritis

COPD Pedal Edema

Depression Rectal Bleeding

Diabetes Mellitus Type 2 Sore Throat

Headache Vaginitis

Hematochezia Vertigo

You are expected to take a focused history and/or perform a limited physical exam and/or counsel the patient during a fifteen-minute encounter. Afterward, you will have ten minutes to write a note summarizing the encounter, your differential diagnoses and treatment plans. You will observe a classmate’s recorded performance and then detail strengths and weaknesses on that performance.

SPA Tips for Success• Suspend disbelief. Act like this is your patient and play the role of a third year

student.• Read your instructions. They tell you exactly what to do…and what may be

unnecessary! • Form a plan outside the exam room, even before you go in.• Begin open-ended… then track the answers to the next obvious question, but

don’t forget the differential you formulated beforehand, which may need direct questioning (closed ended questions).

• Use best technique of asking questions, doing physical maneuvers, and educating the patient. Don’t talk over the patient, string questions, or discount the information they are willing to share.

• Be patient centered. Show empathy. Smile. Tell the patient what you are doing with them and why.

Common Causes of CPEX and CS Failures• Failure to wash or sanitize your hands before ANY patient contact.• Failure to use Stethoscopes to listen directly ON the SKIN.




MID-ROTATION EXAMStudents will complete an exam based on ALL 40 cases in the Aquifer FM Cases. You will receive an overall formative score in addition to your Mid Rotation exam score based on the 15 designated case questions (page 5-6).

The Exam will generally be given on Monday, PM, of Week 5 of the Rotation. The exam will count as 10% of your final grade. Minimum passing score of 60% required.

GOLD OBSERVATION CARDSDuring the rotation, you are required to actively seek observation and feedback. You document this on your GOLD OBSERVATION CARD while working in the clinic, on wards and in private offices. Have a preceptor document that you were observed doing each component of the physical exam at least once during the rotation. The completed cards should be turned in to your Clerkship Coordinator by Wednesday of your final week.

FORMATIVE OBSERVATION is also provided on yellow coaching cards as well as on your One45 Clinical Evaluations during your rotation. These provide you coaching feedback, and those comments do not appear in your Dean’s letter summary.

MID-ROTATION FORMATIVE EVALUATION You will meet with your Director to review your progress and to develop a learning plan to meet your specific needs. The following will be discussed:

1. Review of collated feedback or strengths and weaknesses during clinic and wards, (summary of coaching cards or whatever method you use to monitor student progress).

2. Standardized Patient Assessment performance.3. Data entries on patient encounters, physical findings, and procedures.4. SOAP notes and one comprehensive H&P.5. Professionalism (attitude, attire, punctuality, collegiality, etc).6. Student goals for clerkship, barriers they perceive toward succeeding, and any

problems they are having inside the curriculum of this clerkship.7. Mid-Rotation Exam: Review of scoring on the Aquifer/FM Cases.

PREVENTIVE MEDICINE PROJECTYou are required to prepare a presentation on a preventive medicine topic, addressing an issue of primary or secondary prevention.

Resources are available for this project on Canvas.



Purpose of the Project/Presentation• To be able to evaluate the many proposed primary or secondary prevention

interventions for your future practice.• Evaluate a primary or secondary topic in light of the significance of the target

disease, including prevalence, treatability, and mortality/morbidity.• Evaluate costs, economic and non-economic.

Primary Prevention: measures provided to prevent the onset of disease or targeted condition (e.g. immunization of healthy children).

Secondary Prevention - Screening: measures provided to asymptomatic individuals to identify those who have pre-clinical disease with no signs or symptoms (e.g. mammograms). Refer to the Frame and Carlson Criteria for Screening (below). You may also use the Frame and Carlson Criteria for Screening to help organize your presentation.

(Tertiary Prevention, which you should not use, is treatment of factors to prevent disease progression or complication in those who have already been diagnosed e.g. screening for diabetic retinopathy)

Topic Choice – Review/Approval Process:

You may be asked to choose from a pre-approved list of topics – if so, follow your site Director’s instructions. If you are permitted to choose your own topic:

• Your topic choice should be submitted/approved by your Clerkship Director by Friday of Week 1 of the rotation (use the Preventive Medicine Project Topic Approval Request form) unless you are directed otherwise.

• The topic/approval process is part of the learning experience so your initial request may need revised to assure you are appropriately focused as you begin you research and presentation development.

Presentation Tips• Time will be a grading factor. The presentation should be approximately 12-15

minutes maximum and your audience will be faculty, residents, and your peers (setting, date and time will be scheduled at your campus/site).

• You will lose points if you exceed your time limit.• Be familiar with the Evaluation as these are the criteria by which you will be

evaluated.• Become familiar with the technical equipment before your presentation. • Slides should have only the key points, do not read from slides.• Check background colors and font colors for readability. General rule is dark on

light and light on dark. No red on black.• Make eye contact, engage the audience, speak clearly-slowly and loudly enough

to be heard without amplification.• Wear your white coat.• Introduce yourself at the onset and state the title of your presentation.• Briefly state why you chose this topic.


• Present findings including cost leading to your recommendation(s) and conclusion.

