FAMILY MEDICINE
THIRD YEAR CLERKSHIP
COLLEGE OF MEDICINE
DEPARTMENT OF
UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCE
2014 – 2015
http://familymedicine.uams.edu/medical-student-education-program.
Welcome to the UAMS Family Medicine Clerkship.
We sincerely hope that you will enjoy learning and practicing new skills during
your time with Family Medicine. This syllabus should provide you with the
information you need to be successful during this clerkship.
The clerkship will be delivered in a decentralized fashion, with training sites in
Springdale, Fort Smith, Jonesboro, Little Rock, Magnolia, Pine Bluff, Texarkana,
and the Northwest Campus. If there is any additional information or help that
you need throughout the month, please contact either our Clerkship
Coordinator, Kathy Carlson, at carlsonkathleenl@uams.edu or 501-686-6564 or
your site coordinator (see table on page 5). You should have received details
about each clerkship site as a separate attachment, but if you are unable to
find that document, please go to department website.
Family medicine is the specialty which provides continuing, comprehensive
health care for the individual and family. It is a specialty that integrates the
biological, clinical and behavioral sciences. The scope of family medicine
encompasses different genders, ages, organ systems and disease entities.
The clerkship will focus on the outpatient management of medical problems
commonly encountered by family physicians. The student educational
experience incorporates the philosophy that each patient is a unique individual
who has the right to dignity, respect and the pursuit of a healthy, fulfilling life.
Our statewide faculty is committed to providing you with an educational
experience which will be valuable, regardless of your field of future practice.
Website information
For academic year 2014-2015, the Family Medicine Junior Clerkship syllabus will
be available online at the UAMS website:
http://familymedicine.uams.edu/medical-student-education-program.
Since we will be making online updates, students are encouraged to check it
periodically. If students have difficulty using the website or have questions prior
to their rotation they may contact the clerkship coordinator at the address
above.
2
TABLE OF CONTENTS
Family Medicine Clerkship Dates
Clerkship Directory 2013-2014
NW Longitudinal Information
Clerkship Policies
Attendance Policy
Vacation
Work Hour Rules
Participation in Invasive Procedures
Notification of Grades
Student Responsibilities
Faculty Responsibilities
Family Medicine Clerkship Goals and Objectives
Resources
Grades and Evaluations
Overview
Minimum Passing Standards
Grade Appeal Process
Student at Risk of Failure
Clinical Performance
NBME information and example questions
fmCases
Evidence-Based Medicine Module
Nutrition and Cardiovascular Disease module
Requirement Checklist
Healthcare Reform Video
Interactive Video Lectures
Conferences
Course and Preceptor evaluations
Course Evaluation
Faculty Evaluation
Appendix A
Evidence-Based Medicine Module
Overview, Student Responsibility, Principles
Duke University Website link
Common Study Designs
Tips for reviewing articles
Review of Statistical significance
Critical Review Forms
Grading sheet for the module
Worksheet
4
5
6
7
7
7
7
7
8
8
9 - 12
13
14 - 23
14
14
15
15
15, 19 - 21
15, 18 – 19
16 - 17
16
16, 18
16
16
17
17
22 – 23
22
23
24 – 36
24
25
25 – 27
28 – 30
30 – 32
32 – 34
35
35 – 36
3
2013-2014 Family Medicine Clerkship Dates
Rotation #1: July 8 – August 1, 2014
Orientation/Pre NBME: Tuesday, July 8
Mid-Rotation Evaluation: see site calendar
Post fmCases exam: Friday, July 25
NBME: Friday, August 1
Rotation #2: August 4 – August 29,
2014
Orientation/Pre NBME: Monday, August 4
Mid-Rotation Evaluation: see site calendar
Post fmCases exam: Friday, August 22
NBME Final Exam/Friday, August 29
Rotation #3: September 1 –
September 26
Holidays: Thanksgiving: Thursday, November
27 and Friday, November 28
Winter Break: December 22 - January 4
Rotation #7: January 5 – January 30,
2015
Orientation/Pre NBME: Monday, January 5
Mid-Rotation Evaluation: see site calendar
Post fmCases exam: Friday, January 23
NBME Final Exam: Friday, January 30
Holiday: Martin Luther King Day, Monday,
January 19 – see site calendar for work
schedule
Rotation #8: February 2 – February 27
Holiday: September 1
Orientation/Pre NBME: Tuesday, September
2
Mid-Rotation Evaluation: see site calendar
Post fmCases exam: Friday, September 19
NBME Final Exam: Friday, September 26
Orientation/Pre NBME: Monday, February 2
Mid-Rotation Evaluation: see site calendar
Post fmCases exam: Friday, February 20
NBME Final Exam: Friday, February 27
Holiday: President Day, Monday, February
16 – see site calendar for work schedule
Rotation #4: September 29 – October
24
Rotation #9: March 2 – March 27
Orientation/Pre NBME: Monday, September
29
Mid-Rotation Evaluation: see site calendar
Post fmCases exam: Friday, October 17
NBME Final Exam: Friday, October 24
Rotation #5: October 27 – November
21
Orientation/Pre NBME: Monday, October 27
Mid-Rotation Evaluation: See Site calendar
Post fmCases exam: Friday, November 14
NBME Final Exam: Friday, November 21
Holiday: Veterans Day, Tuesday, November
11 – see site calendar for work schedule
Rotation #6: November 24 –
December 19
Orientation/Pre NBME: Monday, November
24
Mid-Rotation Evaluation: see site calendar
Post fmCases exam: Friday, December 12
NBME Final Exam: Friday, December 19
Orientation/Pre NBME: Monday, March 2
Mid-Rotation Evaluation: see site calendar
Post fmCases exam: Friday, March 30
NBME Final Exam: Friday, March 27
Spring Break: March 30 – April 3
Rotation #10: April 6 – May 1
Orientation/Pre NBME: Monday, April 6
Mid-Rotation Evaluation: see site calendar
Post fmCases exam: Friday April 24
NBME Final Exam: Friday, May 1
Rotation #11: May 4 – May 29
Orientation/Pre NBME: Monday, May 4
Mid-Rotation Evaluation: see site calendar
Post fmCases exam: Friday, May 22
NBME Final Exam: Friday, May 29
Holiday: Memorial Day, Monday, May 25 –
see site calendar for work schedule
Rotation #12: June 1 – June 26
Orientation/Pre NBME: Monday, June 1
Mid-Rotation Evaluation: see site calendar
Post fmCases exam: Friday, June 19
NBME Final Exam: Friday, June 26
4
FAMILY MEDICINE/CLERKSHIP – Directory of Campuses and Sites
Overall Clerkship Coordinator
Overall Clerkship Director
UAMS Central Office
Executive Director
Director for Education
Kathy Carlson
Arlo Kahn, MD
501-686-6564
501-686-6564
Mark Mengel, MD, MPH
501-686-5798
501-686-6557 or 1-800-482-9612
Tricia Edstrom
Clerkship Sites:
DFPM Little Rock Site
Overall Clerkship Director
Clerkship Site Coordinator
Arlo Kahn, MD
Kathy Carlson
501-686-6564
501-686-6564
Scott Laffoon, MD
Cheryl Broadaway
Robin Mouzy
870-972-9603
870-336-7941
870-931-9137
870-930-2911 ex 271
Block Rotation Site Director
Michael Macechko, MD
Longitudinal Site Director
Linda McGhee, MD
479-750-6585 or
1-800-292-2541
479-521-0263
Clerkship Site Coordinator
Janice Huddleston
Longitudinal Site Coordinator
Morgan Hogue
UAMS Northeast - Jonesboro
Clerkship Site Director
Clerkship Site Coordinator
UAMS Northwest - Springdale
479-521-0263
479-466-9847
479-713-8303
UAMS South - Magnolia
Clerkship Site Director
Clerkship Site Coordinator
Elisabeth Avramescu, MD
Jana Terry
870-234-7676
870-234-7676 ext 1215
870-866-3005 cell
Herb Fendley, MD
Cynthia Turner
870-541-6010
870-541-3179
870-541-6010 or
800-395-6011
Kyle Diaz, MD
Debbie Birmingham Lusk
870-779-6021
870-779-6063
Bryan Clardy, MD
Allexcia Rankin
479-424-3193
479-424-3175 or
479-785-2431
UAMS South Central – Pine Bluff
Clerkship Site Director
Clerkship Site Coordinator
UAMS Southwest - Texarkana
Clerkship Site Director
Clerkship Site Coordinator
UAMS West – Fort Smith
Clerkship Site Director
Clerkship Site Coordinator
Northwest Campus
Longitudinal Program
CLERKSHIP DIRECTOR
Arlo Kahn, M.D.
UAMS Main Campus
4301 W. Markham
Little Rock, AR 72205
Office: 501-686-6564
SITE DIRECTOR
Linda McGhee, M.D.
Office: UAMS Regional Program Center
1125 North College
Fayetteville, AR
Office #: 479-521-0265
NW Contact
Morgan Hogue
Office: UAMS Northwest Campus
College of Medicine
Office #: 479-713-8303
Cell: 479-409-9039
Email: mahogue2@uams.edu
The Goals and Objectives used with the longitudinal
students are the same as with the traditional block students.
Please see the section on UAMS Northwest for site specific
information.
6
Clerkship Policies:
Please follow the UAMS Student Manual policies for all topics on this
page. http://com.uamsonline.com/files/2012/05/STDMAN-webversiondecember-2013.pdf
Attendance Policy:
Family Medicine Clerkship: Attendance is required throughout the
entire 4 week rotation. Page 107
Note: While third year medical students do not have personal or sick
days, we do recognize illness or personal emergencies may occur.
Absentee Policy for the Junior Year page 107
Vacation Policy: page 112
All Junior Medical students receive Christmas Break (December 20 –
January 4, 2015) and Spring Break (March 30 – April 5, 2015) and all
College of Medicine holidays as noted in the College of Medicine
Academic Schedule.
Work Hour Rules page 108
Student Participation in Invasive Procedures page 10
Notification of Grades page 34
7
Student Responsibilities
1. Participate in patient care at the assigned clinical facilities.
2. Develop a knowledge base and understanding of problems common to
Family Medicine through exposure to these problems in clinical care.
