MUSC Family Medicine Rural Clerkship Syllabus

Transcription

1 (06/30/15) MUSC Family Medicine Rural Clerkship Syllabus 1

2 TABLE OF CONTENTS DESCRIPTION OF CLERKSHIP, OBJECTIVES AND ACTIVITIES... 3 OUTCOMES/GOALS FOR FAMILY MEDICINE RURAL CLERKSHIP... 3 Core Objectives... 3 Medical Knowledge... 3 Patient Care (PC)... 3 Interpersonal and Communication Skills (CS)... 4 Professionalism (PR)... 4 Practice Based and Lifelong Learning (PL)... 4 Systems Based Learning (SL)... 4 CLERKSHIP DIRECTOR, STAFF AND AHEC COORDINATORS... 4 STUDENTS AS PARTICIPANTS IN CLERKSHIP DIDACTIC ACTIVITIES... 5 Orientation / Academic Days First 2 Days of Rotation - MANDATORY... 5 Objective Structured Learning Experience (OSLE) MANDATORY (Day 2)... 5 ASSESSMENT OF STUDENT PERFORMANCE... 6 Grading... 6 The Family Medicine Exam... 7 Objective Structured Clinical Exam (OSCE)... 7 Timeliness of Meeting Clerkship Requirements... 7 Final Grades / Student Notification / Honors... 7 A SUCCESSFUL BEGINNING... 8 First Day at Site... 8 First Week at Site... 8 Clerkship Calendar OVERVIEW Requirements and Deadlines... 8 MUSC College of Medicine Third Year Student Absence Policy... 8 MUSC College of Medicine Code of Conduct... 9 Students as Learners of Clinical Medicine... 9 Family Medicine Rural Clerkship E*Value Requirements Clerkship Resources - MUSC Students as Trainees of the Population Health Perspective Patient Home Visit Template for Creating the Patient Summary (Due in Week 4: MONDAY) Practice-Based Continuous Quality Improvement (CQI) Project Template for Creating Week 3 Project Posting to Moodle Forum Template for Creating Week 6 Final Project Posting to Moodle Forum Evaluation Instruments Preceptor Student Mid-Rotation Clinical Performance Evaluation Preceptor Student Clinical Performance Evaluation Faculty Home Visit Evaluation Faculty Continuous Quality Improvement Project Faculty Timeliness of Meeting Clerkship Requirements AHEC Coordinator Evaluation of Student

3 DESCRIPTION OF CLERKSHIP, OBJECTIVES AND ACTIVITIES The Family Medicine Rural Clerkship will provide you with the opportunity to gain core competence in family medicine. Outpatient Care The clerkship emphasizes outpatient care, though your preceptor may have you seeing patients in the hospital, home, or extended care facility setting. The clerkship plays a needed role in your education, by providing you with a solid outpatient care experience. Rural, Underserved South Carolina The clerkship focuses on rural, underserved South Carolina, partly because to paraphrase MUSC s President, Dr. Cole this institution is not the Medical University of Charleston, this is the Medical University of South Carolina. You need to get away from a tertiary care institution to get a better sense of what most physicians do, and how the entire health care system functions. Regardless of where and what you will practice in the future, the knowledge that you gain of the overall health care system will always help you. Patient-Centered You will gain firsthand experience of the value of continuity how it can be part of the healing process to understand a patient within the context of his/her life history, relationships, and dreams. Much of patient care in a hospital, especially a referral-based hospital, can be the care of strangers. Knowing the person in context can improve care greatly. Accessible By the end of the clerkship, you will understand the family physician s role as the point of first contact. At the point of first access, a patient s initial presentation can be ambiguous, vague, or uncertain you will understand better why and how there can be a delay to diagnosis or referral. And you will practice playing this role, as the point for first contact. You will go in the room before your preceptor, gather the history and physical exam findings, come up with a reasonable assessment and plan, and then present the findings, your conclusions, and suggestions for the plan to your preceptor. Comprehensive and Coordinated You will understand the family physician s role in managing complexity, care that requires coordination among different health care professionals. You will appreciate that most problems can be handled in a regular doctor s office, with minimal support of labs, imaging studies, or invasive procedures. But we hope that you will also appreciate the complexities and difficulties that patients and health care providers face in managing care across geographic distances, without all the support immediately available in a tertiary care center. Core Objectives OUTCOMES/GOALS FOR FAMILY MEDICINE RURAL CLERKSHIP At the conclusion of the Family Medicine Rural Clerkship, students should be able to do the following: Medical Knowledge Describe the known pathophysiology, epidemiology, risk factors, and the course of commonly encountered conditions in family medicine (see fmcases objectives and the patient diagnoses log). (MK3, MK4) Describe the scientific principles underlying diagnostic methods, including laboratory and radiologic testing, and treatment approaches (pharmacologic and non-pharmacologic) that may be applied to major diseases and conditions. (MK5) Explain how preventive measures, health behaviors and social determinants affect disease, injury and health in individual patients and across populations. (MK7) Patient Care (PC) Demonstrate proper techniques for interviewing a patient to obtain pertinent medical history. (PC1) Perform both diagnostic and directed physical examinations in the office setting. (PC1) Formulate differential diagnoses based on patient history and physical exams in office settings. (PC2) Perform diagnostic and screening procedures utilized by primary care physicians in comprehensive patient care. (PC3, MK5) Interpret results from commonly used laboratory tests. (PC3, MK5) 3

