Introduction to Family Medicine Clerkship FPM 426
Syllabus for Introduction to Ambulatory Family Medicine Clerkship
General Course Information
Course: FPM 426 Ambulatory Family Medicine Clerkship
Course Director: Daniel Slater, MD
Administrative Contact: Carol Bloom-Whitener
The purpose of this 4th year clerkship is to immerse the student in the principles and
practice of family medicine in an urban setting, and to teach core knowledge, attitudes and
skills in the effective practice of family medicine in an urban practice in San Diego. As the
primary component, the student will actively participate in clinical experiences at any one
of the three UCSD Faculty Family Medicine offices (Genesee, Lewis, or Scripps Ranch),
or the office of a community Family Medicine Volunteer UCSD FM faculty member.
Students also complete sessions in underserved primary care at the UCSD Student-Run
Free Clinic Project as well as half day individual sessions in ancillary healthcare services at
the Pacific College of Oriental Medicine (Acupuncture and Herbal traditional Chinese
Medicine), a session with a UCSD nutritionist, and one with a Sharpe Rees Stealy Physical
Therapist. As a group all 426 students meet with Dr. Ruth Heifetz MD of UCSD for an
Occupational Medicine didactic and a site tour of a workplace.
Each student will be asked to prepare a 20 minute clinical presentation at the end of the
Clerkship and present it to the Course Director [or appointed surrogate] and fellow
students, based upon a patient encounter during the Clerkship.
Contact Information:
Daniel Slater MD
Email drslater@ucsd.edu
Phone 858 657-8529
Pager 619 290-5681
Carol Bloom-Whitener
Email cbloomwhitener@ucsd.edu
Phone 858-534-6160
Clinic locations (See Attachment) Locations vary and relevant addresses can be found on
each student’s individual schedule
Core Faculty (See attachment) listed by location
Schedule: Attached are samples of student schedules
Required student activities:
Average number of patients seen per week: 30 [details below] There may be minor
variations in the number of patients seen per session among ambulatory Clinic
Office Sites, which are not significant. Fewer patients are seen in Free Clinic
Project sessions
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Average number of write-ups per week: 10
Approximately 5-6 sessions per week in a mainstream Family Medicine practice
Approximately 3 sessions per week in the Student Run Free Clinic Project
(includes evenings)
Approximately 3 didactics per month with the Free Clinic Attending Staff
Two to three sessions in the month with Ancillary Services
One or Two sessions per month for Occupational Medicine
Orientation on the first day of the Clerkship
Final Presentation in the fourth week of the Clerkship
Course Goals and Learning Objectives
The purpose of this 4th year clerkship is to immerse the student in the principles and
practice of family medicine in an urban setting, and to teach core knowledge, attitudes and
skills in the effective practice of family medicine in urban communities.
The learning objectives for this course include the following:
By the end of the clerkship students will be able to:
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Demonstrate core history-taking skills, physical exam skills, verbal patient
presentations, and written documentation of outpatient visits.
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Formulate differential diagnosis for common primary care concerns.
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Describe common issues in the management of patient who have chronic
illnesses such as diabetes, high blood pressure, high cholesterol, metabolic
syndrome, obesity, and asthma.
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Demonstrate familiarity with the diagnosis and management of common
acute conditions for which patients commonly present to Family Medicine
offices for care. These include, but are not limited to musculoskeletal,
infectious, dermatologic, psychiatric, and gynecologic problems
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Demonstrate familiarity with key aspects of health maintenance/preventive
care for all ages and both genders.
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Comprehend and define the distinctions between “primary care,” “general
practice,” and “family medicine.”
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Describe facets of “coordination of care” that a competent family physician
provides for patients & families, including education and ancillary
resources.
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Identify electronic online sources of reliable clinical information and be
able to access and use them in real time while caring for patients in the
office setting.
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Demonstrate knowledge of appropriate follow up care and patient education
for their condition(s) and treatment(s).
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Learning objectives for each type of session vary, depending upon the clinical experience.