3. Complete all didactic assignments.
4. Attend Family Medicine conferences, seminars, and other educational
activities. Follow the College of Medicine Attendance Policies.
5. Complete all student evaluation forms.
Faculty Responsibilities
1.
Communicate with students about the clerkship program and be available
when questions or problems arise concerning course content or curriculum.
2.
Meet with students periodically to discuss the strengths and weaknesses of
the clerkship to date and to ensure that students have a meaningful
learning experience.
3.
Provide timely submission of written evaluations to the Dean’s office. Final
grades will be assigned at the end of each rotation.
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Family Medicine Clerkship Goals and Objectives
A variety of activities are planned in order to reach the goals and objectives below. The
assessment for each objective describes how students will be evaluated.
Goal #1: Medical Knowledge: The student will learn the diagnosis and management of
common problems in Family Medicine.
Learning Objectives: At a level appropriate for a third year medical student, the student will:
1.1. See a variety of patients from specific categories of diseases and document each
encounter on their O2 requirement checklist.
1.2. Will demonstrate knowledge of diagnosis and management of acute and chronic
health problems by scoring above a required minimum on fmCase exam and final
NBME test.
Assessment:
1. Students will have seen the required number of patients from each category that is
listed on the O2 requirement checklist.
2. Scores on the fmCases exam and final NBME test must be sufficient to receive a
passing grade for the rotation.
3. Fund of knowledge is evaluated as a routine part of the clinical evaluation by
preceptors.
Goal #2: Patient Care: The student will demonstrate a basic level of competency in
gathering patient information, with an emphasis on problem-specific history taking, physical
examination and problem solving skills required to adequately assess and manage
problems commonly encountered in Family Medicine.
Learning Objectives: At a level appropriate for a third year medical student, the student will:
2.1
Obtain a problem-specific history, review past medical history and conduct an
appropriately focused physical examination based on the patient’s reported
complaint.
2.2
The students will be able to present history and physical exam finding with written
documentation as well as in verbal presentations during encounters in the
outpatient clinic.
2.3
Exhibit an appreciation for comprehensive, coordinated, culturally competent and
continuous care for individuals and their families through participation in direct
clinical care with patients of all age groups.
2.4
Investigate patient barriers to chronic disease management and overall health.
Assessment:
1. Patient care is evaluated by each preceptor as a routine part of the clinical
evaluation.
2. Each student will be directly observed at least once by clinical faculty as they perform
a history and physical examination.
9
Goal #3: Interpersonal and Communication Skills: The student will establish effective and
ethically sound relationships with patients, faculty and staff that facilitate the provision of
quality health care.
Learning Objectives: At a level appropriate for a third year medical student, the student will:
3.1
Provide concise and accurate presentations to faculty and resident preceptors.
3.2
Communicate effectively and demonstrate caring, respectful and culturally
sensitive behaviors when interacting with patients and their families.
3.3
Communicate effectively with members of the inter-professional team including
nurses, physicians, office staff and consultants to provide patient-focused care.
Assessment:
1. Interpersonal and communication skills are evaluated by each preceptor as a routine
part of the clinical evaluation.
2. Each student will be directly observed at least once by clinical faculty as they perform
a history and physical examination.
3. Preceptors and clinical faculty will evaluate students as to their interpersonal
relationships with peers.
Goal #4: Population Health and Preventive Medicine: The student will apply principles of
wellness and health promotion in the provision of patient care.
Learning Objectives: At a level appropriate for a third year medical student, the student will:
4.1
Demonstrate familiarity with appropriate resources for health promotion and
disease prevention during discussions with clinical preceptors.
4.2
Examine the role of fitness, nutrition, and smoking cessation in health promotion.
4.3
Counsel patients about the effect of harmful personal behaviors and habits and
appropriate health maintenance strategies.
4.5
Recommend appropriate immunizations based on age and risk factors.
Assessment:
1. Adequate performance on the Nutrition and Cardiovascular Disease On-Line Module.
2. Adequate performance of the fmCases related to population health and preventive
medicine.
3. Counseling skills are evaluated as a routine part of the clinical evaluation by
preceptors.
10
Goal #5: Practice –Based and System-Based Healthcare: The student will be introduced to
aspects of the organization and management of a family medicine clinic.
Learning Objectives: At a level appropriate for a third year medical student, the student will:
5.1
Observe and discuss cost effective healthcare and resource allocation affecting
the practice of family medicine.
5.2
Discuss billing and coding with preceptors during patient visits in the outpatient
clinic.
Assessment:
1. Adequate completion of the on-line Health reform module.
2. Cost effectiveness, billing, and coding are discussed and assessed with preceptors
during patient care. Student understanding is assessed as part of the routine clinical
evaluation.
3. The performance of the student as part of the healthcare team is reported as part of
the clinical evaluation.
Goal #6: Professionalism: The student will demonstrate a commitment to excellence and
ongoing professional development and will be provided feedback concerning his/her
performance during the clerkship.
Learning Objectives: At a level appropriate for a third year medical student, the student will:
6.1
Actively seek and act upon feedback and constructive criticism about
performance, application of medical knowledge and interpersonal interactions
with staff from faculty and staff.
6.2 Demonstrate a commitment to ethical principles pertaining to the provision of
clinical care, confidentiality of patient information and informed consent.
6.3 Demonstrate interest and eagerness to learn through review of medical literature
and use of information technology.
6.4 Attend all required activities and complete all assignments in a timely manner.
6.5 Display proper dress, grooming, punctuality, honesty and respect for patients and
all members of the healthcare team.
Assessment:
1. Attendance, dress and punctuality are closely monitored by the site coordinator.
2. Eagerness to learn through review of medical literature and use of information
technology is assessed by the site director as part of the Evidence-Based Medicine
Module.
3. Commitment to ethical principles and response to feedback is assessed as a routine
part of the clinical evaluation and during the mid-clerkship and wrap-up sessions with
site directors.
11
Goal#7: Medical Informatics: The student will effectively and efficiently use scientific
studies to manage information and optimize patient care.
Learning Objectives: At an appropriate level for a third year medical students, the student
will:
7.1 Identify a clinical problem or question pertinent to the specialty of family
medicine, conduct a literature search, critique the quality of the information
gathered and discuss the article and the conclusions drawn.
7.2 Demonstrate the utility of the electronic medical record in quality patient care
including a review of active problem list, flow sheet data and past medical
history.
Assessment:
1. Objective 7.1 is assessed by the adequate performance on the Evidence-Based
Medicine module.
2. Use of EMR and guidelines for clinical care are assessed as a routine part of the
clinical evaluation by preceptors.
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Resources
Students should ask the Clerkship Coordinator at their assigned sites for
information on access to designated computers. There should be computers
available at the clinic or library of each site where students can access the
internet and the UAMS website.
There is no required textbook for this course. We encourage you to use UpToDate
http://www.uptodate.com as you care for patients on this rotation and to use
the other resources listed here as references and study guides for the NBME
exam.
Blueprints: Family Medicine – Will be provided
Case Files: Family Medicine – Will be provided
AAFP Thumb Drive-will be provided
AAFP Website http://www.aafp.org/home.html
USPSTF A-Z Topic Guide
http://www.uspreventiveservicestaskforce.org/uspstopics.htm
Prevention, Detection, Evaluation & Treatment of Hypertension: The JNC 7 Report
http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf
2014 Evidence-Based Guideline for the Management of High Blood Pressure in
Adults Report from the Panel Members Appointed to the Eighth Joint National
Committee (JNC 8)
http://jama.jamanetwork.com/article.aspx?articleid=1791497&resultClick=3
Prevention, Detection, Evaluation & Treatment of High Blood Cholesterol:
