Key Concepts / Learning Outcomes

Although the Family Medicine Clerkship will be conducted at a variety of clinical sites in different settings, all students are expected to accomplish a core group of competencies. These competencies are based in three major domains: Patient Care, Health Promotion and Disease Prevention, and Professionalism.

a. Medical Knowledge

  1. Individualize effective screening recommendations for a woman over 40, in for her annual exam. fmCASE 1
  2. Individualize effective screening recommendations for a man over 40, in for his annual exam. fmCASE 2
  3. Understand the assessment, differential diagnosis and initial treatment for insomnia in the elderly, including knowledge of major depressive disorder, and elderly abuse. fmCASE 3
  4. Understand the assessment, differential diagnosis and initial treatment of common joint injuries, with special attention to the ankle joint. fmCASE 4
  5. Understand the assessment and differential diagnosis for palpitations, with special attention to the diagnosis and treatment plan for hyperthyroidism. fmCASE 5
  6. Individualize effective assessment and treatment plans for patients with type II diabetes mellitus. fmCASE 6
  7. Understand the assessment and differential diagnosis for unilateral leg swelling, with special attention to the diagnosis and treatment plan for deep venous thrombosis. fmCASE 7
  8. Individualize effective assessment and treatment plans for patients with hypertension. fmCASE 8
  9. Understand risk factors for coronary heart disease, and effectively stratify patients with those risks, based on history, physical exam, and testing strategy. fmCASE 9
  10. Understand the assessment, differential diagnosis and initial treatment of patients with low back pain. fmCASE 10
  11. Understand the assessment and differential diagnosis for knee pain, with special attention to the diagnosis and treatment plan for osteoarthritis. fmCASE 11
  12. Individualize effective counseling, assessment, and management of teenage pregnancy and its complications. fmCASE 12
  13. Understand the assessment and differential diagnosis for an adult with persistent cough, with special attention to the diagnosis and treatment plan for asthma and its co-morbid conditions. fmCASE 13
  14. Understand the diagnosis, dating, and management of intrauterine pregnancy, including complications such as hypertension, preeclampsia, gestational diabetes, vaginal bleeding, domestic violence, and depression. fmCASE 14
  15. Understand the assessment and differential diagnosis for right upper quadrant pain, with special attention to the diagnosis and management of biliary tract disease, and counseling for alcohol abuse. fmCASE 15
  16. Effectively describe skin lesions, understand the treatment principles of topical agents, the specific characteristics of more common skin cancers, along with biopsy options, and preventive measures. fmCASE 16
  17. Individualize effective assessment and treatment plans for patients with benign prostatic hypertrophy. fmCASE 16
  18. Individualize effective screening, counseling, assessment, and treatment plans for women who have reached menopause, with special attention to postmenopausal bleeding, osteoporosis, and hormone therapy. fmCASE 17
  19. Understand the assessment, differential diagnosis, and treatment plans for patients with headache. fmCASE 18
  20. Understand the assessment, differential diagnosis, and treatment plans for patients with epigastric pain, with special attention to peptic ulcer disease, H. Pylori gastritis, and gastroesophageal reflux disease. fmCASE 19
  21. Individualize effective assessment and counseling of those exposed to domestic violence. fmCASE 20
  22. Understand the assessment, differential diagnosis, and treatment plans for patients with an acute respiratory infection, with special attention to bacterial pneumonia. fmCASE 21
  23. Individualize effective assessment, counseling, and treatment plans for pediatric patients with obesity. fmCASE 21
  24. Understand the assessment, differential diagnosis, and treatment plans for patients presenting with new onset neurologic symptoms, with special attention to transient ischemic attack, stroke, and stroke prevention. fmCASE 22
  25. Understand the assessment, differential diagnosis, and treatment plans for pediatric patients with pharyngitis, with special attention to viral pharyngitis and strep throat. fmCASE 23, fmCASE 35, fmCASE 36, fmCASE 37
  26. Recommend appropriate screening and preventive measures for pediatric patients, based on age, with special attention to immunizations and anemia. fmCASE 23, fmCASE 35, fmCASE 36, fmCASE 37
  27. Individualize effective assessment and treatment plans for newborns and their parents during the immediate post-partum period, with special attention to the normal newborn exam, post-partum blues, post-partum depression, and breastfeeding. fmCASE 24
  28. Understand the assessment, differential diagnosis, and treatment plans for patients with fatigue, with special attention to iron deficiency anemia. fmCASE 26
  29. Understand the assessment, differential diagnosis, and treatment plans for patients with scrotal pain, with special attention to testicular torsion, and sexually transmitted illness. fmCASE 27
  30. Understand the assessment, differential diagnosis, and treatment plan for patients with shortness of breath, with special attention to chronic obstructive pulmonary disease (COPD). fmCASE 28
  31. Individualize effective assessment, treatment plans, and counseling for elderly patients with dementia and/or delirium, including caregivers. fmCASE 29
  32. Understand the diagnosis of active labor, and interpret fetal monitoring strips. fmCASE 30
  33. Understand the assessment, differential diagnosis, and treatment plans for patients with congestive heart failure. fmCASE 31
  34. Individualize effective assessment, treatment plans, and counseling for patients with dysmenorrhea, with added attention to premenstrual syndrome. fmCASE 32
  35. Understand the assessment, differential diagnosis, and treatment plans for patients with dizziness and vertigo. fmCASE 33
  36. Understand the important aspects of prenatal screening, with special attention to TORCH infections, HIV transmission, and etiologies for small-forgestational- age (SGA) infants. fmCASE 34
  37. Individualize effective assessment, counseling, and treatment plans for pediatric patients with asthma. fmCASE 38
  38. Understand the assessment, differential diagnosis, and treatment plans for patients with chest pain, with special attention to angina pectoris, atypical angina, noncardiac chest pain, and secondary prevention of ischemic heart disease through the reduction of cardiovascular risk factors. fmCASE 39
  39. Individualize effective assessment, counseling, and treatment plans for patients with obesity, with added attention to dyslipidemias. fmCASE 40

