Preceptor Handbook
Clerkship in Family Medicine
CFM 205
Thank you.
Your willingness to serve as a teacher is critical to our efforts to introduce Duke students to the specialty of Family Medicine. The impact of the clerkship in Family Medicine provides the ideal opportunity for future physicians to appreciate the rich and diverse profession we have chosen.
Welcome to the new edition of the preceptor handbook. This document will provide you with information about the course goals and requirements for the required second year clerkship in Family Medicine. We have also included information pertinent to teaching techniques and feedback. We hope you find this resource helpful. Your suggestions are welcome.
Joyce Copeland, MD
Clerkship Director
Key contacts:
 | Coordinator of Medical Student Programs: Jody Crabtree
| ||||||||
| Clerkship Director: Joyce Copeland, MD
| ||||||||
| ONLINE LIBRARY ACCESS |
Course Structure
Orientation
Students are required to attend orientation on campus prior to their departure for the rotation sites. Orientation is designed to give the students an overview of the course and prepare them for the required course activities. Topics include:
| A discussion of the philosophy and characteristics of Family Medicine |
| Primary care: the role of the primary care provider |
| Course goals and objectives |
| Explanation of the case report, registries and written exam |
| Grading criteria |
| Integration of the student into a busy practice |
| Legal limitations of activities |
| Precepting requirements |
| Resources available through ORPCE and AHEC |
| Etiquette |
| Self learning skills |
| Student responsibilities |
Clinical Experience
The clinical experience is the heart of the clerkship. Students should participate in the evaluation of patients and work on assessment and management skills as the course progresses. It may be reasonable to allow the student to shadow you on the first day and then increase the student's participation in the entire clinical experience.
We do not expect students to see every patient that you see. We do expect that they review each patient that they see and that they think beyond a single presenting complaint when appropriate. This includes reviewing chronic disease and prevention strategies.
Course Requirements
Students have several requirements to complete the course. Each student must select a patient (community partner) to perform a 360° patient centered review. This effort is designed to acquaint them with the complexities of caring for a patient with chronic disease. The description of this case report is outlined in the Chronic Disease Management section of the Course Requirements section. We recommend that you allow one-half day per week for work on this activity and for reading.
Two SOAP notes are to be submitted to the course faculty at the end of the rotation. The student MUST de-identify the protected health information...or receive a zero on the component. This is true of all reports related to patients.
Clinical logging is required by the LCME (the accreditation agency) in an effort to document the clinical experience. The log will be reviewed by the course faculty to see that the experience covers course clinical problem goals. They are logging clinical problems, not the number of patients seen.
Each student will complete a minimum of two clinical registries containing five patients per registry. The registries are designed to have the students learn the clinical goals and monitoring strategies in chronic disease care.
Interim evaluation
Please schedule a time to review the student's performance at mid-course. Use the form supplied by the student. It has to be submitted at the end of the course.
Debriefing
Debriefing is conducted when the students return to Duke. This session allows students to discuss their experiences at the various sites. The family visit, practice profile, interesting cases, and impressions of primary care are included in the dialogue.
Students also discuss the cases and registries they have been working on during the rotation. This is also an opportunity for the students to evaluate the course and the preceptors.
Our education specialist leads a discussion to evaluate the effectiveness of each aspect of the clerkship during debriefing. This session allows the students to present their thoughts and suggestions about the rotation with a neutral faculty member. We use data gathered during the interview to plan and incorporate concepts that might enhance the value of the clerkship experience. We will share this information with you on a periodic basis.
Course Requirements
Community Health and Chronic Disease Management (CDM)
The Department of Community and Family Medicine, Community Health Division, is providing an opportunity for students to learn about community health projects that are in communities throughout the state of North Carolina. Your student will be asking for time to visit these sites and will provide you with information about what they found.
The Future of Family Medicine goals include attention to chronic disease management and emphasizes the importance of linking to community resources to augment care and foster self-management of disease. Duke Family Medicine endorses this concept. The chronic disease management project gives students the opportunity to frame their thinking about CDM as it applies to a patient that they actually follow in their "community practice".
