Family and Community Medicine

EmailEmail    |   Bookmark Page Bookmark  |   RSS Feeds RSS  |   Print Page Print  

Medical Students

M3 Family Medicine Clerkship Syllabus

SYLLABUS SECTIONS:

 1.  Clerkship Introduction 
 2.  Clerkship Curriculum Development
 3.  Clerkship Philosophy
 4.  Goals and Objectives of the Clerkship
 5.  Clerkship Description
 6.  Clerkship Components
 7.  Preceptor Ratings of Students
 8.  Grading
 9.  Uniform Professional Conduct Policy for Clinical Rotations
10. Request for Time Away from M3 Clerkship Rotations
11. Student Evaluation of the Clerkship Experience
12. Reading/Informatics 

 

SECTION 1:  CLERKSHIP INTRODUCTION  
Welcome to the M3 Family Medicine Clerkship.  In this syllabus, you will find useful information pertaining to your M3 Family Medicine Clerkship month. This required clerkship gives all students a chance to experience family medicine, primarily in an office setting. There, under the guidance of superb community family physicians, family medicine faculty physicians or family medicine residents, students will see the broadest possible range of patients, learn and practice real-world management of common medical problems, and discover the satisfactions of family medicine. At the same time, they will be learning the core primary care skills that no other rotation can provide so comprehensively.

Practical problem solving skills in the office setting and evidence-based medicine are taught using Team-based learning (TBL) as a teaching method.  Key office-based communication skills, including motivational interviewing and an approach to difficult/sensitive patient encounters is taught through interactive classroom sessions and practice at your preceptor's site.  Community medicine and being a community-responsive physician are addressed through classroom sessions and a community-based experience.  

If you have any questions about Clerkship content, organization, or grading, please contact the Clerkship Director, Douglas J. Bower, MD, 414-955-4318 (dbower@mcw.edu).

If you have any administrative questions regarding Clerkship scheduling or assignments, please contact the Clerkship Coordinator, Stephanie Shaw, 414-955-8207 (sshaw@mcw.edu)  


SECTION 2:  CLERKSHIP CURRICULUM DEVELOPMENT
The M3 Family Medicine clerkship was first offered at the Medical College of Wisconsin in July 2000. It continues to evolve, based on national and regional trends in Family Medicine, faculty initiatives and student feedback. The original curriculum was developed under the leadership and vision of Alan K. David, M.D., Chairman of the Department of Family and Community Medicine (DFCM), along with the Family Medicine faculty in the DFCM Division of Predoctoral Education.

The three driving forces of the clerkship curriculum included:

1) The MCW Department of Family and Community Medicine, Division of Predoctoral Education Goal and Educational Priority Statement(see wall plaque in the "Predoctoral Hall of Fame" located in the North East corner of the DFCM office in the Curative Care building.
2) The Association of American Medical Colleges (AAMC) Medical Schools' Objective Project (MSOP) recommendations. This group focused on recommending curricular innovation and change several years ago and defined the following objectives for medical student education:

  • Increased ambulatory education
  • Broaden the focus on disease and its affect on patient, family, and community
  • Incorporation of evidence-based medicine, cost-effectiveness, and quality assurance
  • Emphasis on health promotion and maintenance 

3)  The Society of Teachers of Family Medicine (STFM), Family Medicine Curriculum Resource Project (FMCR) completed in 2004, to link medical student competencies to Accreditation Council for Graduate Medical Education (AGCME) for residency training.

The ongoing implementation and development of the M3 family medicine clerkship is the responsibility of the Clerkship Director Dr. Douglas J. Bower and the faculty in the Division of Predoctoral Education for the Department of Family and Community Medicine. While the clerkship is a high priority for the entire Department of Family and Community Medicine, the Division of Predoctoral Education drives its day-to-day implementation. (top)


SECTION 3:  CLERKSHIP PHILOSOPHY 
The M3 Family Medicine clerkship is designed to provide all students with an in-depth educational experience to appreciate the basic principles of Family and Community Medicine and apply them to the care of patients.

