CLERKSHIP ASSIGNMENTS AND REQUIREMENTS

Clinical Responsibilities (50% of final grade)

As previously stated, we expect students to spend a minimum of 30 hours per week in direct ambulatory care. During the clerkship, the students' primary clinical emphasis will be to evaluate ambulatory patients. The expectation is that over the six weeks you will increase your responsibility so that eventually you will be the first person to see patients. After you complete your evaluation, you will review each patient with your preceptor. Additional clinical responsibilities will vary by site. Opportunities to take call, work evening hours, Saturday hours, rounding on inpatients or at the nursing home, are all possible learning venues. You are required to hand in certain documents during your clerkship. Missing documents will result in a 1-2 point reduction of your final grade.

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Patient Log Card

The Liaison Committee on Medical Education (LCME) , requires that students keep a daily patient log of patient encounters. You will be given a yellow log card at the beginning of the rotation and the log should be kept on hand by students at all times in the clinical setting. Log entries should be completed by the end of each day and entered into the portal WEEKLY . Your total number of problems may exceed the number of patients you have seen.

Assigned patient means patients in the clinic, (new or returns) that you are sent to interview, present to the attending and write the clinic note on.

Conditions are (a) those issues your assigned patients have, i.e., active problems being diagnosed or treated and which you read about. (If your assigned patients have issues that you are not diagnosing, treating or reading about, do not list those issues); (b) issues that other patients on your service have (not assigned to you) that you discuss on rounds and read about; or (c) issues that you encounter by way of simulated patients (simulated patients should not be recorded as "assigned" patients).

The Education Coordinator will check your logs intermittently and contact you if there seems to be a problem with your recording. The Clerkship Director must report any student who fails to keep their logs accurately. Do NOT wait until the end of the rotation to enter your data into the portal. The most common error is forgetting to enter the total number of patients. Following is an excerpt from a completed log card, an example of the way data is displayed in the portal, and a list of site acronyms.

 Student Log Report By Card
FAMILY MEDICINE CLERKSHIP - Jul6 / Class of xxxx

Student Log Monitoring
FAMILY MEDICINE CLERKSHIP - 5AB / Class of xxxx
From (Date) To (Date)

Site Acronyms

Contact info:  

Technical: Sabah Al Janabi – saljana@lumc.edu
Other: Amy Andel – aandel@lumc.edu

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Procedural Checklist and Critical Incidents

During the Family Medicine Clerkship, we expect students to encounter a number of common outpatient procedures. Although each preceptor's office may only perform some of the listed procedures, we expect students to perform or assist in at least 10 of the procedures listed on the following pages. The teaching of a procedure may be delegated by the preceptor to a non-physician member of the health care team where appropriate, e.g., nurse, laboratory technologist. Please have the procedure supervisor sign-off and indicate yes or no as to your competency with performing the procedure. Keep the checklist with you at all times in the clinical setting. The procedural checklist is due at your final exam.

Critical incident recording is an additional way to log your experiences. Much like a diary, it provides a systemic and consistent forum to note particularly important or memorable experiences. The critical incidents log is due at your final exam.

You are required to log a minimum of two entries per week, e.g.:

Sample Critical Incidents:

.

Procedural Checklist & Critical Incidents

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Biopsychosocial Project (8% of Final Grade)

This project is designed to help you appreciate health and illness from a biopsychosocial perspective. In part, the term biopsychosocial implies that peoples' health is inextricably linked to what happens in their every day lives. All too often in our practice of medicine, we gain a very limited, sometimes excessively narrow view of the problems that people are facing. This may result in less than adequate care for our patients. Perhaps you can think of some examples from your own lives: a close friend, a family member, a teacher, someone who has suffered an illness or who has died. What was it like for this person to be sick? What were her/his fears and concerns? What other factors played a role in that person's experience of illness? What impact did family have upon the experience? What impact did this experience have upon the family? What enabled that person to feel supported and get back into the swing of things again? These questions represent some ways in which we hope that this project will help you gain a larger view of what people are actually experiencing when they come to you for help. It is our objective to have you select a patient in your practice and examine that patient and her/his family to consider the following principles of Family Medicine:

1. Viewing peoples' health in relation to their daily lives.
2. Understanding the role of family in caring for patients.
3. Appreciating the inseparability of illness and everyday life.
4. Recognizing the importance of optimizing people's daily function.

