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Rural Medical Education
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Friday Lecture Schedules

August 2011
September 2011
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June 2012

Community Clinic Clerkship

Community Clinic Orientation Checklist

Syllabus
CE 9245

  1. General Description
    1. Course Title: Osteopathic Community Clinic
      Course Length: One Month
      Course Format: Small Community Clinical Experience and
      Weekly Didactic Seminars
      Student Level: 3rd Year Osteopathic Medical Students
      Course Coordinator: William Pettit, D.O.
    2. A one-month required clerkship that gives third-year students continued preparation for clerkship training in rural and community-based rotations.

      • Monday through Thursday student's clinical experience is in a physicians' office and may include hospital meetings, house calls, emergency room calls, and attending health or social events.
      • Every Friday students attend didactics which covers a variety of topics.
      • One day a month students are assigned to accompany the Mobile Telemedicine Clinic.
      • Students complete a Procedure Card
      • Students prepare and present a Case Presentation using PowerPoint and distance learning technology.
    3. Students in the Rural Health Option program should contact the Rural Medical Education office for their site options.
  2. Student Responsibilities (See Clerkship Handbook for more details)
    1. Pre-Arrival
      1. Students are required to contact their assigned preceptor 2 week prior to the beginning of the rotation to coordinate the daily schedule and other pertinent aspects of the rotation.
      2. At all times dress appropriately. All students must wear College approved identification and a clean, pressed white clinical jacket. Men are expected to wear a shirt, tie, and dress trousers. Women are expected to wear either slacks or a dress.
      3. Students are required to bring identification passwords for library resources (i.e. MD Consult), and current references for Family Medicine, Internal Medicine and Obstetrics/Gynecology with them.
      4. Students should read the Non-Physician Clinician handout prior to the seminar on that topic.
    2. First Week of Rotation:
      1. First weekday of the month meet with your preceptor for an office orientation.
      2. Be prepared to discuss your clinical strengths and weakness relative to the rotation objectives.
      3. Be prepared to discuss the physicians expectations for the rotation and your expectations.
      4. Attend the rotation orientation and didactics the first Friday of the month at the Center for Rural Health or from other preapproved locations.
      5. Sign and date the Orientation Checklist. You will be given a copy for your records.
    3. During the Rotation:
      1. Didactics: Attend all lectures/didactic seminars/conferences (see rotation objectives).The didactic seminars are every Friday beginning at 8:30 a.m. unless otherwise instructed by pre-rotation email or during the orientation. Some seminars may include participation through Turning Point, assignments, or readings.
      2. Case Presentation: Presented the end of the month, usually the last Wednesday afternoon.
      3. Mobile Telemedicine Clinic Experience: One day a month the student will be scheduled to accompany the OSU Mobile Telemedicine Clinic and complete a Mobile Telemedicine Clinic evaluation.
      4. Clinical Experience: Monday-Thursday all day are scheduled for clinical experience in a physician's office or health care facility. These hours may also include such out-of-office experiences as hospital staff and committee meetings, house calls, hospital emergency room calls, community and public health functions, and fraternal and social functions, as an integral portion of this program.
      5. Procedure Card will be completed and should include physician initials, date and level for each procedure observed, assisted, or performed during rotation.
      6. Provide appropriate patient care under the supervision of the preceptor. Demonstrate appropriate indications and techniques in using OMM.
    4. Midpoint
      1. Meet with your preceptor for a verbal evaluation of your clinical performance and areas to improve. You are responsible for scheduling this meeting.
    5. Final Week
      1. Meet with your preceptor at the end of the rotation to review your clinical performance. You are responsible for scheduling this meeting.
      2. Email the Case Presentation PowerPoint to ruralhealth.clerkship@okstate.edu the day before the presentation.
      3. Email the Mobile Telemedicine Clinic Evaluation to ruralhealth.clerkship@okstate.edu the end of the month.
      4. Turn in your signed Procedure Card at the end of the month.
      5. Complete the online site evaluation.
      6. All paperwork is due within 7 days (postmarked by the 5th day) of the end of the rotation.
      7. If forms are not received within 7 days of the end of the rotation, the student’s grade may decrease up to one letter grade (see Student Evaluation Procedures).
      8. A grade of “I” (incomplete) may be issued until all the paperwork has been received.
  3. Clerkship Calendar
    1. For guidelines on Reporting Time, Holidays, Travel Time, and Attendance: All rotations begin on the first day of the month. The student's actual working days and hours shall fall within the clerkship calendar. The specific scheduling of days and hours shall be made by the preceptor, with approval by the OSU-COM Course Coordinator, and shall generally conform with the student clerkship handbook.
    2. Delays and Absences: If there is a reasonable explanation for a delay in reporting (e.g., auto accident, illness, or similar reason), the student is to contact the preceptor, the Regional Coordinator and the OSU Rural Health Office immediately. If a student is absent for any reason (or multiple reasons) or will be missing a required event he/she is required to complete an Exception to the Rotation Application with the preceptor's signature and submit it to the Center for Rural Health for the course coordinator's approval. If approved, make up may be required.
    3. Rotation Changes: Students may trade rotation assignments, under approved special circumstances only, by completing a Change of Rotation form at least 60 days prior to the rotation. All forms must be forwarded to: Sherry Eastman ( 918-584-4375) or fax 918-582-8938 or email sherry.eastman.okstate.edu
  4. Course Evaluation Procedures
    1. The student's overall performance (grade) is weighed using the following criteria:

