Assignments   Written Patient Case   Didactic Learning Modules   Video Lectures     Calendar     Live Videoconference (password=OSU)     Evaluation   Checklist

Rural Clinic Clerkship

Curriculum

This one-month required clerkship gives third-year students the opportunity to have direct involvement and experience in a functioning rural family practice under the direct supervision of a family medicine physician, provides exposure to the role of physicians in rural communities and their interrelationships with community health agencies and offers a wide variety of clerical and office management experience.

Trainees participate in:

• Weekly didactic sessions with a rural didactic coordinator
• An interactive videoconference lecture and community oriented activities arranged by their regional Area Health Education Center (AHEC) coordinator.
• Activities emphasize areas relevant to family medicine, community medicine and rural health.
• Students prepare a PowerPoint Case Presentation where they highlight the use of rural resources and utilize distance learning technology.
• Interactive laptop computers are used to decrease travel and demonstrate the use of distance learning technology in remote sites.

Syllabus
CE 9145

1. General Description
   1. Course Title: Osteopathic Rural Clinic Clerkship
      Course Length: One Month
      Course Format: Rural Office-Based Ambulatory Clerkship
      Student Level: 3rd Year Osteopathic Medical Students
      Course Coordinator: William Pettit, D.O.
   2. The Rural Clinic clerkship gives 3rd year medical students direct involvement and experience in a functioning rural family practice office. This clerkship is a one-month rotation in an affiliated family practice office. This rotation is designed to provide a wide variety of clinical experiences that emphasize patient, office and personnel management in a rural setting. This course incorporates the development of relationships and referrals to community health agencies in patient management. In addition, such out-of-office experiences such as hospital rounds, surgical assistance, labor and delivery management, hospital staff and committee meetings, house calls, hospital emergency room calls, community and public health functions are all integral parts of this course. This course provides training and experiences vital to primary medical care.
   3. The student will spend the majority of their time in a rural family physician’s office seeing patients, working on an assigned patient case, and participating in didactic seminars for two hours per week. Physician Didactic Coordinators in each "hubsite" will facilitate the seminars, which consist of two hours each week of classroom lectures and/or case presentations. The student is required to connect to at least one online videoconference lecture and transmit their case presentation via videoconference back to OSU-COM. Videoconferencing equipment and computers will be available in the hubsite community for physicians and students to access OSU-COM videoconference lectures, transmit case presentations to OSU-COM, and access the Internet for medical information, resources and colleagues.
   4. Students live in a rural community during the rotation. Housing is reserved as a courtesy to students and is scheduled through the regional Area Health Education Center (AHEC) offices. The regional AHEC coordinator is a regional resource for the Rural Clinic course including arranging housing, course orientation at the hub-site, and providing guidance to students on community resources.
   5. This practical clinical experience in primary care medicine is designed as an integral part of each OSU-COM clerkship program. The clerkship program is under the direction of the OSU-COM, and the course is conducted at affiliated primary care facilities. Successful completion of the course is an OSU-COM requirement for graduation.
2. Student Responsibilities
   1. Pre-arrival Student Responsibilities and Information
      1. Contact Hospital:
         1. The student is required to contact the regional AHEC Coordinator at least one week prior to the beginning of the rotation to obtain housing, preceptor and course information.
         2. Students are required to contact the regional AHEC coordinator for their assigned training site as soon as possible if they will not be utilizing the housing for any reason. For more information about housing, see housing policy.
      2. Contact Preceptor:
         1. Students are required to contact their assigned preceptor at least one week prior to the beginning of the rotation to coordinate the daily schedule and other pertinent aspects of the rotation.
      3. Appropriate Dress:
         1. All students must wear College approved identification and a clean, pressed white clinical jacket.
         2. Men are expected to wear a shirt, tie, and dress trousers.
         3. Women are expected to wear slacks or a dress.
         4. Students are required to bring identification passwords for library resources (i.e. MD Consult), course syllabus, and current references for Family Medicine, Internal Medicine and Obstetrics/Gynecology with them.
   2. Student Responsibilities During the Clerkship
      1. First Week of Rotation:
         1. Students must attend the required group orientation in Tulsa the first weekday of the month and attend the hub-site orientation as scheduled by the regional AHEC Coordinator.
         2. Students will meet with their preceptor for an office orientation and select a patient case from patients they have seen or will see on this rotation.
         3. Be prepared to discuss your clinical strengths and weakness relative to the rotation objectives with your preceptor.
      2. During the Rotation:
         1. At all times dress appropriately (as defined above), utilize College approved identification, and identify yourself as a non-graduate medical student not as a medical graduate or a licensed physician.
         2. Complete all outlined rotation objectives.
         3. Attend weekly seminars (2 hours each week) facilitated by the didactic coordinator at the hub-site.
         4. Participate in one live videoconference lecture and submit the online Video Lecture Evaluation.
         5. Follow the patient case guidelines for the Rural Clinic case presentation to develop a case presentation which includes a treatment plan and community resources for the selected patient case.
         6. Provide appropriate patient care under the supervision of the preceptor.
         7. Demonstrate appropriate indications and techniques in using O.M.T.
      3. Midpoint: Meet with your preceptor for a verbal evaluation of your clinical performance, areas to improve, and a discussion of your progress on the selected patient case. You are responsible for scheduling this meeting.
      4. Final Week:
         1. Meet with your preceptor at the end of the rotation to review your clinical performance and present your case presentation. You are responsible for scheduling this meeting.
         2. During the final didactic seminar, present your PowerPoint case presentation to your peers, the didactic coordinator and course coordinator (or his designee) at OSU-COM via live videoconference.
         3. Submit the Rural Clinic site evaluation to the Clinical Training Coordinator, OSU-COM Center for Rural Health.
         4. All paperwork is due within 7 days (postmarked by the 5th day) of the end of the rotation. A checklist of required paperwork is available for your use. If forms are not received within 7 days of the end of the rotation, the student’s grade may decrease one letter grade.
3. Clerkship Calendar
