Family Medicine Clerkship
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Bryan S. Delage, MD FAAFP
Kamille Sherman, MD FAAFP
Department of Family and Community Medicine
University of North Dakota School of Medicine
and Health Sciences
Orientation
Polycom/VNC/Streaming Video
Problems/Concerns/Surprises
Course Objectives
Evaluation/Grading
Group topics/Presentations
Encounter Database/PowerPoint
Patient-Centered Medical Home
PolyCom
Brandon Thorvilson tutorial
brandon.thorvilson@.med.und.edu
VNC Web Browser
• fmvnc.med.und.edu
• 134.129.166.244
• room2515
Family Medicine Clerkship
• http://www.med.und.edu/familymedicine/clerkship/
• Website for the Family Medicine Clerkship,
Syllabus can be printed or downloaded as
a PDF, or browsed for content by topic
• “Patient Centered Medical Home”
250 Biggest Mistakes 3rd Year
Medical Students Make: and
How to Avoid Them
By S.P. Desai, MD, & R. Katta,
MD
MD2B Publishing, 2007
1. Beginning the rotation without a clear sense of
what the evaluators are seeking,
Underestimating the importance of faculty
comments
2. Quickly glancing over the clerkship evaluation
form
3. Remaining unfamiliar with the goals & objectives
of the rotation
4. Not seeking a mid-rotation feedback meeting
Evaluation
Clinical faculty evaluation of student clinical
performance
Case presentation to faculty
NBME Family Medicine Subject Exam (MCQ)
Small group presentations
Clinical Encounters Database / Professionalism
Student evaluation of clerkship
Student evaluation of preceptor
Grading
50% Preceptor evaluation
30% NBME FM exam
10% Case presentation to faculty
10% Small group presentations and
Professionalism
Grading
• 93 -100% - Honors ,*,**
• 70-92.99 % - Satisfactory *
• < 70%, or preceptor evaluation indicating less
than adequate performance - Unsatisfactory
• ** limited to top 20%, and above the class mean
on NBME
• * And satisfactorily completed all the
requirements for the Clerkship.
• More to follow at the end
NBME Examination
• The NBME Shelf Exam in Family Medicine is now going
to be given electronically, through 2014-2015, it was an
older test not updated since 2011, and a paper test, this
will no longer be available in the 2015-2016 academic
year.
• The Clinical Sciences Curriculum Subcommitte decided
for 2015-2016 that a pilot setting all clerkship passing at
the 10th %tile nationally for the NBME would provide
more uniformity among clerkships.
• This was a score of around 64 based on the old paper
test. The score we will use for passing will be set by the
10th % for the NBME, based on the scores of the 1st
Rotation of 2015-2016 taking the electronic version.
Remediation
Fail by Preceptor
Re-assigned to another preceptor
– Minimum one month
Failed written exam
– Repeat exam once, either after R.3 or R.6;
– if failure with 2nd attempt, repeat four weeks
of clerkship at a site selected by the course
director and repeat NBME exam
Goals and Objectives
• Skills
• Awareness
• http://www.med.und.edu/familymedicine/clerkship/
Objectives
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Data Collection and Problem Solving
Health Promotion / Disease Prevention
Health Care Resources
Impact of Family & Culture (Social
Determinants of Health)
• Personal Strengths & Interests
Resources
• The Following are Available to meet the
Clinical Skills / Experiences we expect you
to obtain:
On-line <fmCASES> http://www.med-u.org/
On-line “Smiles for Life” – oral health
w.smilesforlifeoralhealth.org/default.aspx?tut
=555&pagekey=62948&s1=1855605
• Smiles for Life – Course 1,and Course 7
Required Clinical Experiences
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Clinical Experiences we expect to be logged:
Perform Adult, Pediatric and newborn wellness exam
Diabetes Mellitus
CV Disease
CVA
HTN
Abdominal Pain
URI
Lower Respiratory Infection
Dermatitis
Skin Lesion
Back Pain
Musculoskeletal injury
Obstetrics
Gynecology
Clinical Experiences
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Continued:
Mental Health
Headache
Red Eye
Family Dynamics *
Patient Access *
Oral Health
We expect you to meet these by seeing patients in the clinic and
logging in E*Value, it is likely you will see in some categories a lot of
patients and in others fewer or may not see them at all. If not seen,
then you will need to do an FM case or other remediation that you
log to meet the requirement.
