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Center for Health Sciences
Family Medicine Clinic
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Syllabus

CE 9235

  1. General Description
    1. Course Title: Family Medicine Clinic
      Course Lenth: Four-week block
      Course Format: Family Medicine Office-Based Ambulatory Clerkship/Rotation
      Student Level: 3rd Year Osteopathic Medical Students
      Course Coordinator: Sarah M. Hall, D.O.
    2. The Family Medicine Clerkship is a four-week block that takes place in the OSU-COM Health Care Center. This setting provides a unique opportunity for direct patient care, access to a fully equipped laboratory and X-ray facility, as well as a variety of specialty clinics providing on-site consultation services. The OSU-COM Health Care Center is the only site through which every OSU-COM student will rotate. Consequently, the clerkships provide the opportunity for consistent educational experiences for all 3rd year students. In addition to learning from supervised patient care experiences; a variety of additional learning experiences will be incorporated. These include: Afternoon lectures on Monday - Thursday at 1:00 p.m. and Friday at 8:00 a.m., Jurisprudence, Interviewing Skills, Clinical Performance Exam, On-line fmCases and team-based learning modules.
    3. Each student will be assigned to a practice group or service. All students will report to their attending regarding Health Care Center policy, attendance and patient assignments. If you are going to be absent, please notify Lori Partin (918) 561-8581.
  2. 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 attending, with approval by the OSU-COM Course Coordinator, and shall generally conform to the following:
      1. Rotation Period: This clerkship is four weeks in length.
      2. Date of Arrival: It is the student's responsibility to report to his or her official rotation (course) 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 Supervising Physician immediately.
      3. Working Day: A typical working day is considered to be 8 hours in length, while on clinic, minimum of 40 hours/week, 8:00am-6:00pm, and 7 am to 6 pm while on hospital.
      4. Holidays: A two-day holiday vacation is provided in the schedule during the December rotation, and cannot be transferred to another rotation time-block. A facility may elect to stagger this holiday recess, provided the two day vacation is contiguous, so that a clinical clerk remains on duty, and provided there is more than one student (medical clerk) assigned during the rotation period. Thanksgiving Day is a College holiday (one day).
      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.
    2. NOTICE: All rotations begin on the Monday designated and last four weeks consecutive. Please refer to calendar. Should a holiday fall on a Monday, students are encouraged to contact the DME or Supervising Physician at the new facility to verify date of arrival. 
  3. Student Responsibilities
    1. Student Identification: The student is expected (at all times) to identify himself or herself as a non-graduate medical student by utilizing College approved identification, and is neither to represent himself or herself as a medical graduate, nor function as a licensed physician.
    2. Dress Code: 
      1. Students are expected to dress appropriately and avoid casual attire.
      2. Male students should wear dress slacks, dress shirt and tie.
      3. Female students should dress in professional attire and avoid short skirts.
      4. Lab coats should be worn at all times during patient care. Lab coats should be clean and well pressed.
      5. A professional appearance is important in the impression you make on your patients.
      6. Your attending physician will evaluate you on your appearance and this can be reflected in your final grade.
    3. Patient Confidentiality:
      1. Patient confidentiality must be protected. Charts are not to be taken from the premises of the Health Care Center. Removal of patient records from the Health Care Center will result in automatic failure of the clerkship.
      2. Be careful about conversation regarding the patients in the halls or in the student learning center where patients may overhear. Do not discuss cases by patient names except with your attending or persons directly involved in the patient's care.
    4. Class/Clinic Attendance:
      1. Students will receive a class lecture schedule the morning of orientation. Clinical Performance Exam, Interviewing Skills, Jurisprudence, and workshops are scheduled as designated on your schedule.
      2. Attendance will be taken. If you cannot attend class or clinic, notify the course coordinator so that the schedule can be modified (leave message on the voice mail). If you know that you will be absent ahead of time, complete the request for leave form, have your attending and Dr. Hall sign it. Check out with your attending or resident before leaving the clinic. If you need to leave any earlier, notify your attending and be prepared to make up the time.
  4. Student Performance Evaluation Procedures
    1. Performance evaluation forms are provided by the OSU-COM Department of Family Medicine. Rating determination instructions are provided on each evaluation form. The Supervising Physician is encouraged to exchange a "verbal review", as well as a written evaluation rating, with each student. It is recommended that verbal reviews be conducted at various points throughout each rotation, allowing the evaluator and the student to discuss the student's areas of weakness. The "verbal review" conference should serve as a meaningful exchange of information and ideas, not a confrontation. Supervising Physicians should have "verbal review" conferences with the students at least once mid-way through the rotation and on the final day of the rotation. Students will be responsible for scheduling the meeting times for these conferences.
    2. At the completion of the rotation, an evaluation of the student’s overall performance is to be determined by the Supervising Physician. A single evaluation form is to be prepared for each student. The final (overall) evaluation rating with accompanying comments is to be determined by carefully assessing the characteristics (e.g., medical knowledge, diagnostic acumen, decision-making capabilities, professionalism, etc.) enumerated on the performance evaluation form.
    3. Course Grade: Sarah M. Hall, D.O., Course Coordinator, determines and issues a grade following the completion of each rotation. The grade is based on the clerkship evaluation completed by your attending and successful completion of all requirements of the rotation including, clinical performance, final test and administrative responsibilities (e.g. evaluation forms).
      1. 50% = Clinical Evaluation
      2. 30% = Final Exam
      3. 15% = Jurisprudence
      4. Pass/Fail = Interview Skills
      5. Complete/Incomplete = Clinical Performance Exam (CPX)
      6. Complete/Incomplete = On-line quizzes to monitor your understanding of fmCASES
      7. COMAT Pass/Fail
      8. 5% =OMT Report
      • Must be performed and discussed with resident and Attending
      • Must complete a one page report to include:
        • Case Presentation over a patient seen while at clinic or hospital
        • What OMT techniques you used
        • Why did you choose that particular technique
        • Delineate direct or indirect technique
        • Were results seen with one treatment
      • Will be completed and attached to your final exam
    1. Your numerical grade will be converted to a letter grade based on the academic grading system outlined in the College catalog.
      A Excellent 90-100% 4
      B Good 80-89% 3
      C Satisfactory 70-79% 2
      D Marginal 65-69% 1
      U Unsatisfactory Below 65% 0
      N/A Non-Applicable    