• You should reach your own recommendation(s)/conclusion at the end of the presentation, either for or against the chosen measure, based on the research evidence presented. This should be your conclusion, not just a quote of one of the many “authorities” in this area, e.g. ACS, USPSTF, ACP, AAFM, etc.

• Include references at the end of your presentation noting all references used in the presentation. In addition, please make sure you reference all charts, graphs used from text or journals on the slide and include in your inclusive references at the end of your presentation.

• Ask your audience for questions after the conclusion of your presentation and be prepared to address issues based on your research.

Frame and Carlson Criteria for Evaluation of a Screening TestUse as a guideline for a secondary prevention topic choice:

1. The disease must have a significant effect on quality or quantity of life.2. Acceptable methods of treatment must be reliable.3. The disease must have an asymptomatic period during which detection and

treatment significantly reduce morbidity and/or mortality.4. Treatment in the asymptomatic phase must yield a therapeutic result superior to

that obtained by delaying treatment until symptoms appear.5. Tests must be available at a reasonable cost to detect the condition in the

asymptomatic period.6. The incidence of the condition must be sufficient to justify the cost of screening.

The project will count as 5% of your final grade. See Appendix B for the Prevention Topic Presentation Evaluation Form.

Preventive Medicine Project Topic Approval Request Form – use only if you are not doing a pre-approved topic.

• Please read the full guidelines in the handbook carefully before proceeding with the completion/submission of this form.

• You are required to complete an oral presentation on a primary or secondary prevention topic to complete the Preventive Medicine Project.

• The topic you select must be approved prior to beginning work on the project. Please submit the completed form for approval by your Clerkship Director.

• The form must be submitted to the Clerkship Director by Friday of Week 1.

The purpose of the project/presentation is to enable the student to be able to evaluate the many proposed primary or secondary prevention interventions for their future practice; to evaluate a primary or secondary topic in light of the significance of the target disease, including prevalence, treatability, and mortality/morbidity; and to evaluate economic and non-economic costs.

Primary Prevention: measures provided to prevent the onset of disease or targeted condition (e.g. immunization of healthy children).



Secondary Prevention: measures provided to asymptomatic individuals to identify those who have pre-clinical disease with no signs or symptoms (e.g. screening mammograms). Refer to the Frame and Carlson Criteria for Screening. You may also use the Frame and Carlson Criteria for Screening to help organize your presentation.

(Tertiary Prevention, which does not meet the requirements for your project, is treatment of factors to prevent disease progression in those who have already been diagnosed.)

To be completed by student and emailed to Clerkship Coordinator.

Name

Campus

Phone

E-Mail Address

Date Submitted

Note topic choice under appropriate section (primary or secondary)

Primary Topic

Or your choice of secondary below.

Secondary Topic

To be completed by Clerkship Coordinator.

Comments

Topic Approval

Date

Date Student Notified


MORNING REPORT/IN-SERVICE ROUNDSMorning Report (or its equivalent) and In-Service teaching rounds are conducted at each campus and you are required to attend per campus/site requirements.

CONFERENCESYou will attend conferences (grand rounds, teaching conferences, etc.) as directed by your campus/site Clerkship Director/Coordinator. You will be provided a schedule at your campus/site.



CLINICAL EXPERIENCESOrganized under two criteria groups: Clinical Diagnoses/Patient Encounters and Procedures. You are required to document in One 45 during the rotation as follows:

Clinical Diagnoses/Patient EncountersYou are required to have a minimum of 100 diagnoses/patient encounters related to your clinical encounter experiences and diagnoses/patient encounters must be electronically documented. You may enter up to two (2) diagnoses/patient encounters per patient. You may enter again if you see the patient on a repeat visit on out-patient or daily on in-service. You also have requirements for minimum numbers on kinds of diagnoses seen (see page 19).

Completion of the required numbers and kinds of diagnoses and subsequent electronic documentation is required and composes 5% of your final grade:

• Your results are evaluated on Tuesday of Week 5. If encounters are entered appropriately and the minimum total of 50 clinical diagnoses/patient encounters met you will receive three (3) points toward your final grade.

• Your results are evaluated at the end of the rotation. If the minimum of 100 clinical diagnoses/patient encounters is met by Monday following the last day of the rotation, you will receive two (2) points toward your final grade.

In addition, you are required to continue entering encounters after reaching the required 100 encounters and required specific diagnoses, in order that student settings can be monitored for equivalency.

Physical Findings and Pathways to Safer Opioid Use QuizzesYou are required to document expertise in recognition of core pathological Physical Findings commonly seen in Family Medicine during your rotation by completing the Physical Findings in Family Medicine Quiz in Canvas. Likewise, Safe Opioid Prescribing is a critical patient care skill required in Primary Care. Complete the Pathways to Safer Opioid Use module and quiz on Canvas as well to document your competency in this domain. This is due by Wednesday of week 8.

ProceduresSome Year 3 required MUSM/Procedures must be completed while on Family Medicine. See checklist for requirements. These may be done in workshops, clinics, or in simulated format. All Family Medicine procedures are provided in simulated format on Canvas for your documentation, if needed.

• Diagnoses/Patient Encounters numbers and points are separate from Procedures numbers.