Patient Profile: Managing chronic disease (click on title for outline of the case report)
Each student must select a patient who has one of the target chronic illnesses. The exercise requires a focused look at patient-centered care with respect to disease management in a community setting. The principles of CDM should be reflected in the report:
-
Community resources and policies: impact on management
-
Health Systems: impact on access and barriers/aids to implementation of guidelines
-
Self-management support: identifying and promoting self-management skills
-
Delivery system design: impact on care
-
Decision support: use of guidelines, access to information, evidence
-
Clinical information systems: how does information and communication impact care and implementation of guidelines
The report will include:
|
Brief review of community demographics | ||||||
|
Identification of primary problem, co-morbidities | ||||||
|
Family pedigree and biopsychosocial profile | ||||||
|
Plan of care
| ||||||
|
Review of self-management care needs | ||||||
|
Identification of community resources | ||||||
|
Identification of access issues and brainstorm solutions | ||||||
|
Presentation of resources to patient and assessment of response | ||||||
|
Presentation of findings to preceptor | ||||||
|
Self-learning review |
Disease registry
A disease registry is a useful...and in the Future of Family Medicine, a critical... tool in managing chronic disease. We have designed several databases for the students to practice using this experience to "manage" their "population" of patients. The tools include automatic triggers related to clinical guidelines that will alert the clinician of the need to review and update guideline parameters. We are aware that a true register would include all of the patients with the target illness in the practice panel. You may certainly keep a copy of the register and ask the student to give you all the registry tools for your practice. There are no copyrights on the tools as they are "homegrown" and meant to be distributed. You may find them useful in your own performance improvement programs.
Each student is required to keep a log of two chronic diseases or preventive screening. The logs are designed to allow use as a disease registry if you would like to initiate this process in your practice.
You may also enlist the student to create a registry for your practice if your record system allows you to identify target patients with specific ICD-9 codes. The registry that our students develop as a part of their rotation only includes the patients that they see during the clerkship so it is incomplete. But, you can use it as you wish to add more patients from your practice.
You may keep any data with patient identification for your your own use but no personal health information is allowed in any report returned to us. The student will use the experience as a part of the debriefing seminar.You may wish to have several students follow the "registries" over time to measure your own practice achievements. Ask the student to give you a copy of all the registry tools if you wish.
For more information on disease registries:
http://www.aafp.org/fpm/20060400/47usin.pdf
http://www.aafp.org/online/en/home/policy/policies/d/diseasestatemgt.html
http://www.aafp.org/fpm/20060500/37esca.pdf
You are welcome to learn more about the role of this tool in the Quality Improvement process at Duke CFM's online module on Patient Safety at: http://patientsafetyed.duhs.duke.edu/
The AAFP provides you with online resources to complete Quality improvement modules while receiving CME credit. Information is available at: http://www.aafp.org/online/en/home/cme/selfstudy/metric.html
More information from AAFP:
http://www.aafp.org/online/en/home/practicemgt/quality/qitools/selectingqi.html
Preceptor Participation
We encourage the student to discuss the cases with the preceptor. You may choose to point them to available resources to review the exam issues or use the questions to stimulate a didactic discussion with the student.
A suggestion: review the exam at the beginning of the rotation. Use the topics you see in the exam as subjects for student review and discussion during the rotation. Let the student do the work. You are the expert on common problems in the ambulatory setting.
Student Evaluation
Components of the Evaluation
The learning objectives of the course are available in the student handbook and are linked above in the Goals and Objectives section.
Core abilities
| Basic medical knowledge |
| Knowledge of psychosocial and family issues |
| Knowledge of community issues and population-based care |
| Clinical skills |
| Documentation |
Problem solving skills
| Clinical decision making |
| Management plans and follow-up |
| Incorporation of health promotion and disease prevention |
Professional attributes: ATTITUDE COUNTS
| Professional demeanor |
| Patient rapport |
| Rapport with colleagues and professional staff |
| Educational curiosity and resourcefulness |
| Ability to accept and assimilate feedback |
Comments
| Your comments are truly the most valuable aspect of this form. We use the comments to recommend educational interventions and provide data to the dean when personal references are written in the student’s application for residency. Balanced feedback is the most valuable. |
ATTITUDE COUNTS: WE EXPECT THE STUDENT TO ACT IN PROFESSIONAL MANNER. IF YOU HAVE ANY PROBLEM WITH A STUDENT'S BEHAVIOR LET US KNOW IMMEDIATELY. PLEASE DO NOT WAIT UNTIL THE END OF THE ROTATION TO LET A STUDENT KNOW THAT THERE IS A PROBLEM.
