| Table of Contents I. Introduction to the clerkship II. Learning goals for Primary Care Clerkship III. Formats and activities for learning in the Primary Care Clerkship IV. Learner Centered Learning Goals V. Key Faculty and sites VI General references sources VII. Required readings VIII. Guidelines for selecting patients for weekly report IX. Definitions X. Grading XI. Wednesday Sessions XII. Student Orientation I. INTRODUCTION TO THE CLERKSHIP This four week required clerkship is intended as a brief, but intensive, introduction to the world of the generalist physician. You will have other opportunities to encounter patients in the outpatient setting, and other interactions with physicians who espouse and practice the biopsychosocial, patient-centered philosophy that is central to primary care. These four weeks, however, will allow you the chance to study these approaches in detail, learn a great deal about the broad range of clinical problems encountered by the generalist, and gain a broader perspective on the role of medical care in people's lives. The core faculty of the primary care clerkship strongly endorses the eight institutional curricular goals of the medical school, and expects each student to progress during the clerkship in addressing each of these areas: 1. The Core Knowledge of Medicine 2. Clinical Data Gathering Skills 3. Information Management Skills 4. Communication Skills 5. Clinical Decision-making Skills 6. Professional Attitudes in Ethical Principles and Human Values 7. Commitment to Lifelong Learning Principles 8. Commitment to Health Promotion and Disease Prevention We have constructed the clerkship curriculum to emphasize, in particular, communication skills, clinical decision-making skills, a commitment to lifelong learning, and health promotion and disease prevention. All the institutional goals are important to the clerkship, however; their relationship to specific clerkship goals is quite evident on page 5, where superscripts refer to the institutional goals, as numbered above. II. LEARNING GOALS FOR THE PRIMARY CARE CLERKSHIP Adapted from: Lawrence RS. The goals for medical education in the ambulatory setting. J Gen Intern Med 1988;3:S15-S25. ATTITUDES Acknowledge the patient's role as an active participant in his or her own care, through recognition of the patient's perceptions of his illness and his or her priorities for intervention * 4,2,6,8 Recognize the potential of the physician-patient encounter itself as a therapeutic tool * 4,6,8 *see readings on "the scope of primary care internal medicine" and "the doctor-patient relationship" Accept uncertainty & learn to defer part of the evaluation to later visits when appropriate 5,2,3 Appreciate the cost of health care and the need for parsimony in choosing diagnostic and treatment methods 5,6 SKILLS Refine patient communication skills, with particular emphasis on counseling skills for patient instruction, education, and motivation 4,2,1,6,8,7 Refine physical examination skills; in particular, the ambulatory setting provides a good opportunity to practice fundoscopy, the ENT exam, the musculoskeletal exam, the genital exam, and the rectal exam 2,1,8 Learn to conduct a focused evaluation, rather than a "complete H & P," where appropriate 2,5,3,8 Demonstrate the ability to present a patient's problem to other members of the health care team, focusing on the main complaint and pertinent positives and negatives from the history and physical examination. Apply principles of clinical decision-making in evaluation and test ordering, demonstrating understanding of the use of sensitivity, specificity, and predictive value 5,1,3,7 Use appropriate consultation and referral, and develop the ability to succinctly present a patient's problem to other members of the health care team 3,4,5,7 Use accurate but concise and legible means of documentation in the patient record and in other written communications 2,3,4,6,8 Demonstrate the ability to counsel a patient on preventive health measures, including healthy diet, exercise, and immunizations. KNOWLEDGE Learn to manage common problems encountered primarily or exclusively in the ambulatory setting 1,5,3,7 e.g. hyperlipidemia, fatigue, common psychiatric problems in primary care, rashes, low back pain, upper respiratory infections, vaginitis, contraception Develop a broader perspective on diseases also commonly seen in the hospital 1,5,3,7 e.g. hypertension, diabetes, HIV infection Understand principles of health promotion and disease prevention 1,8,7 e.g. the periodic examination, immunization, smoking cessation, nutritional counseling Understand the basic principles of medical economics in the United States, particularly as they relate to payment for and access to ambulatory services. In addition to the above, the following is a list of specific learning objectives that we expect you to know by the end of the Primary Care Clerkship. Given a patient who smokes cigarettes, outline a smoking cessation counseling plan, based on the Agency for Health Care Policy and Research Clinical Practice Guideline for smoking cessation. Given a patient who smokes cigarettes, counsel the patient on use and side effects of Buproprion nicotine patch and nicotine gum. Describe the mechanism of action and side effects of a) HMG CoA Reductase