• However, if you have entered Diagnoses/Patient Encounters and the patient has a procedure, you may enter on the same patient.

Failure to complete Procedures - either in Real or Simulated form - will result in notification of the Third Year Director and an incomplete may be issued until successfully completed.


CLINICAL DISGNOSES/PATIENT ENCOUNTERS CRITERIA

Clinical Diagnoses/Patient Encounters Number* Experience criteria = PERFORM

Anxiety/Depression 2

ADD/ADHD 1

Back Pain/Joint Pain 2

CHF 1

COPD/Asthma 3

COLD symptoms/Viral Syndrome 1

Diabetes Mellitus 5

Dyslipidemia 5

GERD/PUD 1

Headache 2

Hypertension 5

Menopause 1

Obesity 5

Smoking Cessation 1

STI 1

Procedures Number* Experience criteria = PERFORM

Peak Flow 1 Real Patient

Diabetic Foot exam with Monofilament 1 Real Patient

Ultrasound: Pulmonary A lines 1 Image Capture or real-time demonstration; Real Patient

Normal IVC and Abdominal Aorta 1 Image Capture or real-time demonstration; Real Patient

Popliteal Vein with compression 1 Image Capture or real-time demonstration; Real Patient

SIMULATION

Joint Injection 1 Real or sim

Punch Biopsy 1 Real or sim

SUPPLEMENTAL

Eye irrigation/foreign body removal and fluorescein staining**

1 May be real, sim or video review (Canvas)

Telehealth Encounters Number* Experience criteria = PERFORM

Audio , Audio/video, or e-visit 1

*Miniminum number required. ** These less common procedures are important to recognize/understand.

If not seen in clinic, review in Canvas materials.


The Family Medicine Third Year Medical Student Clerkship evaluation system consists of both formative (non-graded) and summative (graded) components.

CLINICAL PERFORMANCE MID-ROTATION EVALUATION As you approach the mid-rotation, you will meet with your campus/site director to discuss your progress. This evaluation is for feedback only and is a non-graded component. Formative

STANDARDIZED PATIENT ASSESSMENT The Standardized Patient Assessment is a formative evaluation at mid-rotation.

In addition to the SP’s feedback, faculty members review the clinical performance and grade the written assignments. If students have difficulties, either with bedside skills or professional behavior, remedial assignments may be necessary. After the exercise, each student is required to review a video-recording of a peer on the rotation. The assessment is based on bedside skills scored by the standardized patient (taking a history, doing a physical and communicating) and written assignment graded by a faculty. Formative

CLINICAL PERFOMANCE EVALUATIONStudents are required to average a 70 or higher on the Clinical Performance Evaluations. Additionally, any student who receives a grade of less than 70 by two separate faculty preceptors will be considered incomplete for this component of the clerkship. All faculty members that have worked with you may complete clinical evaluations. In addition, residents and private office preceptors will complete the evaluation.

The grade comprises 40% of the final grade. Summative

MID-ROTATION EXAMThe mid-rotation exam will be over the 40 Aquifer FM Cases. Students receive two (2) scores:

1) Students are required to score a 60 or higher on the 15 designated Aquifer FM Cases (highlighted on page 5).


Note: If a student fails the Mid-Rotation exam once, a second opportunity to take the exam will be provided. Failure to pass the exam for the second time will result in remediation of the 8-week rotation. On the successful retake, the minimum passing score of 60 will be used on the final grade calculation.

2) In addition, students receive an overall formative score on all 40 Aquifer FM Cases to guide students in identifying their strengths and weaknesses at mid-rotation as they move toward the NBME/FM Shelf Exam.

FORMATIVE AND SUMMATIVE EVALUATION SUMMARY


COMPLETION OF AQUIFER FM CASES Students should complete the 15 designated cases for the mid-rotation exam and complete all 40 cases prior to the FM Shelf Exam.


NBME SHELF TESTStudents are required to score a 60 or higher on the Shelf Test in order to pass the rotation.

Note: If a student fails the NBME exam once, a second opportunity to take the exam will be provided. Failure to pass the exam for the second time will result in remediation of the 8-week rotation. On the successful retake, the minimum passing score of 60 will be used on the final grade calculation.

The grade comprises 25% of your final grade. Summative

PREVENTIVE MEDICINE PROJECTYou will present the findings of your preventive medicine project to a group of faculty, and/or residents and students at an appropriate forum specified by the Clerkship Director. You are evaluated on how well you cover the criteria set forth on the Evaluation.


DIAGNOSESDocumentation of the numbers and kinds of clinical diagnoses. Timely documentation is rewarded with three (3) points at mid-rotation (50 diagnoses) and two (2) additional points on the final day of the rotation (100 diagnoses). Any student failing to meet the required number and kinds of diagnoses will receive an Incomplete–Clinical Encounter (I-CE) and will not receive credit for this component until it is successfully completed.


PATIENT NOTESSuccessful completion of one SOAP note (2 points) and one History and Physical (3 points) note to be reviewed and graded by the Clerkship Director. There may be penalties for late submission. No notes will be accepted after end of rotation.


