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Rural Clinic Orientation Checklist

Rural Clinic Clerkship

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. A one-month required clerkship that 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. Students:
      • Attend didactic sessions (presented by rural physicians) on topics relevant to rural health (Interactive laptop computers are used to decrease travel and demonstrate the use of distance learning technology in remote sites).
      • Participate in community activities arranged by the Area Health Education Center (AHEC) coordinator that emphasize the areas relevant to family medicine, community medicine and rural health.
      • Prepare a PowerPoint Case Presentation where they highlight the use of rural resources and utilize distance learning technology and present to their peers, a physician, and an AHEC representative (Interactive laptop computers are used to decrease travel and demonstrate the use of distance learning technology in remote sites).
      • Complete a Procedure/Skills Card
      • Write a one page article with pictures (suitable for publishing) describing the rural experience.
      • Present to a local school (Kids in Health/Careers in Medicine)
   3. Students live in a rural community during the rotation. Housing is reserved as a courtesy to students and is scheduled through the OSU Regional Coordinator. The OSU Regional Coordinator is a regional resource for the Rural Clinic rotation and includes arranging housing, providing a site orientation, and assist in collection of required assignments. OSU Regional Coordinators are in contact with students and physicians to provide local event information and schedule social activites.
   4. AHEC Coordinators provide information about community resources for patients, and coordinate the required Careers in Medicine or Kids in Healthp presentation and the required community experience.
   5. The Rural Clinic rotation is under the direction of OSU-CHS Center for Rural Health, and conducted at affiliated primary care facilities. Successful completion of this rotation is an OSU-COM requirement for graduation.
   6. Students in the Rural Health Option program should contact their OSU Regional Coordinator for site options.
2. Student Responsibilities (See Clerkship Handbook for more details)
   1. Pre-Arrival
      1. Contact AHEC Coordinator:
         1. Students are required to contact the OSU Regional Coordinator at least two week prior to the beginning of the rotation to obtain housing, preceptor and course information. Contact the OSU Regional Coordinator as soon as possible if not utilizing the provided housing. For more information about housing, see housing policy.
      2. Contact Preceptor:
         1. Students are required to contact their assigned preceptor at least two week prior to the beginning of the rotation to coordinate the start date, 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. Men are expected to wear a shirt, tie, and dress trousers. Women are expected to wear either slacks or a dress.
         2. 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.
         3. First Week of Rotation:
            1. Students must attend the required group orientation in Tulsa the first weekday of the month and attend the site orientation as scheduled by the OSU Regional 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.
         4. 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 seminars facilitated by the didactic coordinator at the site.
            4. 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.
            5. Provide appropriate patient care under the supervision of the preceptor.
            6. Demonstrate appropriate indications and techniques in using O.M.T.
            7. Participate in community activities planned by the AHEC coordinator for your area which include a Kids in Health Presentation to a local school and a community health-related activity.
         5. Midpoint:
            1. 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.
         6. 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. E-mail your Case Presentation Power Point to ruralhealth.clerkship@okstate.edu the day before your presentation.
            3. During the final didactic seminar, present your PowerPoint case presentation to your peers, the OSU-CHS course coordinator (or designated physician) and an AHEC representative via live videoconference.
            4. Turn in your signed Procedure/Skills Card at the end of the month.
            5. Send you article/picture electronically to ruralhealth.clerkship@okstate.edu .
            6. Be sure to give written permission to publish. If your picture includes another person (physician, patient, office staff, etc) you MUST also have their permission in writing with a signature. No name will be used unless they request it.
            7. Complete the online Rural Clinic site evaluation.
            8. Complete the AHEC Evaluation.
            9. 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 online for your use. If forms are not received within 7 days of the end of the rotation, the student’s grade may decrease up to 10 points.
            10. You must sign and return the Orientation Checklist at the end of the rotation.
3. Clerkship Calendar
   1. For guidelines on Reporting Time, Holidays, Travel Time, and Attendance: All rotations begin on the first weekday 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 OSU Regional Coordinator, and the Tulsa office immediately. If a student is absent for any reason (or multiple reasons) for up to 3 days they must have the preceptors permission prior to the absense and make-up is up to the preceptors discretion. If more than 3 days or a required event will be missed the student is required to complete an Exception to the Rotation Application with the preceptor and course coordinator signatures. 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:
      1. 50% = Student Performance Evaluation
      2. 15% = Case Presentation
      3. 15% = Procedure/Skills Card
      4. 5% = Kids in Health Presentation
      5. 5% = Community Experience
      6. 5% = Didactic Participation
      7. 5% = Article/Pictures of Rural Experience
   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. Student Performance Evaluation: At the completion of the Rural 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. Student Performance Evaluations will be made available to students after the online site evaluation is completed.