inhibitors, b) bile acid resins, c) nicotinic acid, d) fibric acid derivatives, e) ezetimibe. Describe each of their effects on the lipid profile. Describe the indications for TLC versus medications given a patient’s cholesterol valves and medical history. Describe criteria necessary for a diagnosis of hypertension. For each of the following classes of hypertensive medications, list side effects, indications, and demographic features (age, race, comorbid diseases) associated with greater therapeutic effectiveness: a) Beta blockers b) Thiazide diuretics c) ACE inhibitors d) Calcium channel blockers e) ARB’s. Define malignant hypertension Given an overweight patient with hypercholesterolemia and hypertension, list specific dietary measures which will help a) reduce weight b) lower cholesterol c) control hypertension. List the characteristics of a) migraine headache b) tension headache c) cluster headache. Outline acute therapy for each of these three types of headache. Given a patient with acute low back pain, compare and contrast the history and physical examination most consistent with a) lumbosacral strain b) sciatica. Describe therapy for lumbosacral strain. Given a patient with acute low back pain, list indications for obtaining a plain film of the lower back. Define role for advanced imaging e.g. MRI. The student should be able to list the common diagnoses presenting as shoulder and knee pain to the primary care office and know which diseases present in certain patient populations. The student should be able to perform an adequate shoulder and knee exam and know the names of the physical exam maneuvers used in each exam. List criteria for diagnosing diabetes mellitus. List the classes of oral hypoglycemic agents and describe their mechanism of action and associated side effects. Given a patient with adult onset diabetes mellitus, describe preventive measures for a) foot care b) immunizations c) diabetic nephropathy d) diabetic retinopathy e) diabetic neuropathy. Given a patient with acute chest pain, compare and contrast history and physical examination characteristics associated with a) coronary ischemia b) musculoskeletal chest pain c) gastroesophageal reflux. Define somatization disorder. Outline an effective approach to the care of a patient with somatization disorder. List at least eight verbal or nonverbal clues that make a diagnosis of somatization more likely. List signs and symptoms of irritable bowel syndrome. Outline a treatment plan for a patient with irritable bowel syndrome. Describe the clinical presentation of acute and chronic sinusitis and outline an appropriate treatment plan. Compare and contrast symptoms and physical exam findings consistent with a viral upper respiratory infection vs. streptococcal pharyngitis. Given a patient who complains of sore throat, describe indications for obtaining a rapid streptococcal screening test. The student should know the prevalence of upper respiratory infections presenting to the Primary Care Practitioner. The student should know how to diagnose and treat rhinosinusitis. The student should be able to explain the mechanism of antibiotic resistance in upper respiratory infections. To understand antibiotic resistance mechanisms and the impact on primary care physicians. Given a patient with a urinary tract infection, define an "uncomplicated" urinary tract infection, and list examples of a "complicated" urinary tract infection. Describe a cost-effective approach to the diagnosis and treatment of an uncomplicated urinary tract infection. Compare and contrast signs and symptoms of viral, bacterial, and allergic conjunctivitis. Outline a treatment plan for a) viral b) bacterial c) allergic conjunctivitis. Know the signs and symptoms of hyperthyroidism and hypothyroidism. Know the etiologies of hyperthyroidism and hypothyroidism. Gain an understanding of the labs and studies used to diagnose thyroid disease. Know the work-up of a thyroid nodule. Understand how to treat hyperthyroidism and hypothyroidism. Know how to classify and define osteoporosis. Know the risk factors for developing osteoporosis. Know the screening guidelines for osteoporosis. Understand how to diagnose osteoporosis Understand the strategies for preventing and treating osteoporosis. Compare and contrast signs, symptoms, and simple lab findings of a) bacterial vaginosis b) candida vaginitis c) trichomonas vaginitis. Outline treatment for a) bacterial vaginosis b) candida vaginitis c) trichomonas vaginitis. Outline the immunization schedule for a well infant. List indications for a) influenza vaccine b) pneumococcal vaccine c) hepatitis B vaccine in the adult patient. List the U.S. Preventive Task Force Guidelines for screening for breast, prostate, cervical, and colon cancer. List the relative benefits for patients (example: years of life saved) associated with screening for breast, prostate, cervical, and colon cancer. Define test sensitivity, specificity, and positive and negative predictive value. Be able to list at least five (5) tactics used by Pharmaceutical companies to influence physician prescribing Describe what limitations the FDA has over controlling direct marketing to patients Describe the typical time course for rare, serious side-effects to surface after a drug is released on the market.