GOLD OBSERVATION CARDSYou will submit your GOLD OBSERVATION CARD(s), and document observed clinical exam experience in all of the content areas listed, by Wednesday of week 8. This grade comprises 5% of your final grade.

FORMATIVE AND SUMMATIVE EVALUATION SUMMARY


GRADE DISTRIBUTION/ REMEDIATION POLICY

Graded Components Weight Minimum Passing/Remediation

NBME Shelf Test 25% 60 ( Repeat allowed once, score 60 if above pass on repeat. 2nd non-passing score requires repeat of the entire clerkship.)

Mid-rotation Exam 10% 60 ( Repeat allowed once, score 60 if above pass on repeat. 2nd non-passing score requires repeat of clerkship.)

Clinical Evaluation 40% 70 (Repeat clerkship.)

Prevention Presentation 5% 70 (Repeat once. Average of two grades.)

FM Cases Completion 5% 100

Clinical Encounters 5% 100

Patient Notes 5% 100

Gold OB Cards 5% 100

The minimum overall passing score for the Family Medicine Clerkship is 70. Failure to meet this requirement requires a repeat of the entire 8-week rotation.

REMEDIATION POLICYAll students must complete the entire clerkship curriculum and all Formative and Summative Evaluations for the Clerkship. Your grade for the clerkship will be either PASS or FAIL. In addition, you will receive a composite score of the evaluation components described in the curriculum. The remediation program will address three components: 1. Identification of the deficit, 2. Instruction/Intervention, and 3.Re-evaluation.

Remediation Plan1. All students must meet with the Campus Clerkship Director within four (4) weeks

of notification of unsuccessful completion of any component of the clerkship to discuss the deficits and devise a remediation plan, which will be signed and dated by the Campus Clerkship Director and the student. This remediation plan will be copied with a copy to the student, to the Dean of Academic Affairs, to the Campus Clerkship Director and a copy placed in the student’s file.

2. The student will be given eight (8) weeks after the completion of his/her 3rd year to successfully complete the remediation plan. The remediation must occur before the student begins the required rotations of the fourth year. Failure to successfully complete the remediation within eight (8) weeks after completion of the third year will result in a failure in the clerkship and the need to repeat the entire clerkship.

3. Any student scoring ‘fails to meet minimal expectations for student at this level of training’ on any component of the professionalism portion of the final evaluation or who scores a ‘no’ on the final evaluation question ‘did the student behave in an ethical and professional manner as described in The Student Code of Honor and Professional Conduct’ will be referred to the Dean of Academic Affairs for further evaluation and action as a violation of ethics and professionalism. An unsatisfactory evaluation as described above on any component of the final evaluation dealing with professionalism or ethics may result in failure of the clerkship.

GRADE DISTRIBUTION SUMMARY


MUSM POLICIES

Students on the Clerkship are expected to maintain the highest standards of professionalism, and to abide by all MUSM policies including the MU Honor Code, the Medical Student Code of Honor and Professional Conduct, Dress Code, Duty Hour Requirements, Blood-Borne Pathogen response program, and Attendance as recorded in the MUSM, MD Program, Handbook.

PARTICPATION: Participation is expected at all scheduled activities unless otherwise directed by the Clerkship Director. Students are expected to remain on the hospital property during ‘on-call/Night Float’ periods unless directed otherwise by their Attending or Clerkship Director.

DUTY HOURS: Logging duty hours is required and should be done in One45.


APPENDIX A: STFM COMPETENCIES

Table 3: Core Acute Presentations with Common Diagnoses, Serious Diagnoses, and Topic-Specific Objectives

TOPIC* COMMON SERIOUSTOPIC-SPECIFIC OBJECTIVES

ADDITIONAL SKILLS

Upper Respiratory Symptoms

Infections (viral upper respiratory infection, bacterial sinusitis, streptococcal pharyngitis, otitis media, and mono-nucleosis) and noninfectious causes (allergic rhinitis)

• Recognize that most acute upper respiratory symptoms are caused by viruses and are not treated with antibiotics.

• Determine a patient’s pretest probability for streptococcal pharyngitis and make appropriate treatment decision (e.g., empiric treatment, test, or

• Neither treat/test (PBLI)Joint Pain and Injury

Ankle sprains and fractures, knee ligament and meniscal injuries, shoulder dislocations and rotator cuff injuries, hip pain, Carpal Tunnel Syndrome, osteoarthritis, and overuse syndromes (e.g., Achilles’ tendinitis, patella-femoral pain syndrome, subacromial bursitis/rotator cuff tendinosis)

Septic arthritis, acute compartment syndrome, acute vascular compromise associated with a fracture or a dislocation

• Describe the difference between acute and overuse injuries.

• Elicit an accurate mechanism of injury.

• Perform an appropriate musculoskeletal examination †

• Apply Ottawa decision rules to determine when it’s appropriate to order ankle radiographs. (PBLI)

Detect a fracture on standard radiographs and accurately describe displacement, orientation, and location (e.g., nondisplaced spiral fracture of the distal fibula).

Pregnancy (initial presentation)

• Recognize that many family physicians incorporate prenatal care and deliveries into their practices and studies support this.

• Recognize common presentations of pregnancy, including positive home pregnancy test, missed/late period, and abnormal vaginal bleeding.