In order to accomplish these goals, you will be expected to interview a patient whom you have identified together with your preceptor. Your preceptor will help you choose someone who is open to this. Ideally, it would be done at the same time the patient is in for a visit and the patient can be asked to spend just a little longer. In some cases, the patient may prefer to return on a different day when it is more convenient, or you may conduct your interview via phone. You should try to complete the interview within 45 minutes to an hour. Again, the purpose of the interview is to get a better idea of what your patients' lives are all about, what their families are like, what problems they may be facing, to whom they turn for support, and how this relates to their health in general. Inquire if your preceptor would like a copy of your write-up for the patient's chart. We expect you to use the following strategies:  

1. Clinical summary of present illness. In one paragraph, briefly describe what's going on with your patient. Mention her/his chief complaint and then discuss the primary aspects of your patient's illness, including pertinent information from Past Medical History, Family History, Social History, etc.
   
   
2.  Three-generation genogram. (See “Working with Families,” in the Articles Appendix for a guide to constructing the genogram.) Focus on structural and functional relationships (conflict, affiliation, abuse, separation, etc.) within the family. Also, be sure to identify and label medical problems within the family. A good way to begin this segment is by saying, “I'd like to learn a little more about your family so that I can draw your family tree. This will help me understand more about you and your health.”
   
   
3.  Family and occupational assessment
   This is an opportunity for you to learn how your patient gets along with family members and co-workers. Ask your patient to complete the Family System APGAR and Work System APGAR, when applicable, which appear later in this section.
   
   
4.  Stressors and resources
   In addition to the problems that patients present to you, there often exist other challenges that they are facing. These challenges can be viewed as stressors. Stressors may be positive (getting married, receiving a promotion, buying a new house, graduating from school, etc.) or negative (losing a loved one to death, learning about having cancer, sustaining a broken leg, being fired from a job, having service cut off by the electric company, etc.). One way of learning more about peoples' stressors is to ask, “What concerns do you have about your life right now?” or “What else is on your mind that's been troubling you?” You may encounter resistance when you ask these questions. If so, it might help to say, “Learning more about your concerns gives me a better idea of what your life is all about. In that way, your doctor and I can take better care of you.”
   
    In order to respond to these various stressors, people need help. Help can come in a variety of ways. These are called resources. Examples of resources include money, physical health, neighbors, community agencies, transportation, etc. Usually, the most important resources that people have to buffer the impact of stressors are family and friends. One way of learning about personal support is by asking, “Who is the most important person in your life you can turn to for help or to talk to about your feelings?” Asking, “What else has made it easier for you to cope with everything that you are going through?” may enable you to further assess peoples' resources. You may also want to learn more about peoples' religious and spiritual beliefs, their hobbies, and things that they do for fun.
   
    One way of remembering potential sources of distress and support is the following acronym, SCREEEM:
   • S Social
   • C Cultural
   • R Religious
   • E Educational
   • E Environmental
   • E Economic
   • M Medical
     
     
5. Patient's perspective of illness
   Often, when people come to us for help, they have a number of underlying, related concerns. Unfortunately, patients are rarely able to bring these concerns to our attention. Reasons for this include lack of time, fear of appearing foolish and physician disinterest. Perhaps, one of the biggest reasons is that physicians fail to listen to their patients. It is easy to see how this can happen. We are preoccupied with making an accurate diagnosis, determining appropriate treatment, and getting on to see the next patient. As a result of this preoccupation, we tend to miss clues that patients give us about what is really on their minds. When this happens, even though we may have prescribed the appropriate medicines and ordered the necessary tests, we run the risk of leaving our patients still feeling anxious and uncertain about their condition. In order to reduce peoples' anxiety, it is important to explore their feelings and concerns and to identify what worries them the most. This will give them a chance to share what may really be on their mind. The following questions will help you solicit this information:
   