Regardless of specialty choice, students will develop an important appreciation of the challenges and the special doctor-patient relationship in family medicine practice.

Family medicine is a required discipline of study in all medical schools and provides opportunities for new kinds of learning. The family medicine educational experience is not merely a repeat of what is experienced on other major traditional clerkships (e.g. surgery, internal medicine, pediatrics, ob/gyn, psychiatry/neurology). Family physicians see patients unrestricted by age, sex, or disease process and they focus on the illness of a patient in the context of that patient as an individual, and in the context of that patient's family, that patient's community, and the population from which that patient arises.

Family Medicine is the content (body of knowledge and skills) that composes the discipline of family practice. Family practice is the application of the principles of Family Medicine to the care of individuals and families in day-to-day practice including first contact care, personal care, continuous care and comprehensive care.

In order to understand the practice of a family physician, one must understand the content/discipline on which that practice is based. Family Medicine is often criticized for having too broad a scope in which no one can be completely competent or, on the other hand, for not having enough depth in any one area to be of significant utility to many individual patients. What is often not understood is that Family Medicine is a process-oriented specialty in which the undifferentiated patient with multiple issues presents to the family physician that has to organize these issues, balancing the physician's prioritization of these issues with the patient's prioritization. This balance requires knowledge of the patient's origins in terms of family, ethnicity, culture, community, and health beliefs. Family Medicine goes beyond the scientific reductionistic method that is taught in most of medicine, particularly in the basic sciences. This means one looks for patterns and connections to make a big picture rather than focus on the smallest molecule. Thus, one of our major purposes is to teach the process of patient care in the family practice setting and to help students understand that Family Medicine is a process, problem solving, problem-prioritization specialty.


The Clerkship office-based clinical experiences and classroom sessions will help students to further appreciate the content and process of specialty of Family Medicine and its value in the health care system.    (top)


SECTION 4:  GOALS AND OBJECTIVE OF THE CLERKSHIP 
There are nine goals for this learning experience with pertinent objectives that specify what is to be learned in this clerkship. In many ways, the goals reflect the distinctive system of values and approach to problem solving of family physicians

Goal 1
Provide personal care for individuals and families as the physician of first contact and continuing care in health as well as in illness.

  1. Compare and contrast the epidemiology of diseases seen in patients in primary and tertiary care settings and discuss the implications of this epidemiology for the care of patients in these settings.
  2. Describe and discuss the forces that can affect the process, timing, and reasons for the patient to seek medical care.
  3. Demonstrate a basic level of competency in the history, physical examination, procedural, and problem-solving skills needed to assess and manage the wide spectrum of problems seen in family medicine.
  4. Identify how normal and abnormal family relationships affect health and illness. 
  5. Describe the importance of maintaining continuing personal responsibility for the patient's and family's health care.
  6. Use the initial patient encounter to begin to establish an effective relationship with the patient and family.
  7. Demonstrate a basic understanding of the professional and ethical issues facing family physicians, including the role of the physician as part of managed care systems.

Goal 2
Assess and manage acute and chronic medical problems frequently encountered in the community.

  1. Discuss the diagnosis of common, acute, and undifferentiated medical problems using probability estimates of disease prevalence specific to the geographic and socioeconomic community of the practice location.
  2. Assess and initially manage common acute illnesses using a focused problem-oriented approach.
  3. Demonstrate an understanding of the need to make basic diagnostic and treatment decisions that consider the limitations of clinical data.
  4. Develop a treatment plan that responds to the ongoing changes in patients and their illnesses.
  5. Recognize the importance and complexity of providing longitudinal, comprehensive, and integrated care for the patient with common chronic medical problems.
  6. Describe the skills and information required to develop, in conjunction with the patient and patient's family, a chronic disease management plan that enhances functional outcome and quality of life.

Goal 3
Provide anticipatory health care using education, risk reduction, and health enhancement strategies.