National Cholesterol Education Program High Blood Cholesterol Desk Reference
http://www.nhlbi.nih.gov/guidelines/cholesterol/atglance.pdf
http://circ.ahajournals.org/content/129/25_suppl_2/S1.full
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Grades and Evaluations
The Department of Family Medicine will issue the grade “A”, “B”, or “C”, as
defined in the UAMS College of Medicine’s grading policy. Under highly unusual
circumstances the department may issue the grade of “I” when work is
incomplete at the end of the clerkship or academic year. The minimum passing
standard for the Junior Year Family Medicine Clerkship will be met by attaining
at least 50% of all possible points.
The final grade for the clerkship will be calculated from the following
components:
Clinical Performance Evaluations
NBME Final Subject Exam
fmCases Exam
55%
30%
15%
Additional requirements in order for grades to be released include satisfactory
completion of the following activities:
Nutrition and CVD Project
Patient Log
Viewing of Healthcare Reform Video
Interactive Video Seminars
Site-specific Conference Attendance
Evidence-Based Medicine Project
Grading Example:
Clerkship student Athena receives 250 out of a possible 300 points on her clinical
performance (from 5 preceptor evaluations); a raw score of 74 on her NBME final
subject exam (62 percentile rank for the national norm); and a 14 out of a
possible 15 points on her fmCases exam.
Her grade is calculated as follows:
Clinical Performance: 250/300=83.33%;
NBME national percentile:
62%
fmCases Exam:
14/15=93.33%;
Total Points:
83.33 x 0.55= 46 points
62.00 x 0.30= 19 points
93.33 x 0.15= 14 points
46 +19+14= 79 points
14
78-100 points =
60-77 points =
50-59 points=
A
B
C
In this example, Athena would receive an “A” for the course.
Grade Appeal Process:
A student may appeal their clinical performance scores in the following order:
1. Clerkship Site Director
2. Course Director
3. Promotion Committee Board
Students at Risk of Failure
All Students will receive a mid-rotation evaluation approximately two weeks into
the rotation. If a student is identified as performing unsatisfactorily in the
Clerkship, he/she will be informed and a written improvement plan will be
developed. Every effort will be made on the part of the instructor to assist the
student in improving his/her performance.
Requirement and Evaluation Details:
A) Clinical Performance
Clinical performance evaluations will be requested from each clinical instructor
(faculty or resident) who has had an adequate opportunity to work with the
student in the clinic or in another significant capacity. The final clinical
performance score will be based on the average of ratings from clinical
instructors. A copy of the evaluation form used is on page 19 - 21.
Clinical performance constitutes 55% of the final grade for the clerkship.
B) NBME Subject Exam
This web-based exam is required by the College of Medicine. We recognize
that the comprehensive nature of Family Medicine makes this exam particularly
challenging. (Please see NBME distribution of question topics below on page18.
To aid in preparation, Case Files Family Medicine and Blueprints in Family
Medicine books are loaned to the student at orientation. These books must be
returned at the final NBME session to receive a grade.
The NBME Subject Exam constitutes 30% of the final grade for the clerkship.
15
C) fmCases. This project is to be completed by the 3rd Thursday of the rotation.
A 15- item multiple choice test will be given on the third Friday of the rotation
and will cover information in the required fmCases cases. Please see page 17 18 for instructions.
This exam constitutes 15% of the final grade for the clerkship.
D) Evidence Based Medicine Project: (EBM)
This project teaches students the skills of critical appraisal of the literature. The
student will work through the process of developing a clinical question,
performing an on-line journal search, choosing a journal article, appraising the
article, and presenting findings to the site director. Please see Appendix A on
page 24 -36 for background and instructions on how to complete the EBM
project.
The EBM project is pass/fail. Final grades will not be released until this
requirement is completed.
E) Nutrition and CVD Project . This project is to be completed by the 2nd Friday of
the rotation.
The student will be provided with a booklet to record risks for coronary heart
disease for 10 patients and a detailed nutrition and CVD risk assessment on 1
patient seen during the clerkship. This information will be used to complete the
on-line module in Blackboard. Please turn in the booklet to your site coordinator
prior to leaving the site. Please see page 18 for instructions.
This project is pass/fail. Final grades will not be released until this requirement is
completed.
F) Requirement Checklist
The recording of patient encounters will be accessed through the Oasis (O2)
software. The student will be required to record all of the patients seen, where
seen, student’s level of involvement with the patient, key diagnoses addressed
at the visit, and the preceptor (faculty or resident).The site director will review
the checklist at the mid-clerkship evaluation and sign off at the end of the
clerkship. The requirement checklist will also have a place to document when a
faculty member observes student performance of a history and physical. This
observation will be either in person or by digital recording.
Completion of the log is pass/fail. Final grades will not be released until the log is
completed.
G) Healthcare Reform Video. Please view this video within the first ten (10) days
of the clerkship.
The student will be required to view the presentation by Dr. Joe Thompson on
Health care reform and the potential impact that it will have on the practice of
medicine in the future. It can be found in Blackboard.
16
This project is pass/fail. Final grades will not be released until this requirement is
completed.
H) Interactive Video Seminars
The topics of Diabetes, Hypertension and Hyperlipidemia will be presented by 3
PharmD professors located at the UAMS Regional program centers. The
presentations will be on the 2nd, 3rd, and 4th Tuesday’s of the rotation. They are
currently schedule from 1:30 – 2:30 pm with a 30 minute question and answer
session following the presentations. Check with the site coordinator for the
location of the presentations. An evaluation will be sent from O2.
I) Conferences
Students are required to attend conferences at their respective sites. The Site
Director or Coordinator will describe these on the first day of the rotation.
fmCases
fmCases is a series of interactive virtual patient cases that are designed to build
clinical competency, fill educational gaps, and teach the core values and
attitudes of family medicine through an evidence-based and patient-centered
approach to patient care. The on-line virtual patient cases are at www.medu.org. Each student will be required to register at the Med-U website using the
students UAMS e-mail address. Student will be expected to work through each
case assigned and have the weekly cases completed during the assigned
week.
At the web site, scroll to the bottom to see:
Click on the fmCases button.
Click on the Sign in button.
On the next screen click on the gray Register button,
Follow the instructions on the screen that comes up.
Once registered, you will then have access to the fmCases.
Over the first 3 weeks of the clerkship, students will complete the following cases:
#1. 45-year-old female annual exam – Mrs. Payne
#2. 55-year-old male annual exam – Mr. Reynolds
#6. 57-year-old female presents for diabetes care visit – Ms. Sanchez
#8. 54-year-old male with elevated blood pressure – Mr. Martin
#10. 45-year-old male presenting with low back pain – Mr. Payne
17
#20. 28-year-old female with abdominal pain – Ms. Bell
#35. (CLIPP #2) Infant well child (2, 6 and 9 months) - Asia
#40. (SIMPLE # 16)45-year-old man who is overweight – Mr. James
Nutrition and Cardiovascular Disease Module
To help you understand the role of nutrition in Cardiovascular Disease including
prevention, you will be responsible for completing the Cardiovascular Disease
and Nutrition Assessment booklet and online module and discussing it with your
site director or their designee towards the end of your rotation.
NBME Distribution of Question Topics
Distribution Across Age Groups
Childhood
5%–15%
Adolescence
5%–10%
Adulthood
65%–75%
Geriatric
10%–15%
General Principles
10%–15%
Infancy and childhood (normal growth and development)
Adolescence (sexuality, separation from parents/autonomy; puberty)
Senescence (normal physical and mental changes associated with aging)
Medical Ethics and Jurisprudence
Applied Biostatistics and Clinical Epidemiology
Patient Safety
Organ Systems
Immunologic Disorders
1%–5%
Diseases of the Blood and Blood-forming Organs
1%–5%
Mental Disorders
5%–10%
Diseases of the Nervous System and Special Senses
5%–10%
Cardiovascular Disorders
10%–15%
Diseases of the Respiratory System
10%–15%
18
Nutritional and Digestive Disorders
10%–15%
Gynecologic Disorders
5%–10%
Renal, Urinary, and Male Reproductive System
5%–10%
Disorders of Pregnancy, Childbirth, and the Puerperium
1%–5%
Disorders of the Skin and Subcutaneous Tissues
1%–5%
Diseases of the Musculoskeletal System and Connective Tissue
5%–10%
Endocrine and Metabolic Disorders
5%–10%
Physician Task
Promoting Health and Health Maintenance
