The overall goal of the family medicine clerkship is to provide an outstanding learning experience for all medical students.
The objectives of a family medicine clerkship are:
• Demonstrate the unequivocal value of primary care as an integral part of any health care system.
• Teach an approach to the evaluation and initial management of acute presentations commonly seen in the office setting.
• Teach an approach to the management of chronic illnesses that are commonly seen in the office setting.
• Teach an approach to conducting a wellness visit for a patient of any age or gender.
• Model the principles of family medicine care.
• Provide instruction in historical assessment, communication, physical examination, and clinical reasoning skills.
Student Learning Objectives for the Family Medicine Clerkship
At the end of the family medicine clerkship, each student should be able to:
• Discuss the principles of family medicine care.
• Gather information, formulate differential diagnoses, and propose plans for the initial evaluation and management of patients with common presentations.
• Manage follow-up visits with patients having one or more common chronic diseases.
• Develop evidence-based health promotion/disease prevention plans for patients of any age or gender. Demonstrate competency in advanced elicitation of history, communication, physical examination, and critical thinking skills.
• Discuss the critical role of family physicians within any health care system.
Listed below are some common conditions seen in family medicine. Students should ensure, through clinical experience and self-directed study that they have a working understanding of how to diagnose and manage these conditions in an ambulatory setting. Students should be familiar with the information noted below. Web References and additional resources can be found in the Student Resources Section of this website
· Health Promotion / Disease Prevention
o Well Woman Care
o Well Child Care
o Routine Screening
o Patient Education
· Chronic Disease Management
o Diabetes Mellitus
· Common Ambulatory Illnesses
o Upper and Lower Respiratory Tract Infections
o Sexually Transmitted Infections
o Many others
The field of Family Medicine is very broad. As such, it is difficult for any one textbook to adequately survey the entire field. We do not require the purchase of a specific textbook for the Family Medicine clerkship, although we encourage that you become familiar with at least two of the references listed below. Students should also read on patient problems in more detail from a standard reference, and/or on-line resources, both available through the UIC Health Sciences Library.
You may use any standard medical, obstetrical, surgical or pediatric textbook. However, these need to be supplemented by a text that covers ambulatory and preventive medicine. Following are suggested references and textbooks in primary care and family medicine, copies of which are on reserve in the library and for sale at the bookstore:
Sloane PD, Slatt LM, Ebell MH, Jacques, LB: Essentials of Family Medicine, Fifth Edition. William & Wilkins, 2007
Goroll, AH, Mulley AG: Primary Care Medicine, Office Evaluation and Management of the Adult
Patient. Lippincott Williams, and Wilkins 2002
Montauk SL: Guide to the Family Medicine Clerkship, First Edition, Lippincott Williams, and Wilkins, 2001
Rakel RE: Essentials of Family Practice, Second Edition. W.B. Saunders Company, 1998
Steele DJ, Susman JL, McCurdy FA: Student Guide to Primary Care: Making the Most of Your Early Clinical Experiences, Hanley & Belfus, Inc., 2003
Tallia AF : Swanson’s family practice review: A Problem-Oriented Approach., Fifth Edition. Elsevier /Mosby, 2005
Taylor RB (ed): Family Medicine: Principles and Practice, Sixth Edition. Springer, 2003
Weiss BD: 20 Common Problems in Primary Care. McGraw-Hill, 1999
Case Files: Family Medicine by Toy
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CLERKSHIP POLICIES AND PROCEDURES
A. Students are expected to attend all clinical and academic sessions as scheduled. Failure to be punctual, professional, and reliable is grounds for remediation for the clerkship or receiving a recommendation for dismissal from the College of Medicine. Be advised that some sites do have Saturday morning hours.
B. Clinic sessions may include evening and weekend hours. Scheduling (and any arrangements for compensatory time) is determined by each site coordinator.
C. Students are required to attend the Academic Series here at UIC, as scheduled (Mondays and some Thursday mornings) and to review their email regularly (for schedule changes/additions). An unexcused missed academic session will result in a lower final clinical grade.
D. All evaluation forms, patient encounter logs, and/or assignments must be submitted (or filled out) by the Friday of your Shelf Exam. All evaluations, logs and assignments are considered a required part of the Academic Series. Failure to do so will result in a lower final clinical grade.