  1. Identify health risks in given patients, families, and communities.
  2. Demonstrate basic knowledge used for selecting protocols and strategies for reducing identified health risks in patients, families, and communities.
  3. Use appropriate screening tools and protocols for health maintenance in specific populations.
  4. Identify appropriate indications and schedules for immunizations in all age groups.
  5. Counsel patients and families about signs and serious effects of harmful personal behaviors and habits.
  6. Demonstrate basic knowledge of the complex factors involved in behavioral change.
  7. Identify the roles of the family physician and other members of the health care team in patient education and health promotion.

Goal 4
Provide continuous as well as episodic health care, not limited by a specific disease, patient characteristics, or setting of the patient encounter.

  1. Encourage patients seen for episodic or acute illness to seek continuing medical care.
  2. Describe the prevalence, essential pathophysiology and natural history of common problems and illnesses over the course of the individual and family life cycles.
  3. Document in the problem-oriented patient record appropriate information for acute and continuing care.
  4. Recognize and explain the various settings in which family physicians provide care.
  5. Recognize the need for the family physician's continuing role and responsibility in the care of patients during the process of consultation and referral.

Goal 5
Provide and coordinate comprehensive care of complex and severe problems using biomedical, social, personal, economic, and community resources, including consultation and referral.

  1. Describe the role of the family physician as a coordinator of care, including understanding the value of serving as a member of a health care team and understanding the roles of other family practice health care team members.
  2. Describe the important factors related to communication during the patient care process, including communication with others within the practice, consultants, patient, and family.
  3. Demonstrate an awareness of cost-effective health care, quality assurance, and available resources.
  4. Recognize appropriate consultation resources, both medical and non-medical, and discuss effective use of these resources.
  5. Recognize the social, community, and economic factors that affect patient care.

Goal 6
Establish effective physician/patient relationships by using appropriate interpersonal communication skills to provide quality health care.

  1. Respect the individuality, values, goals, concerns, and rights of the patient and the patient's family.
  2. Demonstrate a basic knowledge of ethical principles, such as autonomy and beneficence, and the issues of informed consent and confidentiality, which contribute to the formation of a strong and effective physician/patient relationship.
  3. Collect and incorporate appropriate psychosocial, cultural, and family data into a patient management plan.
  4. Develop diagnostic and treatment plans in partnership with the patient and the patient's family.
  5. Demonstrate interpersonal skills which will enhance communication with the patient and the patient's family.
  6. Discuss physician, patient, and family factors that contribute to difficult physician/patient/family relationships.

Goal 7
Develop medical problem-solving skills to define and prioritize a patient's problems, and develop and implement a management plan - evaluating and adjusting it continually.

  1. Gather data efficiently and accurately.
  2. Recognize patterns of illness and wellness and use them in the assessment and management of patient problems.
  3. Prioritize problems appropriately and use problem-solving skills to manage patient problems.

Goal 8
Develop proficiency in assessing and using computer-based resources for improving their knowledge and performance in patient care, including:

  1. Appropriate use of computer-based databases, using principles of Evidence-Based medical practice, for medical problem solving. 
  2. Appropriate use of high quality computer-based databases for patient education. 
  3. Appropriate use of electronic health record for patient care. 

Goal 9
Integrate principle of community medicine, and the population factors of heritage, environment, and disease prevalence into a patient's care, including:

  1. Safety issues, pollution, and public health
  2. Genetics
  3. Culture and religion
  4. Family relationships and dynamics
  5. Socioeconomic status and occupation
  6. Educational level/opportunities
  7. Age and lifestyle

Goal Summary:
These goals and objectives describe an all-encompassing and very daunting task. However, each of these goals can be accomplished at a level of learning specific for that of a third year medical student. Mastery of these goals is the life-long task of learning that an individual assumes when he or she enters the specialty of family practice. These goals and objectives will be accomplished by means of different learning opportunities. The majority of time will be spent in a clinical practice seeing patients, working with a family physician, and learning from both. Team-based learning groups will help students learn the clinical problem solving process and medical management of selected common conditions.   Community health assignments will help students understand non-medical influences that affect a patient's health and understand the role of the Family physician and incorporating these issues into an appropriate plan of care.  There will be required textbook readings, and other reference materials accessed through the Family Medicine Clerkship ANGEL site.  In addition, students will be encouraged to use the "point-of-care" reference material available on the medical software applications students have loaded on their hand-held electronic devices. (top)