   
   • “What worries you the most about what's happening to you right now?”
   • “It's important for me to know what's been on your mind about this.”
   • “What do you expect your doctor to do for you about this problem?”
     
     
   Once you receive this information, you may feel overwhelmed by some of the emotions that people may express. Remember one important principle: You do not have to fix peoples' feelings. Instead, listen. Then, put yourself In their shoes for a moment and respond to what they have to say. For example, when Ms. Chiles tearfully says to you, “I was just hoping that I didn't have cancer. My sister died three years ago from lymphoma in her bowel.” You can respond by remaining silent, holding her hand, allowing her to cry, and then saying, “It seems like you're feeling a lot of pain about your sister.” Showing people empathy proves that their feelings are important to you and that you care. This builds their trust and gives them confidence in you as their doctor.
   
   
6.  Assessment
   Using all of the information you have now obtained, list and describe your evaluation of your patient, both “medically” and “psychosocially.” Be sure to explain how the concerns that you have identified relate to your patient's primary medical problems and impact upon her/his health care.
   
   
7. Plan
   State your treatment recommendations for each problem and concern identified in your assessment.
   
   
8.  Feedback
   Now that you have had this opportunity to more extensively evaluate your patient from this biopsychosocial perspective, please answer the following questions:
   • What has this project meant to you?
   • What have you learned from this assignment that you may not have learned otherwise?
     
     
9. Presentation to Class
   You will present your patient back at Loyola to one-third of the students currently doing the Family Medicine Clerkship. You will have about 10 minutes to present the patient's history, genogram, APGARS, your assessment, etc. and then there will be 10 minutes for group discussion. Come prepared with a hard copy of your project including the genogram and APGAR table(s). Failure to present due to an error on your part (e.g. forgetting to come at designated time) will result in two points automatically deducted from the total grade for the assignment.

Biopsychosocial Project Outline / Biophychosocial Project Example / Genogram Template

Smilkstein's Family System Apgar Items / Smilkstein's Work System Apgar Items

Biopsychosocial Grading Criteria / Mid-Rotation Evaluation / Education Contract

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Evidence Based Medicine (EBM) Project (8% of Final Grade)

This exercise is designed to provide you with experience in applying the results of medical research to clinical practice, i.e., to help you provide care for your patient that is based on the best evidence available. This is known as Evidence-Based medicine. You will continue to utilize Evidence-Based Medicine throughout your medical career. 

The project is based on the articles located on the Family Medicine LUMEN website, “Users' Guides to the Medical Literature” created by the Evidence-Based Working Group from McMaster University. Carefully reading these articles will provide you with the tools you need to complete the assignment. You need to start thinking of a clinical question about one of your patients early in your clerkship. Define a question related to therapy or prevention, a diagnostic test, or the harmfulness of an intervention or treatment. If you choose to answer a different type of clinical question, or use a type of study other than the ones described in these articles, you will need to review additional guides online at http://pubs.ama-assn.org/misc/usersguides.dtl. Please be sure to apply the appropriate guides to answer the questions in the assignment. If you do not use the appropriate guides, you will not receive full credit. If you need additional help, be sure to contact one of the Research and Access Services librarians at 708-216-5305 .  

Your clinical question should have three parts: 1) the patient; 2) the intervention; and 3) the outcome of interest. The patient refers to the type of patient/condition (for example, an adult postmenopausal female). The intervention refers to the test/treatment/preventive strategy of interest (for example, hormone replacement therapy). The outcome of interest refers to the medical outcome, such as improvement/cure or worsening of a condition or death. Your question should be as specific as possible without being too restrictive. For example: How effective is hormone replacement therapy in a postmenopausal Caucasian woman in preventing hip fractures?