   4. 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 initials are required for the rotation, students can use as many cards as needed to add value to the report. These cards count 5% and are required for all Rural Health rotations. Students are encouraged to use on all rotations including electives.
   5. Kids In Health/Careers in Medicine Presentation: Students will present to junior high or high school students in the area. This is arranged by the AHEC Coordinators.
   6. Community Experience: Students working with the AHEC Coordinator will choose a community experience. This should provide the opportunity for both the community and the student to benefit. Preference is given to experiences that are health related or allow the student the opportunity to present at a community event where the topic includes OSU-CHS COM, Osteopathic medicine, or what it means to be a medical student. Activities that are a part of your preceptors clinical training does not count as the Community Experience (Examples: Nursing home rounds, sports physicals)
   7. Didactic Events: These weekly sessions will vary site to site and are planned by the Didactic Coordinator or OSU. Dates, times, and locations will be provided at the site orientations.
   8. PowerPoint Case Presentation: An evaluation of the patient case presentation is conducted by the course coordinator (or representative) on factors such as, the appropriateness of the student’s assessment and medical plan recommendations, and by AHEC representative on appropriate community resources used.
   9. Article/Pictures of your Rural Experience: Student will send (electronically) a one page article that briefly describes your rural experience to the OSU Regional Coordinator and ruralhealth.clerkship@okstate.edu. Article should be suitable for publishing and include pictures when possible. Permission to publish article and/or pictures should be included in your email. If others are in the picture or article, you must also have their permission (physician, patients, staff, etc)
   10. Students are also required to complete an online AHEC evaluation form. This tool is used by AHEC to evaluate the role of the regional AHEC offices in the administration and coordination of the rotation and is used for federal reporting. Students are required to complete the online form and submit it at the end of the rotation.
   11. Final Grade: The final (overall) grade will be determined and issued by the Course Coordinator following the completion of the rotation.
   12. 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), AHEC support, if appropriate, OSU staff support and student experiences at that site. The individual site evaluations and responses will remain confidential. Students are responsible for ensuring that all paperwork for Rural Clinic is completed and received by the OSU-CHS 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.
   13. Non-Cognitive Grade: 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.
   14. 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; or the student fails to submit the required paperwork.
   15. 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.
   16. 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's feedback. Preceptors and will receive aggregate reports only. The individual site evaluations and responses will remain confidential.
5. Goals:
   1. Gain an appreciation of the rural osteopathic family physician's role as the physician of first contact that delivers family-oriented medical care to patients entering the health care system.
   2. Gain an understanding of 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, peers, physicians, and the community.
   5. Gain a better understanding of how to respond to moral/ethical aspects of patient care.
   6. Improve OMT skills.
   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	Clinical experience with an assigned rural physician.
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.	Complete a Procedure/Skills card
OMT Hands-on Application	Demonstrate appropriate techniques and indications in knowledge of uses of OMT
Didactic Lectures Medical Knowledge	Attend and participate in all required medical didactics presented by physicians. Complete all assigned readings Describe the rural health status of Oklahoma	Available On-line Didactic Modules Up to 2 hours a week of planned didactics
Community Experiences Presentation skills	Display presentation skills during the Kids in Health or Careers in Medicine presentation scheduled by AHEC Coordinator. Coordinate with AHED to demonstrate presentation skills during a community event approved by Center for Rural Health. Both should be medically related and both parties should benefit. Preference should be given to experiences that promote OSU-CHS, Osteopathic Medicine, or Careers in Medicine.	Attend community events and health related activities as assigned. Article/Pictures about the rural experience suitable for publishing.
Patient Case Research & Presentation skills	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 Coordinator Guidelines for patient case Guidelines for PowerPoint presentation Present case presentation last week of rotation. Case Presentation Tips
Distance Education Technical skills	Utilize videoconference equipment Transmit PowerPoint case presentation to Course Coordinator (or designee) in Tulsa during the final didactic session.	Connect using the Codian Bridge Transmit case presentation to course coordinator in Tulsa