SECTION 5:  CLERKSHIP DESCRIPTION

Overview/Schedule
This clerkship is organized by calendar month with the first day of the clerkship consisting of an orientation morning at the Department of Family and Community Medicine department offices located on the first floor of the Curative building on the medical school campus. The first day of each clerkship will be the first regular working day of that calendar month at 8:30 am. A typical week will have the student spending eight half days in the clinical practice to which they have been assigned. All day Tuesday will be devoted to Team-based learning (TBL). Graded Family Medicine OSCE's will be done during the last week of the course.  The last day of the clerkship will be devoted to the final exam and student evaluations of the clerkship. The final exam will be a short answer and multiple choice test. Students will evaluate the clerkship after the final exam using on-line and paper-based evaluation forms. The specific schedule time/location for all activities will be provided at orientation. (top)


SECTION 6:  CLERKSHIP COMPONENTS

1. Clinical Experience

a. Clinical Practice Assignment
Each student will be assigned to a clinical practice with family physician faculty from the Department of Family and Community Medicine or to the practice of a voluntary community family physician or family physician group. Students will be notified of the assignments in advance. Please contact Stephanie Shaw (414 456-8207) about your assignment. There will be one physician at each site who will coordinate the schedule at that practice site and the schedule with other physicians at different times during the clerkship at that site. The physician clerkship coordinator at that practice site will provide an orientation to the practice, to the office staff, to other physicians, and to that practice's schedule. While the emphasis of the clerkship is office-based family practice patient care, the faculty have been instructed to allow for opportunities for supervised learning outside of the office when feasible and appropriate. These additional activities might include: work with hospitalized patients, involving the student in selected call experiences (such as deliveries), attending sporting events as team physicians, spending select time with other health care providers or organizations, visits to patients outside the office or hospital such as at home or in nursing homes, and in other opportunities to learn what the life and practice of a family physician is all about.

b. Student Responsibilities
Students will be expected to dress professionally -- neatly and cleanly wearing a clean white coat and bringing appropriate pocket instruments to their rotation on a daily basis. Any absences from the clinical practice must be cleared by the Clerkship Director (see section 1 of this syllabus for details) in advance or with the site preceptor in instances of acute personal illness. The students will be expected to keep a log using their iForm software for the majority of patients that they have seen, with whom they have been professionally involved. This clinical experience log, will be described in more detail later in this syllabus (Section #4).

2. Team-based Learning Groups

Team-based learning (TBL) groups will be assigned at your clerkship orientation. The TBL cases are intended to emphasize clinical problem solving and patient management.


3. The Chairman's Message 
 

Students will have the opportunity to reflect on the specialty of Family Medicine through discussion with the Chairman of the Department of Family and Community Medicine, Dr. Alan K. David, MD. 

4. Community Health Curriculum

The Family Medicine Clerkship is one of the few opportunities where students will consider community health in a systematic manner.  The Department of Family and Community Medicine utilizes faculty from its community medicine division for student teaching. 

a. Purpose:  To help third-year medical students develop an understanding of some of the social, economic and environmental influences that affect a patient's health, and understand the role of the Family Physician in incorporating these issues into an appropriate plan of care.  

b. Learning Objectives
Students will begin to:

  1. understand the guiding principles of community-responsive care; 
  2. understand private and public health insurance systems and local "safety nets", and their affect on access to care;
  3. understand how social and economic status affects health status and access to health care;
  4. acknowledge and understand one's own cultural definitions of health and wellness;
  5. acknowledge and respect different cultural definitions of health and wellness;
  6. understand the effect cultural differences have on health and health seeking behavior;
  7. develop the skills to assess and work from each patient's cultural frame of wellness;
  8. understand the concept of physician and community health educator;
  9. understand the breath and limitations of community resources available to assist patients;
  10. learn how to effectively link patients to appropriate resources.  