    1. COMAT Examination Remediation Policy:
      Beginning July 2012, if a student does not pass the COMAT Exam, he/she must enter a formal remediation process as described by each course coordinator including entering into a mentorship with a designated faculty member in the department. The designated faculty member will direct the student to review specific topics of weakness as identified by their personalized COMAT Exam score sheet. After remediation, the student will be eligible to retake the COMAT Exam. If the student fails the same COMAT Exam a second time, a letter grade of "I" for incomplete will be assigned and the student will be referred to the Academic Standards Committee for a plan of corrective action.

      http://www.nbome.org/COMATMAIN.asp

      http://www.nbome.org/docs/COMAT-Family_Medicine.pdf

      Please review this site and make a day to day schedule of study topics

    2. Non-Cognitive Standards: In addition to an academic grade, all students will be held accountable to the non-cognitive academic standards as the standard of professionalism for their conduct. A grade of S (Satisfactory) or NI (Needs Improvement) will be issued by the Course Coordinator based upon evaluation of the student by the supervising faculty physician.
    3. Incomplete Grade: A grade of "I" (Incomplete) will be assigned in the event:
      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 Rural Community Primary Care rotation, and sets forth reasoning for the recommended extension.
      3. In the event the student fails to submit the required site evaluation and Community Resource Component evaluations to the Osteopathic Family Medicine department within 28 days of completing the rotation, the student will be considered to be in the standing of "incomplete" for that rotation.
    4. Grievance Authority: Grievance of a rotation, rotation evaluation, or examination grade should start with the clinical faculty at the assigned facility. The final authority will be with the Course Coordinator.
  5. Rotation Objectives
    3rd Year, four week, Family Medicine Clinic
    1. Goals: Provide the student a variety of learning experiences designed to enhance their knowledge and skills relevant to the care of patients in a family medicine ambulatory care setting.
      1. Gain an understanding and appreciation of the unique, continuous, comprehensive approach to health care delivery by the osteopathic family medicine physician with patients and their families.
      2. Recognize the importance of the physician's role as coordinator of the heath care team.
      3. Improve his/her basic interpersonal/psychosocial skills required in the practice of medicine.
      4. Improve the technical skills needed to perform common office procedures and developed other skills.
      5. Become familiar with basic diagnoses and management of diseases and conditions commonly presented by patients in the family medicine setting.
      6. Be introduced to and gain an understanding of how patients enter the health care delivery system, as well as progress through it.
      7. Gain a greater understanding of the discipline of family medicine.
      8. Gain self-evaluation skills.
      9. Gain skills that facilitate the small group learning process.
Subject/Method Learning Objectives Resources/Assignments
Psychomotor Skills
Observation by attending physician and family medicine residents.
Exhibit basic, positive psychosocial skills during patient interactions:
  1. proper greetings and introductions
  2. respect and support
  3. appropriate eye contact
  4. confidence in him/herself
  5. attentiveness & concern
  6. empathy & sensitivity
  7. active listening
  8. proper closure of interaction
 
