Family Medicine Clerkship

• Bryan S. Delage, MD FAAFP

• Kamille Sherman, MD FAAFP

• Department of Family and Community Medicine

• University of North Dakota School of Medicine and Health Sciences

Orientation

Polycom/VNC/Streaming VideoPolycom/VNC/Streaming VideoProblems/Concerns/SurprisesProblems/Concerns/Surprises

Course ObjectivesCourse ObjectivesEvaluation/GradingEvaluation/Grading

Group topics/PresentationsGroup topics/PresentationsEncounter Database/PowerPointEncounter Database/PowerPointPatient-Centered Medical HomePatient-Centered Medical Home

PolyCom

Brandon Thorvilson tutorial

brandon.thorvilson@.med.und.edu

VNC Web Browser

• fmvnc.med.und.edu

• 134.129.166.244

• room2515

Family Medicine Clerkship

• http://www.med.und.edu/family-medicine/clerkship/

• Website for the Family Medicine Clerkship, Syllabus can be printed or downloaded as a PDF, or browsed for content by topic

• “Patient Centered Medical Home”

250 Biggest Mistakes 3rd Year Medical Students Make: and

How to Avoid ThemBy S.P. Desai, MD, & R. Katta,

MDMD2B Publishing, 2007

1. Beginning the rotation without a clear sense of what the evaluators are

seeking,Underestimating the importance of

faculty comments

2. Quickly glancing over the clerkship evaluation form

3. Remaining unfamiliar with the goals & objectives of the rotation

4. Not seeking a mid-rotation feedback meeting

EvaluationClinical faculty evaluation of student clinical

performance Case presentation to facultyNBME Family Medicine Subject Exam (MCQ)Small group presentationsClinical Encounters Database / Professionalism

Student evaluation of clerkshipStudent evaluation of preceptor

Grading

50% Preceptor evaluation

30% NBME FM exam

10% Case presentation to faculty

10% Small group presentations and Professionalism

Grading• 93 -100% - Honors ,*,**• 70-92.99 % - Satisfactory *• < 70%, or preceptor evaluation indicating less

than adequate performance - Unsatisfactory • ** limited to top 20%, and above the class mean

on NBME • * And satisfactorily completed all the

requirements for the Clerkship.

• More to follow at the end

NBME Examination• The NBME Shelf Exam in Family Medicine is now going to

be given electronically, through 2014-2015, it was an older test not updated since 2011, and a paper test, this will no longer be available in the 2015-2016 academic year.

• The Clinical Sciences Curriculum Subcommitte decided for 2015-2016 that a pilot setting all clerkship passing at the 10th %tile nationally for the NBME would provide more uniformity among clerkships.

• This was a score of around 64 based on the old paper test. The score we will use for passing will be set by the 10th % for the NBME, based on the scores of the 1st Rotation of 2015-2016 taking the electronic version.

Remediation

Fail by Preceptor Re-assigned to another preceptor

– Minimum one month

Failed written exam – Repeat exam once, either after R.3 or R.6; – if failure with 2nd attempt, repeat four weeks

of clerkship at a site selected by the course director and repeat NBME exam

Goals and Objectives

• Skills

• Awareness• http://www.med.und.edu/family-medicine/cler

kship/

Objectives

• Data Collection and Problem Solving

• Health Promotion / Disease Prevention

• Health Care Resources

• Impact of Family & Culture (Social Determinants of Health)

• Personal Strengths & Interests

Resources

• The Following are Available to meet the Clinical Skills / Experiences we expect you to obtain:

On-line <fmCASES> http://www.med-u.org/

On-line “Smiles for Life” – oral health w.smilesforlifeoralhealth.org/default.aspx?

tut=555&pagekey=62948&s1=1855605

• Smiles for Life – Course 1,and Course 7

Required Clinical Experiences

• Clinical Experiences we expect to be logged:

• Perform Adult, Pediatric and newborn wellness exam

• Diabetes Mellitus

• CV Disease

• CVA

• HTN

• Abdominal Pain

• URI

• Lower Respiratory Infection

• Dermatitis

• Skin Lesion

• Back Pain

• Musculoskeletal injury

• Obstetrics

• Gynecology

Clinical Experiences• Continued:• Mental Health• Headache• Red Eye• Family Dynamics *• Patient Access *• Oral Health• We expect you to meet these by seeing patients in the clinic and

logging in E*Value, it is likely you will see in some categories a lot of patients and in others fewer or may not see them at all. If not seen, then you will need to do an FM case or other remediation that you log to meet the requirement.