• Appreciate the wide range of responses that women and their families exhibit upon discovering a pregnancy. (PR)




ADDITIONAL SKILLS

Abdominal Pain

Gastro-esophageal reflux disease (GERD), gastritis, gastroenteritis, irritable bowel syndrome, dyspepsia, constipation, and depression

Appendicitis, diverticulitis, cholecystitis, inflammatory bowel disease, ectopic pregnancy, and peptic ulcer disease

• Recognize the need for emergent versus urgent versus non-urgent management for varying etiologies of abdominal pain.

Common Skin Lesions

Actinic keratosis, seborrheic keratosis, keratoacan-thoma, melanoma, squamous cell carcinoma, basal cell carcinoma, warts, and inclusion cysts

• Describe a skin lesion using appropriate medical terminology.

Common Skin Rashes

Atopic dermatitis contact dermatitis, scabies, seborrheic dermatitis, and urticarial

• Describe the characteristics of the rash.

• Prepare a skin scraping and identify fungal elements.

Abnormal VaginalBleeding

• Elicit an accurate menstrual history

• Recognize when vaginal bleeding is abnormal

Low Back Pain

Muscle strain, altered mechanics including obesity, and nerve root compression

Aneurysm rupture, acute fracture infection, spinal cord compromise, and metastatic disease

• Describe indications for plain radiographs in patients with back pain. (PBLI)

Conduct and appropriate musculoskeletal examination that includes inspection, palpitation, range of motion, and focused neurologic assessment.

Cough Infections (pneumonia, bronchitis, or other upper respiratory syndromes, and sinusitis) and non- infections causes (asthma, GERD, and allergic rhinitis

Lung cancer, pneumonia, and tuberculosis

• Understand how pretest probability and the likelihood of test results altering treatment can be used to guide diagnostic testing. (PBLI)

• Recognize pneumonia on a chest X-ray.




ADDITIONAL SKILLS

Chest Pain Gastrointestinal (e.g., GERD), musculoskeletal (e.g., costochrondritis), cardiac (e.g., angina and myocardial infarction), and pulmonary (e.g., pulmonary embolism, pneumothorax)

• Describe how age and comorbidities affect the relative frequency of common etiologies.

• Apply clinical decision rules that use pretest probability to guide evaluation. (PBLI)

• Recognize the indications for emergent versus urgent versus non-urgent management for varying etiologies of chest pain.

Recognize cardiac ischemia and injury on an electro-cardiogram (ECG).

Headache Tension, migraine, and sinus pressure headaches

Meningitis, subarachnoid hemorrhage, and temporal arteritis

• Determine when imaging is indicated.

Vaginal Discharge

• Discuss the interpretation of wet prep and potassium hydroxide (KOH) specimens.

Dysuria Urethritis, bacterial cystitis, pyelonephritis, prostatitis, and vulvovaginal candidiasis

Interpret a urinalysis

Dizziness Benign positional vertigo (BPV), labyrinthitis, and orthostatic dizziness

Cerebral vascular disease (CVA), brain tumor, and Ménière’s Disease

Shortness of breath/ wheezing

Asthma, chronic obstructive pulmonary disease (COPD), obesity, angina, and congestive heart failure (CHF)

Exacerbations of asthma or COPD, pulmonary embolus, pulmonary edema, pneumothorax & acute coronary syndrome

Recognize typical radiographic findings of COPD and CHF

Fever Viral upper respiratory syndromes, streptococcal pharyngitis, influenza, and otitis media

Meningitis, sepsis, fever in the immuno-suppressed patient

• Describe focused, cost-effective approach to diagnostic testing. (SBP)

• Propose prompt follow-up to detect treatable causes of infection that appear after initial visit. (SBP)




ADDITIONAL SKILLS

Depression (initial presentation)

• Appreciate the many presentations of depression in primary care (e.g. fatigue, pain, vague symptoms, sleep disturbance, and overt depression).

• Use a validated screening tool for depression. (SBP)

• Assess suicidal ideation.

• Recognize when diagnostic testing is indicated to exclude medical conditions that may mimic depression (e.g. hypothyroidism).

• Recognize the role of substance use/abuse in depression and the value of identifying and addressing substance use in depressed patients.

• Recognize the potential effect of depression on self-care and ability to manage complex comorbidities.

Male Urinary Symptoms/ Prostate

• Select appropriate laboratory tests for a male patient with urinary complaints.

Dementia • Perform a screening test for cognitive decline (e.g., clock drawing test or mini-mental status exam).

• Select appropriate initial diagnostic tests for a patient presenting with memory loss, focusing on tests that identify treatable causes.




ADDITIONAL SKILLS

Leg swelling Venus stasis and medication-related edema

Deep venous thrombosis (DVT), obstructive sleep apnea, and CHF

• Recognize the need for urgent versus non-urgent management for varying etiologies of leg swelling, including when a Doppler ultrasound test for DVT is indicated.

* Ordered from most to least common based on numbers of ambulatory care visits to primary care offices to diagnostic groups, United States 2005-2006 (National Health Statistics Reports No.8, August 2008).