III. FORMATS AND ACTIVITIES FOR LEARNING IN THE PRIMARY CARE CLERKSHIP Experiential learning with preceptors -- You will spend a total of seven half-day sessions per week in office settings; for most students there will be a combination of two office sites (e.g. three sessions per week at one site and four at another). One faculty member will be primarily responsible for your supervision at each site. You will participate in patient care activities through a combination of independent interviews and examinations with faculty supervision and encounters carried out side-by-side with the preceptor. Weekly Report patient care conference - a weekly conference, led by a faculty facilitator who will be with the group throughout the month, where students will present patient problems encountered at their office sites. The format will assure that all students are involved in discussion of essential topics in primary care, and allow you to share the perspectives gained at different office sites. Focus Seminars: topics in primary care -- didactic presentation/discussion of core issues in primary care that are difficult to address solely through independent study. These would include (a) somatization and other psychosomatic disorders, (b) smoking cessation, and (c) screening and prevention issues. Learner centered learning goals -- You will be expected to identify, in the second week, three or more specific skills, knowledge areas, or attitudinal perspectives for self-study during the rotation (see page 11). These goals, and your anticipated means of addressing and evaluating them, will be recorded and shared with the core faculty facilitator and with your office preceptors. Progress in this and other aspects of the rotation will be assessed in the third week with the core faculty facilitator. Cases -- Two sets of cases, representing common outpatient problems will be handed out during the orientation. These cases and their accompanying objectives will be discussed in a group format during two separate sessions. Please see the monthly schedule for the times and dates. Students are asked to review the cases and come prepared to discuss the cases and objectives on the first and second Wednesday of the clerkship. Clinical Skills Exam -- You will be required to participate in a clinical skills exam using standardized patients on one Friday afternoon of the clerkship. This will take place in the Clinical Education Center (CEC) and be modeled after the new USMLE Step 2 CSA. This exercise is formative (not graded) but is required. You will perform a focused hx and physical exam on two patients presenting with acute medical problems. One case will have an advanced communications topic embedded into it. You will then write up your findings, received feedback from the standardized patients and have the opportunity to watch your own videotaped encounter. Faculty from the clerkship will provide individual feedback at the end of the session. Web Based Dermatology Module - As a part of your Primary Care Clerkship you will be required to access a Dermatology teaching module via the Blackboard system. You will be able to access the website and review the material at a time convenient to you before the end of the rotation. You will be tested on the material and the estimated time that the module takes to complete is about 90 minutes. Your grade will be incomplete until the module is completed. You will be able to access the course documents for the blackboard course site with your net ID once I have entered you into the course. The course requires you to use Internet Explorer. If you do not use Internet Explorer you can access the site from the computers in the Galter Health Sciences Library.
IV. LEARNER CENTERED LEARNING GOALS There is no better way to learn than by identifying your own needs and priorities. You are now well into the core clerkships, and very likely have discovered areas in which you are particularly interested, things you feel you didn't have time to adequately address during earlier clerkships, and topics, skills, work habits, etc. that you feel don't come naturally and need special attention. We ask that you identify for this clerkship at least three such items that you would like to focus on. List them as either a knowledge area, skill, or attitude on the sheet below. Include how you expect to address this issue during the clerkship, and how you (and/or we) will know that you have achieved your objective. These sheets will be kept by you, by the month's core faculty facilitator, and by your office preceptors (it is up to you to give it to your preceptors). You will be asked to identify your three learning goals, your means of attainment, and how you will measure by the beginning of the second week of the clerkship. You will then need to e-mail them to Dr. Jennifer Bierman at jbierman@nmff.org. On the third Wednesday of the rotation each student will briefly present to the facilitator and the group how they achieved their learning goals. Your efforts in addressing these goals, as evaluated by you and your supervisors, will constitute 15% of your grade for the rotation. Grading: Grading for the principal Goal will be based on the oral presentation and the handout. Grading of the other two Goals will be based on the handouts. Handouts: You should prepare a handout for each Goal. The written part of the handout should be one page long – this is the optimal length, since distilling information to the essentials is an important skill. References may be listed on a separate page. If a diagram or table is essential to the topic, you may also include this on a separate page. The handouts are due by the third week at the LCLG presentations. Handout content: Knowledge topic: describe the important information you learned. Structure the handout so the other students can use it as a learning tool. You can include diagrams or tables if you feel they are a useful learning aid for the particular topic. If you cite data from research studies, try to number the references and use footnotes so that students who want to learn more about the topic can easily find the articles with the relevant information. Skill topic: describe the skill you want to improve; tell what you did to improve it and if appropriate, how you tracked your improvement. It may be helpful to outline the steps involved in performing the skill you are trying to improve. Attitude topic: describe the source/cause of your initial attitude, what you did to try to change your attitude, and how it changed. How did you measure the change? If it did not change, why not? You may include anecdotes if it helps explain the topic. References: include references at the end of each handout. One reference is the minimum; most students cite 2 or 3 references, occasionally more if the topic warrants it. Copies of handouts: - Make copies of the principal Goal (long presentation) for each student in your group; you can use the department’s copier. The code is 54985.