Once you identify one or more questions, discuss them with your preceptor to determine the best one to “answer.” Then, follow these steps for the respective type of question. The first step is to do a literature search to identify the most helpful article. This search should be based on the principles you learned in the e-learning module “Searching for Evidence-Based Medicine” and the EBM handout distributed at the start of the school year. Based on that article, you will need to answer the following questions: 1) Are the results of the study valid? 2) What are the results? And 3) Will the results help me in caring for my patients? If the answer to question #1 is “no,” try to find a better alternative paper, if available. If not available, you can use that article, pointing out the weaknesses of the study, and go ahead and answer the remaining questions.

Additional Requirement:

The Health Sciences Library worked with Dr. Levin to create an online module for the library portion of the Evidence-Based Medicine project. You will receive credit for the library portion of the Evidence-Based Medicine project upon completion.

Library Module for the Evidence-Based Medicine Project pilot URL: http://archer.luhs.org/login?url=https://softchalkcloud.com/lesson/serve/FlUsSBYvQCWbx4/html

Login with your Single Sign-On ID and password (your UVID and password) to access the module and then enter your first and last name in the “User Identification” field to enter the module.

Please only begin the module when you have chosen your case for the Evidence-Based Medicine Project. If you start the module and then return at different time, the module will start over at the beginning.

When you have completed the assignment, please email the Health Sciences Library at HSL@luc.edu with the subject line of “Completed EBM Module.” A librarian will confirm the module is complete, review your assignment, and provide any feedback. You will receive credit for the library portion of your Evidence-Based Medicine project after a librarian has confirmed the module is complete.

Questions:  Elizabeth Huggins, Information Services & Instruction Librarian, ehuggins@luc.edu or 708-216-5305

Use the outline on the following page to write up your assignment. Don’t forget to attach your original article. An Internet printout can be used only if it clearly displays all tables and figures.

 Hand in this project at your final exam.

Evidence Based Medicine Project Outline / Evidence Based Medicine Project Sample

Evidence Based Medicine Grading Criteria

Evidence Based Medicine Resources - Online Tutorials

Online tutorials provide easy access to practical instruction and tools to help a student learn about topics of interest. This sampling of free evidence-based medicine tutorials provides valuable info that addresses developing clinical questions, evaluating evidence, and performing efficient literature searches.

Duke University Medical Center Library and University of North Carolina-Chapel Hill Health Sciences Library: Introduction to Evidence-Based Medicine -- This site provides assistance in developing clinical questions, performing literature searches, evaluating evidence and testing knowledge. Each topic is broken down to help the beginner become proficient in EBM. http://www.hsl.unc.edu/services/tutorials/ebm/index.htm

Michigan State University, College of Human Medicine, Department of Family Practice: An Introduction to Information Mastery -- This online course was developed by family physician, Dr. Mark Ebell. It consists of modules designed to help you learn how to read and apply articles about diagnosis, therapy and prognosis; know the steps in performing a meta-analysis; and understand when it is appropriate to perform a decision analysis. Each module contains goals and tools, topic-specific curriculum and a quiz. http://www.poems.msu.edu/infomastery

University of Illinois-Chicago, Library of Health Sciences-Peoria: Evidence-Based Medicine: Finding the Best Clinical Literature -- Designed to assist health care professionals and students become effective and efficient users of the medical literature, this site helps with such things as formulating patient-centered questions, applying clinical search filters and using MEDLINE-key aspects in developing your EBM skills. http://www.uic.edu/depts/lib/lhsp/resources/ebm.shtml

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Clinical Skills exercise

Loyola Stritch School of Medicine has developed a clinical skills workshop in an effort to further objectify evaluation of clinical performance.  This is part of a national trend which moves the traditional Goals and Objectives of a course, towards Competencies and Outcome Objectives.  As a Third Year Family Medicine Clerk, you are required to attend a session at the SSOM Clinical Skills Lab, interviewing and counseling a standardized patient.  The cases that have been developed are meant to enhance your Family Medicine educational experience, as well as evaluate your knowledge, skill, and attitude.  Your performance will figure into your final grade. 