   1. The student's actual working days and hours shall fall within the clerkship calendar. The specific scheduling of days and hours shall be made within the clinical facility by the preceptor, with approval by the OSU-COM Course Coordinator, and shall generally conform to the following:
      1. Rotation Period: This clerkship is one month in length.
      2. Date of Arrival: It is the student's responsibility to report to his or her official rotation site on the date specified. 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 AHEC coordinator and the OSU-COM clinical training coordinator immediately.
      3. Working Day: A typical working day is considered to be 12 hours in length (minimum 4 days/week); however, there may be instances when the working period may exceed 12 hours especially when accompanying the physician on "out of office" professional duties. Two hours during the week are didactic seminar hours.
      4. Holidays: Students receive one day off for the Thanksgiving holiday and two consecutive days off for the Christmas holiday. You must request approval for specific days off for Thanksgiving and Christmas holidays from their preceptor.
      5. Travel Time: Travel time may be taken for rotations requiring travel of more than 50 miles outside the greater Tulsa area as specified in the student clerkship handbook.
      6. Attendance:
         1. One hundred percent (100%) attendance is required on all clinical rotations.
         2. The student is required to inform the supervising physician, the AHEC coordinator, the didactic coordinator and clinical training coordinator of any absence in a timely manner.
         3. If a student needs time off the rotation, make up time may be required.
         4. A student is required to complete an Exception to the Rotation application with the preceptor, didactic coordinator and course coordinator signatures if he/she is absent for any reason (or multiple reasons) for more than 3 days.
      7. 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
         OSU-CHS Center for Rural Health
         1111 West 17th Street
         Phoenix Building
         Tulsa, OK 74107
         918.584.4375
         918.582.8938 fax
   2. NOTICE: All Rural Clinic rotations begin with a group orientation in Tulsa on the first weekday of the month. Should a holiday fall on the first weekday of the month, students will be notified of the group orientation time and date. Students are encouraged to contact the supervising physician at the new facility to verify date of arrival.
4. Student Performance Evaluation Procedures
   1. The student's overall performance (grade) is weighed using the following criteria:
      1. 80% = Student Performance Evaluation
      2. 10% = Case Presentation
      3. 10% = Participation in other required activities
   2. Each 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 as defined in the College Catalog.
      1. Student Performance Evaluation:
         1. At the completion of the Rural Clinic rotation, the preceptor and didactic coordinator will evaluate the student's performance on clinical activities, assigned patient case and seminar activities of the rotation on the student performance evaluation form.
         2. The final (overall) grade will be determined and issued by the Course Coordinator following the completion of the rotation.
         3. The grade is based on the requirements outlined above and timely receipt (within 7 days) of all the paperwork. 
      2. PowerPoint Case Presentation: An evaluation of the patient case presentation is conducted by the didactic and course coordinator (or designee) on factors such as, the appropriateness of the student’s assessment and medical plan recommendations, appropriate community resource recommendations and the presentation.
      3. Videoconference Lecture: Students are required to participate in a videoconference lecture transmitted from an affiliated residency program and complete an online evaluation.
      4. Final Grade:
         1. The final (overall) grade will be determined and issued by the Course Coordinator following the completion of the rotation.
         2. The grade is based on the student performance evaluation, case presentation, other required activities and timely receipt (within 7 days) of all the paperwork (evaluation forms and copy of the powerpoint presentation).
         3. If forms and paper are not received within 7 days of the end of the rotation, the student’s grade may be decreased one letter grade.
      5. Paperwork: Students are responsible for ensuring that all paperwork (site evaluation, videoconference evaluation, and case presentation) 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).
   3. In addition to an academic grade, all 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.
   4. A grade of "I" (Incomplete) may be assigned if:
      1. A student is unable to complete the course requirement of approved 100% attendance.
      2. The Course Coordinator recommends an extension of the student's Clerkship and sets forth reasoning for the recommended extension.
      3. The student fails to submit the required paperwork.
   5. 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. Program Evaluation
   1. Students are required to complete a site evaluation form at the end of each rotation. This online tool is used to evaluate the course curriculum, faculty (preceptors and didactic coordinators), AHEC support and student experiences at that site. Students are required to complete and submit the form with other paperwork to the Center for Rural Health within 7 days of completing the rotation (postmarked by the 5th day). The Course Coordinator reviews all site evaluations and will address any problems or issues, which are identified in the evaluations. Data will be collated for preceptor & didactic coordinator feedback. Preceptors and Didactic Coordinators will receive aggregate reports only. The individual site evaluations and responses will remain confidential.
   2. Students are also required to complete a student evaluation of AHEC form. This tool is used to evaluate the role of the regional AHEC office in the administration and coordination of the rotation. Students are required to complete the form and submit it with all their paperwork to the OSU-COM Center for Rural Health at the end of the rotation.
6. Rotation Objectives
   1. The Rural Clinic clerkship gives medical students direct involvement & experience in a functioning rural family practice. This learning experience consists of a four-week office-based rotation in a rural family practice; a weekly session of structured group didactic activities, self-directed learning & a patient-centered community service project.
   2. Goals:
      1. Gain an appreciation of the rural osteopathic family physician's role as the physician of first contact that delivers holistic family-oriented medical care to patients entering the health care system.
      2. Gain an understanding family systems concepts, the impact that family functioning and psychosocial/economic factors have on health & illness, and the importance of involving the family in the treatment of the patient in order to provide overall health care in a rural setting.
      3. Gain knowledge and skills in performing procedures commonly done in the office of the rural osteopathic family physician.
      4. Gain skills in communicating effectively with patients.
      5. Gain a better understanding of how to respond to moral/ethical aspects of patient care.
      6. Improve skills in OMT.
      7. Gain skills in self-evaluation and self-directed learning.
      8. Gain skills in presenting patients in verbal and written format.
      9. Acquire knowledge and skills using community resources in the development of a medical care plan and the provision of patient care.

