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Family Medicine

Objectives Readings/Assignments Evaluations/Assessments Student Presentation

Family Medicine - Handbook (PDF)



 

Objectives:

Knowledge and Lifelong Learning

By the conclusion of the Family Medicine clerkship the student will:

Demonstrate knowledge in the clinical sciences appropriate to the discipline of Family Medicine, integrating the basic sciences as indicated.

  1. Demonstrate knowledge of the fundamental principles of diagnosis and management of common outpatient problems which present to the family physician.

  2. Develop diagnostic assessments and management plans for common ambulatory illnesses utilizing clinical problem-solving techniques.

  3. Develop the capacity for self-directed learning as evidenced by:

    1. Exploring the medical literature regarding cases seen in the preceptor sites.

    2. Read pertinent articles about outpatient topics seen in the office or discussed in didactic sessions.

    3. Perform an in-depth examination of a topic of interest in preparation for the major talk.

    4. Develop knowledge of the socioeconomic and cultural influences on health and healthcare delivery to all patient populations.

  4. Participate in patient care of a continuing nature, including follow-up of cases and preventive health techniques, by spending four days per week in a Family Medicine setting.

  5. Attend to hospitalized patients with their preceptor when appropriate.

  6. Advocate for quality patient care and assist patients in dealing with system complexities, recognizing the barriers to coordination of health care and recommending improvements.

  7. Participate in a community service experience during the rotation. Identify psychosocial, cultural, familial, spiritual, economic, legal, and political factors affecting healthcare and respond by advocating for appropriate action needed for individuals and communities.

  8. Demonstrate sensitivity and responsiveness to patients’ culture, ethnicity, age, gender, and disabilities when providing care.

  9. Participate in the practice of clinical medicine within the Family Medicine model, emphasizing first contact, continuing, coordinated, and comprehensive care for all patients.

  10. Participate in Family Medicine activities of personal interest (i.e. sports medicine, chemical dependency, rural Family Practice, etc.) as desired.

Interpersonal and Communication

Establish professional relationships with patients, gather medical family and social histories, and conduct physical examinations as indicated in order to construct a differential diagnosis and recommend treatment consistent with standards of care.

  1. Develop hands-on experience in patient care by seeing patients independently and performing necessary history-taking and physical examination.

  2. Participate in discussion and impromptu teaching sessions with the preceptors in order to gain exposure to approaches in management of common ambulatory illnesses. Demonstrate clear, professional, and effective communication (written and oral) with patients, family members, colleagues, and other health care professionals.

  3. Document history and physical findings, assessments, and management plans in the medical record.

  4. Develop and refine the skills of teaching and communicating with professionals and patients by:

    1. Preparing and presenting the major and mini-talks to classmates.

    2. Presenting cases to the preceptors.

    3. Interacting with patients in the capacity of teaching and counseling.

    4. Deliver and accept constructive feedback.

  5. Demonstrate the capacity to respond appropriately to constructive feedback given throughout the rotation and specifically at mid-rotation evaluations and in the observed focused visit.

  6. Complete weekly evaluation forms for student and faculty presentations.

Professionalism, Advocacy, and Personal Growth

Identify personal strengths and weaknesses in patient care and within the healthcare team and work to facilitate collaborative relationships.

  1. Interact with other health care professionals to comprehend the role of the Family Physician as the coordinator of total health care of the patient.

  2. Demonstrate respect for patients and families.

  3. Recognize limits of personal knowledge.

  4. Assess one’s own strengths, weaknesses, and health (physical and emotional) and be willing to seek and accept supervision and constructive feedback.

  5. Demonstrate responsible behaviors, consistent with the highest ethical standards of the profession of Family Medicine.

  6. Be punctual and attend all required events.

  7. Demonstrate integrity, responsibility, and accountability in the care of all patients.

  8. Document and present medical data accurately and truthfully.

  9. Recognize the importance of maintaining continuing professional responsibility for the patients’ and families’ health care.

  10. Demonstrate respect for patient confidentiality and privacy regulations.

  11. Avoid imposing personal values by using non-directive counseling when appropriate.

  12. Demonstrate respect for patients whose lifestyles and values may be different from your own. Demonstrate commitment to leadership and the advancement of knowledge.

  13. Demonstrate scholarship in the form of contributing to a positive learning environment, collaborating with colleagues, and performing self-assessment and self-directed learning.

  14. Perform concise, problem-focused presentation of the patient that reflects critical thinking in clinical decision making.



 

Readings/Assignments:

TBL Sessions/Application Workshop:

Topic
Reference

Cardiovascular Disease Risk Assessment Part I

 
Third Report of the National Cholesterol Education Program (NCEP) Expert Panel of Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. (Adult Treatment Panel III): pages 11-33
Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines
NC VII Express: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure  

Cardiovascular Disease Risk Assessment Part II

This article is optional; only the pages below are suggested for those who choose to read.
 
ADA 2010 guidelines, pages S11-S39 except:
  p S15- NOT section IIC (Type 1 DM) and section III (Gestational DM)
  p S23- NOT section 3a (Type 1 DM)
  p S39- Stop at section VII
 
 

Geriatrics TBL Sessions

Geriatrics for Family Medicine Clerkship Students  
JAMA, January 20, 2010—Vol 303, No. 3 (Reprinted), Pgs. 258-266
 
 
 

Women’s Health TBL Sessions

AM Fam Physician 2005; 72(12):24912496
Contraception Bascelli, Lynda M., Current Clinical Practice: Women's HEalth in Clinical Practice, Humana Press Inc.
Read pages 1-11 only
Evidence-Based Prenatal Care: Part I.  General Prenatal Care and Counseling Issues. AAFP. April 2009;71(7) pp 1307-1316. 
 