Grading Scale
| The preceptor evaluation accounts for 50% of the grade. The remainder of the grade is based on the performance on the case reports, disease registry report, SOAP notes and exam. |
| Exam Format
| ||||||||||||||||||
| The skills that are assessed by the exam may include:
|
Preceptor Responsibilities
Communicate freely with the course faculty and staff.
| The Duke Family Medicine faculty and staff welcomes contact concerning student progress and are available to offer general assistance or answer questions you might have. Please contact us as soon as possible if you feel a student is not performing up to expectations or if problems arise. |
Maintain a collegial relationship with the student.
| Duke students have been very enthusiastic in their positive reviews of their family practice experience in community sites. This apprenticeship is enhanced by your willingness to accept them as colleagues. |
| The student is instructed to contact their preceptors before the scheduled rotation time to introduce himself or herself and arrange a meeting place for the first day. |
| Introduce the student to your partners and office staff and orient them to the practice on the first day. Orientation may be delegated to other members of your staff. |
Orientation Checklist
| Clinical schedule |
| Meeting place for morning |
| Critical phone numbers |
| Rounding expectations: The student cannot participate in hospital care without a formal affiliation agreement with the facility. Please contact us if this is an option for pursuit. |
| Call expectations |
| Requirements for attire |
| Location of area to store personal items |
| Daily routine of the practice |
| Precepting rules |
| Available educational resources as applicable |
| Office library |
| Hospital library |
| Any electronic resources |
| AHEC library |
| Orientation to community |
| Hospital, Nursing homes |
| Community services |
| Restaurants, theaters, and recreational facilities |
| Churches |
| Community events |
| Special characteristics of the community |
Establish a learning contract with the medical student.
| The student has primary responsibility for addressing the educational objectives of the course. You can help facilitate that process. |
| A learning contract outlines a mutually agreed upon plan of work activities and is negotiated on the first day of the rotation. |
| Review the student’s self-assessment form and previous rotation experience. The assessment form is provided to the student during orientation as a tool to help them define their level of comfort with clinical skills based on previous experience. You can use this evaluation to help you and the student agree on what he or she can realistically accomplish during the rotation and how you can provide assistance as a clinical teacher. |
Provide opportunities for supervised clinical experience.
| The clerkship is a clinical rotation and should involve as much student-patient interaction as possible. Students arrive at various stages of training and preparation. You will need to monitor each student’s clinical skills and arrange patient care responsibilities at appropriate levels. |
| Shadowing: You may want to have the student to shadow you while you see patients the first day. You can allow the student to initiate the encounter under your direct observation as time and circumstances allow. |
| It is essential that students have the opportunity to independently interview and do a focused assessment of the patient, then present their findings to you. This is not a substitute for your encounter with the patient. You can demonstrate the appropriate focused approach and critique the student’s performance by didactic interchange and by modeling good clinical skills. |
| Allow the student to participate in home visits, nursing home rounds and hospital rounds. Night call is a reasonable part of the rotation as well. We do want the student to have the opportunity to become aware of the average lifestyle of a family doctor. Call should be proportional to your obligation to the practice. |
Inform patients that a supervised Duke medical student is seeing them.
| You may have a prepared letter or sign to inform patients that you are a Duke clinical faculty member. |
| Consider having the nurse or medical assistant inform the patient that a student is working with you ask permission for the student to see the patient. |
| Patients are usually quite happy to participate in the education of future physicians. However, they always have the option to say no. |
Provide an orientation to the community and life outside the clinic.
| Community is the core of Family Practice. |
| Local health issues and resources, the health care delivery system, and the relationship between the doctor and the community is critical to the success of this rotation. |
| Invite the student to participate in or observe community and professional functions when appropriate |
Supervise the student’s completion of course goals and objectives and case study.
