Family Medicine Clerkship

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Family Medicine Clerkship

• Bryan S. Delage, MD FAAFP
• Kamille Sherman, MD FAAFP
• Department of Family and Community Medicine
• University of North Dakota School of Medicine and
  Health Sciences

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Orientation

• Utilizing the Patient Centered Medical Home to
  Increase the Quality and Years of Healthy Life

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Orientation

• Polycom/VNC/Streaming Video
• Problems/Concerns/Surprises
• Course Objectives
• Evaluation/Grading
• Group topics/Presentations
• Encounter Database/PowerPoint
• Patient-Centered Medical Home

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PolyCom

• Brandon Thorvilson tutorial
• brandon.thorvilson_at_.med.und.edu

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VNC Web Browser

• fmvnc.med.und.edu
• 134.129.166.244
• room2515

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Family Medicine Clerkship

• http//www.med.und.edu/family-medicine/clerkship/
• Website for the Family Medicine Clerkship,
  Syllabus can be printed or downloaded as a PDF,
  or browsed for content by topic
• Patient Centered Medical Home

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250 Biggest Mistakes 3rd Year Medical Students
Make and How to Avoid ThemBy S.P. Desai, MD,
R. Katta, MDMD2B Publishing, 2007
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Beginning the rotation without a clear sense of
what the evaluators are seeking,Underestimating
the importance of faculty comments
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2. Quickly glancing over the clerkship
evaluation form
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3. Remaining unfamiliar with the goals
objectives of the rotation
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4. Not seeking a mid-rotation feedback meeting
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Evaluation

• Clinical faculty evaluation of student clinical
  performance
• Case presentation to faculty
• NBME Family Medicine Subject Exam (MCQ)
• Small group presentations
• Clinical Encounters Database / Professionalism
• Student evaluation of clerkship
• Student evaluation of preceptor

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Grading

• 50 Preceptor evaluation
• 30 NBME FM exam
• 10 Case presentation to faculty
• 10 Small group presentations and Professionalism

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Grading

• 93 -100 - Honors ,,
• 70-92.99 - Satisfactory
• lt 70, or preceptor evaluation indicating less
  than adequate performance - Unsatisfactory
• limited to top 20, and above the class mean
  on NBME
• And satisfactorily completed all the
  requirements for the Clerkship.
• More to follow at the end

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NBME Examination

• The NBME Shelf Exam in Family Medicine is now
  going to be given electronically, through
  2014-2015, it was an older test not updated since
  2011, and a paper test, this will no longer be
  available in the 2015-2016 academic year.
• The Clinical Sciences Curriculum Subcommitte
  decided for 2015-2016 that a pilot setting all
  clerkship passing at the 10th tile nationally
  for the NBME would provide more uniformity among
  clerkships.
• This was a score of around 64 based on the old
  paper test. The score we will use for passing
  will be set by the 10th for the NBME, based on
  the scores of the 1st Rotation of 2015-2016
  taking the electronic version.

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Remediation

• Fail by Preceptor
• Re-assigned to another preceptor
• Minimum one month
• Failed written exam
• Repeat exam once, either after R.3 or R.6
• if failure with 2nd attempt, repeat four weeks
  of clerkship at a site selected by the course
  director and repeat NBME exam

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Goals and Objectives

• Skills
• Awareness
• http//www.med.und.edu/family-medicine/clerkship/

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Objectives

• Data Collection and Problem Solving
• Health Promotion / Disease Prevention
• Health Care Resources
• Impact of Family Culture (Social Determinants
  of Health)
• Personal Strengths Interests

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Resources

• The Following are Available to meet the Clinical
  Skills / Experiences we expect you to obtain
• On-line ltfmCASESgt http//www.med-u.org/
• On-line Smiles for Life oral health
• w.smilesforlifeoralhealth.org/default.aspx?tut555
  pagekey62948s11855605
• Smiles for Life Course 1,and Course 7

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Required Clinical Experiences

• Clinical Experiences we expect to be logged
• Perform Adult, Pediatric and newborn wellness
  exam
• Diabetes Mellitus
• CV Disease
• CVA
• HTN
• Abdominal Pain
• URI
• Lower Respiratory Infection
• Dermatitis
• Skin Lesion
• Back Pain
• Musculoskeletal injury
• Obstetrics
• Gynecology

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Clinical Experiences

• Continued
• Mental Health
• Headache
• Red Eye
• Family Dynamics
• Patient Access
• Oral Health
• We expect you to meet these by seeing patients in
  the clinic and logging in EValue, it is likely
  you will see in some categories a lot of patients
  and in others fewer or may not see them at all.
  If not seen, then you will need to do an FM case
  or other remediation that you log to meet the
  requirement.
• Family Connection and Access to Care
  videoconferences will meet the requirement for
  these, and do not need to be logged, but
  participation is mandatory.