4 Evaluate patient problems in a community and family context. (PC4) Identify how interpersonal relationships, social characteristics and cultural norms can alter the presentation and management of an illness. (PC4) Interpersonal and Communication Skills (CS) Demonstrate effective and professional interpersonal and communication skills, including interviewing patients from diverse cultural and socioeconomic backgrounds. (CS1,CS2) Identify health beliefs that differ from the traditional biomedical model. (CS1, PC4, MK7) Create clear and organized progress notes. (CS1) Evaluate the nature of the physician-patient relationship and its impact upon the management of the patient s illness. (CS2) Assess the patient and the family in the context of the bio-psychosocial model. (CS1, CS2, PC4) Professionalism (PR) Demonstrate honesty, integrity, respect, and compassion in all interactions with patients, peers, faculty, staff, and other health care professionals in all settings. (PR1) Demonstrate ethical, patient-centered decision-making and respect for the confidentiality of patient information in all settings (i.e., clinical, academic, electronic or web-based). (PR2) Demonstrate sensitivity and responsiveness to the personhood of the patient inclusive of culture, ethnicity, spirituality, gender, age, disabilities, family-context and other aspects of personal and health beliefs, practices and decisions. (PR3) Demonstrate accountability for academic and patient care responsibilities, and a commitment to continuous professional development. (PR4) Acknowledge personal limitations and mistakes openly and honestly, and critically evaluate mistakes to promote professional development. (PR5) Demonstrate a commitment to personal health and well-being, and recognize and address personal attributes, attitudes, and behaviors that may adversely influence one s effectiveness as a physician. (PR6) Practice Based and Lifelong Learning (PL) Identify the principles and tools of continuous quality improvement. (PL4) Apply continuous quality improvement principles and tools as well as population health principles to the system of care within a medical practice. (PL4, PL6) Systems Based Learning (SL) Collaborate with interprofessional students and clinicians from other health related fields including Pharmacy, Social Work, Public Health and Nursing in providing care for individual patients, families of patients, or groups of patients who share similar health concerns such as a diabetes education and support group. (SL3, CS3) Refer patients to other health professions and agencies as appropriate. (SL3) CLERKSHIP DIRECTOR, STAFF AND AHEC COORDINATORS MUSC Family Medicine Rural Clerkship Directors Ms. Marti Sturdevant Medical University of South Carolina Department of Family Medicine 5 Charleston Center Drive, Suite 263, MSC 192 Charleston, SC , FAX sturdev@musc.edu Kristen Hood Watson, MD Assistant Professor of Family Medicine Clerkship Director watsonkh@musc.edu MUSC FM Rural Clerkship Student Coordinators EMERGENCY CONTACT INFO Ms. Marti Sturdevant, Dr. Kristen Hood Watson, or Pager

5 AHEC Coordinators LOWCOUNTRY AHEC Counties: Allendale, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Colleton, Dorchester, Hampton, Jasper, Orangeburg 87 Academy Road Walterboro, SC , Fax Emily Warren cell Kim Stephens cell MID-CAROLINA AHEC Counties: Aiken, Cherokee, Chester, Fairfield, Kershaw, Lancaster, Lexington, Newberry, Richland, Union, York 1824 Hwy 9 By-Pass West, Lancaster, SC , Fax Julie Ghent cell jughent@comporium.net Jeff Cauthen cell jcauthen@comporium.net PEE DEE AHEC Counties: Chesterfield, Clarendon, Darlington, Dillon, Florence, Georgetown, Horry, Lee, Marion, Marlboro, Sumter, Williamsburg 555 East Cheves St. Florence, SC 29501, Fax Kam Richardson , cell krichard@mcleodhealth.org Traci Coward , cell , tcoward@mcleodhealth.org UPSTATE AHEC Counties: Abbeville, Anderson, Edgefield, Greenville, Greenwood, Laurens, McCormick, Oconee, Pickens, Saluda, Spartanburg 200 N. Main St, Ste 200 Greenville, SC 29601, Fax Lakesha McCutchen - cell lmccutchen@upstateahec.org Tina Fulton - cell tfulton@upstateahec.org AHEC Community Site Coordinators will meet with students within the first week of the rotation and maintain contact throughout the rotation. In most areas, site coordinators will mail welcome packets to student s home address or students prior to the rotation. AHEC Site Coordinators: Are the first point of contact for preceptors regarding medical student scheduling; Maintain a close working relationship with MUSC clerkship faculty; Arrange student housing in areas where housing is provided--site coordinators will provide students with housing details (e.g. what to bring, where to pick up key, directions, etc.); Introduce students to practice, hospital, community, and community resources; Are ALWAYS available to provide support and assistance to students and preceptors. AHEC Coordinator s evaluation of student included in this document under evaluation instruments STUDENTS AS PARTICIPANTS IN CLERKSHIP DIDACTIC ACTIVITIES Orientation / Academic Days First 2 Days of Rotation - MANDATORY Day 1 Orientation / Academic activities on campus conducted by MUSC faculty members Day 2 Morning: OSLE (see below) Afternoon: Orientation / Academic activities on campus conducted by MUSC faculty members Objective Structured Learning Experience (OSLE) MANDATORY (Day 2) Preparation on Moodle -- review the night before the OSLE. 6 learning stations with feedback from the faculty and the Standardized Patient (NOT graded). Learning scenarios and checklists will be given to students upon arrival at OSLE. Day 3 First Day at Practice; students going to sites in Berkeley, Charleston and Dorchester Counties will report to the practice by 8:30am. All other students should arrive at the practice by 11:00am. Some students will have been directed by their AHEC Coordinators to arrive earlier at another location (e.g. hospital orientation, meet the preceptor at the hospital for morning rounds the first morning, etc.). 5