• * Family Connection and Access to Care videoconferences will meet
the requirement for these, and do not need to be logged, but
participation is mandatory.
CE Remediation
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1. FM Case #1, or 2.
2. FM Case #12(adolescent) CLIPP case # 2,3,4
3. CLIPP Case # 1
4. FM Case # 6, Dr. Eric Johnson You tube lectures https://www.youtube.com/user/DrELJOHNSONDIABETES
5. FM Case # 9, 31
6. FM Case # 22
7. FM Case # 8
8. FM Case # 15, 19, 20,
9. FM Case # 23, 13, 9, 33
10. FM Case #13, 28
11. FM Case # 16,
12. FM Case # 16, *general workup of both benign/or malignant lesion
13. FM Case #10
14. FM Case #11, 25
15. FM Case # 12, 14
16. FM Case # 12,14, 17, 20, 32
17. FM Case # 29
18. FM Case # 18
19. Red Eye Lecture – developed online lecture You Tube / Podcast**
20. VPN online presentation participation mandatory for successful completion of FM Clerkship
21. VPN online presentation participation mandatory for successful completion of FM Clerkship
22. Smiles for Life – Course 1, and 7; or documented cases with a dentist
* benign or malignant lesion workup ** In development, will be posted to You Tube page
FM Cases
http://www.med-u.org/
– Expand experience options
– Prepare for NBME subject exam
“First Time User” http://app1.medu.org/player/app/homepage.html
• First/last names/e-mail//password
– Must use either <@my.und.edu>
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or <@med.und.edu>
Clinical Science Curriculum
Subcommittee - Assignments
Musculoskeletal examination
Dermatologic examination
Oral Health*
Essentials of Family Medicine,
6th Edition, Sloane, et al
Good orientation
Evidence-based
Musculoskeletal Exam
• U of West Alabama, Athletic Training & Sports Medicine
Center “AH 323 Evaluation of Athletic Injuries”
http://at.uwa.edu/CurrHome/AH323/skillsshoulder.asp
NEJM “Rotator Cuff Failure”, F.Matsen; May 15, 2008, Vol
358 #20, p 2138
• Coming – Online Exam Tutorials (2015
goal)
Dermatologic Examination
www.logicalimages.com/resourcesDerm.htm
http://www.logicalimages.com/educationalTo
ols/learnDerm.htm
• Review of Atopic Dermatitis
http://www.aafp.org/afp/2012/0701/p35.html
Dermatology
More sites to review Dermatologic images :
DermIS
http://www.dermis.net/dermisroot/en/home/in
dex.htm
The Electronic Textbook of Dermatology
http://telemedicine.org/stamfor1.htm
Smiles for Life
• Oral Health and its link to Systemic Health
w.smilesforlifeoralhealth.org/default.aspx?tut
=555&pagekey=62948&s1=1855605
Course 1 – Relationship of Oral
to Systemic Health
Course 7 – The Oral Examination
Additional Resources
• American Family Physician
• http://www.aafp.org/online/en/home/public
ations/journals/afp.html
• Other on-line sites
• http://www.med.und.edu/familymedicin
e/clerkship/hotlinks.html
Diabetes Updates and MiniLectures
• http://www.youtube.com/user/DrELJOHNS
ONDIABETES
Procedures
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Indications
Contraindications
Limitations
Anatomy & Physiology
Required equipment & special techniques
Complications and follow-up care
http://www.nejm.org/multimedia/medicalvideos
• Need a log in to use, try YouTube
Student/Clinical Faculty Meeting
• Planning Session
• http://www.med.und.edu/familymedicine/clerkship
/learnercontract.html
• Learner Contract
– Clinical Skills Checklist
– Previous clerkship experiences
• Revisit mid-rotation (see Mid Clerkship Feedback
form)
Learner Contract
• Student goals
Clinical Skills Inventory
• Data collection, assessment, reporting
• Health Promotion/Disease Prevention
• Acute & chronic problem management
• Preceptor goals
• Report concerns to Clerkship Director(s)
Questions to Answer
• The LCME thought it was not documented that students
were ever observed doing an H and P and did not get
feedback on their presentations, and asking for formative
feedback.
