AC505M.40

Family Medicine Elective

Sites: CAM, SOM
Director(s): Katherine Miller
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time every month.
Location: OTHER - Other U.S. Institutions (40)
Open to Exclerks: No (HMS only)
Description: This four-week outpatient clerkship will provide an immersive outpatient family medicine experience, with emphasis on evaluation and development of Entrustable Professional Activities (EPAs) 1-12 for Residency. Please see the table below for a list of the EPAs and how they will each be addressed. In addition, students will complete written assignments to demonstrate their competence in evidence based medicine, and a case based family and community evaluation. Clinical Experiences Students will be assigned to Cambridge Health Alliance affiliated community family medicine practices. All of the teaching practices will provide full spectrum outpatient family medicine patient care, including patients of all ages and all genders, with the exception that all practices may not provide prenatal care. The range of clinical problems is expected to include: ● routine health maintenance for adults and children ● management of chronic and recurrent medical and psychiatric problems ( for example diabetes, COPD, thyroid disorders, sports injuries, GERD, Inflammatory bowel disease, depression, ADHD) ● routine women's health (for example pap smears, menstrual concerns, menopause management) ● reproductive health (sexually transmitted infections, contraception, pre-conception counseling, erectile dysfunction), ● evaluation of the acute undifferentiated complaint (for instance abdominal pain, cough, fever). ● Procedural visits (IUD placement, colposcopy, skin biopsy, cryotherapy and more) There will be a maximum of one student per preceptor in a given month. ● Students will independently evaluate patients who present for acute visits, health maintenance visits, hospital follow up, and follow up of chronic conditions. Students will be assigned patients at the beginning of each care session, 1-2 per hour, with the following expectations: Review the chart prior to seeing the patient for recent issues, health-care maintenance needs, and problems in need of follow-up. ● Obtain history and perform physical exam ● Develop and prioritize a differential diagnosis and problem list for each patient ● Provide written and oral presentations of each patient ● By the end of this rotation, students will place orders for appropriate treatment and evaluative testing (to be reviewed by the preceptor) , discuss assessment and treatment plans with the patient, deliver patient education and practice shared decision-making models (with the guidance of the preceptor). ● Interpret all testing results both during and after the visit, and communicate with patients about these results. Patients will be seen initially by students alone; once the student has completed an oral presentation including assessment, workup, and treatment plans, the preceptor will see the patient and confirm the findings. Students may also follow prenatal patients, and participate in outpatient procedures such as IUD placements and skin procedures including pre-procedure counseling and informed consent. Students will participate in care team meetings and coordinate their patient care activities with other members of the team including nurses, medical assistants, social workers, nutritionists and clinical pharmacists, depending on the team structure at their site. EPAS 1-6 will be demonstrated repeatedly in the context of patient care in the office, in which students will see patients independently, perform the H&P needed for each patient, present each patient to the attending including a differential diagnosis, assessment, and workup/treatment plan, and document the encounter in the medical record including order entry. Preceptors will see each patient and confirm findings as needed once the student work has been completed (documentation may be completed after the patient has left the visit). (1) Gather a history and perform a physical exam (2) Prioritize a differential diagnosis following a clinical encounter (3) Recommend and interpret common diagnostic and screening tests (4) Enter and discuss orders and prescriptions (5) Document an encounter in the medical record (6) Provide an oral presentation of a clinical encounter (7) Form clinical questions and retrieve evidence to advance patient care Will be demonstrated both by identifying and incorporating evidence-based recommendations for workup and treatment into the plan for patients at the time of care, and by completion of a once-weekly information mastery assignment (see attached). (8) Give or receive a patient handover to transition care responsibly For patients transferred to the emergency or inpatient setting during the course of the rotation, students will contact the receiving team and provide clinical information (with supervision) (9) Collaborate as a member of an interprofessional team Students will work with all members of the office team, including nurses, medical assistants, behavioral health specialists, nutritionists, and others based on the needs of the specific patients seen during the rotation (10) Recognize a patient requiring urgent/emergent care and initiate evaluation and management Students are expected to identify patients who require transfer to the emergency or inpatient setting or who require urgent/emergent testing or intervention (would include conditions such as respiratory distress, suspected thromboembolic events, anaphylaxis), alert the preceptor, and with preceptor supervision initiate treatment (nebulizers, oxygen, etc) and initiate/assist with transfer. (11) Obtain informed consent for tests and/or procedures Students will obtain informed consent (with supervision) for routine office procedures, including but not limited to skin biopsies, colposcopy, IUD insertions. (12) Perform the general procedures of a physician Students will participate in the procedures listed above as a first assistant, and will have the option to become proficient in phlebotomy. (13) Identify system failures and contribute to a culture of safety and improvement Written Assignments In addition to daily patient write-ups and follow up of lab and consultant reports, students will have written assignments which strive to develop students’ understanding of essential longitudinal concepts in family medicine. Descriptions are provided below. ● Assignment 1 - Each week students will submit a one page Evidence Based Medicine assignment, in which the student will document the results of an evidence based medicine search on a clinical question encountered during an office visit. These assignments should be discussed with the clinical team and then submitted to the course director ● Assignment 2 - Students will complete a community study based on a complex patient from the practice, following the instructions outlined in the course description.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Students are asked to include basic science correlations in their clinical assessments and preceptors are required to comment on this integration in evaluations.
Emphasis on EBM is highlighted by the preceptors in each patient encounter, and a structured exercise ( recently piloted)is performed with 2 patients.
Grade Criteria:
Honors with Distinction:
Consistently evaluated clinically as performing "consistently above appropriate level" on all categories outlined in "Preceptor evaluation of FM elective student" assessment and ,in almost all cases, producing( both verbally and in writing) a Family /Community Study which reflects exceptional insight and understanding of the patients' issues. These insights are also located within the context of relevant academic literature.
Honors:
Consistently evaluated clinically as performing "most often above appropriate level" across all categories outlined in the " HMS Preceptor evaluation of FM elective student" assessment, and , in most cases, producing both verbal and written presentations of a Family/Community Study which reflects detailed engagement and knowledge of the patient' issues.
Satisfactory:
Consistently evaluated clinically as performing "appropriate to level of training" on all categories outlined in the "HMS Preceptor evaluation of FM student" and , in most cases, producing both verbal and written presentations of a Family/Community Study which reflects a sound understanding of the patients issues.
Unsatisfactory:
Consistently evaluated clinically as performing "occasionally " or
"consistently below appropriate level" on all categories outlined in the "HMS Preceptors evaluation of FM student" , and , in most cases, producing a Family/Community study which reflects little engagement and/or understanding of the patients' issues.