6 ASSESSMENT OF STUDENT PERFORMANCE Student performance in the clerkship will be assessed through multiple methods. Students clinical performance is evaluated by the site preceptor(s). Copies of the evaluation instruments are found on the following pages. Students are also required to log online E*Value Procedures and Diagnoses to document their performance of specific clerkship objectives. Grading GRADING SYSTEM Preceptor Assessment Written Exam Continuous Quality Improvement Project OSCE Home Visit AHEC Coordinator Evaluation Timeliness HONORS PASS FAIL All of the following must be achieved: Greater than 3.5 average OR more than half of the items are ranked at highest level Greater than 1.5 Standard Deviations above the mean of reference group on first attempt Any evaluation scores that do not meet criteria for honors and do not qualify as failure are considered 'pass'. Absolute Criteria for Course Failure A clinical grade of 2.5 or less; OR a written exam grade equal to or less than two (2) standard deviations below the national norm for that exam; OR a failing grade on any secondary component of the grade. Additionally, a student is eligible for failure at the discretion of the Clerkship Director if the student receives any one of the following: one (1) or more ratings of Rarely, if ever on the CPE form; four (4) or more ratings of Inconsistently on the CPE form; any comments of concern about the professional behavior of the student. 23/32 points 24/32 points or more 14/32 points or less or less Secondary Criteria: Any of these criteria alone or in combination may constitute failure at the Clerkship Director s discretion. < 66% of checklist points (on retake) or < average of 3 for the communication items (on retake) <50% of points <50% of points <50% of points* *although one unexcused absence alone can result in failure What if a student fails some component of the grade? If student fails the written examination, the student will receive an incomplete grade and will have the opportunity to remediate that exam. The student will not receive honors for the written exam or for the course as a whole regardless of the score obtained on the remediated exam. A note will be made in the Dean s letter of the need to remediate the exam. If the written examination is failed a second time, the student must repeat the course. If a student fails the clinical component of the grade, the student must repeat the course. The Dean s letter will reflect the need to repeat the course. If a student fails a secondary component of the grade (OSCE, etc.) the student will receive an incomplete grade and will have the opportunity to remediate that portion of the grade. The student will not receive honors for the course as a whole regardless of their performance on the remediated portion of the grade. If the secondary component is failed a second time, the student must repeat the course. 6

7 The Family Medicine Exam Last Week of Rotation (Thursday) Students will report to the designated room (announced in Moodle) Exam is 100 questions; time allotted to take exam is 3 hours (180 minutes). Late arriving students will not be allowed in the room once the exam begins. A MUSC staff member will be present to proctor the exam. Special arrangements will be made for students who require additional time to take the exam (including use of private room). How should you prepare for the exam? The final examination comes directly from fmcases. A national collaborative of experts created the multiple choice question exam pool, based upon the standards of the National Board of Medical Examiners (NBME). So the format of the questions should be identical to what you expect for Step 1 and other discipline s subject exams. The best way to prepare for the exam is to complete the 40 fmcases. But, if you prefer to prepare for the exam s content using textbooks or other sources, please do. Why do we use an exam not created by the NBME? We used the NBME s family medicine subject exam for several years, and we continue to review this subject exam on a regular basis the NBME s exam does not correlate with a typical third year student s experience. Despite repeated and ongoing attempts of family medicine s national leadership to work with the NBME to improve this exam, the NBME has not improved the exam sufficiently at this time. Disconnected from the typical content learned by a student on a family medicine clerkship, the NBME s family medicine subject exam is not a valid examination. The fmcases exam is valid, because the test is directly connected to the learning activities expected on the clerkship the exam comes directly from fmcases content. And the fmcases content was created directly from the list of objectives created by the Society of Teachers of Family Medicine s Family Medicine Clerkship Curriculum task force. Objective Structured Clinical Exam (OSCE) Last Day of Rotation - Morning Education Ctr/Library Building, report to CCET on 2nd floor (specific information will be ed during Week 6). Stations similar in format to teaching OSLE. However, there will be a writing portion to the cases as well. Details will be provided to students upon arrival. Students are evaluated by standardized patients using an evaluation checklist no faculty feedback. Timeliness of Meeting Clerkship Requirements Timely attendance, communication, document submission on Moodle, online cases, and return of materials/equipment according to clerkship calendar. Failure to comply with submission of E*Value Diagnosis Summary Report can result in an automatic two points (2.0) being deducted from timeliness grade, and can trigger a comment in the Medical Student Performance Evaluation (MSPE), previously known as the Dean s Letter. Timeliness of Meeting Clerkship Requirements included in this document under evaluation instruments. Failure to comply with completion of the online fmcases can result in an automatic two points (2.0) being deducted from timeliness grade. The fmcases have an engagement score; a metric that actually reflects the student engagement in each case. The engagement meter will be visible as you progress through the cases. Students will see a "traffic light" indicator, showing red (low), yellow (medium), or green (good) depending on their level of engagement, based on different components such as multiple choice questions, key findings, differential diagnosis, summary statement, and time. You are required to complete the 33 fmcases with at least a medium level of engagement Yellow by the fifth Monday of the rotation. Final Grades / Student Notification / Honors Ms. Marti Sturdevant, Clerkship Coordinator, will submit grades online via WebAdvisor. A written evaluation with grades (to include preceptor, faculty, and site coordinator comments) will be ed to the student and submitted to the Dean s Office. (Grades will NOT be given by phone or fax.) Students receiving honors will be notified once honors are computed. 7