      50% = Student Performance Evaluation by preceptor

      10% = Mobile Telemedicine Clinic Experience and Evaluation

      15% = Case Presentation

      15% = Procedure/Skills Card (minimum of 5 signed procedures or skills)

      10% = Didactics (points will be deducted for missed didactics, non-participation or unprofessional behavior )

    2. Course requirement: Must be passed with a 70 percent or higher to pass this course. Letter grades of A, B, C, or U will be assigned according to procedures outlined in the student handbook.
    3. Didactic: Attendance will be taken during all lectures. For each missed lecture (unexcused), points will be deducted from the final grade up to 10%. Arriving late or leaving early from a lecture must be preapproved and points may be deducted.
    4. Student Performance Evaluation: At the completion of the Community Clinic clerkship, the preceptor will evaluate the student's performance on clinical activities and other activities of the rotation on the student performance evaluation form. The final (overall) clerkship grade will be determined and issued by the Course Coordinator following the completion of the rotation.
    5. Mobile Telemedicine Clinic Experience: One day a month the student will be scheduled to accompany the OSU Mobile Telemedicine Clinic. An evaluation describing the experience will count 10% and be graded based on the learning objectives.
    6. Case Presentation: An evaluation of the case presentation is conducted by the attending physician evaluator based on the learning objectives listed below which include factors such as, the appropriateness of the student’s assessment and medical plan recommendations, summary of references used, presentation and design techniques, and video conferencing skills used for 15% of the final grade.
    7. Procedure/Skills Card: Completed cards will go in the students file and student will be provided a report prior to graduation. Although a minimum of 5 are required for the rotation, students can use as many cards as needed to add value to the report. These cards count 15% and are required for all Rural Health rotations.
    8. Final Grade: The final (overall) grade will be determined and issued by the Course Coordinator following the completion of the rotation. The grade is based on the student performance evaluation, case presentation, attendance/participation, telemedicine experience evaluation, didactics and other required activities. Students are responsible for ensuring that all paperwork for Community Clinic is completed and received by the OSU-COM Center for Rural Health by the 7th day following the end of the rotation (postmarked by the 5th day). If paperwork is not received within 7 days of the end of the rotation, the student’s grade may be decreased up to one letter grade for each month it is late.
    9. Students are held accountable for the non-cognitive academic standards as the standard of professionalism for their conduct. A grade of S (satisfactory) or N (needs improvement) is determined by the Course Coordinator based upon evaluation of the student by the preceptor and other course participation factors.
    10. Students are required to complete a site evaluation form at the end of each rotation. This tool is used to evaluate the course curriculum, faculty (preceptors), office staff, regional coordinators, AHEC coordinators and student site experiences. The individual site evaluations and responses will remain confidential.
    11. A grade of "I" (Incomplete) may be assigned if: A student is unable to complete the course requirement of approved 100% attendance.The Course Coordinator recommends an extension of the student's Clerkship and sets forth reasoning for the recommended extension. The student fails to submit the required paperwork.
    12. Grievance Authority: Grievance of a rotation, performance evaluation, or course grade should start with the Course Coordinator. The final grading authority will be with the Course Coordinator.
  5. Rotation Objectives
    1. The Community Clinic clerkship provides third year students with clinical experiences in a small community clinic setting.
    2. Goals
      1. Observe and demonstrate knowledge in telemedicine technology use and operation.
      2. Acquire an understanding of differentiating factors in rural and urban medical settings.
      3. Demonstrate appropriate clinical and interpersonal skills.
Subject/Method Learning Objectives Resources/Assignments
Distance Learning
Lectures/Hands-on Training
  • Distance learning/ literature searches
  • Telemedicine overview/ equipment
  • Telemedicine skills demonstration and hands-on practice
  • Recognize various uses for interactive videoconferencing
  • Name components of videoconference equipment
  • Connect and participate in a videoconference
  • Perform troubleshooting to prevent or correct videoconferencing issues
  • Demonstrate skill in videoconferencing by presenting using PowerPoint

