Family Medicine Clerkship

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Welcome to Family Medicine! This four-week block affords students the opportunity to improve their basic clinical skills, and gives special attention to practicing the musculoskeletal exams. You will enjoy working with a variety of ages during this rotation, and focus on which preventive measures apply to which patients. Many students will work outside of the Indianapolis area and also have the unique opportunity for a ton of one on one interaction with a family med physician. Take advantage of this! Become familiar with treatment options for common medical conditions-HTN, diabetes, etc. and be proactive in trying to form your own assessments and plans. This is the best way to learn.

Your grade will be decided largely by an exam at the end of the rotation, but clinical evaluations by your preceptor will also be weighted heavily. The exam is based off of online cases, and some suggest the best strategy would be to go through each case individually and then print out the summaries for referencing closer to the exam. Don’t wait until three weeks into your rotation to start on these! There are quite a few of them and, depending on your pace and interest, can take a long time to get through. In previous years students have taken an NBME shelf for the family medicine exam, but the test now focuses specifically on the information presented in the online cases. The test is a standard paper-and-pencil exam, which is comprised of 100 questions and takes approximately two hours to complete.

Also included in your grade is participation in weekly lectures (if you are located in the Indianapolis area). No secrets here. Show up on time, be attentive, and you will have no problems. The project at the end of the rotation also needs to be completed. Ask your preceptor at the beginning of the rotation to help you identify possible patients who would be willing to speak with you at length about their barriers to healthcare and their family tree. Try not to wait until the last minute to do this, as it adds unnecessary stress to the end of the rotation if your patient is difficult to track down. Speak with your patient, identify resources in the community that may help address barriers to healthcare, and then present your findings to your peers. You will get out of this project what you put into it. Pay close attention to your specific center’s requirements, as the guidelines vary widely from site to site throughout the state.

There are several modules that must be accomplished during this rotation. Some of them you can access early, so if your vacation month is right before you do your FM rotation, make your life easier and get some of them out of the way. With everything else you have to do, getting the modules done early will really help. Towards the end, you will be focusing on your cases and finishing your final project and will be happy to have the busy work out of the way.

To succeed in this rotation it is best to be involved and proactive in your patient care. If your preceptor thinks you are interested in helping out and improving your physical exam skills, it is likely you will be allowed to do even more. Pap smears, biopsy, incisions/drainages, and other office procedures are routinely done in family medicine offices---so don’t be afraid to respectfully ask if you can get more hands on experience!

When it comes to logging the necessary encounters in, stay on top of it. It is easy to get behind, and even more annoying trying to catch up. Keep a small notebook with you as you enter each patient’s room or take the patient list at the end of the day. Quickly jot the patient’s gender, age, and chief complaint down after each encounter and enter the information at the end of each day. It is nearly impossible to remember whom you saw three days ago, so if you can’t bear to log your patients after a long day, at least you will have a reference to refer to when you do get around to completing the requirements.

Resources

If you are worried the cases will not be enough to fuel your study train, other resources students have liked in the past include:

  • American Board of Family Medicine (ABFM) Exam Prep - An application for your phone with practice questions, documents and videos
  • Case Files Family Medicine

Eugene Toy, Donald Briscoe, Bal Reddy, Bruce Britten

  • Blueprints Family Medicine

Martin S. Lipsky, Mitchell S. King

  • Family Medicine PreTest Self-Assessment and Review

Doug Knutson Some useful clinical resources include:

  • Step-Up to Medicine

You can also use this to study for your medicine rotation.

  • Pocket Medicine

Again,often used on the medicine rotation, and it is small enough to fit in your white coat pocket.


Helpful apps/websites

  • American Academy of Family Physicians (AAFP). You can google a search topic (i.e., “diabetes guidelines and AAFP”) to find journal articles that will go through pathophysiology, diagnosis, treatment, or anything else you want to know about a topic and how it relates to family practice.
  • Epocrates

You’ll use this forever. Just get it.

  • Shots by STFM

A quick way to get the CDC immunization schedules. Very helpful, especially during well-child checks. AHRQ ePSS Allows you to put in information about a patient (age, gender, smoking status, etc) and will give you the USPSTF screening recommendations. This is the group many family physicians look to for screening/treatment guidelines.