8 A SUCCESSFUL BEGINNING First Day at Site 1. Meet with the preceptor to discuss expectations and schedule. You have an extra copy of the pink calendar for your preceptor. 2. Tell the preceptor your goals for the rotation: I would really like to get feedback on my knee exam 3. During initial meeting with preceptor, schedule a 15-minute appointment for Week 3 to discuss your midrotation evaluation. Give preceptor the blank mid-rotation evaluation form (included in your orientation packet). First Week at Site 1. Meet with your preceptor - formulate and begin work on Practice-Based Continuous Quality Improvement (CQI) project. 2. Begin identifying a home visit patient and scheduling appointment. Things do come up, so you are strongly advised to get the visit scheduled early in case you or the patient has to cancel. Clerkship Calendar OVERVIEW Requirements and Deadlines Moodle - Students will use Moodle during the rotation to post messages on the Moodle Forum concerning the CQI project and home visit. Faculty will give feedback and guidance. If you do not post in a timely manner, faculty may not have enough time to give critical feedback on your work. WEEK 3: MONDAY Practice-Based Project proposal posting on Moodle WEEK 4: MONDAY Home Visit summary posting on Moodle WEEK 5: MONDAY Complete online cases as preparation for exam WEEK 5: SATURDAY Complete and Submit Family Medicine Diagnoses & Procedures Log WEEK 6: MONDAY Final Project due posting on Moodle MUSC College of Medicine Third Year Student Absence Policy Overview: Approved by the UCC on July 20, 2012 The expectations for quality student performance are different in the clinical training years than those of the first two years. Student attendance (both physically and mentally) is expected at all times deemed appropriate by the clerkship/course directors and the supervising physicians. Educational experiences (e.g., rounds, conferences, clinics, presentations, etc.) are not considered optional unless clearly stated. Students should strive to minimize absences. When a student must miss a required activity, the following guidelines are used. Emergency Excused Absences: In case of an emergency, the student must contact the preceptor, rotation coordinator, and the course/clerkship director as soon as possible. Students may be granted emergency excused absences under the following circumstances: Death or serious illness of a close family member (i.e., grandparents, spouse, children, siblings). Personal illness. A doctor's excuse is needed if the student is away for 2 days or longer. The Dean s office centrally tracks absences and students who have frequent absences for illness will be asked to meet with the Office of Student Affairs. Planned Excused Absences: For a planned excused absence, the student must first contact the rotation coordinator and course/clerkship director (at least 6 weeks in advance) to obtain initial approval; the student should then contact the Assistant and/or Associate Dean for Student Affairs to confirm the approval of absence. Either the course/clerkship director or the Office of Student Affairs may deny a student s request. Planned excused absences are not permitted on specific first and last days of a rotation due to orientation and exam scheduling except under special circumstances. Students may be granted planned excused absences under the following circumstances: 8

9 The student is making an academic presentation at a regional or national conference. Significant life events occur that involve a close family member, such as wedding or graduation. Time away from clinical rotations must be no more than 2 patient care days in six weeks or 1 patient care day in 3 or 4 weeks. Students are encouraged to schedule residency interviews during free periods. If scheduled during a rotation, time away must be minimal and preferably no more than 2 patient care days. Up to 2 additional days may be added at the discretion of the Course Director for interviews if the course is not a clerkship or a required core course. Procedures for Make Up of Rotation Time for Any Excused Absences: Any missed time (excused and/or unplanned) must be made up with additional clinical work/didactics at the discretion of the course director. Make up of rotation time should minimally disrupt the educational experience and the dates for the make-up of rotation time are at the discretion of the course director. In addition, for planned excused absences, students must arrange for all patient care responsibilities to be covered during the period of absence. Senior Required Rotation - Post-Match Excused Absences: After the Match, students are allowed a maximum of two days during one rotation to be engaged in residency related preparation activities (i.e., locating housing). All requests for absences with justification for time away must be approved by course directors and requests should be submitted within at least 14 days of the planned absence. Course Directors will inform the Dean s Office OSA of all emergency and planned student absences and will submit a physicianship form to the COM Dean s Office for all unexcused absences. We also realize that unforeseen events may necessitate your absence from clerkship activities. You should strive to minimize absences, but in the event you must miss a required activity Please notify Ms. Sturdevant and Dr. Kristen Hood Watson immediately, as well as your primary preceptor and AHEC Coordinator. Course Directors/Coordinators will inform Myra Singleton in the Dean s Office of all student absences granted. If you are sick and having to miss anything more than one day, please: o See a health care provider OUTSIDE of your preceptor's practice. You may NOT receive health care from anyone connected to the practice in which you are learning. Our school's accrediting body does not permit any blurring of the roles of health care provider and teacher, especially a teacher who eventually will grade your performance. We provide a list of geographically convenient health care sites for you, but you are welcome to go to a non-listed practice for your care. o Get a formal sick excuse from the provider, and send it to Ms. Sturdevant. o If you have to miss 2 days or more because of illness, then we will have to work to find clinical learning activities to make up for this lost experience. MUSC College of Medicine Code of Conduct MUSC and the College of Medicine are invested in maintaining an academic and clinical environment in which students, faculty, fellows, residents, nurses and staff can work together freely without threat of mistreatment or bias with regard to their race, color, religion, sex, sexual orientation, national or ethnic origin, age, disability or any other factor irrelevant to participation in the activities of the College. Students are responsible for reading and understanding the Code of Conduct Policy. Students as Learners of Clinical Medicine Students are responsible for learning about the diagnosis and management of common ambulatory conditions, including the delivery of health promotion and disease prevention services. Students are expected to interview and examine patients in the practice under the supervision of an attending physician. Students participation in clinical care addresses clinical knowledge and skills and cultural competency objectives. 9