• You will need to ask your preceptor to observe you doing
a history and physical exam, and you will also get
feedback from the preceptor, but also Dr. Sherman and
Dr. Delage will give you oral and written feedback on
your case presentation.
• So when asked on questionnaire’s –”was
• I observed doing a history and physical and did I get
mid-clerkship feedback, hopefully you can answer this
positively.
Clinical Skills
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Data collection, recording, and assessment
Common problem management
Clinical procedures
Age-specific Health Risk Assessment &
Counseling
• Derm & Musculoskeletal exams
• Oral-Dental exam
Clinical Encounter Database
Clerkship – FM (except ROME students)
Home Campus
Site –
Program –
Preceptor –
Setting – (including “on-line cases”)
Age –
Gender –
(Ethnicity)
System
Role
Clinical Encounters
• You should be doing this already, but with the change in
rotation, be sure to log cases and alert us if any
problems arise early ! (first few days)
• Any questions ? How can we help ?
• You have to log and log regularly, most students log
between 250 and 400 patient encounters on the FM
Clerkship, you cannot leave this until the end, if you do
not log enough, we will deduct points from your grade.
Case presentation to Preceptor
(Before beginning presentation, identify
assessment/plan in your mind)
Convince listener (SOAP)
S: appropriate historical data
O: appropriate physical exam findings
A: identify DDx based on H & P
P: lab/X-ray/consultation/management
or SNAPPS – engage teacher by asking question
How do you elicit feedback?
SNAPPS?
Daily learning plan
SNAPPS
• 1. Summarize briefly the history and findings
• 2. Narrow the differential to two or three relevant
possibilities
• 3. Analyze the differential by comparing and contrasting
the possibilities
• 4. Probe the preceptor by asking questions
• 5. Plan management for the patients medical issues
• 6. Select a case-related issue for self-directed learning
• *SNAPPS: A Learner-centered Model for Outpatient
Education, Academic Medicine, Vol. 78, No.9, Sept.
2003, Wolpaw, T.M., Wolpaw, D.R., Papp, K.K.
Case Presentation
to clerkship director/ faculty
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Data Collection and Problem Solving
Health Promotion/Disease Prevention
Reciprocal Impact of Family and Culture
Scope of Practice
Learning Issues
http://www.med.und.edu/familymedicine/clerkship/
Mid Clerkship Feedback
• https://secure.med.und.edu/evaluations/in
dex.cfm?eval=studassessfm
Evaluations **
Preceptor Evaluation of Student
• Done through E*Value, Tracy Uhlir; e-mail
tracy.uhlir@med.und.edu; sends out a link to
the preceptor which takes them to their eval in
E*Value, you should sit with your preceptor on
one of your last days as this is sent at the
beginning of the week, and help them
accomplish and go over this with them.
Evaluations**
Student Evaluation of Clerkship
Student Evaluation of Preceptor
• Also done through E*Value, are required to be
completed before finishing the Family
Medicine Clerkship.
• Tracy Uhlir, tracy.unhlir@med.und.edu
Group Topics
• Networking/Sharing
– Focused – 5 min presentation – (prepared)
• then open for discussion for 3-4 min
• All sessions begin at 1:30 CST, but the screen
and camera need to be “ON” by 1pm, so
Brandon can complete connections
• Topics
Social Determinants of Health
• First Session - Community-Oriented Primary
Care/High Risk Populations;”Access to Care”
• Thursday, September 24th, 2015
• Second Session - "Family Connection”
- Thursday, October 8th, 2015
- related to or independent of first session
topic
Community-Oriented Primary
Care
“Access to Care”
• Outside the Office Walls
1. Syllabus –”Group Topics”, ‘2nd session’
2. “Essentials of Family Medicine, 6th ed”, Sloane et al,
chap 1, “Primary Care and the Evolving US Health
Care System”
3. “Essentials of Family Medicine, 5th ed”, Sloane et al,
chap 1, “Family Medicine in Today’s Changing
Health Care System”
Family Connection
• Keeping the Focus on “Family”
– The Family Connection
– http://www.med.und.nodak.edu/depts/fammed/Cler
kship/documents/TheFamilyConnection.doc
• chapters 46-50 of the 6th edition of “Essentials of FM”
• or chapter 32 of the 5th edition of “Essentials of FM”
texts may provide some ideas
• Patient/family you have seen on more than
one occasion encouraged, but not mandatory
Family Connection
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Example of Family Connection Material:
“Cry on Me” – Natalie Kong, M.D.
