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M3 Clerkship Syllabus

Course director

• Sheree C. Melton, MD
  Assistant Professor, Family Medicine
  Clinical Science Building L436-1
  (601) 984-5422; fax (601) 984-5411 

Course coordinator

• Beth Wilson, MHA
  Education Administrator
  Clinical Science Building, L439
  (601) 984-5422; fax (601) 984-5411 (fax)

Description of clerkship 

This is a 6-week rotation in Family Medicine where third- year medical students will gain experience in ambulatory primary care. The clerkship exposes students to the depth and breadth of primary care and provides the primary exposure to outpatient medicine in the medical school curriculum. The clerkship centers on the 5 basic principles of Family Medicine: biopsychosocial care, comprehensive care, contextual care, continuous care, and coordinated care.

In this rotation, it is hoped that students’ experience an introduction to the role of primary care in the American health care system, skills in the management of acute & chronic illnesses, the ability to select preventive services, practical skills in patient management and development of skills related to population health.

Schedule

Students will spend four weeks working one-on-one with a community preceptor in the state of Mississippi. The remaining two weeks will be spent with the Department of Family Medicine’s ambulatory clinics.  As a result, each student's schedule will vary and a master schedule will be provided in Canvas.

Students are expected to spend one Saturday at the Jackson Free Clinic during the rotation.

UMMC clinics

Students will be assigned to work for 2 weeks of the clerkship in the Department of Family Medicine’s ambulatory sites, including Lakeland or Flowood. During this time, students will spend each half day with a different faculty or resident preceptor. Students will be assigned 1-2 “shifts” each day. The shifts are as follows: 7-11 a.m., 10 a.m.-2 p.m., and 1-5 p.m. Students should arrive no later than those start times to be prepared to start clinic.  

Absences

Up to 3 days of excused absences may be approved by the Clerkship Director for reasons including illnesses, family emergencies, or conferences. Whenever possible, absences must be requested in advance. Excused absences beyond 3 days will require remediation time in order to pass the course. Unexcused absences will result in course failure.  Except in cases of illness or emergencies, no absences will be approved during the Family Medicine Subject Exam or Clinical Skills Examinations.

Course objectives*

• Discuss the principles of family medicine and the role of family physicians in the health care system.
• Elicit focused histories for acute and chronic conditions, including information about adherence, self-management, and barriers to care.
• Perform focused physical examinations for acute and chronic conditions that include identification of complications.
• Formulate differential diagnoses and plans for initial evaluation and management of common acute and chronic diseases.
• Management of follow-up visits with patients having one or more chronic diseases.
• Describe the major evidence-based treatment modalities for acute and chronic diseases.
• Describe the initial management of dangerous/life-threatening conditions that may presents with a particular symptom.
• Develop evidence-based health promotion plans for patients of any age or gender.
• Find and apply the current guidelines for adult and pediatric immunizations, including ‘catch-up’ protocols.
• Identify developmental stage of pediatric patients and detect deviations from the norms.
• Describe factors that affect patient adherence to treatment regimens, including internal, physician, systemic, and social factors.

Core competencies

Patient care 

Students must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

• Corresponding course objective(s):  2, 3, 4, 5, 6, 7, 8, 9, 10, 11

Medical knowledge 

Students must be able to demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

• Corresponding course objective(s): 6, 7

Practice-based learning and improvement 

Students must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

• Corresponding course objective(s):1,6,8,9,10,11

Interpersonal and communication skills 

Students must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patients’ families, and professional associates.

• Corresponding course objective(s): 11

Professionalism 

Students must be able to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

• Corresponding course objective(s):1

Systems-based practice 

Students must be able to demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

• Corresponding course objective(s): 1,11

Teaching methods

A significant proportion of the teaching in this course will be through direct patient care in the ambulatory setting. Students will be expected to obtain histories, perform physical examinations, and propose treatment plans for patients while under direct supervision of UMMC faculty and residents.

Learning will also occur in conferences and online:

• Three times during the clerkship a half-day conference will be scheduled. Students rotating in Jackson will be required to attend, while those outside of Jackson will attend using web-conferencing software. These conferences will involve a combination of presentations from faculty and from the students themselves.
• Three times during the clerkship students will collaborate to create a study guide on an assigned topic using Google Documents.

Assignments

Collaborations

Three times during the six-week course, the cohort will work together to produce a study guide on a different topic pertinent to family medicine. One Drive will be utilized. Instructions, due dates, and specific assignments for each student (or group of students) are available in each document. Some of these assignments will be utilized in conference presentations and students will be responsible for teaching or answering their peers’ questions on their portion of the assignment. Once completed, the documents can be used to help the student review for the NBME examination in Family Medicine.

Direct observation clinic

Each student will be assigned a patient encounter and a member of the faculty will directly observe all aspects of the interaction, including history taking, physical examination, and clinical decision making, and will provide immediate formative feedback on performance and areas for improvement. Following the encounter, students will document a progress note within 24 hours that will be provided to the faculty supervisor for review. This must be done in Epic or a Microsoft word document.

Jackson Free Clinic

All students are required to spend one Saturday afternoon at the Jackson Free Clinic working with the underserved population. Failure to attend on the assigned date, or arrange coverage, will result in an unexcused absence and course failure. 