10 Students are expected to conduct the initial patient interview and examination on at least 4-6 patients per half day and present their findings with an assessment and plan to the attending physician. Students are expected to write or dictate encounter notes on at least one patient seen every half day. Ask to be observed Seek out preceptor feedback to maximize opportunities for improvement. Students are also expected to participate in the full spectrum of care activities with the practice physician, e.g., attend hospital rounds, nursing home visits, etc. Students are expected to perform routine lab tests and interpret their results under supervision. Family Medicine Rural Clerkship E*Value Requirements: E*Value Procedures & Diagnoses (PxDx) Experiences Family Medicine Rural DIAGNOSES --- Number of Patient Encounters 30 diagnoses Alcohol abuse (1) Chest pain (1) Chronic respiratory disease - asthma, bronchitis, COPD (3) Congestive Heart Failure (1) Depression and Anxiety (1) Diabetes Mellitus (5) Dizziness (1) Fatigue and chronic benign pain (1) Headache (1) Hypertension (5) Musculoskeletal (1 each) knee pain, low back pain, shoulder pain Obesity (1) Pelvic Pain (1) Skin rash (1) Upper Respiratory Infections OM, OE, sinusitis, sore throat (1) Vaginitis and urinary tract infections Dysuria (2) Wounds (1) Log diagnoses and procedures at least weekly, so you do not get behind. Please note that there are 30 possible diagnoses. Log diagnoses and procedures are due the fifth Saturday of rotation. Clerkship Resources - MUSC Online Resources Diabetes Initiative of South Carolina - Cultural Competency - Blue, Amy V The Provision of Culturally Competent Health Care Reducing Medical Errors - fmcases Orientation packet Clerkship Calendar Cardiac Examination Information Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R). Helpful Tips and Reminders Diagnosis and Procedure Directions Sources of Medical Care fmcases InTIME Virtual Patient Cases - Registration Student Mid-Rotation Clinical Performance Evaluation Instrument with preceptor guidelines (for your preceptor) Student Clinical Performance Evaluation Instrument (for your preceptor) All these resources can be found in Moodle. 10

11 Students as Trainees of the Population Health Perspective Patient Home Visit: 1. Identify the patient (Ideally, the practice will help you identify a patient.) You must complete one visit with the patient IN THE PATIENT S HOME in addition to any visits in the office or practice setting. You may choose to visit either (1) A patient who has been visited by a previous student previous students summaries will be available within Moodle OR, (2) a patient who has NOT been visited by a clerkship student. NOTE: if the home visit was prior to academic year , the requirements and formatting were different from yours. Use the current syllabus requirements to create your home visit assignment. "Who will help me identify the home visit patient?" o Preceptor/practice staff can assist in arranging home visit - it varies in each of the practices. o Or, you may encounter a patient in clinic who looks like a good candidate for a home visit - you could ask if he/she would be willing to have you come to visit. Ask the preceptor if this patient would be a good candidate. o AHEC coordinators can assist you. They will sometimes direct you to a Home Health/DHEC nurse. o There may also be an interprofessional student in your area, and you two (or more) can partner together to visit the patient in the home, come up with a collaborative assessment and plan. "Who is a good candidate?" A patient who has something interesting happening in their lives some change in life situation, such as a marriage, graduation, or death some recent change in health or health care some concern about getting or taking medication some confusion on the part of the patient or the preceptor about how the patient is living, behaving, or interacting with the health care system. "What if a home visit patient cancels/project member postpones a meeting & I can't meet a deadline?" We understand that uncontrollable situations arise, but you must let us know of these situations on Moodle and BEFORE the deadline is missed! I have been trying to get in touch with my patient and she has not returned my phone calls...i will continue to try to get in touch with her. I am nervous that she will not respond and I will not get my visit. What do I do? 1. Keep trying to contact the patient. Maybe unforeseen circumstances are distracting the patient. 2. Find another patient. Some people will not refuse the request for a home visit to your face, but they do not want you to come to the house, and they will avoid both a direct refusal and actually showing up for the visit. 3. Find a patient in the hospital or office setting. Establish rapport there first. 2. Review the patient s chart to gather preliminary information about the patient health, illnesses, and control measures for any chronic conditions. Review any previous student summaries, if applicable. 3. Conduct a home visit with the patient. Contact the patient either in person during an office or hospital visit, or by phone, to arrange the home visit appointment. During the home visit, gather information from the patient and the patient s family members, if possible. This visit should NOT be for patients in nursing homes or rehabilitation centers. 4. Discuss the patient home visit with your preceptor: a. There may be some health care concerns that would benefit from intervention. Seek advice from the preceptor about next steps that might improve the health and health care of this person. b. Update the preceptor on the patient's situation, including family, home situation, medicines. You will be helping the preceptor to understand this patient better, by providing a window into this person s life outside of the hospital and physician s office. c. Your preceptor will comment on the information that you bring back to him/her. If the preceptor s comments are informative, we will incorporate this text into the written assessment that we provide the Dean s Office for your Dean s Letter. 5. Use the Template for Creating the Patient Summary (below). Please use complete sentences. Use INITIALS ONLY when referring to patients. (No names or identifying information, e.g. address, phone number, etc.) 6. Post the completed assignment on Moodle by the 4th Monday of your rotation. 11