Understanding Mechanisms of Disease
15%–20%
5%–10%
Establishing a Diagnosis
30%–35%
Applying Principles of Management
25%–30%
Clinical Performance Evaluation Form in O2
1.
Patient Care: History taking, physical exam, and presentation skills
 Generally incomplete; frequently disorganized without pertinent
information; lacks confidence (6)
 Generally complete, but needs direction in the organization of pertinent
information. Major exam finding missed. (7)
 Generally complete with good organization. Usually includes all
important information. Clearly prepared and confident. (8)
 Complete and thorough. Well organized. All important information
consistently included. Reliable, selection of facts highlights understanding.
(9)
 Outstanding history taking and exam. Superior organization and always
includes important information. (10)
 Not Observed
2. Medical Knowledge: Overall fund of knowledge and ability to apply to
patient care
 Limit knowledge of disease, pathophysiology, diagnosis, and treatment.
No application to patient care. (6)
 Inconsistent knowledge of disease, pathophysiology, diagnosis, and
treatment. Poor application to patient care. (7)
19
 Appropriate fund of knowledge for level of training. Can sometimes
apply to basic patient care principles. (8)
 Very good knowledge base. Consistently applies basic science to
medical pathophysiology. (9)
 Superior knowledge of disease, pathophysiology, diagnosis, and
treatment. Frequently applies knowledge to complex patient care
scenarios. (10)
 Not Observed
3. Practice-Based Learning: Use of experiences and feedback as well as
evidence based medicine for improvement
 Rarely show initiative in seeking out information, feedback, etc.
Infrequently responds to instruction. (6)
 Seeks out information but only when directed to do so. Difficulty in
accepting instruction. (7)
 Often show initiative in seeking out information. Responsive to instruction
and feedback. (8)
 Shows clear evidence of seeking out additional knowledge. Engages in
outside reading and research. Shows great initiative after receiving
instruction. (9)
 Exceptional initiative in seeking out information; uses PDA, web-based,
and other resources in daily activities. (10)
 Not Observed
3.
Interpersonal Communication Skills: Based on interactions with faculty,
residents, staff, patients, and families
 Poor team skills. Works in isolation. Does not interact well with medical staff or
patients. (6)
 Difficulty in collaborating with others. Self-centered goals. Basic communication
with patients and families only. (7)
 Ease of communications with all staff. Cooperative and reliable. Good member
of team. Mature and dependable. Sensitive to others. Shares pertinent
information. (8)
 Staff and peer relationships are productive and meaningful. Establishes good
rapport with other hospital staff, patients, and families. Always a team player. (9)
 Outstanding interpersonal skills. Appropriately respectful, mature, and
cooperative. Superior team member. (10)
 Not Observed.
4.
Professionalism
 Disruptive behavior. Unreliable. Fails to study, read, or investigate. Does not
attend assigned duties or is frequently late. Unprofessional attire. (6)
20
 Lacks insight into own deficits and ignores feedback. Assumes responsibility only
when stimulated. Frequently late or misses lectures and rounds. Unprepared.
Marginal behavior and appearance. (7)
 Good insight into own deficits & assets. Incorporates feedback. Assumes share of
workload, conscientious & reliable. Punctual with good attendance for assigned
duties. Generally aware of professional behavior & responsibilities. (8)
 Almost always prepared & punctual. Identifies sensitive issues & addresses them.
Marked improvement on skills addressed with feedback. Proactive in patient
responsibilities & takes ownership of patients. Exhibits self-directed investigation &
study. (9)
 Curious and solicits feedback. Exceptional insight into strengths and deficits.
Exceptionally hard worker. Unusually mature and professional. Always courteous,
well groomed, punctual, and prepared. (10)
 Not Observed
5. Systems Based Practice: Understanding the health care delivery system on a
global and local level
 Poor knowledge of health care delivery. Lacks interest in learning basic
systems issues. (6)
 Limited knowledge of health care delivery. Can use basic campus
systems inconsistently. (7)
 Appropriate knowledge of health care delivery. Consistently uses local
systems for patient care. Desire to learn. (8)
 Good understanding of health care delivery. Actively seeks out new
information for education. Shows application of newly obtained
knowledge. (9)
 Superior knowledge and understanding of health care delivery. Can help
others in use of local systems. Able to identify system barriers to patient
care. (10)
 Not Observed
6. General Comments (Use complete, grammatically correct sentences. These
comments WILL BE USED in the students' Dean's Letters):
7. Additional comments NOT to be included in Dean's Letters (Include areas
needing improvement):
21
Clerkship and Preceptor Evaluations by Students
The student will log into the O2 during the last few days of the clerkship rotation to complete
the course and preceptor evaluations. These must be completed before grades can be
released.
Course Evaluation by Students
This process is anonymous and the comments are collated and reviewed by
the entire faculty at the end of the academic year. This feedback from
students informs the faculty about student concerns in order that the
clerkship can improve from year to year. We appreciate your honest input,
but expect your statements to be made in a professional manner. This
evaluation is one of the Dean’s office requirements.
Faculty/Resident Evaluation: The purpose of gathering this information is
to evaluate the effectiveness of our clinical preceptors. This information will
be shared quarterly with preceptors
Course Evaluation Items
1.
2.
3.
4.
5.
6.
7.
8.
Organization: Clinical experience was well organized, information and
procedures were presented in a logical sequence, student assignments and
activities were well organized.
Clarity: Goals and objectives of the clinical experience were clear, faculty
expectations of the students were clear, course content was presented
clearly, and questions were answered understandably.
Testing: Material on exams was related to material covered during the
clinical experience.
Participation: Clinical experience provided adequate opportunities for
"hands-on" experience and for appropriate student participation in the
patient care process of this specialty.
Content: Informational content of the clinical experience was current and
facilitated student ability to achieve clerkship goals and objectives.
Professional Characteristics: Instructor(s) demonstrated qualities that were of
use to me (respect for Students, Cultural Awareness, and Respect for Health
Professions).
Overall: The quality of this course is outstanding.
Comments: Please make any comments about this clerkship here.
22
Faculty Evaluation Items
1.
The above named faculty/house-staff participated in my learning
experiences during this rotation.
2. Organization and Clarity (presents material in an organized fashion,
understands students' questions and answers questions clearly, emphasizes
important points, summarizes well).
3. Enthusiasm (is enthusiastic about medicine and the teaching of medicine,
stimulates student interest, is dynamic and energetic, and enjoys teaching).
4. Knowledge (is knowledgeable in his/her specialty area, discusses recent
developments, directs students to appropriate research/literature,
demonstrates breadth of knowledge, discusses multiple viewpoints).
5. Rapport (listens attentively to students and residents, is interested in student
progress, treats students and residents with respect, is sensitive to needs of
others, asks/answers questions and corrects students in a positive manner, is
accessible to students and residents).
6. Communication Skills (uses resources and technology effectively,
encourages student participation, reinforces students efforts, gears teaching
to student level of readiness, uses questions effectively, helps students
organize and clarify their thoughts about patient problems, demonstrates
clinical procedures and techniques well, communicates effectively, explains
well).
7. Clinical Supervision (communicates performance expectations to students
and residents, actively guides development of clinical skills, provides
specific, appropriate practice opportunities, directly oversees performance
frequently)
8. Professional Characteristics (sensitive to moral and ethical practice issues,
demonstrates empathy with patients, takes responsibility for actions, has selfconfidence, recognizes limitations, is open-minded and non-judgmental,
does not display arrogance)
9. Overall excellence of instructor (based on the responses to items above, the
summative evaluation for this preceptor would be.....)
10. Enter any additional comments in the space provided.
23
Appendix A:
EVIDENCE-BASED MEDICINE MODULE
Definition of EBM
Evidence-based medicine is the conscientious, explicit and judicious use of
current best evidence in making decisions about the care of individual patients.
The practice of evidence-based medicine means integrating individual clinical
expertise with the best available external clinical evidence from systematic
research.
Student Responsibilities:
