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Rural Clinic

Patient Case Guidelines

Rural Clinic Project Overview
During the rotation, students will develop a medical care plan, including appropriate community resources, for a patient they have seen. Their preceptor may assigned a patient for this project. Below are guidelines for the case and an outline of a patient case presentation which details key components.  Students will review their case with their preceptors at the end of the rotation. During the final didactic session, students will present their case in a PowerPoint presentation to their peers, didactic coordinator, and the OSU-COM Course Coordinator (or designee) via live videoconference.  The didactic coordinator and course coordinator (or designee) will evaluate students based on the following objectives. In addition, students are responsible for submitting a copy of the case presentation PowerPoint to OSU-COM Center for Rural Health prior to their presenting.

Learning Objectives

  1. Identify community referral resources.
  2. Acquire knowledge & skills in appropriate use and access of community resources for medical care plan & patient care.
  3. Describe barriers to patient compliance.
  4. Develop an appropriate treatment plan.
  5. Design a case management plan using community referral resources.
  6. Develop a PowerPoint presentation that addresses all the key components. Preceptor may have the student present the PowerPoint to a group.

Approximate Timeline
Week One

  • Student selects or is assigned a case.
  • Student reviews the case with the preceptor.
  • Student reviews outlined expectations of the case presentation with the preceptor.

Week Two

  • Student researches information about relevant community resources. Suggested personnel resources include office managers, nurses and/or other office personnel.
  • Student documents relevant factors such as:
    • Services provided by each agency
    • Cost and payer of services
    • Eligibility
    • Point of entry by patient
    • Barriers to patient receiving services
    • Develop a draft outline of the case

Week Three

  • Brief review of case presentation outline with preceptor for guidance
  • Finalize the case presentation outline
  • Develop PowerPoint presentation of case

Week Four

  • Student emails PowerPoint case presentation to ruralhealth.clerkship@okstate.edu the day before the presentation.
  • Online Site evaluations are done at the end of the presentations when possible.
  • Site evaluations are counted as late if not received by the Center for Rural Health's Clinical Training Coordinator within 7 days of the end of the rotation.

Patient Case Outline
The following outline illustrates the issues that students should address in their medical plan and PowerPoint case presentation. For confidentiality, please do not use patient’s name(s).

  1. Chief Complaint(s):  Present patient’s chief complaint and relevant symptoms.

    For Example: Patient is a 45-year old white female who presented to Dr. Doe’s office complaining of shortness of breath and chest pain.

  2. History of Present Illness:  Present patient’s relevant medical history of present illness/compliant.

    For Example: Has had chest pain for one week and shortness of breath since yesterday while at work, hypertension 142/96, hyperlipidemia, uncontrolled diabetes due to diet and not taking medications.

  3. Past Medical History:  Summarize patient’s relevant past medical/surgical history and other relevant social information including family/social (include genogram of household and significant relatives/contacts), other social factors (may include living arrangements, health insurance status, family relationships, socioeconomic status/employment, access to transportation, educational level, etc.).

    For Example: The patient currently lives with her 72 year old mother in a two-bedroom apartment 15 miles outside of the community where she works and receives health care. She has no other family in town. She works 40 hours a week for minimum wage as a cashier at a local superstore and has no health insurance benefits. She works from 10:00am-6:00pm Tuesdays-Fridays and from 10:00am-7:00pm on Saturdays. She does not accumulate leave time. During the time she is at work the patient has to arrange for care for her mother who has had a stroke. Her mother receives social security and is on Medicare.

  4. Review of Systems:  Summarize a review of the pertinent systems only.

  5. Physical Exam:  Summarize pertinent positive and negative exams only, including vital signs and systems.

  6. Lab, X-ray, EKG, and other studies:  Summarize pertinent labs, X-ray, EKG or other studies.

  7. Working Diagnosis, Problem List:  Develop a working diagnosis and problem list.

  8. Special Problems:  Identify and summarize special problems including financial, social, familial, physical limitations, insurance, etc.

    For Example:

    • Has a car, but it is frequently unreliable. She often relies on rides from members of her church or neighbors. This sometimes causes her to miss work and medical appointments.
    • Works during most mealtimes, so she often eats on the run at fast food restaurants.
    • Has no health insurance and has to pay her medical care costs out-of-pocket, which causes her to delay or avoid care.
    • Takes her medications inconsistently. Some months she cannot afford the medications she has been prescribed for hypertension and diabetes.
    • Patient has no leave time from work, when she cannot locate transportation or find care for her mother, she is forced to miss work and does not get paid.
  9. Needs: Describe patient's needs to improve health and relevant social/special programs.

    Among Patient’s needs are: reliable assistance with care for her mother, financial assistance with medications, transportation services, and education about diet.

  10. Health and Social Services Referrals:  Describe the health and social services that the patient (and her family, if relevant) should be referred to for assistance (obtaining transportation, health education, medications, free care, and other needed services). Document relevant factors, such as agencies contacted, services provided, cost and payer of services, point of entry, eligibility requirements, etc.

  11. Barriers to Care:  Describe any barriers the patient may have to compliance with medical care plan. Barriers may include lack of transportation to services, agency not accessible because of hours, location or staff, language barriers, cost of services or patient may not qualify for services, etc.

  12. Treatment Plan: Briefly describe therapeutic, diagnostic and educational recommendations by problem, including assessment and plan for problems including needs for community services for patient and her mother. Include medications, surgeries or further evaluation planned for the patient and supportive measures and consultations requested.