Each student will be required to write a reflection piece of their time spent at the clinic. This will need to be completed to pass the course.

Journal reflections

Students will complete a series of 3 guided journal entries. The goal of these journals is to promote reflection on what is being learned. These are private and are only seen by the course director. These assignments are a place for students to share their personal thoughts and feelings without judgment. Credit is awarded based on effort, not content.

Patient Log (PxDx)

Students must log all of the core diagnoses they are exposed to in either the preceptorship or Jackson components of the course via PxDx. At the end of the course, students must have had exposure to all of the core acute, chronic, and health maintenance conditions listed in the syllabus. If students are lacking this exposure, alternative opportunities will be arranged. Student grades will not be penalized if they have not seen these diagnoses.

Social and behavioral determinants of health interviews

During the 6 weeks of the clerkship, students will identify 2 patients on which to complete a guided interview.  Once completed they will present to their peers about their experience.

Tar Wars health education

Each student will lead this 30-45 minute presentation to at least one group of third- or fourth-grade students, using a prepared curriculum. An online evaluation of the program must be completed prior to taking the final examination. Presentation information may be found in Canvas.

Assessment methods

The course uses the standard UMMC Medical Student Clinical Performance Evaluation forms. Rubrics are available for review prior to submitting assignments.

Preceptor formative evaluations

It is each student’s responsibility to ensure completion of the formative evaluation after two weeks with their community preceptor. The content of this evaluation must be submitted to the clerkship administrator via fax or email within 24 hours of its completion and the form itself submitted at the time of the final examination.

Preceptor summative evaluations

It is each student's responsibility to ensure completion of the summative evaluation and invoice at the end of their community preceptorship. These may be submitted by the student prior to taking the final examination or may be faxed or mailed to the Division of Student Programs by the preceptor.

University evaluations

Medical students will be evaluated by the faculty and residents with whom they work. All students are responsible for submitting evaluations through “Who I Worked With” in E*value. Students rotating in the clinics will submit evaluations for completion to each faculty or resident with whom they work. The preceptors and dates for which evaluations should be submitted are indicated on the Master Schedule.

Grade calculation

Clinical evaluations: 50%
Board Exam: 20%
Collaborations: 15%
Journals: 5%
Conferences: 10%

Educational resources

• Smith M, Schranger S, WinklerPrins V. Essentials of Family Medicine. 7th ed. Philadelphia, PA:Wolters Kluwer;2019. (ISBN-10: 978149636975)

Course policies

Dress code

All faculty, staff, residents, and medical students working within the Department of Family Medicine abide by the medical center's policy on professional appearance. Gross or repeated violations of this policy may result in a student being sent home from the rotation.

Email

UMMC Outlook email and Canvas Announcements should be checked daily. Schedule changes will be announced only by these mechanisms. Missed activities or tardiness due to changes of which the student should have been aware (i.e. with 24+ hours’ notice) will result in an unexcused absence. Students who have difficulty accessing email while at their preceptor’s site should inform the course administrator as soon as this is discovered. Under no circumstances should emails containing Protected Health Information (PHI) be sent through any email provider other than UMMC Outlook. Any emails sent in this manner will be referred to the Office of Compliance and Integrity for investigation.

Flexibility

Though unlikely, the syllabus and course schedule may be changed at any time and without notice, as determined by the clerkship director and Family Medicine faculty based upon the needs of the department and the students. Any changes will be communicated as soon as possible via email and every attempt will be made to provide at least 24 hours’ notice.

Professionalism

Any member of the faculty or clerkship staff member may deduct points from a student's final grade due to egregious or repeated professionalism lapses, up to and including, enough points to result in failure of the clerkship, provided that feedback has first been given followed by an opportunity for improvement. Particularly egregious professionalism violations may result in lost points without a remediation period.

Student-pPreceptor mismatch/student mistreatment

Though rare, students may find themselves in a hostile learning environment due to a mismatch with their preceptor. It is the policy of the School of Medicine and the Department of Family Medicine that no student should ever be placed in a hostile situation including due to any type of discrimination or bias. Students who find themselves in such a situation are encouraged to try and address the issue if possible. However, if they cannot or find themselves in an untenable situation, the student should contact the course director, course administrator, or chair of the Department of Family Medicine immediately so that, if appropriate, a new clinical assignment should be made. Such re-assignments can be done anonymously (especially in the case of community preceptors with whom the student or their family may have a pre-existing relationship). 

Technology

To successfully complete this course, students will require access to a computer capable of running Microsoft Word and Power Point. Additionally, it should have a functional web browser. Firefox or Chrome are recommended due to intermittent compatibility issues with Canvas. Updated versions of Adobe Reader and Java Script are recommended. Students are required to sign up for a free Google account for use with Google Docs. Students must have access to a web cam, microphone, and headphones for web conference meetings. UMMC Outlook email accounts should be used for any emails that contain protected health information (PHI) and are highly recommended for all other communications.

It is the student’s responsibility to ensure that their devices are compatible the software utilized in this course. Technological failures (such as images not rendering) will not result in additional attempts or extra points on quizzes or other assignments. Due dates will not be extended due to technological failure.