c. Overview of Community Health Curriculum
The World Health Organization defines health as "A state of complete physical, mental and social well-being and not merely the absence of disease of infirmity."  During the Community Health component of the TBL sessions students will begin to understand how non-physical factors such as socio-economic status, culture and health literacy can affect one's health status and access to health care.  In the process, student will learn the importance of becoming a community-responsive physician, and begin to develop the knowledge and skills necessary to become a community-responsive physician.  Required reading will compliment the sessions.  Students will complete several OSCE's at the end of Clerkship that will assess students competencies in community health. 


d. Community Health Competencies

These are seven competencies associated with the Community Health Curriculum:

e. Community-Based Experience
In their role as clinician, advocate, and educator, students are required to complete one of several community-based experiences and demonstrate their ability to apply core community health concepts through a brief written essay.  Students will either: 1) prepare and present a health topic at one of Milwaukee's low-income public housing communities; 2) shadow a public health nurse for home visits; 3) work with a Family Care case management team as they service independent living elderly; 4) see patients at the Saturday Clinic for the Uninsured; or 5) interview a patient and/or family member to understand the socioeconomic, cultural and educational factors that affect health status.  All visits and subsequent written assignments require the student to personally reflect on the experience.

f. Grading
A grade for the Community Health sessions will be determined based on students' written paper. 

5. Clinical Experience Log (iForms)

a. Why
It is important to know what you are seeing and it is important for us to know the content of this clerkship month-by-month, site-by-site and over the entire year as the clerkship evolves, develops, and completes its first cycle. Therefore, you will be required to record any significant encounter with a patient in which you have played a role, either observing a significant part of the clinical encounter or by conducting part of that encounter and presenting it to your faculty physician.

b. How
Your hand-held computer iForm software will be used to efficiently log your patient care experience. The log will be done in an anonymous fashion to protect the patient's individual identity. Thus, you will not record social security numbers, chart numbers, or name - simply age, sex, diagnoses, procedures, and other important information that would describe this patient's role in that particular practice. Record your iForm data on the day you see the patient. It should take no more than two minutes per patient, or for five patients about ten minutes per half day.

c. Outcome
Accumulated patient data, recorded by students over time, will enable us to build a profile of each practice to better understand and guide the learning of future students in that particular clinical site and to better organize and direct the overall clinical learning for students who will come after you in this clerkship. You may obtain a printout at the end of your clerkship (or any time during the clerkship) of your individual data by contacting Stephanie Shaw sshaw@mcw.edu 414 955-8207.

d. Patient Experience Objectives
Five percent of your grade will be determined by fulfilling the following three objectives.  Fulfilling these objectives is intended to be a readily achievable standard.  Most students will receive full credit for this part of the clerkship.

Objective 1: Each student is to document 80 clinical encounters during the month on their PDA log.  (3% of grade)

Objective 2:  Each student's documented clinical experience will include at least one encounter with 80% of the top 20 diagnoses/diagnosis groups seen in family practice.  (1% of grade)  These are listed below. 

1. CV: Hypertension/elevated blood pressure 11. Resp/ENT: Sinusitis
2. Endo: Diabetes 12. Resp/ENT:  Otitis media/Ear pain
3. Prev: Well adult/physical 13. Endo: Hyperlipidemia
4. Resp/ENT: Upper respiratory infection (URI) 14. GI: GERD (reflux)/Dyspepsia/PUD
5. OB: Prenatal Exam/Pregnancy 15. Resp/ENT: Acute Pharyngitis
6. MS: Low back pain 16. Neuro:  Headache
7. Prev: Well child/Adol exam/Issue 17. Resp: Lower respiratory infection (pneumonia/bronchitis)
8. MS: Extremity Sprain/Strain/Tendonitis/Bursitis 18. MS: Arthritis/Rheumatism/DJD
9. Resp/Allergy: Asthma 19. Endo:  Obesity
10. Psy:  Depression 20. Allergy/ENT:  Allergic Rhinitis/Vasomotor Rhinitis