12 Template for Creating the Patient Summary (Due in Week 4: MONDAY) To create your posting, we suggest that you simply copy and paste this template from our online syllabus and paste onto Word document. Then fill in the appropriate information using complete sentences. When complete, copy and paste (do not ATTACH) your Patient Summary into the message box of Moodle Discussion Message. -Name of practice and city/town in which practice is located -Your name (including address) and date -Title ("Home Visit Patient" followed by patient's initials) -If patient previously seen by student(s), list student name(s) and/or months visited Define the Patient Refer to Patient and Patient s Family Members by INITIALS ONLY Describe the patient: age, ethnicity, occupation, and illnesses. The patient s current medical history What are reasons that the patient sees the preceptor? Describe the current medical history. Include any markers of disease progress and measures of successful care (such as serum creatinine, Hemoglobin A1c, and LDL in a patient with diabetes). Past Medical, Social, and Family History (PMH, SH, and FH) Include where appropriate patient s understanding of causes, impact on daily life, and prognosis for any PMH issues. Include exercise likes and dislikes. Family History: Describe relationships with family members, mention the health of family members. Some questions to ask (if appropriate): Who is in the household? Who is in the family? What worries you? What are your sources of hope, strength, comfort and peace? Who would you call upon at 2 AM in an emergency, and you didn t need EMS? What if that person or those people were not available, who next? Describe the home (This visit should NOT include patients in nursing homes or rehabilitation centers.) What does the house look like, inside and outside? Use any kind of descriptive language to paint a clear picture of this person's living situation. For example, describe any photographs or decorations on the wall. Who lives nearby? If relevant, any safety issues (good lighting, nothing to trip over)? Prescribed medications Provide list of medications, with indications and dosing regimen. Monthly costs of medications. Ask permission to see the medicine cabinet, and examine the bottles, checking for presence of discontinued medications. Non-prescribed medications Ask about any regular use of over-the-counter meds, herbs, vitamins, and supplements. Describe the medicine cabinet, including expiration dates of OTC medications. Define the drivers and barriers to health for this patient Use the questions below to help you identify key areas that help or hinder the patient s health. You do not need to answer each question individually. Economic drivers/barriers: About how much do you spend on groceries per month? What kind of health insurance do you have? What are your health care costs every month? How much do you pay for medications every month? What do you give up to make ends meet / pay for your medication? What modes of transportation do you use? Education drivers/barriers: What is the highest grade in school that you completed? Use the REALM-R to assess the patient s health literacy (see handout in your student packet). Health beliefs drivers/barriers: How healthy are you? Do you believe you can be healthier? What do you believe has caused your health problems? What about your health would you like to change? What changes would you like help with? Personal reflections Offer personal reflections on the patient s overall situation. Discussed personal responses to any barriers or drivers (economic, education, or health). How has this home visit experience changed your point of view? Conclusions, future steps What conclusions can you draw about the future? What future steps do you propose? How might the health care system interact with this patient better? How might this person improve his/her health and/or interact more productively with the health care system? 12

13 Discuss with the preceptor Describe the preceptor s reactions. How will health care change in the future for this patient, based upon the information you gathered? BEFORE leaving practice - Give to preceptor or designated person, the home visit patient s initials, full name, contact info, & any other appropriate and/or unique information that might be useful to the preceptor or future students (e.g. driving directions, pets, unique cultural traditions, handicapped, special needs issues). Practice-Based Continuous Quality Improvement (CQI) Project: You will engage in a practice-focused CQI project. You will use continuous quality improvement (CQI) concepts and tools to implement and measure its effectiveness. These projects should progress as multiple students during the academic year participate in them at each site. Moodle maintains archival material about each site s community projects and the projects progress in order for students to retrieve information about projects underway at their assigned site. In addition, an AHEC community site coordinator will facilitate students work on already existing proposals/projects to provide continuity of student activity between clerkship rotations. Students will receive guidance from MUSC faculty through student and faculty Moodle Bulletin Board postings. By the end of the clerkship, students will have created a clear document of the project, available on Moodle for all present and future students. To conduct the Practice-Based CQI project, you will: 1. Review any relevant past Projects in the clerkship community/site and consult with preceptor. Select a project to continue, or initiate a new project that the preceptor supports. 2. Develop the project, maintaining progress notes about your work. Post project progress via Moodle according to clerkship calendar (see Template for Creating Week 3 Moodle Project Posting below). Faculty will reply on Moodle Forum with feedback / advice. 3. Create your Practice-Based CQI project (see format guidelines below) for the final due in Week Post in the correct forum/location. Look for the county where your site is located and then post under the practice name. Project Deadlines / Requirements Summary Deadline - MONDAY of Week 3 of rotation Post project information on Moodle Forum. Please do not attach this information in Moodle. We suggest completing the template in Word and then copying and pasting the information into the forum/post under your County/Site. Expect to receive reply/ feedback from faculty within days of posting. If faculty suggests changes, make appropriate changes and repost revisions. Continue dialogue in project thread for feedback/advice from faculty and to keep faculty updated on project. If you cannot meet the Moodle deadline, THE COORDINATOR AND YOUR EVALUATOR relating the situation and your projected action BEFORE the deadline. Timeliness is part of your final grade! Template for Creating Week 3 Project Posting to Moodle Forum 1. Topic 2. Explain the need a. Regional (local) or national data that say this problem is important. If you are continuing with work begun by a previous student, this background information may have already been summarized, and you are welcome to copy this prior summary, after verifying its accuracy. b. The ideal project focus has proof in the scientific literature that this type of intervention can make a positive difference, but sometimes evidence may be hard to find. At the least, make sure that national groups believe there might be value in this approach. Avoid a project focus that has been discouraged by such groups as the US Preventive Services Task Force or the American Diabetes Association. c. Describe how the preceptor values and supports this focus. d. If it applies to what you are doing, briefly detail the work by previous students. 13