| Be aware of the goals and objectives of the course. |
| Help the student find a family and occupational site. |
| Discuss the CDM case study with the student and help "open doors" to community resources. |
| Review the written reports. |
Provide the student with constructive feedback: the essential ingredient for learning.
| People learn when they are provided with specific and timely feedback based on observation of behavior and skills. The feedback should be given as descriptions of specific behaviors with both positive and negative statements. Feedback should be given privately and on a regular basis throughout the rotation. |
| Review the Interim Clinical Evaluation Form about half way through the rotation. |
| See "Characteristics of Constructive Feedback" |
Perform a careful evaluation of clinical performance.
| Review chart notes and give appropriate feedback. |
| Observe the student during patient encounters throughout the rotation. Allow the student the opportunity to see patients alone and present findings to you. |
| Listen to and critique presentations. |
Document your involvement in patient care.
| The student should be given the opportunity to write S.O.A.P. formatted problem oriented notes. They will need feedback on the appropriateness and clarity of their documentation. You can determine whether or not to include their work in the clinical chart. | ||||
| Preceptors must provide documentation adequate to
demonstrate active involvement in the care of the patient. This is
a legal responsibility in the case of Medicare patients.
Student Chart DocumentationStudents need to learn how to write a succinct and competent clinical note. The student note also represents an opportunity to demonstrate his or her knowledge of the clinical problem and the clinical reasoning process. Click on this guide for Do's and Don'ts of student documentation as it relates to Medicare patients. BUT: the student note is NOT a substitute for your documentation on Medicare patients. You may wish to review the Family Practice article outlining student documentation at: http://www.aafp.org/fpm/20000500/37offt.html. We DO want students to write notes. You can decide if they will be included in the official record. You may find that the student note is a great memory aid for your dictation. Remember, students are usually more verbose and, at their stage of the game, this is quite appropriate. North Carolina Medicaid does not use Medicare guidelines for documentation. |
Student Responsibilities
| Establish a collegial relationship with the preceptor. |
| Clarify responsibilities. |
| Dress professionally and wear an identifying name tag. |
| Know the goals and objectives. |
| Identify personal educational needs or interests. |
| Ask questions. |
| Complete the learning objectives of the course. |
| Integrate into the usual work pattern of the practice. |
| Arrive on time. |
| Review the office schedule with your preceptor each day. Discuss which patients that you might expect to see during the day. Determine how much time is reasonable for you to spend with a patient. Expect to remain in the office until the session’s work is complete. |
| Provide a high level of patient care congruent with your level of training, and ask for the preceptor’s supervision and consultation whenever necessary. |
| Present findings clearly and succinctly, focusing on the reason for the visit. Use legible SOAP notes when recording data in the patient’s record. |
| Select and complete CDM case study under the preceptor’s supervision. |
| Complete training in blood-borne and airborne pathogen training as required by OSHA prior to this rotation. |
| Call early regarding problems during the clerkship. |
| The student is responsible for completing the clinical skills self-assessment at the beginning and end of the rotation. The student is also responsible for sharing his/her checklist with the preceptor at the beginning of the clerkship; this gives the preceptor information on the student’s background so that teaching can be geared to the appropriate level for the learner. The completed clinical skills self-assessment must be handed in to the course faculty at the end of the rotation. |
Absence from rotation
Duke students are expected to be present in the clinic on a schedule consistent with the routine schedule. Any absence of more than one day should be documented with the campus faculty responsible for the course. In the event of an illness or emergency that requires a more extended absence, the Clerkship Director will negotiate plans for making up for the time missed.
Duke University observes the traditional holidays of New Year’s Day, 4th of July, Labor Day, Thanksgiving and Christmas. Thanksgiving is the major holiday that the calendar interrupts the starting date of the rotation. You will be notified by the student or our staff of the expected date of arrival.
Students are to follow the category one policy of the Duke severe weather policy. This requires them to make every reasonable and safe effort to report for scheduled work in a timely fashion.