• * Family Connection and Access to Care videoconferences will meet the requirement for these, and do not need to be logged, but participation is mandatory.

CE Remediation• 1. FM Case #1, or 2.• 2. FM Case #12(adolescent) CLIPP case # 2,3,4• 3. CLIPP Case # 1• 4. FM Case # 6, Dr. Eric Johnson You tube lectures https://www.youtube.com/user/DrELJOHNSONDIABETES• 5. FM Case # 9, 31• 6. FM Case # 22• 7. FM Case # 8• 8. FM Case # 15, 19, 20, • 9. FM Case # 23, 13, 9, 33• 10. FM Case #13, 28• 11. FM Case # 16, • 12. FM Case # 16, *general workup of both benign/or malignant lesion• 13. FM Case #10• 14. FM Case #11, 25• 15. FM Case # 12, 14• 16. FM Case # 12,14, 17, 20, 32• 17. FM Case # 29• 18. FM Case # 18• 19. Red Eye Lecture – developed online lecture You Tube / Podcast**• 20. VPN online presentation participation mandatory for successful completion of FM Clerkship• 21. VPN online presentation participation mandatory for successful completion of FM Clerkship• 22. Smiles for Life – Course 1, and 7; or documented cases with a dentist• * benign or malignant lesion workup ** In development, will be posted to You Tube page

FM Caseshttp://www.med-u.org/

– Expand experience options– Prepare for NBME subject exam

“First Time User” http://app1.med-u.org/player/app/homepage.html

• First/last names/e-mail//password– Must use either <@my.und.edu>– or <@med.und.edu>

Clinical Science Curriculum Subcommittee - Assignments

Musculoskeletal examination

Dermatologic examination

Oral Health*

Essentials of Family Medicine, 6th Edition, Sloane, et al

Good orientation

Evidence-based

Musculoskeletal Exam

• U of West Alabama, Athletic Training & Sports Medicine Center “AH 323 Evaluation of Athletic Injuries”

http://at.uwa.edu/CurrHome/AH323/skillsshoulder.asp

NEJM “Rotator Cuff Failure”, F.Matsen; May 15, 2008, Vol 358 #20, p 2138

• Coming – Online Exam Tutorials (2015 goal)

Dermatologic Examination

www.logicalimages.com/resourcesDerm.htm

http://www.logicalimages.com/educationalTools/learnDerm.htm

• Review of Atopic Dermatitis

http://www.aafp.org/afp/2012/0701/p35.html

DermatologyMore sites to review Dermatologic images :

DermIS

http://www.dermis.net/dermisroot/en/home/index.htm

The Electronic Textbook of Dermatology

http://telemedicine.org/stamfor1.htm

Smiles for Life

• Oral Health and its link to Systemic Health

w.smilesforlifeoralhealth.org/default.aspx?tut=555&pagekey=62948&s1=1855605

Course 1 – Relationship of Oral to Systemic Health

Course 7 – The Oral Examination

Additional Resources

• American Family Physician

• http://www.aafp.org/online/en/home/publications/journals/afp.html

• Other on-line sites

• http://www.med.und.edu/familymedicine/clerkship/hotlinks.html

Diabetes Updates and Mini-Lectures

• http://www.youtube.com/user/DrELJOHNSONDIABETES

Procedures• Indications• Contraindications• Limitations• Anatomy & Physiology• Required equipment & special techniques• Complications and follow-up care• http://www.nejm.org/multimedia/medical-

videos • Need a log in to use, try YouTube

Student/Clinical Faculty Meeting• Planning Session• http://www.med.und.edu/familymedicine/

clerkship/learnercontract.html

• Learner Contract– Clinical Skills Checklist

– Previous clerkship experiences

• Revisit mid-rotation (see Mid Clerkship Feedback form)

Learner Contract

• Student goalsClinical Skills Inventory

• Data collection, assessment, reporting• Health Promotion/Disease Prevention• Acute & chronic problem management

• Preceptor goals

• Report concerns to Clerkship Director(s)

Questions to Answer• The LCME thought it was not documented that students

were ever observed doing an H and P and did not get feedback on their presentations, and asking for formative feedback.