14 3. Create the Aims a. Each aim should be a positive statement of the practice s or patients goal, e.g. Patients in the practice will improve their cardiovascular fitness. OR Patients with diabetes will have good care of their feet. b. Types of aims o Can have aims that describe an outcome like health of a population, e.g. The 6th-12th grade students in the practice will increase physical activity to reduce and prevent obesity and obesity-related morbidity. ) o Can have aims that target an improvement to the process of health care, e.g. the practice will adhere to nationally accepted guidelines for asthma care. o Can also expect to improve the relationship between groups. It can be valuable outcome, for example, that future medical students and the preceptor s practice develop a trusting, mutually beneficial relationship with community groups and organizations, e.g. the practice and the elementary school will have an improved relationship and plan future projects together. o Make sure that at least ONE of the aims relates to actual behavior, and not simply knowledge. If the project focuses mainly on the practice s involvement in community outreach through contact at a fair, you can work for behavior change within just a small, 4-6, group of patients or students. 4. Develop Measures a. The measures should match the aims--every aim should have a measure, and every measure an aim. b. Measures do not have to be numbers. The actual language for this part of the improvement plan is How will we know that a change is an improvement? The emphasis is on KNOWING, and not numbers. Information comes in many forms, and informal interviews can provide essential data. c. When the data lend themselves to numbers, plan on showing the numbers visually for your final presentation. Present a series of numbers in a table or a graph. d. Measures can track process or outcomes. For example, the practice seeks to improve care of children with asthma in the practice and the neighboring school. A simple process measure could be the number of parents who show up at a meeting. An outcome measure could be the parents knowledge of normal vs. abnormal peak expiratory flow levels. e. Make sure that at least one measure relates to actual behavior (not just knowledge.) e.g. Using the asthma example above, an outcome measure of behavior could be: The number and percentage of parents who can demonstrate correct use of the Peak Expiratory Flow meter. 5. Describe your Intervention a. What will you actually do? Who will be involved? b. Are you developing your own materials (presentation, database, etc)? OR Are you utilizing materials that have been tested in a larger sample of people, like validated surveys or presentations created for low literacy patients (always a good idea when possible). For example, the CDC website has tools for teaching students about obesity. Deadline MONDAY of Week 6 of rotation You should submit the final CQI project to Moodle. Please use complete sentences in paragraph form, and do NOT attach your project information (i.e. need, aims, measures, intervention, results, next steps, lessons learned or references) to this post; your project content is pasted into the actual post. You will only be attaching the supporting materials if you have them. Feel free to submit ahead of deadlines. Template for Creating Week 6 Final Project Posting to Moodle Forum 1. Topic 2. Explain the need 3. Create the Aims 4. Develop Measures 5. Describe your Intervention 6. Results: 14

15 What data did you collect? What did it tell you about the intervention? 7. Next Steps 8. Lessons Learned 9. References 15

16 Evaluation Instruments Preceptor Student Mid-Rotation Clinical Performance Evaluation MUSC Family Medicine Rural Clerkship Evaluation of Student Mid-Rotation Provide daily/ongoing feedback - students want specific feedback on strengths and areas for improvement. Please don't be hesitant in pointing out weaknesses to the student. Preceptors are very nice people who, by nature, only want to say, "You're doing great!" While this is encouraging to the student, students will be better served if you help them address their weakness now. If you have serious concerns about a student (skills, professionalism), PLEASE contact the clerkship director immediately; the earlier in the rotation, the better. Kristen Hood Watson, MD, director watsonkh@musc.edu Mid-Rotation Clinical Evaluation (attached) Please arrange time in Week 2 or 3 to discuss this 2-page mid-rotation evaluation with the student. This instrument is a vehicle for the preceptor and student to identify the student s strengths and weaknesses and, thereby, allow the student time for improvement prior to the preceptor s completion of the final evaluation (separate instrument) at the end of the rotation. The attached mid-rotation evaluation is not calculated into the student s grade (only the final evaluation becomes part of the student s grade). MUSC is flexible concerning the mid-rotation evaluation method preferred by the preceptor: MUSC instructs its students to provide you with a blank copy of the evaluation instrument (a timesaver for busy preceptors). Some preceptors prefer to ask the student to complete the evaluation himself/herself as a selfevaluation, then the preceptor and student discuss strengths and weaknesses on which both will work to help the student improve. Other preceptors verbally discuss the evaluation criteria, with the student writing in comments made by the preceptor. And still other preceptors prefer to complete the evaluation instrument themselves and then discuss it with the student. Please fax the completed mid-rotation evaluation to Marti Sturdevant, MUSC Family Medicine, FAX