Harassment of any kind is not acceptable at Duke University. It is inconsistent with the University’s commitments to excellence and to respect for all individuals. Duke University is also committed to the free and vigorous discussion of ideas and issues, which the University believes will be protected by this policy.
Duke Hospital is a place where people of diverse
backgrounds work together, and the administration of the
School of Medicine is very interested in making sure that everyone has an equal
opportunity to learn. This
commitment to education extends to keeping the learning environment free of harassment.
Harassment, as defined
by the Duke University Harassment Policy, is "the creation of a hostile or
intimidating environment, in which verbal or physical conduct, because of its severity
and/or persistence, interferes significantly with an individual's conduct, because of its
severity and /or persistence, interferes significantly with an individual's work or
education, or adversely affects an individual's living conditions. Sexual coercion is a
form of harassment with specific distinguishing characteristics. It consists of unwelcome
sexual advances, requests for sexual favors, or other verbal or physical conduct of a
sexual nature when:
Submission to such conduct is made explicitly or implicitly a term of condition of an
individual's
employment or education; or
Submission to or rejection of such conduct is used as a basis for employment or
educational
decisions affecting an individual."
Some examples include unwanted or inappropriate comments or jokes of a sexual nature,
gratuitous references to
parts of the body, obscene gestures, disparaging remarks about a person's gender, and
inappropriate touching.
Ethnic or racial harassment may include inappropriate jokes and comments or disparaging
remarks about one's
ethnicity. Harassment may take other forms as well, and if an individual feels
uncomfortable with the learning
environment, s/he does have a way of correcting the situation. Because many students may
feel uncomfortable
addressing the subject of harassment with someone who will evaluate them, any student can
go to his/her dean
when a problem arises and discuss the situation. The dean can then see that the
appropriate action is taken.
The administration has been keeping its finger on the pulse of the harassment issue by
surveying the climate
perceived by the second-year students. The first year on the wards is a particularly
sensitive time to monitor the
environment because of the increased interaction with people in positions of power and the
more subjective
grading system. A survey regarding any sexual harassment experienced or witnessed by
MSII's is administered
twice during the second year. Departments are informed of results and monitored for
improvement.
The administration has been very receptive to additional discussion of sexual harassment.
This includes a
student-organized forum on the issue to allow students to voice their opinions and
concerns. The administration is
also very concerned about any observed or experienced episode of ethnic harassment. All of
the deans have
pledged their continuing support to reduce and ideally eliminate harassment from the
Medical Center and are
willing to take action as necessary. This administration is committed to making Duke a
place of equal learning
opportunity for all students.
The complete Harassment Policy and the Procedures for Resolution of Claims of Harassment are available for review through the Duke Personnel Office.
Duke Family Medicine works collaboratively with the Office of Regional Primary Care Education, a division of AHEC. Payment for clinical rotations is coordinated through this office. We will notify ORPCE of the student’s completion of a clinical rotation. The stipend for precepting is managed by the regional ORPCE office.
ORPCE also arranges for student housing. Problems associated with housing should be addressed to your regional ORPCE coordinator.
ORPCE DIRECTORY
The faculty of the Duke Family Medicine Clerkship conducts periodic site visits to clinical teaching practices. This gives us the opportunity to meet you and the members of your practice. It also allows the campus faculty to gather information about you, your practice, and your community. This often proves valuable in our orientation of the student to the practice and in matching students to practice sites.
Site visits are planned well in advance and at your convenience. If you wish to schedule a visit to your practice please contact Jody Crabtree at 919-681-3066
Golden Rules of the Effective Questioner
- Make sure questions are clear, concise, and specific.
- Pause to give student the opportunity to think of a response.
- Avoid lengthy questions that are more like statements than questions.
- Avoid "yes" or "no" questions.
- Use higher level questions—an excellent method for assessing the student’s ability to problem solve.
- Do not interrupt the student with a question when he or she is speaking.