• You will need to ask your preceptor to observe you doing a history and physical exam, and you will also get feedback from the preceptor, but also Dr. Sherman and Dr. Delage will give you oral and written feedback on your case presentation.

• So when asked on questionnaire’s –”was • I observed doing a history and physical and did I get mid-

clerkship feedback, hopefully you can answer this positively.

Clinical Skills

• Data collection, recording, and assessment

• Common problem management

• Clinical procedures

• Age-specific Health Risk Assessment & Counseling

• Derm & Musculoskeletal exams

• Oral-Dental exam

Clinical Encounter Database

Clerkship – FM (except ROME students)Home Campus -Site –Program –Preceptor – Setting – (including “on-line cases”)Age –Gender –(Ethnicity)System

Role

Clinical Encounters

• You should be doing this already, but with the change in rotation, be sure to log cases and alert us if any problems arise early ! (first few days)

• Any questions ? How can we help ?

• You have to log and log regularly, most students log between 250 and 400 patient encounters on the FM Clerkship, you cannot leave this until the end, if you do not log enough, we will deduct points from your grade.

Case presentation to Preceptor(Before beginning presentation, identify

assessment/plan in your mind)

Convince listener (SOAP)

S: appropriate historical data O: appropriate physical exam findings

A: identify DDx based on H & P

P: lab/X-ray/consultation/management

or SNAPPS – engage teacher by asking question

How do you elicit feedback?SNAPPS?

Daily learning plan

SNAPPS• 1. Summarize briefly the history and findings• 2. Narrow the differential to two or three relevant

possibilities• 3. Analyze the differential by comparing and contrasting

the possibilities• 4. Probe the preceptor by asking questions• 5. Plan management for the patients medical issues• 6. Select a case-related issue for self-directed learning• *SNAPPS: A Learner-centered Model for Outpatient

Education, Academic Medicine, Vol. 78, No.9, Sept. 2003, Wolpaw, T.M., Wolpaw, D.R., Papp, K.K.

Case Presentationto clerkship director/ faculty

• Data Collection and Problem Solving

• Health Promotion/Disease Prevention

• Reciprocal Impact of Family and Culture

• Scope of Practice

• Learning Issues

• http://www.med.und.edu/family-medicine/clerkship/

Mid Clerkship Feedback

• https://secure.med.und.edu/evaluations/index.cfm?eval=studassessfm

Evaluations **Preceptor Evaluation of Student

• Done through E*Value, Tracy Uhlir; e-mail tracy.uhlir@med.und.edu; sends out a link to the preceptor which takes them to their eval in E*Value, you should sit with your preceptor on one of your last days as this is sent at the beginning of the week, and help them accomplish and go over this with them.

Evaluations**

Student Evaluation of Clerkship

Student Evaluation of Preceptor

• Also done through E*Value, are required to be completed before finishing the Family Medicine Clerkship.

• Tracy Uhlir, tracy.unhlir@med.und.edu

Group Topics

• Networking/Sharing– Focused – 5 min presentation – (prepared)

• then open for discussion for 3-4 min

• All sessions begin at 1:30 CST, but the screen and camera need to be “ON” by 1pm, so Brandon can complete connections

• Topics

Social Determinants of Health

• First Session - Community-Oriented Primary Care/High Risk Populations;”Access to Care”

• Thursday, September 24th, 2015

• Second Session - "Family Connection”

- Thursday, October 8th, 2015

- related to or independent of first session topic

Community-Oriented Primary Care

“Access to Care”• Outside the Office Walls

1. Syllabus –”Group Topics”, ‘2nd session’

2. “Essentials of Family Medicine, 6th ed”, Sloane et al, chap 1, “Primary Care and the Evolving US Health Care System”

3. “Essentials of Family Medicine, 5th ed”, Sloane et al, chap 1, “Family Medicine in Today’s Changing Health Care System”

Family Connection

• Keeping the Focus on “Family” – The Family Connection– http://www.med.und.nodak.edu/depts/fammed/

Clerkship/documents/TheFamilyConnection.doc• chapters 46-50 of the 6th edition of “Essentials of FM”

• or chapter 32 of the 5th edition of “Essentials of FM” texts may provide some ideas

• Patient/family you have seen on more than one occasion encouraged, but not mandatory

Family Connection

• Example of Family Connection Material:

• “Cry on Me” – Natalie Kong, M.D.

