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 practice under the direct supervision of a primary care 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.
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 assistance in collection of required assignments. OSU Regional Coordinators are in contact with students and physicians to provide local event information and schedule social activities. They provide information about community resources for patients and coordinate the required Careers in Medicine presentation and the required community service.
4. The Rural Clinic rotation is under the direction of OSU-CHS Center for Rural Health and is conducted at affiliated primary care facilities. Successful completion of this rotation is an OSU-CHS requirement for graduation.
5. Students in the Rural Health Option or the Rural Medical Track should contact their OSU Regional Coordinator for site options.
2. Student Responsibilities (See Clerkship Handbook for more details.)
1. Pre-Arrival
2. Contact OSU Regional Coordinator:
   Students are required to contact the OSU Regional Coordinator at least two weeks 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.
3. Contact Preceptor:
   Students are required to contact their assigned preceptor at least two weeks prior to the beginning of the rotation to coordinate the start date, daily schedule and other pertinent aspects of the rotation.
4. First Week of Rotation:
   1. Students must attend the required group orientation in Tulsa (or other prearranged location) the first weekday of the month and attend the site orientation as scheduled by the OSU Regional Coordinator. Students must sign and return the Orientation Checklist that will be provided.
   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. 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.
5. During the Rotation:
   1. Students must dress appropriately at all times and 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. 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. Follow the patient case guidelines for the Rural Clinic case presentation to develop a case presentation that includes a treatment plan and community resources for the selected patient case.
   4. Provide appropriate patient care under the supervision of the preceptor.
   5. Demonstrate appropriate indications and techniques in using O.M.T.
   6. Participate in community activities planned by the Regional Coordinator for your area, which include a Health Career Presentation to a local school or organization and a community health-related activity.
   7. 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.
   8. 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. Present your PowerPoint case presentation to your peers, the OSU-CHS course coordinator (or designated physician) and a Center for Rural Health representative via live videoconference.
      4. Turn in your signed Procedure/Skills Card at the end of the month.
      5. Send your 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. All paperwork is due within seven days (postmarked by the fifth day) of the end of the rotation. A checklist of required paperwork is available online for your use. If forms are not received within seven days of the end of the rotation, the student’s grade may decrease up to 10 points.
3. Clerkship Calendar
1. For guidelines on Reporting Time, Holidays, Travel Time, and Attendance: All rotations begin on the first weekday of the month. Rural Medical Track students please refer to your schedule for start and end dates. 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) they must have the preceptor's permission and make-up may be required. The Exception to the Rotation Form must be completed with the preceptor's signature and submitted to the Tulsa office to be reviewed by the Course Coordinator.
3. Rotation Changes: Students may trade rotation assignments, under approved special circumstances only, by completing a Change of Rotation form. All changes must be completed at least 45 days prior to the rotation. All forms must be forwarded to the Center for Rural Health Office (918-584-4375) or fax 918-582-8938 or email to 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. 10% = Case Presentation: Medical
   3. 10% = Case Presentation: Rural Disparities
   4. 15% = Procedure/Skills Card
   5. 5% = Careers in Medicine Presentation
   6. 5% = Community Experience
   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 student's file and the student will be provided a report prior to graduation. Although a minimum of five 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 this on all rotations including electives.
5. Careers in Medicine Presentation: Students will present to junior high or high school students in the area. This is arranged by the Regional Coordinator.
6. Community Experience: Students working with the Regional 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 preceptor's clinical training do not count as Community Experience (Examples: Nursing home rounds, sports physicals).
7. PowerPoint Case Presentation: An evaluation of the patient case presentation will be conducted by the course coordinator (or representative) on factors such as the appropriateness of the student’s assessment, medical plan recommendations and resources used, and by a Center for Rural Health representative on appropriate health disparities encountered, community resources identified and presentation skills. Peer evaluations will not affect the grade. Presentations that are top-ranked by peers will be acknowledged.
8. Article/Pictures of your Rural Experience: Students will send (electronically) a one- to two-page article that briefly describes their rural experience to the OSU Regional Coordinator and ruralhealth.clerkship@okstate.edu. The article should be suitable for publishing and should include pictures when possible. Permission to publish the article and/or pictures should be included in your email. If others (e.g., physician, patients, staff) are in the picture or article, you must also have their permission.
9. Final Grade: The final (overall) grade will be determined and issued by the Course Coordinator following the completion of the rotation.
10. Site Evaluation: 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), OSU staff support and student experiences at that site.
11. Completed Assignments must be received within seven days of the end of the rotation: Students are responsible for ensuring all paperwork for Rural Clinic is completed and received by the OSU-CHS Center for Rural Health by the seventh day following the end of the rotation (postmarked by the fifth day). If paperwork is not received within seven 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.
12. 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.
13. 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.
14. 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.
15. The Course Coordinator reviews all site evaluations and will address any problems or issues that are identified in the evaluations. Data will be collated for the preceptors' feedback. Preceptors 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 and 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 and committee meetings, house calls and hospital emergency room calls.	Complete a Procedure/Skills card
OMT Hands-on Application	Demonstrate appropriate techniques and indications in knowledge of uses of OMT
Community Experiences Presentation skills	Display presentation skills the Careers in Medicine presentation scheduled by Regional Coordinator. Coordinate with Regional Coordinators to participate in a community event approved by the 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 and skills in appropriately accessing community resources for medical care plan and 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, Course Coordinator (or designee) and Center for Rural Health representative at the end of the rotation.	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 week of the rotation.	Connect using MOVI Transmit case presentation to Course Coordinator in Tulsa