The overall clerkship objectives above largely refer to hands-on patient care that students
engage in at the medical office settings and the Student Run Free Clinic sites. Other
experiences provided during the clerkship include half day didactic sessions, interactive
lectures by the core faculty, (including, but not limited to) Drs. Sunny Smith, Michelle
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Johnson, Natalie Rodriguez, and Ellen Beck on topics such as current guidelines and
approaches for family physicians in the diagnosis and management of chronic diseases
such as hypertension, diabetes, asthma, obesity, and oral health as well as reflection
sessions on becoming a teacher and clinician and learning more about social resources
available for underserved patients.
Core clinical learning objectives are similar when patients are seen at the free clinic
project. However, there are some differences in students’ roles when they are involved in
treating uninsured patients in the Student-Run Free Clinic than seeing patients in the
daytime ambulatory office setting with preceptors caring for patients with funding
(insurance). Fewer patients are seen per session in the Free Clinic setting, as the 4th year
student has additional roles of coaching first and second year medical students, working
closely with ancillary medical personnel such as social workers, pharmacy students,
dentists, providers from PCOM, interpreters, and others. Students in 426 are also taking a
larger lead role in the coordination of care and team leading for the patients seen at the
Free Clinic Project, which is a core competency in the disciplines of primary care in
general, and of Family Medicine specifically.
Additional Learning Objectives from Free Clinic Experiences:
To identify and list social resources and programs available to underserved patients for
access to care and for needed health maintenance and screening.
To identify and practice core behaviors needed for coordination of care and teamwork.
To identify key aspects of working with interpreters.
To identify key elements of clinical coaching/teaching.
To practice and identify reflection as a key element of service-learning.
Students in FPM 426 also may spend half days with Dr. Ruth Heifetz, MD learning
Occupational Medicine, with a UCSD Nutritionist, with physical therapists at Sharpe Rees
Stealy, and faculty and students at the Pacific College of Oriental Medicine in San Diego.
Learning objectives for clinical observation experiences and site visits:
When students participate in half day experiences that do not involve direct participation in
ambulatory patient care, the objectives become:
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Observe the current approach to ancillary professions relevant to the care of
patients to become familiar with both the limitations and the breadth of care that
these disciplines offer, regardless of the field of medicine any student chooses.
Become familiar with the role a family physician must assume to coordinate care of
patients outside the standard medical office setting, among other providers of care
that patients commonly use or are referred to
Obtain fundamental knowledge of occupational medicine principles, both in he
classroom, and at a jobsite
Observe the paradigm shift of the Traditional Chinese Medicine perspective on
health, illness, and healing, and recognize that mainstream patients we care for
often use complementary and alternative healing systems, whether the patients
disclose this to us or not
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Course Requirements
1) Attendance at all clinical and didactic sessions: attendance record must be turned in
at the end of the clerkship (see absence policy below).
2) Review the required reading (see reading list at the end of the syllabus)
3) At least one history and physical examination during the 4 week clerkship, and
Daily: one acute and one chronic care visit observed by the faculty preceptor
4) Final case presentation to course director
5) Student will complete a Course Evaluation
Attendance Record: Students keep an attendance record during the month documenting
the days they participate at the clinic. This record must be turned in at the end of the
rotation.
Absence Policy: Students are not permitted to miss any days of this rotation except in
special circumstances such as personal or family emergencies. To request an absence due
to unforeseen circumstances, the student must notify Carol Whitener as soon as possible.
(contact information is listed above). All missed days must be made up in order to receive
a passing grade.
Required Lectures: Topics vary from month to month but include Asthma,
Hypertension, Type 2 Diabetes, Hyperlipidemia, Oral Health, Occupational Medicine, and
others.
Required Reading: A textbook is provided. See reading assignments at the end of this
syllabus. In order to be an effective primary care clinician, it is important to understand
that a large part of how we practice is based on guidelines provided by national
organizations that are revised over the course of time as more data becomes available.
These guidelines are always being revised. Students are asked to read and refer to the
guidelines listed at the end of the syllabus in items number 3, 4, and 5.