• (Family Medicine 2014; 46(4):304)

• Note this can also be an experience that affected you emotionally, or led you to reflection or reliving your own experiences.

Harley E. French Library

Resource for preceptors– Make preceptors aware of resources

If you choose Power Point

• Not necessary, are optional but -

• If you use; no more than one topic/slide

• 6x6 rule – no more than 6 lines of text and

• No more than 6 words per line

• Other rules, simple font, no complete sentences, no periods, question marks, exclamation points, and avoid ALL CAPS; and one transition for all slides

Patient-Centered Medical Home

• We have created a separate power point for this from Dr. Delage and Dr. Sherman

• Other lecturers:

• Aaron Garman, MDCoal Country Community HealthBeulah, ND

Work Hour’s• There is a policy on work hours allowed,

on the school website at:http://www.med.und.edu/policies/students.cfm and look under Duty Hours

• If your working in the clinic and hospital and you are averaging over the work hour limits; (shall not exceed 80 hours per week), and not getting any time for study and self learning, please use this as a tool to inform your preceptor of the limits on work hours that students can engage in, and please inform the Co-Director’s if this is an issue, as we can then work on this as a Clinical Faculty development issue, with the preceptor.

Do We Have ?• Your cell phone number ?• Your correct e-mail address ?• Do You have –• Our contact numbers? Bryan Delage MD (320)

760-1722, Kamille Sherman MD (701) 690-2900• E-mail – bryan.delage@med.und.edu;

kamille.sherman@med.und.edu• Mona Shilling (701) 777-3200,

mona.shilling@med.und.edu.

Questions ?• Questions ?• 1. eValue -

http://help.e-value.net/adminHelp/index.cfm/tutorials/evalue-getting-started-tutorial-intro-to-pxdx-trainee/http://help.e-value.net/adminHelp/index.cfm/tutorials/evalue-getting-started-tutorial-intro-to-pxdx-trainee/

• Do we have any more interest in getting more specifics about the grading ?

•

Grades• How you will find out your grade –• Many questions have arisen, and we felt we needed to

streamline this; we understand your need to know:• 1. The Grades will be submitted in E*Value about 3

weeks after the end of the Clerkship from the department of Family and Community Medicine, and the student will be sent an e-mail alerting them that the grades have been submitted.

• 2. NBME scores – as soon as all the scores return, you will get an e-mail with your score recorded on it and some information from NBME with your score attached. This is usually about 2-3 weeks after the first rotation, and then about 5-10 days after the other rotations.

Grades• We set an average of 93% or above and above

the class average score on the NBME, as Honors; and Satisfactory as above 70%, with the caveat that all other requirements of documentation of adequate numbers of cases in E*Value, All Required Clinical Experiences accomplished, participation in the 3 video conferences, and a satisfactory score from the preceptor; and scoring on the NBME above the 10% tile, historically a score of about 64 or above.

Grades• After the submission of Grades to the Assistant Deans

office, if you need to remediate a call will be placed from the department on your remediation for this Clerkship; and reasons.

• Your transcript will have your final grade before 6 weeks after the end of the clerkship. For almost all of you this will be the final grade, and if you have satisfactorily met the requirement the worst you can get is a satisfactory. We will review at the end of the year, and if less than 20% received Honors we will upgrade the next highest scores in the class to Honors until at least 20% are reached, if over 20% of the class received Honors based on this percentage, that will not be changed.

Thanks for Your Participation

• Have a Great Day and Family Medicine Clerkship experience !

• Make sure you get your learner’s contracts done and seek a Mid-Clerkship feedback.

Thanks for Your Participation

• Have a Great Day and Family Medicine Clerkship experience !

• Make sure you get your learner’s contracts done and seek a Mid-Clerkship feedback.