Other important top diagnoses that are included in your iForms are listed below:

21. CV:  Other (CHF, arrhythmia, murmur, edema, etc.) 31. Psy: Anxiety/Stress/Panic
22. GI:  Abdominal pain; N&V; Const & Diarrhea 32. Gyn:  Pregnancy prevention/Contraception
23. Gyn:  Menstrual disorder 33.  Neuro:  Other (chronic pain, dementia, CVA, seizure, etc.)
24. Gyn:  Vaginitis/Vulvitis 34.  Eye:  Conjunctives/other vision
25. URO: UTI/Dysuria/Urinary frequency 35.  Psy: Addiction (Smoking, Alcohol, other substance)
26.  Derm:  All other (Acne, dermatitis, wart, etc.) 36.  Gyn:  Menopause/Osteoporosis 
 27.  Endo: Thyroid diseases  37.  Psy:  Child behavior/development MR/ADHD
 28.  Resp:  COPD/Emphysema  38.  Neuro/ENT: Dizziness/Vertigo
 29.  CV: Chest pain/Coronary artery disease/PVD  39.  STD:  GC, Chlamydia, Genital wart/Herpes/HIV
 30.  Derm:  Injury (laceration, wound, contusion/abrasion)  40.  Uro:  Prostate/Erectile Dys

Objective 3: Each student is required to complete a mid-clerkship evaluation with their preceptor and turn it in to the Clerkship Coordinator by the end of the month.  (1% of grade)  (top)


SECTION 7:  PRECEPTOR RATINGS OF STUDENTS
This section describes the methods for preceptors to rate students' performance at their clinical sites.

1. Mid-clerkship evaluation
You and your preceptor will complete a required mid-clerkship evaluation form. This evaluation should provide early feedback to the student to allow the student to improve their clinical learning and/or performance for the remainder of the clerkship. Students should use the form to do their own self-assessment first, then give it to your preceptor for their feedback. Fax the form to 414 456-6523 or turn in to Stephanie Shaw, the clerkship coordinator, by the end of your Clerkship month.

2. End of clerkship evaluation
The responsible preceptor designated at your site will complete an M-3 clerkship evaluation form. This is the college wide form used for all M-3 clerkships. If you have had contact with multiple teachers at your clinical site, the site coordinator will solicit and synthesize feedback from as many of your clinical teachers as is possible. The evaluation form is "behaviorally based" and allows your preceptor(s) to rate your performance. Your preceptor will not give you a grade (e.g. honors, high pass, pass, etc.). Preceptors are making an effort to rate students in a consistent manner from site to site. The ratings are sent to the clerkship director who ultimately will assign you a standardized score based on the ratings.  The standardized score is calculated by subtracting the average score from the student score and then dividing by the standard deviation. Preceptor comments are included in your final evaluation, which is sent to the Registrar's office. (top)


SECTION 8:  GRADING
This section will address Clerkship grading.

1.  Overview: 
The grade for the Family Medicine Clerkship will be based on six components:

  • 45% - Preceptor's ratings on the M3 Clerkship Evaluation form (Section 7.2)
  • 20% - Final examination
  • 15% - TBL, 11-12% are quizzes and 3-4% from preceptor evaluation of participation
  • 10% - End of Clerkship OSCE's
  •   5% - Community health paper (Section 4)
  •   5% - Practice-based learning (Section 5) 

The clerkship grade will be calculated by combining the scores for each of the six clerkship components using the percentages listed above, i.e., 45% clinical preceptor rating, 20% exam, 15% TBL ratings, 10% OSCE's, 5% practiced-based learning and 5% community health paper. The distribution of clerkship grades will be approximately 25-40% Honors, 45-60% High Pass. 15-30% Pass and 0-2% Low Pass/Fail.  

2.  Final exam: 
The final exam is on the morning of the last day of the Clerkship.  The exam is given in the Curative Department of Family and Community Medicine (DFCM) classroom.  Students are referred to a current calendar for the date and time. 