Observed History and Physical Examination: Each student will have at least one patient
encounter per day observed by one of the faculty preceptors. This may be a visit for an
acute problem, or a follow up encounter for a chronic condition. At minimum one
preventive health maintenance exam (“physical”) will be observed by one of the faculty
preceptors one time during the 4-week clerkship. For all of the above, direct feedback will
be given.
Mid Clerkship Feedback: The student and preceptor should meet on or about Friday
afternoon at 5:00 PM, at the end of the second week, for direct faculty feedback on
performance to date. This mid clerkship session may be brief, and will be initiated by a
faculty member at the clinical site where the student is spending the majority of time,
namely the medical office the student is assigned to. The mid clerkship feedback may also
be initiated and provided by the clerkship director.
Specific topics will include clinical skills (patient interviewing, physical examination,
clinical decision making, and planning for follow up). Direct feedback will be provided at
that meeting, phone call, or by email, to the individual student.
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If it is not possible to physically meet and sit down together, the clerkship faculty onsite or
the clerkship director will call or email the medical student and provide mid course
feedback regarding the student’s progress to date, with any suggestions for improvement,
should that be necessary. The clerkship director will also facilitate a discussion with each
student at this time regarding the student’s planned final presentation topic, scope, and
progress to date.
Mechanisms to ensure that students are exposed to core family medicine cases and topics
with the varied schedules include the following:
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Retrospective: Each student is responsible for a complete listing of the diagnoses of
patients seen during the clerkship. The course director periodically reviews these to
ensure that students are exposed to a representative breadth & depth of patient ages,
both genders, and types of diagnoses, to represent ambulatory family medicine.
Clearly the expectation for variety is influenced by the venue, e.g. physical therapy
office, nutritionist, Student Run Free Clinic, PCOM, preceptor’s office.

Didactic Sessions: These are required for all students regardless of their varied
schedules. These, as noted above, cover key cover topics and concepts in the
practice of family medicine.
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The entire faculty at each site who our core preceptors are provided with a list of
the core objectives and competencies expected as part of this clerkship. Faculty
providing direct student supervision are provided with the syllabus and core
objectives.
Final Case Presentation: Each student will prepare a 20-minute presentation, typically
presented on the final day of the rotation. This should be based on an actual patient seen
by the student during the clerkship. The final presentation must demonstrate a deeper level
of clinical knowledge and awareness of at least one issue related to family medicine than is
typically taught in the first 3 years of medical school (e.g., a symptom, a diagnostic test, a
diagnosis, a clinical finding, a treatment modality, etc.). An expectation of this final
presentation is a literature search and bibliography demonstrating up to date evidencebased thought relevant to the topic selected. The student will be prepared for a 10-minute
discussion, including questions by the group, following the presentation.
Course Evaluations: (See page 7 below.) The identity of individual students will not be
shared with course instructors.
Student Assessment/Grading
This clerkship is pass/fail/honors. A passing grade is achieved when the course
requirements are met. It is our intention is provide an honors grade to 25% of the clerkship
students over the year (but not necessarily in each clerkship block), based on their
performance in the criteria listed below.
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The course director and faculty preceptors will each complete the attached evaluation
form, which is used to grade students’ performance. Other supervising physicians may
additionally complete this evaluation.
Criteria for Passing
Students are assessed on [must include but not limited to]:
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Attendance at didactic lectures, clinical sessions, and conferences
Completion of required reading
Participation in patient care
Written and/or oral presentations
Satisfactory performance/demonstration of learning objectives
Ability to obtain a complete history and physical exam, verbal presentation skills,
note writing, and ability to form an accurate assessment and plan. Their clinical
skill set and knowledge base is judged based on repeated interaction with core
continuity faculty members.
Ability to interact well with patients, their families, and other members of the
health care team.
Knowledge and comments during didactic sessions with the faculty preceptors and
course director throughout the clerkship are also used in assessing the students.
Final case presentation, which must demonstrate clinical knowledge as well as
awareness of issues related to the practice of family medicine.