- Post all ll three handouts on Blackboard - remember to put your name at the top of each handout
Presentation format: The principal Goal will be presented orally to your group. The presentation should take no more than 8 minutes, (unless your preceptor allows more time - depending on class size). The use of lecture aids (overheads, slides, etc.. ) is optional; however, if you are presenting a topic that is highly visual (such as “review of knee anatomy”) then a diagram on the handout can be helpful. Contact Damaris Cintron in advance if you will need to use an overhead projector, or slide projector. If you need an LCD projector, you may rent one at the Library’s resource center by using your Wildcard.
You can state to the group what your other two LCLG’s were, but you will not be required to present them to the group. The grade for these will be based on the handouts and will be graded by your group’s preceptor. V. KEY FACULTY AND SITES Clerkship Administration This clerkship is a collaborative effort of the Department of Medicine, the Department of Pediatrics, and the Department of Family Medicine. Responsibility for clerkship administration, however, resides within the Department of Medicine. The following people are responsible for organizing and directing the clerkship: Clerkship Director: Jennifer Bierman, MD Division of General Internal Medicine 675 N. St. Clair, Suite 18-200 Jbierman@nmff.org Clerkship Co-Director: Gary Martin, MD Division of General Internal Medicine 675 N. St. Clair, Suite 18-200 Gmartin@nmff.org Administrator: Damaris Cintron 676 N. St. Clair, Suite 200 Chicago, IL 60611 (312) 695-0957 d-cintron@northwestern.edu Family Medicine Faculty: Mark Macumber, MD m-macumber@northwestern.edu Rebecca Weiss Coleman, MD Rweiss@enh.org Robert Wolfe, MD r-wolfe@northwestern.edu Core Faculty: Two core faculty members will be responsible for the patient care conference in each week of any given month. One of the Family Medicine faculty will also be responsible for running and grading the learner centered learning goal presentations. These faculty will include: Gary J. Martin, MD - Dept. of Medicine Jennifer Bierman, MD - Dept. of Medicine Mark Macumber, MD - Dept. of Family Medicine Rob Wolfe, MD - Dept. of Family Medicine Rebecca Weiss Coleman, MD - Dept. of Family Medicine
Preceptors: You will be assigned to office-based faculty in family practice, general internal medicine, and pediatrics. Many of these preceptors practice individually or in small groups, making it impossible to list them all here. VI. GENERAL REFERENCE SOURCES This annotated listing of reference sources is meant to guide your reading on areas from the core topics list, and on problems you encounter in the office. Given the regular hours of this rotation, and the absence of night call, you should have plenty of time for reading. Copies of some of the textbooks, including Barker's Principles of Ambulatory Medicine and Cohen-Cole's The Medical Interview, are available in Damaris’ office call 312-695-0957. To facilitate your reading, you may sign out one of these copies. To do so, you will be required to sign a statement assigning you the responsibility for the book; if the book is not returned at the end of the rotation, or is returned in poor condition, your grade for the rotation will be noted as "incomplete" until you replace the book. Arrangements for book sign-out may be made through your core faculty preceptor. Textbooks Goroll AH, May LA, Mulley AG. Primary Care Medicine (5th Ed). Philadelphia, J.B. Lippincott, 2006. A problem oriented organization addressing adult medicine. Reilly BM. Practical Strategies in Outpatient Medicine. 2nd Ed. Philadelphia: WB Saunders, 1991. Not a comprehensive textbook, but instead offers detailed, readable, and practical discussion of 22 selected common problems in adult ambulatory care. Barker LR, Burton JR, Zieve PD. Principles of Ambulatory Medicine, (6th Ed). Baltimore, Williams and Wilkins, 2002. (1900 pp) A readable and coherently organized text; useful overall for general internal medicine and family medicine issues, but doesn't address pediatric issues. The first section, "Issues of general concern in ambulatory care," could stand alone as a treatise on the craft of practicing primary care medicine. Reference Manuals Dornbrand L, Hoole AJ, Fletcher RH. Manual of Clinical Problems in Adult Ambulatory Care. Boston, Little, Brown and Co. 3rd edition, 1997. The ambulatory equivalent of the "Wash U. Manual." An excellent quick reference