Case Presentation student presents to a physician at at distant site

  • Demonstrate presentation skills through a PowerPoint presentation requiring the use of medical literature searches and EBM references
  • Construct a differential diagnosis and develop treatment/management strategies for common diseases and conditions seen in family practice.
  • Protocol of Care - Demonstrated by student in the following format:
  1. Problem or diagnosis
    • Description of disease or problem
    • Criteria for diagnosis
    • Lab or diagnostic procedures
  2. Management
    • Special diet (if any)
    • Lifestyle changes
    • Activity
    • Medication
      1. Class of drugs used & dosage
      2. Pharmokinetics
      3. Drug interactions
      4. Indications/ Contraindications
      5. Side effects
    • OMT – Rationale
    • Patient education
  3. Follow-up
    • Physician/Nurse Visits
    • Procedures, if any
    • Lab
  4. Preventing & treating complications
  • OSU Medical Library - Online Resources
  • Prepare PowerPoint lecture and present at the end of rotation using videoconferencing skills.
  • The student selects a patient case and a written Protocol of Care is submitted using PowerPoint & presented to an attending physician and classmates during a Friday seminar
  • Include a summary of Evidence-Based Medicine (EBM) references used (resources include):
    1. MEDLINE - Ovid Search Engine
    2. Ovid
    3. UpToDate
    4. InfoPOEMS/ InfoRetriever
    5. FIRST Consult
    6. PIER (From ACP)

Medical Conferences attend when available

  • Attend 4 sessions of choice
  • Network with physicians
  • Attend lectures on current, timely topics
  • Discover the CME and Conference methods
  • Meet with Key leaders in the medical community

 

Attend one of the following and complete an evaluation

  • Emergency Medicine CME
  • OOA Summer CME
  • OOA Winter CME
  • Family Medicine CME
  • Small Rural Hospital Conference
  • Rural Health Association of Oklahoma Conference
  • DO Day on the HIll (OK)
Non-Physician Clinicians (NPC) and Their Role in Rural Health Care lecture with Turning Point Participation
  • Evaluate the non-physician clinicians' role in osteopathic medicine and the rural community
  • Compare and contrast the physicians role in healthcare and the NPC with reference to education, scope of practice, and licensure
  • Describe what physicians can expect from NPC's professionally
  • Discuss how the physician can advise patients on how the NPC fits into the scope of practice and their role in the case management scheme
  • Know what academic knowledge and practice skills/procedures separate rural practicing primary care physicians from rural practicing NPC's?
  • Describe basics of the Patient Centered Medical Home and the concept of case management
  • Discuss the concept of “collaboration” between physicians and NPCs.

Rural Health Topics:

Overview of Rural Health and the CRH lecture with Turning Point participation

Economics of Rural Health Care lecture with Turning Point participation

Communication and the Cancer Patient lecture

  • Identify the diferent service areas the Center for Rural Health supports
  • Idenitify two sponsored programs that office under the Center for Rural Health
  • Describe Critical Access Hospitals
  • Discuss rural primary care physician lifestyle
  • Evaluate factors used in determining the need for a rural physician in a rural community
  • Identify Cancer Survivorship Issues
  • Identify the essential components of cancer survivorship care
  • Identify the role of the primary care physician in cancer treatment
  • Locate and discuss the Institute of Medicine's report concerning end of life treatment summaries
  • Recognize communication barriers when treating cancer survivors
  • Understand how to communicate effectively with cancer survivors
 

Rural Physician Series

 

Discuss a variety of topics relating to rural practice as presented by the Residents from residencies across the state. May include but not limited to:

  • Emergency Medicine in Small Community Hospitals
  • Rural Community Leadership and the Rural Physician
  • Geriatric Care in a Rural Setting
  • Lifestyles of rural physicians
 
Clerkship
Local physician's office or local health care facility
  • Apply clinical skills in physician's offices in small community
  • Complete a Procedure/Skills card
* Lecture Topics may vary from month to month.