Criteria for Honors Include the following [not all are necessary]:
1. Medical Knowledge
a. Sophisticated knowledge base
b. Consistently describes relationships between principles and practice
c. Highly self-motivated to acquire knowledge
2. Clinical Reasoning; Student consistently:
a. Identifies and interprets pertinent clinical findings
b. Formulates rational differential diagnoses
c. Supports/refutes hypotheses
d. Describes rationale for care plans
3. Data gathering skills; Student Routinely:
a. Gathers accurate and appropriately detailed historical data
b. Performs accurate and appropriately focused Physical Exam
c. Identifies significant changes in patients' symptoms and findings
4. Communication of Clinical Data and Medical Information
a. Verbal and written presentations and notes:
b. Are always well organized, clear and succinct, and of appropriate length
c. Consistently include rationales for assessments and plans
5. Interpersonal Communication Skills and Humanistic Qualities; Student
Consistently:
a. Values the patient's and family's perspective
b. Empathizes with all patients
c. Demonstrates effective listening and non-verbal communication skills
d. Provides encouragement to patients when needed
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6. Professionalism; Student Always:
a. Respects the opinions of other professionals
b. Respects the patients' rights to informed consent and participation in
care
c. Maintains patient confidentiality
d. Completes all assigned tasks on time
e. Exhibits high level of motivation for self-improvement
7. Potential as a resident in this discipline (consider likely performance in domains
of medical knowledge, clinical skills, humanistic qualities and professionalism)
a. Likely to excel in all domains of performance; high probability of
becoming a leader among his/her peers
A failing (F) grade will occur if one or more of the above criteria for passing are not met
or adequately remediated.
 For unethical or unprofessional discretions that could result in "failure," please see
the Policy on the Evaluation of Professionalism in the Advisor and Student
Handbook at https://mededportal.ucsd.edu/webportal/docs/UCSD%20SOM%20Advisor%20&%20Student%2
0Handbook%20August%202010.pdf
Student evaluation of course and faculty
Medical students must complete course and faculty evaluations of this and all School
of Medicine courses in order to receive a grade. Online evaluations of the
course/clerkship and faculty are conducted through the Office of Educational
Development and Evaluation (OEDE). Any questions about this evaluation process
may be directed to OEDE at meded-oede@ucsd.edu. OEDE Contact information is
also available at http://meded.ucsd.edu/ugme/oede/contact_us/.
The identity of individual students will not be shared with the course instructors.
Course Materials and Resources:
1. Textbook: Essentials of Family Medicine, 5th edition, Philip D. Sloane et al.
(Check out from Dr. Slater or Carol Bloom-Whitener)
Chapters not limited to, but including Chapters 1, 2, 29, 30, 31, 35, 40, and 45
(Alternative text, highly recommended*: “Primary Care Medicine” (6th edition) by
Allan H. Goroll.)
2. RESOURCE - Use the UCSD Clinical Web Reference for links to
Databases, Textbooks (*may be viewed Online) & Journals, Drug Information, Medical
Reference, Patient Education and Evidence Based Resources
3. Cholesterol Treatment Guidelines:
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(Please refer to all three to see how guidelines were updated in 2001, 2004, and 2006 based
on new data.)
-ATP III 2001. (JAMA. 2001; 285:2486-2497). Full report: (Circulation.
2002;106:3143-3421.)
-ATP III Update 2004. Implications of Recent Clinical Trials for the National
Cholesterol Education Program Adult Treatment Panel III Guidelines. (Circulation.
2004;110:227-239.)
-AHA/ACC Guidelines for Secondary Prevention for Patients with Coronary and
Other Atherosclerotic Vascular Disease: 2006 Update. (Circulation. 2006;113:2363-2372.)
4. Hypertension Treatment Guidelines
-JNC 7: Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation,
and Treatment of High Blood Pressure. (JAMA. 2003;289:2560-2572.)
5. American Diabetes Association Clinical Practice Recommendations 2011.
Executive Summary: Standards of Medical Care in Diabetes—2010 (Diabetes Care
January 2010 33:S4-S10; doi:10.2337/dc10-S004)
Also available at: http://care.diabetesjournals.org/content/34/Supplement_1
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