for the office setting. The annotated references are of particular help. VII. REQUIRED READINGS FOR THE PRIMARY CARE CLERKSHIP The Gorroll text (see previous page) is cited here as the primary reference source for most topics. When another of the general texts is particularly good on a topic, that citation is given as an alternate reading. For some topics, the best source is a journal article; each of these is included on the pages immediately following. Once again - these are the required readings, but we also want you to read as much as possible on other problems you may encounter in your patients, using the objectives on page 6. Clinical preventive medicine Goroll Chapter 3 (p. 18) Guide to Clinical Preventive Services: Report of the U.S. Preventive Services Task Force. A brief introduction to the Task Force approach is followed by representative tables from the report. (Tab 1) Health Maintenance and Screening Goroll Chapter 3 (p. 18) Common psychiatric problems in primary careGoroll Chapter 230 (p. 1371) Barsky, Arthur J. A 37 Year-Old Man with Multiple Somatic Complaints: Clinical Crossroads. JAMA 1997;278:673-679. (Tab 9) Quill TE. Somatization disorder: one of medicine's blind spots. JAMA 1985;254:3075-3079. (Tab 9) Fatigue Goroll Chapter 8 (p. 47) Hyperlipidemia Goroll Chapter 27 (p. 190) Gorroll Chapter 15 (p. 96) Drugs for Lipids. Treatment Guidelines for The Medical Letter. Vol. 3 (Issue 31), March 2005. (Tab 7) Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) JAMA 2001;285:2486-2497. (Tab 8) Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. (Tab 8) Hypertension Goroll Chapter 14 (p. 93) Goroll Chapter 19 (p. 117) Goroll Chapter 26 (p. 175) Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (Dash) diet. NEJM 2001; Vol 344: Number 1, January 4, 2001. (Tab 6) Immunizations in adults Goroll Chapter 6 (p. 27) Irritable Bowel SyndromeGoroll Chapter 74 (p. 552) Low Back Pain Goroll Chapter 147 (p. 955) Pharyngitis Goroll Chapter 220 (p. 1310) Sinusitis Goroll Chapter 219 (p. 1306) Smoking cessation Identification and Assessment of Tobacco Use. Treating Tobacco Use and Dependence: Quick Reference Guide for Clinicians. October 2000. U.S. Public Health Service (Tab 10) The scope of primary care Hughes JS. Medical art and medical science: an exhortation to students on primary care. J Gen Intern Med 1989;4:48-53. (Tab 3) Sexually Transmitted DiseasesDrugs for Sexually Transmitted Diseases. Treatment Guidelines from The Medical Letter Vol. 2 (Issue 26) – October, 2004. Algorithms Headaches Goroll Chapter 165 (p. 1077) Sinusitis Goroll Chapter 219 (p. 1306) VIII. GUIDELINES FOR SELECTING PATIENTS FOR WEEKLY REPORT Any patient you find interesting is fine but examples of characteristics that are good for discussion include: · Patients with Common Problems. Such presentations generate meaningful discussion of the outpatient management of commonly encountered problems such as cholesterolemia, diabetes, hypertension, etc. · Patients where multiple diagnoses were possible initially (ex: chest pain, dizziness, shortness of breath, headache). · Patients where tests to get could be debated. · Patients facing tradeoffs between 1) risks & benefits of surgical vs. medical treatments, or 2) quality of life vs. immediate although small risk of death. · Examples of errors or surprises we can learn from (ask your preceptors to share these stories with you). Patients you are seeing now may have been good examples that we can learn from with the retrospectoscope; the true diagnosis eventually surfaced. · Psychosocial issues that impacted on the patients’ clinical situation or doctor-patient relationship. Please read on a topic relevant to the case you are presenting and be prepared to share information with the rest of the group. You may choose any aspect of the case to discuss: Sensitivity or specificity of a test you used, prevalence of signs or symptoms for a disease, efficacy and side effects of a treatment you recommended, interesting pathophysiology. Your presentation will necessarily be brief (2-3 minutes) to enable all students to present. You will be assigned to present a case during three of the four weeks. Those assignments will be available at orientation. Please make sure you check this schedule so that those assigned will be ready to present the first week. IX. DEFINITIONS (for Evidence-Based Medicine) Prior probability = the likelihood of disease before a given test result is available; example: risk of colon Ca before hemoccult screening. Conditional