(Family Medicine 2014; 46(4):304)
Note this can also be an experience that
affected you emotionally, or led you to
reflection or reliving your own experiences.
Harley E. French Library
Resource for preceptors
– Make preceptors aware of resources
If you choose Power Point
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Not necessary, are optional but If you use; no more than one topic/slide
6x6 rule – no more than 6 lines of text and
No more than 6 words per line
Other rules, simple font, no complete
sentences, no periods, question marks,
exclamation points, and avoid ALL CAPS;
and one transition for all slides
Patient-Centered Medical Home
• We have created a separate power point
for this from Dr. Delage and Dr. Sherman
• Other lecturers:
• Aaron Garman, MD
Coal Country Community Health
Beulah, ND
Work Hour’s
• There is a policy on work hours allowed,
on the school website
at:http://www.med.und.edu/policies/studen
ts.cfm and look under Duty Hours
• If your working in the clinic and hospital and you are
averaging over the work hour limits; (shall not exceed 80
hours per week), and not getting any time for study and
self learning, please use this as a tool to inform your
preceptor of the limits on work hours that students can
engage in, and please inform the Co-Director’s if this is
an issue, as we can then work on this as a Clinical
Faculty development issue, with the preceptor.
Do We Have ?
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Your cell phone number ?
Your correct e-mail address ?
Do You have –
Our contact numbers? Bryan Delage MD (320)
760-1722, Kamille Sherman MD (701) 690-2900
• E-mail – bryan.delage@med.und.edu;
kamille.sherman@med.und.edu
• Mona Shilling (701) 777-3200,
mona.shilling@med.und.edu.
Questions ?
• Questions ?
• 1. eValue - http://help.evalue.net/adminHelp/index.cfm/tutorials/evaluegetting-started-tutorial-intro-to-pxdxtrainee/http://help.evalue.net/adminHelp/index.cfm/tutorials/evaluegetting-started-tutorial-intro-to-pxdx-trainee/
• Do we have any more interest in getting more
specifics about the grading ?
Grades
• How you will find out your grade –
• Many questions have arisen, and we felt we needed to
streamline this; we understand your need to know:
• 1. The Grades will be submitted in E*Value about 3
weeks after the end of the Clerkship from the department
of Family and Community Medicine, and the student will
be sent an e-mail alerting them that the grades have
been submitted.
• 2. NBME scores – as soon as all the scores return, you
will get an e-mail with your score recorded on it and
some information from NBME with your score attached.
This is usually about 2-3 weeks after the first rotation,
and then about 5-10 days after the other rotations.
Grades
• We set an average of 93% or above and above
the class average score on the NBME, as
Honors; and Satisfactory as above 70%, with the
caveat that all other requirements of
documentation of adequate numbers of cases in
E*Value, All Required Clinical Experiences
accomplished, participation in the 3 video
conferences, and a satisfactory score from the
preceptor; and scoring on the NBME above the
10% tile, historically a score of about 64 or
above.
Grades
• After the submission of Grades to the Assistant Deans
office, if you need to remediate a call will be placed from
the department on your remediation for this Clerkship;
and reasons.
• Your transcript will have your final grade before 6 weeks
after the end of the clerkship. For almost all of you this
will be the final grade, and if you have satisfactorily met
the requirement the worst you can get is a satisfactory.
We will review at the end of the year, and if less than
20% received Honors we will upgrade the next highest
scores in the class to Honors until at least 20% are
reached, if over 20% of the class received Honors based
on this percentage, that will not be changed.
Thanks for Your Participation
• Have a Great Day and Family Medicine
Clerkship experience !
• Make sure you get your learner’s contracts
done and seek a Mid-Clerkship feedback.
Thanks for Your Participation
• Have a Great Day and Family Medicine
Clerkship experience !
• Make sure you get your learner’s contracts
done and seek a Mid-Clerkship feedback.