The final exam is written by DFCM faculty.  We do not use the USMLE shelf exam in Family Medicine.  The USMLE shelf exam in Family Medicine is evolving; however, currently its content does not closely enough reflect the content of the Clerkship to be a useful method of evaluating student learning.

The exam is short-answer and multiple choice.  Sixty percent of the exam questions are based on the top 20 diagnoses in Family Medicine. Twenty-five percent of the exam questions are based on the "next 20 diagnoses" in Family Medicine.  Ten percent of the exam is based on evidence-based medicine and five percent of the exam is based on Community Medicine principles. 

3.  Family Medicine OSCE's: 
There are four validated evaluative OSCE's that are part of the Family Medicine Clerkship grade.  They include: 
   - Obesity/Motivational Interviewing
   - Cultural Competence/Kleinman's Questions
   - Socioeconomic status/Community Resources
   - Health Literacy

4.  Special Circumstances:

a.  Remediation - Exam Retake
A student who fails the written exam may be allowed to retake the final exam (once within two weeks of original exam) if extenuating circumstances can be documented which contributed significantly to the failing score.

b.  The Clinical Experience Log (iForms)
The clinical experience log is a required Clerkship activity (section 5).  Students who do not completely record and download their patient encounters will drop one grade level from the earned clerkship final grade. We recommend you download your data weekly; however, the log data must be downloaded by the end of the month. No later.

c.  Grading Questions 
If you have questions about grading, course organizations, and content, please contact clerkship director, Dr. Douglas J. Bower (414) 955-4318 or dbower@mcw.edu.

(top)


SECTION 9:  UNIFORM PROFESSIONAL CONDUCT POLICY FOR CLINICAL ROTATIONS

This policy was approved by the Clerkship Directors, June 2001

During Clinical Rotations medical students will adhere to the following standards of professional conduct:

1. Professional Appearance

a. Identification: While on clinical rotations, students at all time must wear MCW Name Tag/ID Badge and appropriate identification at all times as outlined by the facility at which they are rotating.
b. Clothing and Accessories: Clothing, including white coats, must be clean and professional looking. Any clothing or personal accessories (e.g., jewelry, tattoos, or piercings) that interfere with the provision of patient care, is not acceptable. This includes clothing or personal accessories that limit a student's ability to effectively communicate with patients, families, staff and/or their ability to perform a physical examination or procedure.

2. Communication

a. Introduction to Patient: Students will introduce and identify themselves to the patient and their families as "medical students". The student will advise the patient that he/she has been directed to evaluate the patient and share the findings with the staff physician who is responsible for the patient's care.
b. Cultural Differences: Students must acknowledge and respect the cultural differences of patients, families, and staff.
c. Respect: Students will demonstrate respect in all interactions with patients, families, supervisors, peers and members of the healthcare team.

3. Patient Care Responsibility

a. Responsibility: Patient care is the responsibility of the supervising physicians.
b. Supervision: Students must be supervised in their interactions with patients. Student/patient interactions must be within the confines of resident/faculty teaching.
c. Patient Access: Student interaction with patients is limited to only those patients of the supervising physician or service to which they have been assigned. Student should limit and qualify discussions of any findings (e.g., H and P, laboratory findings, prognosis, treatment) with the patient.
d. On Call: When the student is on call, he/she may interact with patients seen in consultation by the service to which they are assigned or with those patients in need of emergent/urgent problems that require evaluation/treatment.
e. Confidentiality: All aspects of patient care (e.g. conversations re: H & P, diagnosis, test results, treatment, prognosis, and written medical record) will remain confidential. Discussions should occur in appropriate venues with treating physicians for the purposes of patient care or education.
f. Medical Records: Students may make notations in the actual or electronic chart consistent with the protocol of the facility to which they are assigned and at the direction of the supervising physician.