 Week 1 – Identify a clinical problem or a question that you’ve encountered in
the care of patients at the clinic site.
 Week 2 – Conduct a literature search on that problem or question and pick
an article that you want to present.
 Beginning, Week 3 – Critique the quality of the information gathered, i.e., are
the claims in the article supported by the research, using the Duke University
Critical Appraisal Worksheets.
 Ending, Week 3 – Be prepared to discuss the article reviewed and
conclusions drawn from your research with the site director. Students will fill
out the Evidence-Based Medicine Clerkship Worksheet (sample given below
on page 35 - 36) which will be e-mailed to them or they may use the form
below and submit it electronically to Little Rock using the address at the
bottom of the form.
 If you encounter problems with electronic submission, print your completed
form and turn it in to the coordinator on the last day of the rotation.
 Presentation –All students will meet with their site assigned faculty moderator
and present their clinical question and an overview of their article. Students
will review their Evidence-Based Medicine Clerkship Worksheets. This is a
requirement of the clerkship.
Four basic principles of EBM
1. Build a good clinical question
2. Conduct an efficient search for the best external evidence (search PubMed,
EBSCO, etc.)
3. Critically appraise the literature for validity and relevance
4. Apply what has been learned to clinical practice
Four elements of a well-built clinical question (P.I.C.O.)
1. What is the Problem or patient issue?
2. What is the educational Intervention or the exposure to the new/different
material?
24
3. Is there a Comparison group or intervention?
4. What is the educational Outcome?
Criteria for article selection:
1) All articles should be peer-reviewed and published in a medical/scientific
journal.
2) For this exercise, the studies should be limited to experimental designs
(Randomized controlled trials), the more scientifically convincing
epidemiological/observational studies (Cohort or case control designs), or
some combination of any of the 3 designs above (see attached
description of the study designs, if necessary). Review articles, meta
analyses, and case reports-are not acceptable for this exercise.
3) Keep in mind that many times information from more than one article is
necessary to make a good clinical or research-based decision on any
particular topic; however, this exercise is only requiring the selection of
one article.
Included below:
a) Review of study types
b) Duke University Critical Appraisal Worksheets to help you evaluate the
validity of your article. The hyperlinks below are for an optional EBM
tutorial and for online versions of the worksheets:
http://www.hsl.unc.edu/services/tutorials/ebm/index.htm
http://guides.mclibrary.duke.edu/content.php?pid=274373&sid=2262222
c) Evidence-Based Medicine Clerkship Worksheet
Background
Common Study Designs
The descriptions below include the types of studies allowed for article
selection for the clerkship (randomized controlled trials, cohort, and case
control), plus descriptions for other types of studies (surveys, ecological studies,
review articles, meta-analysis, case series) for your information. This summary was
provided by Bridget Mosley, MPH.
Randomized controlled trials:
An experimental study in which the study participants are randomly assigned
by a research investigator to a treatment group and followed for the
outcome(s) of interest. The goal is usually to evaluate the effects of one or
more types of treatments/therapies/medications on a disease or condition.
The randomization helps ensure that the treatment alone resulted in the
outcomes being observed. These studies are usually the more expensive
25
studies, because they require close monitoring and follow-up procedures.
But, they are also the most convincing scientifically. Ethical considerations
and expense prevent many research questions from being addressed with
this type of study design.
Examples: Women’s Health Init.: Rossouw JE et. al. Risk and
benefits of hormone replacement therapy in postmenopausal
women. JAMA 2002; 288: 321-33.
Tashkin DP. et. al. Cyclophosphamide versus placebo in
scleroderma lung disease. New Eng J Med. 2006; 354(25):265566.
Cohort:
An observational study in which a research investigator observes the
exposure levels of interest among the study participants, classifies
participants into an exposure group based upon a priori criteria, and then
follows the participants for the outcome(s) of interest. These types of studies
are commonly used when assessing a causal relationship between a
detrimental or preventive exposure (especially rare exposures) and a health
condition of interest. These studies can be prospective, i.e., the health
outcome has not occurred or been identified at the time of study enrollment,
or retrospective, i.e., the status of the health outcomes has occurred and
been recorded in a data set, but the investigator are only assessing the
outcomes after exposure statuses have been determined. A well-designed
prospective cohort study can be quite convincing to the scientific
community.
Examples: Framingham Heart Study: Wilson PWF, et. al. Creactive protein and risk of CVD in men and women. Arch Intern
Med. 2005; 165: 2473-8.
Polluck BE, et. al. Patient Outcomes after Vestibular
Schwannoma Management: Comparison of Microsurgical
Resection and Stereotactic Radiosurgery. Neurosurgery. 2006;
59(1): 77-85.
Case-control:
An observational study in which a research investigator observes and
classifies study participants into groups based upon their disease status or
health condition, and then retrospectively assesses their exposure levels prior
to the disease occurring. These types of studies are commonly used when
assessing a causal relationship between a detrimental or preventive
exposure and a health condition of interest. For rare diseases, these types of
studies are the most common and feasible design to use.
Example: National Birth Defects Prevention Study: Cleves MA, et.
al. Maternal use of acetaminophen and NSAIDs and ventricular
septal defects. Birth Defects Research Part A. 2004; 70(3):107-13
26
Adelow C, et. al. Epilepsy as a risk factor for cancer. J Neurology,
Neurosurg & Psych. 2006; 77(6):784-6.
Surveys (cross-sectional studies):
An observational study in which a research investigator assesses both
exposure and disease outcome at the same time and usually with the same
measurement tool. Participants usually respond to self-reported survey
questions and/or an investigator-led assessment tool on multiple exposure
and health condition topics. These studies are commonly used to assess
health behaviors and conditions among a large population.
Example: Youth Risk Behavior Surveillance System: Eaton DK, et. al. YRBSSUnited States, 2005. MMWR Surv. Summ. 2006; 55(5):1-108
Ecological studies:
An observational study in which a research investigator measures disease
occurrence within a population and implies a connection with the
prevalence of the exposure of interest within that same population.
Individual level measurements for both exposure and disease are not
conducted, only comparisons of rates/occurrence between populations are
conducted. These types of studies are common for some environmental
health assessments and evaluation of public health programs.
Example: Honein MA et. al. Impact of food fortification on the occurrence
of neural tube defects. JAMA. 2001; 283 (23): 2981-6.
Review articles:
A summary of multiple articles or scientific information on a specific topic into
one report. These articles can be quite informative and convenient.
Meta-analyses:
A quantitative summary of multiple research studies on a specific research
hypothesis. There is a whole discipline within statistics that concentrates on
complex meta-analyses methods. Caution should be used when evaluating
these reports, as some may not appropriately take into consideration the
varying degrees of scientific credibility of the studies being assessed.
Case series:
A descriptive report on a unique event or rare disease occurring in the
medical community. Usually these reports only involve a few patients and no
statistical comparisons take place. These reports may be helpful to develop
new hypotheses or to inform the medical/scientific community of new
diseases or treatments.
Other clinical trials or experimental studies (not randomized):
27
An experimental study that does not involve randomizing participants into
treatment groups. Assignment to a treatment group may be based upon
medical evidence, self-selection, or convenience sampling.
Other: Some studies use combinations of any of the above.
Tips for reviewing Medical/Scientific articles in general:
For any type of study, remember to look for:
 Measurement errors: Measurement errors are possible and are not
uncommon in research studies. Understanding those errors and how
they may be influencing the observed results helps one better know how
to interpret the findings. Some studies are more prone to certain types of
errors than others. When reviewing an article one should ask if the tools
used to identify the outcomes of interest and the treatment/exposure of
interest are misclassifying participants. This becomes a major concern for
the study if the misclassification is occurring differentially within the study
population, i.e., errors are different across the study groups being
compared.