E. Students are allowed up to three half days (or 1.5 days) of excused absences. Absences for planned events (e.g., a doctor’s appointment, a family wedding, conferences, presentations, etc.) must be arranged and approved in advance by the Medical Student Education Director (contact Claire Bridges at 3-8493 or Dr. Stringham at email@example.com for details).
F. If you are sick, you must personally call and email Claire Bridges (3-8493) to notify her of your illness (leave a voice message if she is not at her desk). You must also contact your site to inform them that you will be absent.
G. You will be excused from clinic duties on the Thursday before your shelf exam for study time.
H. Students participating in the LPC program can be excused from their respective sites for one-half day per week to participate in the program. LPC time must be scheduled on clinic days, and not during the UIC Academic Series.
I. Claire Bridges (3-8493) needs to be notified of any changes in preceptor assignments or schedules at the clinical site, i.e. prolonged vacation, significant change of hours the clinic is open, etc.
* For further information regarding excused and unexcused absences, please refer to the OSA website.
2. Basic Expectations
A. Written or other assignments may be required for the UIC Academic Series as well as by individual sites. It is each student’s responsibility to complete all assignments in a timely fashion, and turn them in as directed. Failure to do so will result in the final clinical grade being lowered.
B. Attendance will be noted and each student’s performance will be evaluated for scheduled Academic Series sessions at UIC.
C. At all clinical sites, students are expected to see patients on their own (followed by discussion/collaboration with a supervising physician) and to write a minimum of 2 SOAP 7notes per half-day clinic session.
D. The College of Medicine has established the goal of developing well-rounded, generalist physicians. Whether or not you are interested in a career in family medicine, we expect your full participation and feel that this will result in many positive learning experiences for you.
E. Students are expected to conduct themselves in a professional and respectful manner at all times in interactions with patients and staff. Inappropriate behavior will result in a recommendation for remediation (see guidelines from the OSA website, included in the orientation packet for your convenience).
3. Dress Code and Equipment Needed
Students should wear the standard clinic attire (including the appropriate white lab coat) when at their respective clinical sites. Casual dress is acceptable for the Academic Series sessions held here at UIC. Students should always have their pen, stethoscope, and reflex hammer with them while at their clinic site.
* For further information regarding Professionalism, please refer to the OSA website.
4. Contact information for Concerns and Questions (including grade disputes)
Richard Stringham, MD
Phone: (312) 996-9205
Sagina Hanjrah, MD
Associate Director Medical Education
Phone: (312) 413-3213
Project Coordinator - Medical Student Education
Phone: (312) 413-8493
Fax: (312) 996-2579
Students who need further information on the clerkship, have questions about the clerkship, or who have a problem with their site should contact Claire Bridges to have initial questions answered. If she cannot immediately resolve the issue, she will contact Dr. Stringham.
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Constructive feedback is a crucial part of the learning process. Our faculty and preceptors are committed to providing you with constructive feedback during the clerkship. While the midterm feedback form is required, we encourage students to seek out feedback on a regular basis during the clerkship.
Questions such as “Is there anything more I should be doing?” “How can I improve?” are some suggestions.
During this clerkship, completion of the midterm feedback form is required: primary preceptors are required to provide written midterm feedback to students halfway through the rotation (by the end of week three). We consider a primary preceptor to be an attending physician who has supervised your work for at least four half days during the first three weeks of your clinical rotation. If there is any question about who your primary preceptor(s) is (are) then please ask your individual site coordinator/site director to clarify this for you.
Students must choose a primary preceptor to complete the formative mid-clerkship evaluation form. Once completed and signed by the student and the primary preceptor, the student then needs to return (by fax or in person) a copy of this form to Claire Bridges or Dr. Richard Stringham by the beginning of the fourth week of the clerkship. These midterm feedback forms will then be filed with the student’s final evaluations.
A copy of the Midterm Evaluation form can be found on this website. Students should encourage preceptors to write specific, constructive comments regarding the student's performance in each area.
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SKILLS AND PROCEDURES
We encourage students to actively seek opportunities to learn and practice certain skills commonly used in family medicine. Particularly important are the following:
· immunization administration (giving “shots”),
· TB skin testing,
· glucose testing,
· pregnancy testing,
· EKG, and
· office microscopy (especially wet mount and KOH).