b. Communication Skills fmCASE 25

  1. Write a coherent history and physical, or SOAP note.
  2. Clearly present a patient’s history and physical exam.
  3. Effectively talk to patients and their families, especially in difficult situations, i.e. end of life issues.
  4. Motivate and instruct patients in health promotion and disease prevention.
  5. Demonstrate an understanding of how family, culture, and religious beliefs can influence healthcare decisions and outcomes.
  6. Respectfully and effectively communicate issues of patient care with non-physician healthcare workers, including clergy.
  7. Explain to patients and families, findings from clinical investigations, including plans for follow up, possible courses of therapy with indications, risks, and benefits, and alternatives.
  8. Collaborate with fellow students, healthcare professionals, patients and families. Including strategies for teaching in small groups, especially giving feedback.

c. Professionalism

  1. Demonstrate an effective physician-patient relationship to provide quality health care and understand the therapeutic role these relationships confer.
  2. Understand the major obligations of physicians to their patients and show skill and service to people who come for care for a variety of reasons.
  3. Demonstrate advocacy for patients over personal interests.
  4. Display behaviors that foster patient trust in the physician, by appropriate dress, grooming, punctuality, honesty, respect for patient confidentiality, and other norms of behavior in professional relationships with patients
  5. Converse appropriately and behave with personal integrity in all course and clerkship activities and in interactions with peers, faculty, residents, and non-physician staff and identify these interactions as analogs of future professional relationships thereby maintaining the same high standards expected in patient care.
  6. Work collaboratively as members of a healthcare team in a variety of settings.
  7. Demonstrate commitment to and examples of service to patients in need.
  8. Recognize and accept their own limitations in knowledge and clinical skills and commit to continuously improve their knowledge and ability.

d. Patient Care

  1. Perform, record, present and interpret a complete screening physical exam.
  2. Effectively observe, communicate, and interact with patients, families, and other healthcare workers to obtain histories, deal with difficult situations, and insure proper record keeping.
  3. Integrate data from the history, physical, and laboratory to construct a problem list, develop a prioritized differential diagnosis along with therapeutic, diagnostic, and patient education plans for each problem identified.
  4. Make clinical decisions and solve problems using deductive reasoning based on data obtained about the patient, principles of clinical epidemiology, and evidence-based medicine.
  5. Construct appropriate management strategies (diagnostic, therapeutic and behavioral) for common conditions, both acute and chronic
  6. Develop care plans for patients with chronic conditions not amenable to immediate cure, including: rehabilitative services, care of chronically disable persons and patient facing the end of life.
  7. Interpret the results of the most frequent commonly used clinical laboratory tests.
  8. Perform relevant routine clinical exams and procedures including:
    1. Breast Examination
    2. Testicular Examination
    3. Pelvic examination and PAP smear
    4. Skin exam
  9. Exhibit an understanding of how to perform database retrievals, retrieve patient-specific information, select and use information technology, and employ electronic communications for the direct care of patients.

e. Practice Based And Lifelong Learning 

  1. Demonstrate knowledge of specific topics related to students’ patients and use the medical literature to gather relevant information for patient care.
  2. Use information technology to access and manage clinical information and perform on-line searches to support ongoing self-directed learning.
  3. Search, evaluate, and critically review scientific evidence appropriate to the care of individual patients or as an approach to a clinical problem
  4. Demonstrate an understanding of the variations in physician behavior for common conditions, the importance of developing evidence-based practice methodology to lessen variations, the role of practice pathways to manage common problems, and the need to individualize recommendations for the patient.
  5. Formulate questions regarding outcomes seen in patient care and consider simple methods of quality improvement including improved patient satisfaction, decreased complication rates, improved clinical outcomes, and improved access to healthcare for patients from underserved groups.
  6. Demonstrate a commitment to identifying errors in medicine, reasons for errors, and develop basic strategies to reduce medical errors.
  7. Demonstrate a plan for professional growth.

f. Social And Community Context Of Healthcare

  1. Demonstrate an understanding that some individuals in our society are at risk for inadequate healthcare, including the poor, uninsured, underinsured, children, unborn, single parents, elderly, racial minorities, immigrants, refugees, physically disabled, mentally disabled, chemically dependent, and those with incurable diseases.
  2. Demonstrate an understanding of the impact of economic and health insurance issues on patient care.
  3. Under supervision, develop diagnostic and treatment strategies that are cost-effective, sensitive to limited resources, and do not compromise quality of care.
  4. Appropriately recommend use of consultants and referrals.
  5. Demonstrate knowledge of non-biological determinants of poor health including child abuse, domestic violence, and the economic, psychological, social, and cultural factors that contribute to their development and continuation.
  6. Demonstrate an understanding of economic, psychological, social, and cultural factors that impact patient health.