Uncontrolled factors: The epidemiological terms for these are confounders
and effect modifiers. These are factors that are not the primary topics of
interest to the investigator, but could be influencing these results. A
classic confounder for many studies is smoking. Smoking may confound
an evaluation between alcohol and cancer, because alcohol drinkers
are more likely to be smokers than non-drinkers and smoking is linked
with higher risk of cancer. There are ways to control for many of these
factors, either by the design of the study or by statistical methods.

Sample size: Many have heard that studies with a larger number of
participants are better than studies with smaller numbers. This is primarily
because larger samples, or more units to analyze, provide more
statistical power to see differences when making a comparison.

Clinical/biological/logistical relevance vs. statistical significance: Given a
large enough sample size in a research study, small differences between
comparisons groups will reach statistical significance. However, other
considerations should be taken into account as to whether the
observed difference in the outcomes is relevant to the clinical question
being considered. A difference of 2 mm Hg in systolic blood pressure
between 2 study groups taking different medications may not have
clinical significance given the cost or convenience of one over the
other.
28

Representation: Does the study group represent a population that is
equivalent to a population that is of interest to you? This may be a
concern if one is looking at gender or ethnic-specific populations, or
those with certain medical conditions.
Tips for reviewing Randomized Controlled Trials:
 Did the randomization work?
o In theory, did the investigator design the study so that
randomization of participants could properly occur?
o From the results, did randomization truly occur? The study groups
being compared should be equivalent on all factors other than the
intervention factor (hint: These comparisons are usually reported in
the one of the first descriptive/demographic tables in the results.).