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CE Remediation

• 1. FM Case 1, or 2.
• 2. FM Case 12(adolescent) CLIPP case 2,3,4
• 3. CLIPP Case 1
• 4. FM Case 6, Dr. Eric Johnson You tube
  lectures https//www.youtube.com/user/DrELJOHNSOND
  IABETES
• 5. FM Case 9, 31
• 6. FM Case 22
• 7. FM Case 8
• 8. FM Case 15, 19, 20,
• 9. FM Case 23, 13, 9, 33
• 10. FM Case 13, 28
• 11. FM Case 16,
• 12. FM Case 16, general workup of both
  benign/or malignant lesion
• 13. FM Case 10
• 14. FM Case 11, 25
• 15. FM Case 12, 14
• 16. FM Case 12,14, 17, 20, 32
• 17. FM Case 29
• 18. FM Case 18
• 19. Red Eye Lecture developed online lecture
  You Tube / Podcast

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FM Cases

• http//www.med-u.org/
• Expand experience options
• Prepare for NBME subject exam
• First Time User http//app1.med-u.org/player/ap
  p/homepage.html
• First/last names/e-mail//password
• Must use either lt_at_my.und.edugt
• or lt_at_med.und.edugt

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Clinical Science Curriculum Subcommittee -
Assignments

• Musculoskeletal examination
• Dermatologic examination
• Oral Health

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Essentials of Family Medicine, 6th Edition,
Sloane, et al

• Good orientation
• Evidence-based

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Musculoskeletal Exam

• U of West Alabama, Athletic Training Sports
  Medicine Center AH 323 Evaluation of Athletic
  Injuries
• http//at.uwa.edu/CurrHome/AH323/skillsshoulder.as
  p
• NEJM Rotator Cuff Failure, F.Matsen May 15,
  2008, Vol 358 20, p 2138
• Coming Online Exam Tutorials (2015 goal)

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Dermatologic Examination

• www.logicalimages.com/resourcesDerm.htm
• http//www.logicalimages.com/educationalTools/lear
  nDerm.htm
• Review of Atopic Dermatitis
• http//www.aafp.org/afp/2012/0701/p35.html

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Dermatology

• More sites to review Dermatologic images
• DermIS
• http//www.dermis.net/dermisroot/en/home/index.htm
  
• The Electronic Textbook of Dermatology
• http//telemedicine.org/stamfor1.htm

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Smiles for Life

• Oral Health and its link to Systemic Health
• w.smilesforlifeoralhealth.org/default.aspx?tut555
  pagekey62948s11855605
• Course 1 Relationship of Oral to Systemic
  Health
• Course 7 The Oral Examination

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Additional Resources

• American Family Physician
• http//www.aafp.org/online/en/home/publications/jo
  urnals/afp.html
• Other on-line sites
• http//www.med.und.edu/familymedicine/clerkship/ho
  tlinks.html

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Diabetes Updates and Mini-Lectures

• http//www.youtube.com/user/DrELJOHNSONDIABETES

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Procedures

• Indications
• Contraindications
• Limitations
• Anatomy Physiology
• Required equipment special techniques
• Complications and follow-up care
• http//www.nejm.org/multimedia/medical-videos
• Need a log in to use, try YouTube

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Student/Clinical Faculty Meeting

• Planning Session
• http//www.med.und.edu/familymedicine/clerkship/le
  arnercontract.html
• Learner Contract
• Clinical Skills Checklist
• Previous clerkship experiences
• Revisit mid-rotation (see Mid Clerkship Feedback
  form)

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Learner Contract

• Student goals
• Clinical Skills Inventory
• Data collection, assessment, reporting
• Health Promotion/Disease Prevention
• Acute chronic problem management
• Preceptor goals
• Report concerns to Clerkship Director(s)

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Questions to Answer

• The LCME thought it was not documented that
  students were ever observed doing an H and P and
  did not get feedback on their presentations, and
  asking for formative feedback.
• You will need to ask your preceptor to observe
  you doing a history and physical exam, and you
  will also get feedback from the preceptor, but
  also Dr. Sherman and Dr. Delage will give you
  oral and written feedback on your case
  presentation.
• So when asked on questionnaires was
• I observed doing a history and physical and did I
  get mid-clerkship feedback, hopefully you can
  answer this positively.