probability = the probability of a finding among patients with a known disorder; example: tremor in patients that are hyperthyroid or a positive hemoccult in patients with colon cancer. Post-test probability = the likelihood of disease after test results are known; example: a patient with a positive hemoccult after screening for colon cancer. Sensitivity = proportion of patients with X disease having a positive test result for X. Sensitivity = 100 * TP / (TP + FN) Specificity = The proportion of patients without disease having a negative test result. Specificity = 100 * TN / (TN + FP) Positive Predictive Value = Given a positive test, the likelihood of having disease. PPV = 100 * (Prev * Sens) / (Prev * Sens + ((1 - Prev) * (1 - Spec))) Negative Predictive Value = Given a negative test, the likelihood of not having disease. NPV = 100 * ((1 - Prev) * Spec) / ((1-Prev) * Spec + (Prev * (1 - Sens))) ABBREVIATIONS: TP=True positives TN=True negatives FP=False positives FN=False negatives Prev=Prevalence Sens=Sensitivity Spec=Specificity More details regarding these terms can be found at the ACP web site at: http://www.acpjc.org/shared/glossary.htm X. PCC EVALUATION POLICY Overall scores will be determined by the following method: Clinical Performance: 40 points Weekly Report: 25 points LCLG: 15 points Exam: 20 points There will be 4 general categories: HONORS, HIGH PASS, PASS, FAIL *please see full descriptions of these students following PASS: Full attendance in the office and weekly Wednesday sessions are mandatory, but not sufficient, for a passing grade. All students must attend CSA, complete the dermatology module and return the Mid Clerkship feedback form. In addition to full attendance, students must demonstrate a minimum proficiency in all aspects of the clerkship; their cumulative point score must be greater than 65. A final examination percent score of 65% is required as well. HIGH PASS: In addition to the above these students will generally have excellent evaluations from their preceptors and above average scores in Weekly Report and on their LCLG presentations and handouts. Their total point score is > 80 and a final examination percent score of 80% is required as well. HONORS: In addition to the above these students will receive predominately outstanding evaluations from their clinical preceptors and must excel in all other areas of the clerkship. For example, in Weekly Report, honors candidates are those students who have retrieved and effectively summarized articles relevant to the topic they are presenting. Their total point score is >83 and a final examination percent score of 85% is required as well. FAIL: These students clinical performance is below expectations for a similar student at their level of training as described by their clinical and/or Weekly Report preceptors. Any clinical performance score less than 4 is sufficient to mandate a failure. They may have substandard LCLG projects. They may fail the examination (score <65%) OR their cumulative point score is <65. Students may also fail for professionalism issues i.e. dishonesty, unexcused absences or other inappropriate behavior despite their cumulative scores. * General Descriptions of students** Honors Students: Accountable, professional and motivated. Generally are able to consistently perform a complete history and physical even on complicated cases. They are able to present this patient in a well organized including retrieving pertinent information from the medical record. They are easily able to determine important issues in “acute” type primary care visits and be able to focus their history, physical and plan accordingly. Have an exceptional knowledge base and are able to formulate differential diagnosis, diagnostic and often therapeutic plans. They are independent learners continuing to read extensively and use the literature to advance their knowledge base. In Weekly Report they are active participants adding to the differential diagnoses of other students’ patients, using excellent knowledge base to offer sound diagnostic, therapeutic options. On their own patients they can review the differential clearly for their peers, they bring in relevant original articles and briefly summarize key points for their peers. Their LCLG projects reveal extra effort with good references, thoughtful insights or conclusions. Their handouts and presentations are well organized and succinct. Honors is considered if their cumulative point score is >83 and their final examination score is >85%.