Was blinding appropriately conducted so that participant/investigator
bias was limited?
o Single-blind = participants blinded to intervention
o Double-blind= participants and investigator measuring outcomes
are blinded to the intervention

Was the follow-up time period between the intervention and outcome
appropriate clinically/biologically for the outcome to occur?

If participants were asked to administer the intervention (e.g. take
medications, etc.) were measures in place to ensure compliance?

Was an “intent to treat” approach used for data analysis, meaning those
allocated to a specific group were analyzed in that group no matter if
they remained in that group or not?

What were effects due to loss-to-follow-up, participant withdraw, etc? We
usually think that at least 80% participation at the end of the study is good,
but this could be flexible.

Were the results convincing? Take into account the biological/clinical
significance as well as the statistical significance.
Tips for reviewing Cohort Epidemiological Studies:
 Measurement bias: Measurement errors may occur when the participants
are classified by their exposure of interest. Remember that an investigator
in these studies does not control how much “exposure” a participant
receives, only records what is observed.
29

Was follow-up time period between the potential exposure and outcome
appropriate clinically/biologically for the outcome to occur?

What were the effects due to loss-to-follow-up, participant withdrawal,
etc?

Uncontrolled or unidentified factors (confounders) should always be
considered in observational studies
Tips for reviewing case-control studies:
 Recall bias: Most case control studies are subject to potential recall bias.
Primary exposures of interest in these studies are actually measured after
the health outcome has occurred. Thus, a participant diagnosed with a
disease may recall or record the events in the exposure time period
differently than a control participant who does not have the disease.

Sample size: Many times case control studies are conducted on “rare
diseases”, thus limited number of study participants. An assessment as to
whether the sample size was appropriate to address the hypotheses of
interest should be considered.

Uncontrolled or unidentified factors (confounders) should always be
considered in observational studies.
Quick review of statistical significance:
Statistical testing is used to assess if the results observed from a research study
are considered different between 2 or more comparison groups. The end
product from these tests will be either a p-value calculated from a specific
statistical test or a ratio (odds, risk, or hazard ratio) with a corresponding
confidence interval.
P-values:
 For the non-epidemiologist/statistician, one could think of the p-value
as the likelihood that the observed difference between comparison
groups occurred by “chance”, i.e., not influenced by the
intervention/exposure of interest. A p-value of 0.30 would indicate that
there was a 30% likelihood that the observed difference between
groups was due to chance.

The most common “cut-point” used to decide if a comparison is
statistically different or not is a p-value of 0.05.