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Clinical Skills

• Data collection, recording, and assessment
• Common problem management
• Clinical procedures
• Age-specific Health Risk Assessment Counseling
• Derm Musculoskeletal exams
• Oral-Dental exam

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Clinical Encounter Database

• Clerkship FM (except ROME students)
• Home Campus -
• Site
• Program
• Preceptor
• Setting (including on-line cases)
• Age
• Gender
• (Ethnicity)
• System
• Role

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Clinical Encounters

• You should be doing this already, but with the
  change in rotation, be sure to log cases and
  alert us if any problems arise early ! (first few
  days)
• Any questions ? How can we help ?
• You have to log and log regularly, most students
  log between 250 and 400 patient encounters on the
  FM Clerkship, you cannot leave this until the
  end, if you do not log enough, we will deduct
  points from your grade.

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Case presentation to Preceptor

• (Before beginning presentation, identify
  assessment/plan in your mind)
• Convince listener (SOAP)
  
• S appropriate historical data
  O appropriate physical
  exam findings
• A identify DDx based on H P
• P lab/X-ray/consultation/management
• or SNAPPS engage teacher by asking question

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How do you elicit feedback? SNAPPS?Daily
learning plan
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SNAPPS

• 1. Summarize briefly the history and findings
• 2. Narrow the differential to two or three
  relevant possibilities
• 3. Analyze the differential by comparing and
  contrasting the possibilities
• 4. Probe the preceptor by asking questions
• 5. Plan management for the patients medical
  issues
• 6. Select a case-related issue for self-directed
  learning
• SNAPPS A Learner-centered Model for Outpatient
  Education, Academic Medicine, Vol. 78, No.9,
  Sept. 2003, Wolpaw, T.M., Wolpaw, D.R., Papp, K.K.

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Case Presentationto clerkship director/ faculty

• Data Collection and Problem Solving
• Health Promotion/Disease Prevention
• Reciprocal Impact of Family and Culture
• Scope of Practice
• Learning Issues
• http//www.med.und.edu/family-medicine/clerkship/

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Mid Clerkship Feedback

• https//secure.med.und.edu/evaluations/index.cfm?e
  valstudassessfm

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Evaluations

• Preceptor Evaluation of Student
• Done through EValue, Tracy Uhlir e-mail
  tracy.uhlir_at_med.und.edu sends out a link to the
  preceptor which takes them to their eval in
  EValue, you should sit with your preceptor on
  one of your last days as this is sent at the
  beginning of the week, and help them accomplish
  and go over this with them.

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Evaluations

• Student Evaluation of Clerkship
• Student Evaluation of Preceptor
• Also done through EValue, are required to be
  completed before finishing the Family Medicine
  Clerkship.
• Tracy Uhlir, tracy.unhlir_at_med.und.edu

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Group Topics

• Networking/Sharing
• Focused 5 min presentation (prepared)
• then open for discussion for 3-4 min
• All sessions begin at 130 CST, but the screen
  and camera need to be ON by 1pm, so Brandon can
  complete connections
• Topics

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Social Determinants of Health

• First Session - Community-Oriented Primary
  Care/High Risk PopulationsAccess to Care
• Thursday, September 24th, 2015
• Second Session - "Family Connection
• - Thursday, October 8th, 2015
• - related to or independent of first session
  topic

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Community-Oriented Primary CareAccess to Care

• Outside the Office Walls
• Syllabus Group Topics, 2nd session
• Essentials of Family Medicine, 6th ed, Sloane
  et al, chap 1, Primary Care and the Evolving US
  Health Care System
• Essentials of Family Medicine, 5th ed, Sloane
  et al, chap 1, Family Medicine in Todays
  Changing Health Care System

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Family Connection

• Keeping the Focus on Family
• The Family Connection
• http//www.med.und.nodak.edu/depts/fammed/Clerkshi
  p/documents/TheFamilyConnection.doc
• chapters 46-50 of the 6th edition of Essentials
  of FM
• or chapter 32 of the 5th edition of Essentials
  of FM texts may provide some ideas
• Patient/family you have seen on more than one
  occasion encouraged, but not mandatory

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Family Connection

• Example of Family Connection Material
• Cry on Me Natalie Kong, M.D.
• (Family Medicine 2014 46(4)304)
• Note this can also be an experience that affected
  you emotionally, or led you to reflection or
  reliving your own experiences.