4. Professional Responsibility

a. Responsibility to the Profession: The student will report any witnessed violations of this policy or other forms of unprofessional behavior to his/her immediate supervisor and/or clerkship director.
b. Attendance: The student will participate in clinical care activities as assigned by the supervising physician. In case of a personal emergency, the student must contact the supervising physician and the clerkship coordinator to discuss absence from the assigned service.
c. Sick Leave/Time Off: A written request to the Clerkship Director must be submitted at least one month before the start of the rotation. The Clerkship Director, per the attached policy, will evaluate requests individually.  This request form for time away from the Clerkship, is located below in the next section for student use.    (top)


SECTION 10:  REQUEST FOR TIME AWAY FROM M3 CLERKSHIP ROTATIONS
Approved by M3 Clerkship Directors September 18, 2002.

The knowledge and experience acquired on clinical clerkships must be the top priority for the rotating medical student on a clinical service; attendance on a rotation is required for all assigned activities. There are, however, occasions when time away may be necessary. A serious illness or death in the family, or other circumstances judged by the Clerkship Director as compelling are examples of reasons to allow time away. In cases requiring substantial time away from the school, the student must contact the Associate Dean for Student Affairs to arrange for a formal leave of absence.

Each clerkship director will evaluate the time-away request associated with his/her clerkship and has the final approval.

PROCESS FOR TIME AWAY REQUEST
The process, as outlined below, must be followed and gives no assurance that a student's request will be granted:

1. Submit a written request to the Clerkship Director at least one month before the start of the rotation. Exceptions to this time requirement can be made for extenuating circumstances or dire emergencies, as judged by the Clerkship Director.

2. Written requests should include the following:

a. Student information
Name:
Address:
Phone number:
Pager number:
E-mail address:

b. Clerkship information
Name of clerkship:
Dates of clerkship:
Dates of requested time off:

c. Explanation of reason of requesting scheduled time off

d. With the request for time away, the student must submit a plan that specifies how the time missed will be addressed.


3. After approval of the clerkship director, the student is required to notify the attending physician and chief resident on the service is required. Any student granted time off a clinical clerkship must arrange coverage for night call, care of his/her patients, and all clinical responsibilities during the time off. The plan for addressing missed time, once approved by the clerkship director, must be implemented with oversight by the clerkship director and/or his/her designee.

Clerkship Director: Douglas J. Bower, MD
Clerkship: Family Medicine
Address: Department of Family Medicine, MCW
Phone: (414) 955-8207 (Clerkship Coordinator, Stephanie Shaw)
(top)


SECTION 11:  STUDENT EVALUATION OF THE CLERKSHIP EXPERIENCE

Student evaluation of the Clerkship experience is very important for 1)  maintaining the on-going quality of the Clerkship and 2) curriculum change.  All components in the Clerkship are evaluated.  Evaluations forms are both on-line and paper-based.   Several of the evaluations are MCW wide forms.  Others are Clerkship specific.  All of the evaluation forms will be completed on the day of the final exam.   The MCW wide forms include 1) the MCW Clinical Clerkship Evaluation Form to evaluate their overall clerkship experience, 2) the MCW Clinical Teaching Evaluation Inventory to evaluate the clinical teaching effectiveness of their faculty and community preceptors, and 3) an MCW wide on-line form in ANGEL to evaluate the clinical teaching effectiveness of resident preceptors.    (top)


SECTION 12:  READING/INFORMATICS

Required Readings:

1. Textbook
The Department of Family and Community Medicine will loan each student the required textbook for their Clerkship month: Sloane's Essentials of Family Medicine, Fifth Edition, copyright 2008. This is an excellent text.  You will have reading assignments prior to each TBL session.  The reading assignments can be found in the Family Medicine Clerkship ANGEL website.   Beyond that, when you see a patient with a medical problem, you will learn best if you read about the specific problem in real time.   This text book has excellence evidence-based background information with regular reference to Strength Of Recommendation (SOR).    

2.  The DFCM also loans students 3 other books:

a. Case-Files in Family Medicine

b. The Spirit Catches You And You Fall Down

c. Mama Might Be Better Off Dead

 

 

(top)


webmaster@mcw.edu
© 2014 Medical College of Wisconsin
Page Updated 11/20/2013