High Pass Students: Accountable, professional and motivated. Generally are able to consistently perform a complete history and physical on routine patients, occasionally on complex ones. They are able to present this patient in a well organized fashion. They frequently can determine important issues in “acute” type primary care visits and be able to focus their history, physical and plan accordingly. They may need help with this skill initially but are able to do this by the end of the clerkship. Have a solid knowledge base and are able to formulate differential diagnosis, they may need help to formulate diagnostic and therapeutic plans. They are independent learners continuing to read extensively and use the literature to advance their knowledge base. In Weekly Report they are active participants often adding to the differential diagnoses of other students patients. They occasionally offer sound diagnostic, therapeutic options. On their own patients they can review the differential clearly for their peers. Their LCLG projects reveal good effort with solid references. Their handouts and presentations are well organized and succinct. They elicit and respond to feedback by improving their performance. Honors is considered if their cumulative point score is >80 and their final examination score is >80%.
Pass: Accountable, professional and motivated. They pass the examination i.e. percent score >65. They are able to perform complete histories and physicals on most Primary Care patients by the end of the clerkship. They should rarely miss pertinent positive historical elements, physical findings except on complicated patients. Physical Examination skills should reveal good technique but may occasionally need help with subtle physical findings. Oral presentations/ write ups should be organized, accurate but occasionally missing minor details. In Weekly Report they are engaged in the discussion and contribute to the differential on many patients. They may need help formulating the differential diagnosis and therapeutic plan on some patients. On their own patients they should be able to clearly review the differential and explain their rationale for their workup and plan. They should give some further information on their patients diagnosis. They continue to read and to improve their knowledge base. They elicit and respond to feedback by improving their performance.
Fail: These students often have clinical skills that are reported to be below expectations i.e. they often cannot do complete histories and physicals even on routine cases. They have difficulty differentiating pertinent issues in the primary care setting. Their presentations and writeups may be disorganized and incomplete. They may have poor participation in Weekly Report less frequently adding to the differential diagnosis or being inaccurate. They may fail the examination. These students cumulative point score falls below 65. Students may also fail for professionalism issues i.e. dishonesty, unexcused absences, or other inappropriate behavior despite their cumulative scores.
** As always these are general descriptions and are subject to the clerkship directors discretion based on circumstances. XI. Wednesday SESSIONS (These vary slightly from week to week. Please check your separate schedule of Wednesday sessions for details pertinent to your specific clerkship rotation) 8:00 AM - 10:00 AM - Didactic sessions. 10:00 AM - 12:00 PM - Weekly Report 12:00 PM - 1:00 PM - Lunch Break 1:00 PM – 4:00 PM - Cases, or other seminars
A Primary Care Clerkship Orientation will be held the first Monday of the rotation from 9:00 AM to 12:00 AM. Students will share their progress on their learner centered learning goals on the third Wednesday between 8:00 and 10:00 AM. All students will take the final exam at a time to be announced. The exam will take about 45 minutes. All students are required to complete an evaluation of the clerkship. The website is: https://fsmweb.northwestern.edu/weinberg/ome_eval/sceEvaluator/login.cfm XII. STUDENT ORIENTATION 1. Clerkship Goals: (See page 5 for additional information) Introduce students to commonly encountered problems in primary care Develop commitment to principles of life-long learning Learn principles of medical decision making, including sensitivity, specificity, predictive value, pre and post-test probability and apply them to medical practice. Develop and improve communication skills Develop an appreciation for cost-conscious medical practice Understand principles of disease prevention and health promotion Appreciate the primary care physicians commitment to health in all aspects of the patients’ life
2. Why All Students Regardless of Specialty Choice Can Benefit from the Clerkship. a. Interpersonal/communication skills: Increase effectiveness of data gathering and compliance with instructions. Improve quality of medical care delivered Improve patient-physician relationships for both patient and physician. Decrease malpractice suits
b. Clinical reasoning skills can be helpful with all Dx and Rx decisions.
3. Weekly schedule a. Weekly report b. Communication Skills c. Didactic sessions d. Learner Centered Learning Goals e. Office time
4. Preceptors a. Time management (be conscious of preceptor's need to remain on schedule) b. Bring information to them. Share articles you have pulled, items discussed during Wednesday sessions where relevant. c. Preceptors should know your learning centered learning goals d. Try presenting to preceptor in presence of the patient, but be appropriately discreet when doing this (AIDS, cancer, chronic debilitating disease).
5. Grades (see page 21) | 