Lab technicians, nurses and preceptors are ready to help you learn these procedures and others. Ask for as many pportunities and as much assistance as you need to become proficient. Please also let Dr. Stringham know if you are not being provided sufficient opportunity to learn these procedures at your site.
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PATIENT ENCOUNTER LOG INSTRUCTIONS
Please record all significant patient encounters by placing the “discharge” diagnosis in the “List Specific Diagnosis” column next to the appropriate “Diagnostic Category”. An encounter is considered significant if, after the encounter, a complete SOAP note could be written by the student, for the diagnosis listed. In theory, if a student spends adequate time with a patient, a student could list several diagnoses for that patient. Credit for encounters that take place through learning activities such as case-based sessions, standardized patient scenarios, and web-based cases can be granted by the clerkship director.
The numbers listed are “minimum” numbers that are required for each visit type and diagnostic category. For example, a student needs at least 2 GI encounters under the New Problem Visit category. However, a student is not limited to only 2 GI encounters and may see more GI encounters if the opportunities present themselves. These additional encounters can be applied to the 20-encounter minimum for the New Problem Visits category, under the “other” category. They cannot be used against the totals for any other specific diagnostic encounter however (i.e. a GI encounter cannot replace an acute GU problem.) Likewise a student needs a minimum of 20 New Problem visits. The student should not limit themselves to this number and should see more if the opportunities present themselves. Once the minimum number of visits has been achieved for each Visit Category, the visit diagnoses should be recorded in the “Additional visits” portion of the log. For each encounter, record the specific diagnosis, the date of the encounter, the patient’s age and the patient’s gender. Finally, at the end of each week on the clerkship, have your preceptor initial the log.
A student will be required to achieve the minimum numbers as indicated. He or she should therefore seek out every opportunity to do this. If a student is having difficulty having adequate exposure to any of the diagnostic category visits, they should bring this to the attention of the clerkship director so that actions can be taken to assure such exposures. This should be done in a timely fashion so that there is time, prior to the end of the clerkship, to do this. If a student does not achieve the minimum numbers by the end of the clerkship, he or she will have to meet with the clerkship director to discuss alternative patient encounters at the conclusion of the clerkship or M3 year.
1. Paper copy must be completed/turned in at 3 weeks (for review), and at end of the 6 week clerkship.
2. Signature at end of every week must be collected.
3. Put all procedures in Additional visits section at end of patient Encounter log.
4. A confirmatory email will be sent to the Office of Student Affairs to ACCEPT your procedures/patient encounters once we have the completed form in our possession
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In order to pass this required clerkship, students must receive a passing grade on the end-of-clerkship NBME exam and on their clinical performance (as with other core clerkships). Failure to pass a core clerkship may result in a recommendation for dismissal from the College of Medicine.
The following formula determines the final grade:
67% clinical performance (from preceptor evaluations)
33% NBME exam performance Minimum Pass Level 58
* (Please note that failure to complete any UIC academic assignments may impede your overall clinical grade)
A copy of the Family Medicine Clerkship Evaluation Form can be found on this website and will be used by preceptors at the end of the clerkship to assess each student’s performance. The student may choose to give a copy of it to their preceptor and have them review it with them, but are not obligated to do so. There is also an online evaluation preceptors can submit via Survey Monkey.
Evaluations ask preceptors to assess the student's performance in 8 important areas of family medicine.
Unless there are mitigating circumstances, only the grades of preceptors who have worked with a student for at least four half days (and ideally 6 half days) will be used to compute the clinical performance grade, which will be a composite of preceptors’ ratings.
You must also fulfill all COM requirements (ie. MY EVALUATIONS) satisfactorily, or 10% of your grade will be deducted.
The final clinical grade reported to the Deans office will be one of the following:
Outstanding, Advanced, Proficient, Unsatisfactory, or Incomplete
If students pass the clinical component but not the subject examination, they have one chance at a makeup. If they fail the makeup, they fail the clerkship. An Unsatisfactory grade will appear on their academic record. They must repeat the clerkship in its entirety and retake the examination for a final time. If they are not successful, they will be dismissed.