17 Academic Year / Medical University of South Carolina College of Medicine Student MID-ROTATION Clinical Performance Evaluation The Mid-Rotation Evaluation provides an opportunity for a dialogue between preceptor and student about the student s specific strengths and weaknesses. Discussion at the midpoint allows the student time to build upon positive behavior and correct any deficiencies prior to clerkship end. This mid-point evaluation is only for feedback and does not count in the final grade. STUDENT: Schedule a 15-minute appointment with the preceptor during Week 2 or 3 of the rotation to discuss your progress. Ask your preceptor to fax the completed evaluation to Ms. Marti Sturdevant, MUSC Family Medicine, at , or to sturdev@musc.edu. PRECEPTOR: Please contact Dr. Kristen Hood Watson, Clerkship Director, immediately if you have any concerns about the student s performance. Student s Name: Rotation Dates: Clerkship: FAMILY MEDICINE RURAL Practice Name: PATIENT CARE that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Gathers a complete, relevant and accurate chief complaint and history Performs an appropriately focused and accurate physical examination Fully accepts responsibility, appropriate to the level of training, for the care of the patient ( This is my patient. ) MEDICAL KNOWLEDGE about established and evolving biomedical, clinical and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Integrates patient information with basic science information Interprets pertinent positive and negative findings accurately Accurately interprets and integrates clinical and diagnostic findings to form an appropriate differential diagnosis Develops a medically and culturally appropriate diagnostic and therapeutic plan PRACTICE-BASED LEARNING AND IMPROVEMENT involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care. Recognizes limitations, readily responds to feedback, and seeks assistance to improve Actively seeks to educate self and team INTERPERSONAL AND COMMUNICATION SKILLS that result in effective information exchange and teaming with patients, their families and other health professions. Presents relevant information in a fluent, concise and organized manner Effectively listens and communicates with healthcare team in a timely manner Effectively listens and communicates with patients and families 17

18 PROFESSIONALISM as manifested through a commitment to carrying our professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Displays integrity and honesty in medical ability and documentations Unable to Evaluate Rarely, if ever Inconsistently Frequently Nearly Always Conveys compassion and respect with patients and families Unable to Evaluate Rarely, if ever Inconsistently Frequently Nearly Always SYSTEMS-BASED PRACTICE, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Values and respects all medical team members, including ancillary staff Unable to Evaluate Rarely, if ever Inconsistently Frequently Nearly Always Functions effectively as a team member Unable to Evaluate Rarely, if ever Inconsistently Frequently Nearly Always Any mark of Rarely, if ever or Inconsistently requires comment. REMINDER: any mark of Rarely, if ever may constitute failure of the course. COMMENTS: Specific Strengths of the student s performance so far: Opportunities to Improve performance during the remainder of the clerkship: Did the student discuss his/her patient care experience logbook data with you? YES _ NO Did the student discuss his/her fmcases completion data with you? YES NO Was this evaluation discussed with the student? YES _ NO 18

19 NEW REQUIREMENT PER COM. DEANS OFFICE. PLEASE COMPLETE AND RETURN TO MARTI STURDEVANT EITHER BY FAX ( ) OR AT BY 3 rd FRIDAY OF ROTATION REQUIRED CLERKSHIP MID-POINT FORM Clerkship: Family Medicine Rural Rotation #: Date: By signing below the student agrees to the following attestation: 1. I have received midpoint feedback on my performance during the present Clerkship. I understand that the current feedback is not a guarantee to a particular grade. 2. I am working in a supportive environment that is conducive to learning. In addition, I understand that if I should encounter a negative learning environment on this rotation that I should contact the Clerkship Director to have the situation dealt with promptly. 3. My diagnosis logs have been reviewed by one of my attending physicians. I understand who to ask for help if I am unable to find a patient with a particular diagnosis. 4. My schedule has been in accordance with the College of Medicine Student work hours policy. In addition, I understand that if I should be asked on this rotation to work outside this policy that I should contact the Clerkship Director to have the situation dealt with promptly. Student Name: Signature: Date: Preceptor: I have discussed with the above student that their experience on my clerkship follows the COM student work hours policy, and is in a supportive learning environment. In addition, I attest that they have received midpoint feedback and have discussed their diagnosis logs with them. Preceptor s Name (printed): Preceptor s Signature: Date: Please FAX to: or at: sturdev@musc.edu - Marti Sturdevant, Student Coordinator Medical University of South Carolina, Dept. of Family Medicine 5 Charleston Center Dr, Suite 263, MSC 192, Charleston, SC

20 Preceptor Student Clinical Performance Evaluation Clinical Performance Evaluation (CPE) Please evaluate the student s performance based on the observed frequency of the following behaviors. Please rate the student according to the performance you expect to see at his/her present level of training in third year (i.e., first clinical rotation vs. fifth clinical rotation). Any rating of Rarely, if ever requires justification in the comment box (Question 28) provided at the end of this form. Any rating of Nearly Always should be addressed in the Proposed Comments for Dean s Letter (Question 26). PATIENT CARE that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Gathers a complete, relevant and accurate chief complaint and history (Question 1 of 30 - Mandatory ) Performs an appropriately focused and accurate physical examination (Question 2 of 30 - Mandatory ) Fully accepts responsibility, appropriate to the level of training, for the care of the patient. ( This is my patient ) (Question 3 of 30 - Mandatory ) MEDICAL KNOWLEDGE about established and evolving biomedical, clinical and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Integrates patient information with basic science information (Question 4 of 30 - Mandatory ) Interprets pertinent positive and negative findings accurately (Question 5 of 30 - Mandatory ) Accurately interprets and integrates clinical and diagnostic findings to form an appropriate differential diagnosis (Question 6 of 30 - Mandatory ) 20