Behavior & Character
Observation by attending physician and family medicine residents.
Demonstrate the behaviors & characteristics that predict success in clinical training:
  1. enthusiastic
  2. reliable
  3. honest
  4. analytical
  5. adaptable
  6. thorough
  7. constant improvement of learning skills
 
Clinical Techniques
Hands-on training and observation by attending physician and family medicine residents.
Demonstrate adequate psychomotor skills when performing basic clinical techniques common to office practice of primary care:
  1. pap smears
  2. upper respiratory cultures
  3. joint injections
  4. suturing & suture removal
  5. venipuncture
  6. urinalysis interpretation
  7. EKG interpretation
  8. XRay interpretation
  9. OMT
  10. Spirometry interpretation
  11. Absess incision and drainage
 
Office-based Procedures
Hands-on training and observation by attending physician and family medicine residents.
  1. Perform a thorough physical examination (review of system)
  2. Present patient cases (chief complaint to management plan) in a logical and succinct manner
  3. Identify and become familiar with medications prescribed for common conditions/diseases presented by patients
  4. Describe and conduct patient education and prevention care strategies commonly done in the family medicine setting. Record and synthesize clinical data in a planned and logical manner, e.g., SOAP notes through EHR - Electronic Health Record
    1. describing & demonstrating Breast Self Exam
    2. providing written material
    3. explaining procedures, treatments, etc., using terminology that the patient understands
    4. giving instructions and having patient repeat them back to ensure learning
  5. Apply knowledge of family dynamics to improve patient care
Observed and critiqued by attending
CPX (Clinical Performance Exam)
Student demonstration
Demonstrate knowledge and skills essential to clinical performance Family Medicine faculty will observe and provide feedback to each student providing patient care in a structured setting.
Interviewing Skills
Mock interviews/observed interviews
Determine the techniques and steps to taking a comprehensive history (interview) of a difficult patient encounter Observed and critiqued interview with "real" patient
Medical Jurisprudence
Improve understanding of medical law and ethics as it relates to healthcare Medical Jurisprudence by Dr. Curtis Harris
Inpatient Hospital (OSUMC)
  1. Experience Family Medicine in-patient care
  2. Emphasize continuity of care to office and hospital
Student will be assigned 1 full week at OSUMC.

Afternoon Seminars
Lectures:
• 1 p.m. Monday-Thursday
• workshops as scheduled

  1. GERD
  2. Approach to Dyspnea
  3. Hep C
  4. Headache
  5. Hypertension
  6. Geriatrics
  7. Prenatal care/pregnancy compliations/postpartum
  8. GERD
  9. STDs
  10. Low Back pain
  11. Basics of orthopedics
  12. Rashes
  13. Diabetes
  14. Sleep disorders  
  15. Routine Screening
  16. Overview of well child visit
  17. Diabetes Management: Food, insulin and practical tips
  18. Obesity and type 2 diabetes in children and adolescents
  19. End of life care
  20. Kidney disease
  21. AMS - Altered Mental States
  22. Basics of Endocrinology in FM

The seminars include, but not limited to, the topics above.

Handouts given by the lecturers.
On-line modules to emphasize these topics.  Content and numbers to be determined by the clerkship coordinator.
Final Exam
Last week of the month.
Master learning objectives from didactics and workshops.  

Med U FM cases

Selected cases applicable to FM

online weekly quizzes to monitor progress