If a student fails the clinical portion, they may receive an incomplete grade along with an individualized study plan. They will be allowed additional time to satisfy requirements at a later date. If they cannot complete requirements after the study plan has been executed, they will receive an unsatisfactory grade for that experience and must repeat the entire clerkship. Failure to satisfy requirements after a repeat clerkship will result in dismissal.
Students will be allowed to incur only two unsatisfactory grades. A third clinical unsatisfactory grade would result in a recommendation for dismissal. Please see the official policy at the OSA website, since these policies often change.
Failure in any area of the clerkship will result in repeating that portion of the clerkship. After which, a student’s grade may only improve to Proficient ONLY.
As of June 2007, an outstanding final grade is given only when students score at least at the national mean on the NBME shelf exam.
For any grade concerns, we will first ensure that all the necessary data points and information have been collected and included in the evaluation. Only if you are able to provide new or revised information about your performance will a grade change be considered. These requests should be submitted in writing and with appropriate documentation to Dr. Richard Stringham. After this is completed, the student may schedule an appointment with Dr. Stringham (firstname.lastname@example.org) to discuss and resolve the problem or dispute.
Please do not contact the sites directly in the event of a problem or grade dispute. We are here to help you and to make sure that your evaluation is as fair as possible.
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M4 ELECTIVES IN FAMILY MEDICINE
Students who have completed their M3 Family Medicine clerkship are invited to take senior electives in Family Medicine. Electives are variable in length, but typically are 2-8 weeks. A wide variety of sites are available, including:
· Inpatient elective at UIMC,
· Women’s Health in Family Medicine,
· Advanced Family Medicine,
· Integrative Medicine,
· the Indian Health Service,
· Community-Based Primary Care (U.S. Public Health Service),
· UIC Chicago-area M-3 sites,
· rural Illinois locations, and
· other medical schools around the country
In addition, students can make arrangements for a rotation with a physician or in a location in which they are particularly interested. Past students and current faculty have done rotations in a wide variety of practice settings in Europe, Asia, Central and South America, the Caribbean, and Africa.
Please contact Dr. Stringham (email@example.com) for details and requirements regarding arrangements.
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FAMILY MEDICINE RESIDENCY PROGRAMS
The latest American Academy of Family Physicians (AAFP) Directory of Family Practice Residency Programs is available in the Department and online. Students interested in obtaining their own copy of the AAFP Directory can call the AAFP Order Department at 1-800-944-0000 and ask for item number W203. The directory is also online and searchable.
In addition, The American Academy of Family Physicians publishes a guide called Strolling Through the Match which many students (regardless of specialty choice) often find very helpful. This is also available in hardcopy for free from Claire Bridges or Dr. Stringham.
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ACADEMIES OF FAMILY MEDICINE
The American Academy of Family Physicians and the state chapter, Illinois Academy of Family Physicians, offer several opportunities for students to become better acquainted with family medicine. They sponsor state and national meetings that include residency fairs, skills workshops, Family Medicine policy meetings, student leadership conferences, and summer externship programs for M1 students. Student rates and scholarships are available for these events. The Academies provide a Family Medicine journal to all student members (membership is usually $15.00, but is free if the application is submitted through this rotation - included in orientation packet and online).
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FAMILY MEDICINE INTEREST GROUP
UIC has an active Family Medicine Interest Group that sponsors workshops and speakers on campus throughout the year. Typical events include:
· family physician panel discussions
· phlebotomy, suturing, and casting workshops (in which M3/M4 students are encouraged to help teach), and
· discussions about primary care, loans, and types of family medicine practice opportunities
Claire or Dr. Stringham can put you into contact with the current student leaders if you are interested. Also, these academies support local Family Medicine Interest Group activities.
To join the LISTSERVE: send an email to firstname.lastname@example.org, leave subject field blank and write “subscribe FMIG” in the body of the message. Include your full name in the body of the message. For more information, visit IAFP or AAFP.
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HAVE A WONDERFUL CLERKSHIP!!!
Department of Family Medicine Administration and Faculty
All resident and physician faculty in the Department who are interested in working with students as preceptors please contact Claire Bridges at (312) 413-8493 for additional information.