Effective Questioning
KNOWLEDGE LEVEL |
KEY ELEMENT |
EXAMPLE |
VERBS |
| Information questions: Facts and data |
The ability to recall information previously encountered. | What are the causes of back pain? | Define Identify Know List Name Record Relate Tell |
Higher Level Questions
KNOWLEDGE LEVEL |
KEY ELEMENT |
EXAMPLE |
VERBS |
| Application questions: How the student uses the information and makes decision. |
The ability to apply knowledge to new or novel situations and figure out the necessary relationships. | How do you propose to manage this patient's
care? What is your follow-up plan for this patient's asthma? |
Generalize Detect Design Diagnosis Formulate Organize Plan |
| Problem solving questions | The ability to use any process or resource in solving a problem with potentially more than one answer. | How do you propose to manage this patient's care? What is your follow-up plan for this patient's asthma? |
Generalize Detect Design Diagnosis Formulate Organize |
|---|
| REINFORCEMENT TECHNIQUES | VERBAL EXAMPLE | NON-VERBAL EXAMPLE |
| Positive reinforcement | "Right!" "Good", "Fine", "Excellent",
"Correct", etc. Statement attached to the description of specific behavior |
Facial clues: smile, laugh, eye contact Head movement: nod affirmatively Body movement: move toward student when responding, write response on board, etc. |
| Positive qualified reinforcement: differential reinforcement acceptable parts of a response |
Attending: What factors do we need to consider when adjusting a
patient’s insulin? Student: I would consider the type of diet he is on? Attending: That’s correct, but what are other important factors? |
Same behavior except: Less vigorous and corresponds to the adequacy of the response. Occurs only during acceptable parts of the response. |
| Positive delayed reinforcement: Occurs for emphasis of positive aspects of a student’s response of a student’s response by redirecting attention to an earlier statement. |
"Earlier you said…." "Let’s see if we can build on that idea…" |
Reinforce student’s diagnostic ability with chart audit… Use student case as good example at clinical conference. |
ASSURES QUALITY PATIENT CARE
ASKS EFFECTIVE QUESTIONS
| asks the student questions that correlate the basic sciences, clinical sciences and behavioral sciences to the case discussions |
| asks about hypothetical situations based on the case discussions uses both problem solving and factual recall questions |
KEEPS THE STUDENT ACTIVELY INVOLVED
| gives the student adequate time in the discussions and does not do all the talking motivates the student to learn more on the subject area |
| is sensitive to the student’s feedback |
REINFORCES THE STUDENT AND PROVIDES APPROPRIATE FEEDBACK
| provides frequent reinforcement/feedback |
| uses both positive and negative reinforcement techniques |
| gives private feedback bases feedback on specific behavior |
PROVIDES NECESSARY INFORMATION EFFECTIVELY
| presentations and information is well organized |
| uses both visual and verbal methods |
| presents balance of anecdotes and data |
| provides references to the literature |
CLOSES THE ENCOUNTER EFFECTIVELY
| makes sure all questions have been answered |
| summarizes or asks students to summarize major points |
| reiterates any suggestions for reading or other instruction |
| sets up additional tutorial time if necessary |
EVALUATES HIS/HER TEACHING STYLE
| solicits feedback from peers and students |
Characteristics of Constructive Feedback
| It is descriptive rather than judgmental. By describing our own reactions, it leaves the other person free to use it or not to use it as he/she sees fit and to avoid defensive responses. |
| It is specific rather than general. To be told that one is "dominating" will probably not be as useful as to be told that "in the interview that just took place, you did not appear to be listening to what I was saying." |
| It is focused on behavior rather than on the person. It is important that we refer to what a person actually does rather than to what we think or imagine he/she is. Thus you might say that someone "talked more than anyone else in the contracting session" rather than that he/she is "long-winded". The former allows for the possibility of change; the latter implies a fixed personality trait. |
| It takes into account the needs of both the receiver and the giver of the feedback. Feedback can be destructive when it serves only the needs of one person and fails to consider the needs of the person on the receiving end. It should be given to help, not to hurt. |
| It is directed toward behavior which the receiver can do something about. Frustration is only increased when a person is reminded of some shortcoming over which he/she has no control. |
| It is solicited rather than imposed. Feedback is more useful when the teacher or the students states those behaviors which he/she would like feedback on. |
| It is well-timed. In general, feedback is most useful at the earliest opportunity after the given behavior (depending, of course, on the person’s readiness to hear it, clinic schedule, and so forth). The reception and use of feedback involves many possible emotional reactions. Excellent feedback presented at an inappropriate time may do more harm than good. |
| It involves sharing of information, rather than giving advice. By sharing information, you leave the receiver free to decide for him/herself, in accordance with his/her own goals and needs. |
| It involves the amount of information the receiver can use rather than the amount you would like to give. To overload a person with feedback is to reduce the possibility that he/she may be able to use what he/she receives effectively. When you give more than can be used, you are more often than not satisfying some need of your own rather than helping the other person. |
| It concerns what is said and done, or how, not why. The "why" takes us from the observable to the inferred and involves assumptions regarding motive or intent. Telling a person what his/her motivations or intentions are tends to alienate the person and contributes to a climate of resentment, suspicion, and distrust. It does not contribute to learning or development. If we are uncertain of his/her motives or intents, this uncertainty itself is feedback, however, and should be revealed |
-Adapted from: Constructive Feedback, A Handbook for Faculty Development, CASC/CCFI. Washington, DC, 1975.