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Harley E. French Library

• Resource for preceptors
• Make preceptors aware of resources

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If you choose Power Point

• Not necessary, are optional but -
• If you use no more than one topic/slide
• 6x6 rule no more than 6 lines of text and
• No more than 6 words per line
• Other rules, simple font, no complete sentences,
  no periods, question marks, exclamation points,
  and avoid ALL CAPS and one transition for all
  slides

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Patient-Centered Medical Home

• We have created a separate power point for this
  from Dr. Delage and Dr. Sherman
• Other lecturers
• Aaron Garman, MDCoal Country Community
  HealthBeulah, ND

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Work Hours

• There is a policy on work hours allowed, on the
  school website athttp//www.med.und.edu/policies/
  students.cfm and look under Duty Hours
• If your working in the clinic and hospital and
  you are averaging over the work hour limits
  (shall not exceed 80 hours per week), and not
  getting any time for study and self learning,
  please use this as a tool to inform your
  preceptor of the limits on work hours that
  students can engage in, and please inform the
  Co-Directors if this is an issue, as we can then
  work on this as a Clinical Faculty development
  issue, with the preceptor.

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Do We Have ?

• Your cell phone number ?
• Your correct e-mail address ?
• Do You have
• Our contact numbers? Bryan Delage MD (320)
  760-1722, Kamille Sherman MD [phone]
• E-mail bryan.delage_at_med.und.edu
  kamille.sherman_at_med.und.edu
• Mona Shilling [phone], mona.shilling_at_med.un
  d.edu.

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Questions ?

• Questions ?
• 1. eValue - http//help.e-value.net/adminHelp/inde
  x.cfm/tutorials/evalue-getting-started-tutorial-in
  tro-to-pxdx-trainee/http//help.e-value.net/adminH
  elp/index.cfm/tutorials/evalue-getting-started-tut
  orial-intro-to-pxdx-trainee/
• Do we have any more interest in getting more
  specifics about the grading ?

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Grades

• How you will find out your grade
• Many questions have arisen, and we felt we needed
  to streamline this we understand your need to
  know
• 1. The Grades will be submitted in EValue about
  3 weeks after the end of the Clerkship from the
  department of Family and Community Medicine, and
  the student will be sent an e-mail alerting them
  that the grades have been submitted.
• 2. NBME scores as soon as all the scores
  return, you will get an e-mail with your score
  recorded on it and some information from NBME
  with your score attached. This is usually about
  2-3 weeks after the first rotation, and then
  about 5-10 days after the other rotations.

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Grades

• We set an average of 93 or above and above the
  class average score on the NBME, as Honors and
  Satisfactory as above 70, with the caveat that
  all other requirements of documentation of
  adequate numbers of cases in EValue, All
  Required Clinical Experiences accomplished,
  participation in the 3 video conferences, and a
  satisfactory score from the preceptor and
  scoring on the NBME above the 10 tile,
  historically a score of about 64 or above.

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Grades

• After the submission of Grades to the Assistant
  Deans office, if you need to remediate a call
  will be placed from the department on your
  remediation for this Clerkship and reasons.
• Your transcript will have your final grade
  before 6 weeks after the end of the clerkship.
  For almost all of you this will be the final
  grade, and if you have satisfactorily met the
  requirement the worst you can get is a
  satisfactory. We will review at the end of the
  year, and if less than 20 received Honors we
  will upgrade the next highest scores in the class
  to Honors until at least 20 are reached, if over
  20 of the class received Honors based on this
  percentage, that will not be changed.

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Thanks for Your Participation

• Have a Great Day and Family Medicine Clerkship
  experience !
• Make sure you get your learners contracts done
  and seek a Mid-Clerkship feedback.

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Thanks for Your Participation

• Have a Great Day and Family Medicine Clerkship
  experience !
• Make sure you get your learners contracts done
  and seek a Mid-Clerkship feedback.

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