† Musculoskeletal examination to include inspection, palpitation, range of motion, assessment of commonly injured structures (e.g. ligaments of the ankle and knee, rotator cuff in the shoulder), and assessment of neurovascular integrity. PBLI – problem-based learning and improvement, PR – professionalism, SBP – systems-based practice

Table 5: Core Chronic Disease Presentations with Topic-Specific Objectives

TOPIC* TOPIC-SPECIFIC OBJECTIVESMultiple chronic illnesses (e.g. depression, hypertension, hypothyroidism, type 2 diabetes, mellitus)

• Assess status of multiple diseases in a single visit.• List important criteria to consider when prioritizing next steps for management

of patients with multiple uncontrolled chronic diseases.• Document a patient encounter with multiple chronic diseases using a SOAP

note and/or chronic disease flow sheet or template.Hypertension • Take an accurate manual blood pressure.

• Recognize the signs/symptoms of end-organ disease.Type 2 Diabetes Mellitus • Perform a diabetic foot examination.

• Document an encounter using a diabetes mellitus flow sheet or template. (SBP)• Recognize the signs/symptoms associated with hypoglycemia or

hyperglycemia.Asthma/Chronic Obstructive Pulmonary Disease (COPD)

• Discuss the difference between asthma and COPD, including pathophysiology, clinical findings, and treatments.

• Elicit environmental factors contributing to the disease process.• Recognize an obstructive pattern on pulmonary function tests.• Recognize hyperinflation on a chest radiograph.• Discuss smoking cessation.

Hyperlipidemia • Determine a patient’s cholesterol goals based on current guidelines and the individual’s risk factors.

• Interpret lipid laboratory measurements.Anxiety • Describe how an anxiety disorder can compromise the ability for self-care,

function in society, and coping effectively with other health problems.


TOPIC* TOPIC-SPECIFIC OBJECTIVESArthritis • Guide a patient in setting goals for realistic control of pain and maximized

function.Chronic Back Pain • Obtain a medication use history.

• Anticipate the risk of narcotic-related adverse outcomes.• Guide a patient in setting goals for pain control and function.

Coronary Artery Disease (CAD)

• Identify risk factors for coronary artery disease.• Use an evidence-based tool to calculate a patient’s CAD risk.• ICounsel patients on strategies to reduce their cardiovascular risks.

Obesity • Obtain a dietary history.• Collaborate with a patient to set a specific, appropriate weight loss goal.

Heart failure (HF) • List underlying causes of HF.• Recognize the signs/symptoms of HF.• Recognize signs of HF on a chest radiograph.

Depression (previously diagnosed)

• Assess suicide risk• Describe the impact of depression on a patient’s ability for self-care, function in

society, and management of other health problems.Osteoporosis/Osteopenia • Recommend prevention measures.Substance Use, Dependence, and Abuse

• Obtain an accurate substance use history in a manner that enhances the student-patient relationship.

• Differentiate among substance use, misuse, abuse, and dependence.• Discuss the typical presentations for withdrawal from tobacco, alcohol,

prescription pain medications, and common street drugs.• Assess a person’s stage of change in substance use/abuse cessation.• Communicate respectfully with all patients about their substance abuse.



APPENDIX B: EVALUATION DOCUMENTS

Please consider the following areas in assessing this student’s performance:

CONTENT:1. Problem clearly stated and appropriate to primary or secondary prevention. 1 2 3 4 5

2. Addressed disease effect on quality or quantity of life. 1 2 3 4 5

3. Economic and non-economic costs of preventive measure compared to no intervention addressed. 1 2 3 4 5

4. Efficacy of intervention discussed. 1 2 3 4 5

5. Current guidelines/recommendations reviewed refuted or supported and consistent with data findings. 1 2 3 4 5

6. References appropriate and sufficient and conclusion and recommendation clearly stated and supported by presentation. 1 2 3 4 5

PRESENTATION:7. Understandable speech and appropriate speed. 1 2 3 4 55

8. Clear organization and good time utilization. 1 2 3 4 5

9. Appropriate use of AV materials, including Power Point slide formatting (if used). 1 2 3 4 5

10. Questions well handled. 1 2 3 4 5

Comment below on the factors that led you to the grade you assigned:

Prevention Medicine Project EvaluationStudent: ______________________________ Presentation Date: _________________

Presentation Title: _________________________________________________________

SERIOUSLY DEFICIENT

1DEFICIENT

2

MEETS STANDARDS

3

EXCEEDS EXPECTATIONS

4

WELL BEYOND EXPECTATIONS

5

Strengths: ________________________________________________________________

Areas of Improvement: _____________________________________________________

Evaluator’s Signature/Printed Name: _________________________________________

5 = 10 points4 = 8 points

3 = 6 points2 = 4 points

1 = 2 points

Each question = 10 points = Total 100Student Grade:



FAMILY MEDICINE CLERKSHIP – CLINICAL PERFORMANCE EVALUATIONThis evaluation is completed on each student by faculty, preceptors and residents during your clinical experiences.

Clinical performance is ranked on a Likert scale based on the ACGME competencies.