Any statistical test resulting in a p-value less than or equal to 0.05 is
considered statistically significant, thus different between the 2 groups.
30
If the study is designed appropriately, this would imply that the
intervention/ exposure of interest influenced that difference.

A resulting p-value greater than 0.05 is considered not statistically
different, thus any difference between the groups could be due to
chance alone and not attributed to the intervention/exposure of
interest.
Ratios and confidence intervals:
 When the rate or odds of a health outcome occurring in one group is
divided by the rate or odds of that health outcome occurring in a
different group, an investigator will get a ratio number. If these rates or
odds are similar between the groups, the ratio will be close to 1
(exactly 1 if the rates are identical).

Ratios can be greater than 1, indicating that the intervention group
(numerator or top number) had higher risk of the outcome than the
comparison group (denominator or bottom number). Or, the ratios can
be less than one, indicating a protective effect of the intervention of
interest.
o Example 1: The odds of smoking among cancer patients may be
observed at 15.2%, while the odds of smoking among
participants without cancer was observed at 5.7%. The
corresponding odds ratio would be 15.2 / 5.7 = 2.7.
o Example 2: The rate of neural tube defects among women
taking folic acid vitamins periconceptionally was 4 per every
10,000 live birth, while the rate among women not taking a
vitamin was 7 per every 10,000 live birth. The risk ratio would be 4
/ 7 = 0.57.

Confidence intervals (CI) are used to assess statistical significance
between groups. The most common used in scientific research is the
95% CI. This can be thought of as equivalent to the 0.05 p-value cutpoint mentioned above. A confidence interval is a calculation of a
range of variance (low and high ends) where the ratio measure is
included within that range.
o If 1.0 is included within that range of the interval, the comparison
between the 2 groups is not considered statistically significant.
o If 1.0 falls outside that range of the interval (either higher or
lower) than the difference between the 2 groups is considered
statistically significant and thus may be attributed to the
exposure of interest.
31
Above examples:
Ratios
Smoking among cancer 15.2 / 5.7 = 2.7
patients vs. non-cancer
participants
95% confidence interval
(1.3, 3.8)
statistically significant
since 1.0 is not within CI
NTDs among folic acid
users vs. non-users
(0.43, 1.23)
not statistically significant
since 1.0 is within CI
4 per 10,000 /
7 per 10,000 = 0.57
CRITICAL REVIEW FORM FOR PROGNOSIS STUDY
Citation:
Users’ Guide:
Article:
Are the Results Valid?
Was the sample of patients
representative?
Were patients sufficiently homogenous
with respect
to prognostic risk?
Was follow-up complete?
Were objective and unbiased
outcome criteria used?
What are the Results?
How likely are the outcomes over
time?
How precise are the estimates of
likelihood?
How can I apply the results to patient care?
Were the study patients and their
management similar to my own?
Was the follow-up study long?
Can is use the results in managing
patients in my practice?
From McMaster EBCP Workshop/Duke University Medical Center – 03/18/03,
5/12/09
32
CRITICAL REVIEW FORM FOR DIAGNOSIS STUDY
Citation:
Users’ Guide:
Article:
Are the Results Valid?
Did the clinicians face diagnostic
uncertainty?
Was there blind comparison with an
independent gold standard?
Did the results of the test being
evaluated influence the decision to
perform the gold standard?
What are the Results?
What likelihood ratios are associated
with the range of possible test results?
How can I apply the results to my patient care?
Will the reproducibility of the test result
and its interpretation be satisfactory in
my setting?
Are the results applicable to my
patient?
Will the results change my
management?
Will patients be better off as a result of
the test?
Are the benefits worth the potential
harms and costs?
From McMaster EBCP Workshop/Duke University Medical Center – 03/18/03,
5/12/09
33
CRITICAL REVIEW FORM FOR THERAPY STUDY
Citation:
Users’ Guide:
Article:
Are the Results Valid?
Did experimental and control groups begin the study with a similar prognosis?
Were patients randomized?
Was randomization concealed?
Were patients analyzed in the groups
to which they were randomized?
Were patients in the treatment and
control groups similar with respect to
known prognostic factors?
Did experimental and control groups retain a similar prognosis after the study
started?
Were 5 important groups (patients,
caregivers, collectors of outcome
data, adjudicators of outcome, data
analysts) aware of group allocation?
Aside from the experimental
intervention, were groups treated
equally?
Was follow-up complete?
What are the Results?
How large was the treatment effect?
How precise was the treatment effect?
How can I apply the results to my patient care?
Were the study patients similar to my
patient?
Were all patient-important outcomes
considered?
Are the likely benefits worth the
potential harms and costs?
From McMaster EBCP Workshop/Duke University Medical Center – 03/18/03,
5/12/09Grading for Evidence Based Medicine Module
34
Category
Quality of Clinical
Question
Thoroughness and
Effectiveness of
Literature Search:
Completion of the
EBM Worksheet
Reflects the 4 elements: 1)population
2)intervention
3)comparison
4)outcome appropriately
Student has all elements of thorough and effective
literature search:
1) adequate search method
2) explained why the article was chosen
3) study type is appropriate to answer clinical
question
All parts of the worksheet are complete
Evidence-Based Medicine Worksheet:
Student Name: ________________________
Block _________
Clerkship site____________________________
E-Mail Address: ________________________________
(If you do not have E-mail, please enter your home address)
Describe your initial question:
This question was based on:
Previous rotation
Personal interest
Patient seen in FM clinic (outpatient)
Patient seen in hospital
Describe your final question, including:
Patient/Problem, Intervention, Comparison, Outcomes
Your final question was based on:
Discussion with preceptor or other faculty
Research material available on subject
Discussion with resident(s)
Orientation material
Other reasons (please describe):
35
Identify source of your information
Title & Author ______________________________________________________
Journal (name, volume #, etc.)_________________________________________
Source:
Internet - online OVID - online Medline - Library - utilized research librarian Index Medicus - CD-Rom- hardcopy - Other source not mentioned:
_____________________
Describe the following components of your article:
Background:
Methods:
Result:
Conclusion:
Summarize validity based on the type of question asked & article selected.
(choose the type(s) that most apply and summarize below)
Treatment article (discuss trial design, patients similar to your biases, significance)
Diagnosis article (describe identification of disease & test, comparison w/ gold
standard, reasonableness, patients similar to yours)
Prognosis article (discuss inception cohort, selection criteria, follow-up, patients
similar to yours, where subjects came from)
Why does this matter to you or your patient (Usefulness)
What is your interpretation of the information?
How will the information be applied to your clinical practice?
Send back to predocadminoffice@uams.edu
36