 

Subject/Method	Learning Objectives	Resources/Assignments
Interpersonal Skills with Patients & their Families	Exhibit interpersonal skills with patients and their families to facilitate the communication process between physicians and patients including: Active listening Empathy and sensitivity Appropriate eye contact Proper closure of interaction Attentiveness and concern Proper greetings and introductions Confidence in him/herself Respect and support
Patient Care & Office Procedures Hands-on Application	Perform adequate history and physical examination under direct preceptor observation. Demonstrate competence in common clinical procedures: Laboratory, Diagnostic, & Therapeutic. Evaluate & develop differential diagnoses for undifferentiated problems. Display knowledge about drugs commonly prescribed for patients. Explain how to prevent, diagnose, treat and manage medical diseases/conditions. Demonstrate appropriate skills in patient care to include assessment and management in the context of family and community. Experience out-of-office routines such as hospital rounds, surgical assistance, labor and delivery management, hospital staff & committee meetings, house calls, & hospital emergency room calls.
OMT Hands-on Application	Demonstrate appropriate techniques and indications in knowledge of uses of OMT
Didactic Lectures 2 Hours/Once a Week	Attend and participate in all weekly seminars Complete all assigned readings	On-line Didactic Modules
Patient Case Research & Presentation	Identify community referral resources. Acquire knowledge & skills in appropriately accessing community resources for medical care plan & patient care. Describe barriers to patient compliance. Develop an appropriate treatment plan for a selected case. Design a case management plan in PowerPoint using community referral resources and present PowerPoint to peers, Didactic Coordinator, Course Coordinator (or designee) at the end of the rotation.	Consult AHEC Regional Coordinators Guidelines for patient case Guidelines for PowerPoint presentation Present case presentation during last weekly seminar
Distance Education	Utilize videoconference equipment Participate in videoconference lecture Transmit PowerPoint case presentation to Course Coordinator (or designee) in Tulsa during the final didactic session	Connect to Live Videoconference Participate in scheduled videoconference Transmit case presentation to course coordinator in Tulsa