Establishing a Learning Contract
| Communicate expectations |
| Time limitations Presentation format Location for precepting encounters that respects privacy for both patient and student Make the goals of the precepting encounter explicit |
| Acknowledge individual differences in students as learners and persons. |
| Knowledge, skills, and past clinical experience varies among students. Determine the level of medical experience through direct questioning and observation. Review the student’s clinical self assessment form. This provides a useful starting point for establishing the student’s baseline and educational needs. |
| Patient Care…The ultimate learning experience |
| The best teachers we have are our patients. The clerkship in Family Medicine should
provide the student the opportunity to interview patients, perform physical exams
pertinent to the presenting complaint, and develop a plan for evaluation and management.
The student will benefit from the opportunity to observe your interaction with the patient
during the first day of the rotation. We encourage the student to participate in the initial assessment of the patient followed by presentation of findings and discussion of patient care with the teacher. The preceptor is the ultimate authority for the permission to proceed from "shadowing" to initiating a patient encounter and presenting the patient for discussion. Student performance and the consent of the patient should determine the transition. The student should participate in all the patient care activities that are common to Family Medicine. The office is the primary clinical setting and the emphasis of the rotation should be there. Family doctors are versatile and limited only by time and desire. Allow the student to accompany you on nursing home rounds, hospital rounds and home visits. Students CANNOT participate in care in settings for which there is no affiliation agreement. The student’s schedule should reflect that of the typical family doctor as closely as possible. Discuss consultations and referrals with the student. An awareness of the criteria for sharing patient care with our colleagues and other members of the health care team is critical to their professional development. Discussion topics in this area include: selection of consultants criteria for consultation or referral communication of information: what and how consultation rates referral vs. consultation impact of third party payers on the choice of consultants methods to insure continuity of care. |
|
Topic Suggestions: Issues from the real world perspective |
Local needs for primary care and specialty services
Availability of secondary and tertiary care and referral patterns
Family, occupational, and environmental issues
Access to care Community resources
Community health issues
Lifestyle of the family doctor and the relationships between doctor and community
Health system issues
Managed care
Insurance plans
Charging and coding
Regulations
Reimbursement
| "Mini-Rounds" |
Assign clinical topics relating to the common problems. Have the student review the topic and present a brief discussion outlining the primary care aspects of the subject.
Use patients seen by the student as an incentive to pursue more information.
Share your personal strategies for efficient problem solving.
Use "thinking out loud" as a teaching tool. Be comfortable with "I don’t know". This will allow the student the comfort of responding with equal honesty.
Challenge the student to seek answers to questions and share them with you.
| Hospital and medical society education services |
Allow the student to attend hospital and professional meetings when appropriate Model the method you use to seek continuing medical education
Share the teaching role
Encourage your partners, mid-level practitioners and nurses to participate in the effort. Schedule time with the business manager, insurance office, lab, triage personnel
Allow the student to follow a patient on a consultation visit if time and circumstance allows.
Students should not participate in patient care in hospitals or nursing homes without a formal affiliation agreement with the institution. Contact us if you would like to have us negotiate an agreement.
09/13/09