0=N/A – Did Not Observe 1=Never or Rarely Meets Expectations 2=Occasionally Meets Expectations 3=Consistently Meets Expectations 4=Occasionally Exceeds Expectations 5=Consistently Exceeds Expectations

1. Patient Care Appropriate history taking skills. Appropriate physical exam skills.

2. Medical Knowledge Demonstrated by appropriate biomedical knowledge, appropriate problem

solving skills and an appropriate ability to develop a differential diagnoses.

3. Practice-Based Learning and Improvement Appropriate knowledge of the importance of knowing the “standard” against

which actual performance is compared.

4. Interpersonal and Communication Skills Demonstrates appropriate communication with patients and families, appropriate

oral patient presentations and appropriate written documentation.

5. Professionalism Demonstrated by being punctual, exhibiting a good work ethic, fostering

teamwork, completion of timely and accurate documentation and adhering to the dress code.

6. Systems-Based Practice Appropriately participated in interdisciplinary teams for achieving quality

patient care.

Did the student behave in an ethical and professional manner? If NO, an Unprofessional behavior report will be completed.

COMMENTSSummative narrative for Dean’s letter: (A summary of specific skills and talents demonstrated during the clerkship — NOT, “The best student ever!”)

Formative narrative for Coaching:

Did you meet with the student to discuss this report?


NON-FACULTY EVALUATION OF STUDENTSStaff are asked to facilitate evaluation of students as part of your formative coaching. They will be asked to comment as follows:

Interactions with others:Expectation is that student interacts well; seeks contributions of others on the health care team.

Reliability:Expectation is that student is on time and available for scheduled activities.

Professionalism:Expectation is that student will act in a professional manner at all times as described by the Student Code of Honor and Professional Conduct.

Comments:




CLERKSHIP EVALUATION BY STUDENTSUpon completion, students are encouraged to reflect on their experience and offer comments. The process is anonymous. Comments are collated and reviewed by the entire faculty at the end of the academic year. Evaluations are “site-specific,” and use a Likert scale of 1 (poor) to 5 (exceptional), or 6 (not applicable). Students are also required to complete the standard MUSM clerkship evaluation.

Clerkship criteria for students to comment on include the following:• Clarity of clerkship competencies, goals and objectives• How well the clerkship achieved competencies, goals and objectives• Overall clerkship organization and coherency• Educational value/amount learned• Professionalism of faculty involved with the clerkship• Professionalism of residents involved with the clerkship• Ambulatory care experience – patient care contact• In-Service – patient care contact• Call• Patient notes review• Standardized patient assessment and review• Mid-rotation examination/usefulness of feedback• Mid-rotation evaluation/usefulness of feedback• Preventive medicine project – presentation• Didactic sessions (lectures offered)• Conferences (morning report, educational conferences and/or grand rounds)• Understanding of how you would be evaluated• How well the workload challenged you/level of material appropriate• How well your suggestions for improvement/feedback were received• Text: Aquifer family medicine cases• Overall rating/quality of clerkship

Continue to include in Clerkship: ___________________________________________

Areas of improvement in Clerkship: _________________________________________

Faculty/Staff evaluations are also included for each site, for each Clerkship director, coordinator, preceptors, faculty and residents, using the following patterns:

CLERKSHIP DIRECTOR (we insert name here): Please rank the director on the ability to manage the clerkship components, and on their availability, attitude, interpersonal and communication skills, and professionalism.

OFFICE PRECEPTOR (we insert name here): Please rank the office preceptor on their patient care, medical knowledge, availability, teaching, interpersonal and communication skills, and professionalism.

FACULTY PRECEPTOR (we insert names here): Please rank the preceptor on their patient care, medical knowledge, availability, teaching interpersonal and communication skills, and professionalism.


APPENDIX C: SITE CONTACT INFORMATION

Columbus RegionalFamily Practice Residency Program 1900 Tenth Avenue, Suite 100 Columbus, GA 31901 Phone: 706-571-1402 or 706-571-1430 Fax: 706-660-2895 or 706-571-1604

Residency Director John Bucholtz, D.O.

Clerkship Director Janine Burgher-Jones, M.D., Associate Director of Residency Program, Director of Undergraduate Programs [email protected] Phone: 706-577-5705

Student Coordinator Trina Singleton, Student Coordinator [email protected] Phone: 706-571-1145 Fax: 706-660-2895

FacultyVibhuti Ansar, M.D., Albert H. Eaton, Ph.D.Greg Foster, M.D.Geetanjali Kumar, M.D.Shabbir Motiwala, M.D.Jennifer Roberts-Woodbury, D.O.Jagdish Shukla, M.D.