Succeeding on this important exercise requires you to organize, synthesize, and demonstrate various skill sets you have acquired during your time at Stritch.  Concentrating on a thorough, yet efficient, history, organizing that data into written format, as well as using that data to construct problem lists, assessments, and plans, will be critical.  Feel free to review your materials from our Clerkship, as well as various tools you have used for the PCM Course.

A schedule will be emailed to you a few days after your Family Medicine orientation.

• For this encounter you will have 15 minutes to obtain a screening history from a patient. The patient is here with a change of insurance.  No physical is expected.

• 10 minutes into the encounter you will hear an announcement simply to let you know that 10 minutes have gone by and that you have 5 minutes remaining.  Please do not respond to this announcement.

• If you finish the encounter before 15 minutes have gone by you may close the encounter but know that once you exit the room at this point you may not re-enter until later for the counseling portion of the exercise.  Before leaving the room, the SP will tell you that when you return, they have some questions about one of the prevention and screening topics you were told to review.  (They will specifically tell you which topic).

• Following the patient encounter you will have approximately 10 minutes to complete a Risk Factor and Health Maintenance Outline on the patient you just interviewed.  DO NOT BRING THE OUTLINE INTO THE ROOM WITH YOU.  A CSC MONITOR WILL PICK IT UP.

• You will have 20 more minutes to counsel the patient on any behaviors that need to be addressed.  You should begin by answering the questions the SP has regarding the prevention and screening topic.  Continue by counseling on the risk factors that you found.

•  The list of conditions from which your screening counseling topic can come from is:

Abdominal Aortic Aneurysm

Breast Cancer

Cervical Cancer

Colon Cancer

Lung Cancer

Osteoporosis

Ovarian Cancer

Prostate Cancer

Testicular Cancer

This new piece will serve as an assessment piece not only for the Family Medicine clerkship but also for SSOM's longitudinal curriculum in Prevention and Screening.

http://www.stritch.luc.edu/lumen/MedEd/hmps/index.htm

            To prepare for this you should review the screening recommendation topics and information listed in the USPSTF Prevention & Screening Recommendations pamphlet. You should be familiar with the above topics.

            In addition to help you study you can use the very user-friendly link below from the USPSTF that organizes your approach to screening recommendations and counseling.

            http://epss.ahrq.gov/ePSS/search.jsp

            As above, 15 minutes into this portion of the encounter you will hear an announcement simply to let you know that 15 minutes have gone by and that you have 5 minutes remaining.  Please do not respond to the knock.

Again, if you finish the encounter before 20 minutes have gone by you may close the encounter but know that once you exit the room you will not meet again with the standardized patient until feedback.

The SP will leave the room and your classmate who has been observing the encounter will come over and give you feedback that will be filmed.  During the time your peer is giving you feedback the SP is completing her paperwork in preparation for her feedback.  

            The standardized patient will meet with you briefly and provide feedback on your interpersonal skills through use of the Patient Perception Scale.

PATIENT CHARTS:

Patient charts are located on the door of each examination room providing basic information about your     patient.  You will be given time to review the chart before entering the exam room.  You may take the chart into the room with you.

VIDEOTAPING OF ENCOUNTERS:

All patient encounters are videotaped and reviewed by lab staff and clerkship personnel.

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  © 2001 Loyola University Chicago Stritch School of Medicine. All rights reserved.
Please send questions or comments to:Cathryn Merrick
Updated: 06/20/12 ... Created: 05/02/00