Staff M.A. Dowdell, Medical Education Manager Phone: 706-571-1430 Fax: 706-571-1604

Stephanie Bivens, Resident Scheduler Phone: 706-571-1402 Fax: 706-660-2895

Barbara Sims, Office Coordinator Phone: 706-571-1401 Fax: 706-660-2895

COLUMBUS

St. Francis Hospital3720 Woodruff Road Columbus, GA 31904

Columbus Campus Dean’s Office33 West 11th Street P.O. Box 870 Columbus, GA 31902-0870

Dean, Columbus Campus Alice Aumann House, M.D., FAAFP Professor, Department of Family Medicine [email protected] Phone: 706-223-5179

Columbus Campus Coordinator LaQuanta N. Hamilton [email protected] Phone: 706-223-5119 Fax: 706-223-5180

Columbus Clerkship Coordinator Janelle Hollis Mercer University School of Medicine [email protected] Phone: 706-223-5181 Fax: 706-223-5180

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Martin Army Community HospitalFamily Medicine Residency Program 6600 Van Aalst Boulevard, Bldg. 9250 Ft. Benning, GA 31905

Residency Director Joshua S. Will, D.O. [email protected] Office: 762-408-2656 Cell: 762-207-0873 Pager: 706-317-6564

Student Coordinator Dawn Sloan, M.D., M.B.A. Martin Army Community Hospital Family Medicine 6600 Van Aalst Boulevard, Bldg. 9250 Fort Benning, GA 31905 [email protected] Office: 762-408-2655 Cell: 301-412-1956

Faculty Clark Cobb, M.D. Scott Christensen, M.D. Elizabeth Ellis, LCSW Dawn Sloan, M.D. Patrick Carey, D.O. Kirsten Koenig, M.D., Team Leader/A-Team Catherine Gill, M.D. Daniel Thompson, M.D. Vincent Casiano, M.D. Katie Westerfield, D.O., Deployed David Bury, D.O., Deployed Catherine Gill, M.D. Robert Oh, CMO

Staff Elizabeth St. Armour, Family Medicine Residency Coordinator [email protected] Phone: 762-408-2655

Tonia Wilson, GME Coordinator (in requirements) [email protected]

Ms. Deondrea Bostic-Melendez (Hospital Education in Processing) Education Assistant Martin Army Community Hospital Phone: 706-544-3591

FT. BENNING


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Mercer University School of MedicineDepartment of Family Medicine 1550 College Street, PO Box 174 Macon, GA 31207 Phone: 478-301 4089 Fax: 478-301 2045

Family Health CenterFamily Practice Residency Program 3780 Eisenhower Parkway Macon, GA 31206 Phone: 478-633-0550

Harry S. Strothers, III, M.D. Chair, Department of Family Medicine Chief, Family Medicine Residency

Residency Director Monique Davis Smith, M.D.

Clerkship Director Roberta J. Weintraut M.D. Director, ACT-FM – Macon Campus Director, Integrative Medicine Division Associate Director, Family Medicine Residency [email protected] Phone: 478-633-5540

Clerkship Coordinator Wendy Gaskin [email protected] Phone: 478-301-2879

Faculty Richard J. Ackermann, M.D. Florence Baralatei, M.D. Sarah Choo-Yick, M.D. Bonnie Cole-Gifford, JD, LMFT Monique Davis-Smith, M.D. Warren Hutchings, M.D. Kathy Kemle, P.A.-C Hugh L. McLaurin, M.D. Dipesh Patel, M.D. Sandhya Ramayya, M.D. W. Patrick Roche III, M.D. J. Paul Seale, M.D.

Private Office Preceptors Lynn Denny, M.D. Jack F. Menendez, M.D.

Staff/Department of Family Medicine Debbie Moten, Administrative Coordinator Phone: 478-301-2130

Melissa Vitale, Administrative Secretary Phone: 478-301-4089

Ann O’Neal, Director, Clinical Development and Assessment Center (CDAC) Phone: 478-301-5589

MUSM/Clinical Medical Education Coordinator (Macon Campus-3rd/4th year students)

MACON


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SAVANNAH


Memorial Health University Medical CenterFamily Practice Center Department of Family and Community Medicine Education 107 East 66th Street Savannah, GA 31404 Phone: 912-350 8039

Robert Pallay, M.D., Chair, Program Director [email protected]

Clerkship Director Mary Mier, D.O. [email protected] Cell: 912-414-0345

Family Medicine Clerkship Coordinator LaTasha Jones [email protected] Phone: 912-721 8202 Fax: 912-721-8211

Faculty Ryann Cowart, M.D. Steve Livingston, PhD, LMFT Marvin Sineath, M.D. Ame Wilder, M.D.

Private Office Preceptors Michael Cohen, M.D. Trey Dampier, M.D. Angela Davis, M.D. Julia Johnson, M.D. Bonzo Reddick, M.D. Thad Riley, M.D.

Staff JoAnne Warman, Program Coordinator [email protected] Phone: 912-350-8837

Shonda Price, Administrative Secretary [email protected]

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APPENDIX D: ULTRASOUND PILOT

During 2020-2021, you will be piloting a core Point of Care Ultrasound Curriculum with your fellow Family Medicine students across all three campuses.

You will be asked to develop basic skills in identifying normal anatomic landmarks as well as some variance from norms in simulation settings.

To begin this experience, view the POCUS introductory Powerpoint on Canvas, and familiarize yourself with the materials cited in the accompanying resource document.

Your campus will have Point Of Care US consoles available for documentation of your ability to image capture three (3) normal findings: the Abdominal Aorta, the IVC, and the compressible Popliteal vein.

Follow the instructions on the POCUS Powerpoint for completion of your image capture and review your images with your preceptor prior to documenting them in one 45.

MACON | SAVANNAH | COLUMBUS

medicine.mercer.edu