Health Maintenance for Postmenopausal Women  

 

Readings/Assignments - Application Workshop:

Topic
Reference

Behavior Counseling Workshop

Office-Based Strategies for the Management of Obesity
 GOUTHAM RAO, MD. Am Fam Physician. 2010 Jun 15;81(12):1449-1455.
Facilitating Health Behavior Change
Wedding, Studer Text: Behavior & Medicine, 4th ed: Ch 11:145-152
Interventions to Facilitate Smoking Cessation AM Fam Physician 2006; 74(2): 262-271, 276
Varenicline (Chantix) for Smoking Cessation AM Fam Physician 2007; 76(2):279
Adolescent Bullying  
Adolescents & Sex  
Pain and Addiction
Pain Management Update - AAFP  
Addictions  

Skills Workshops- Optional Readings:

Topic
Reference
Musculoskeletal Workshops, Part I and Part II
The Painful Shoulder: Part I. Clinical Evaluation
http://www.aafp.org/afp/20000515/3079.html
May 15, 2000, American Family Physician
The Painful Shoulder: Part II. Acute and Chronic Disorders
http://www.aafp.org/afp/20000601/3291.html
June 1, 2000, American Family Physician
Chronic Shoulder Pain: Part I. Evaluation and Diagnosis
http://www.aafp.org/afp/2008/0215/p453.html | PDF
February 15, 2008, American Family Physician
Chronic Shoulder Pain: Part II. Treatment
http://www.aafp.org/afp/2008/0215/p493.html | PDF
February 15, 2008, American Family Physician
Acute Ankle Sprain: An Update
http://www.aafp.org/afp/2006/1115/p1714.html | PDF
November 15, 2006, American Family Physician
Evaluation of Patients Presenting with Knee Pain: Part I. History, Physical Examination, Radiographs, and Laboratory Tests
http://www.aafp.org/afp/2003/0901/p907.html | PDF
September 1, 2003, American Family Physician
Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis
http://www.aafp.org/afp/2003/0901/p917.html | PDF
September 1, 2003, American Family Physician
Evaluation and Treatment of Acute Low Back Pain
PDF
SCOTT KINKADE, M.D., M.S.P.H., University of Texas Southwestern Medical School, Dallas, Texas

 

Evaluations/Assessments:

Clerkship Evaluations

 

Much of the current structure of the Clerkship has been developed from the feedback given to us by previous students. We strongly encourage your input into the curriculum by way of the evaluation forms. Throughout the Clerkship you will be asked to complete several forms:

 

Preceptor Evaluations

At the mid-point of the Clerkship, you will be asked to complete an evaluation of your preceptor. At this time, the preceptor will also complete an evaluation of your performance. You are encouraged to review both these forms with your preceptor personally. This mid-clerkship review will give the student and the preceptor the opportunity to discuss the quality of the learning experience and address any potential problems before the end of the clerkship.

At the end of the Clerkship, similar evaluations will be solicited from the student and the preceptor. Your evaluation of the preceptor and the site will be placed in a file that future students may review. The preceptor's final evaluation of the student will be submitted to the Clerkship Director for inclusion in the final grade, then placed in the permanent Department file of each student.

Faculty and students have the option of submitting their final narrative clerkship evaluations anonymously. The Department of Family Medicine will not disclose the author of specific narrative comments with his or her consent. Any questions concerning preceptor evaluations should be directed to the Clerkship Director, not the individual preceptor

 

Faculty Resource Person Evaluation

At the time of your presentation you will be asked to evaluate the performance of your faculty resource person(s). This yellow form is included in your orientation packet.

 

Presentation Evaluations

Following each didactic session, you will be asked to evaluate the presentations for that week. Both faculty and student presentations will be evaluated in this fashion. These evaluations will be kept confidential until after the Clerkship, so feel free to be frank in your observations. Feedback from your individual presentations will be available after the Clerkship upon request in your permanent file.

 

Final Clerkship Evaluation

At the end of the Clerkship, you will be asked to complete an evaluation of the Family Medicine Clerkship. These evaluations are reviewed in detail. In addition, a group discussion will be conducted on the last Wednesday of the Clerkship. These discussions are the fruit of many revisions of the clerkship procedures, so please feel free to discuss any concerns which may have developed during your experience. The Clerkship Director & Associate Directors appreciate your feedback, positive or negative. In no way will your feedback have any bearing on your final evaluation.

 

Student Presentation:

Abnormal Uterine Bleeding
  1. Define Abnormal Uterine Bleeding (AUB) and associated terms
  2. Create an age-appropriate differential diagnosis for a patient presenting with abnormal uterine bleeding
  3. Recognize the components of a focused history and physical exam.
  4. Identify the risk factors for gynecologic cancers.
  5. Select appropriate diagnostic evaluation in a patient with abnormal uterine bleeding
  6. Propose management options for common causes of AUB, including indications/contraindications and risks/benefits for each.

Abnormal Uterine Bleeding


Anxiety
  1. Create an appropriate differential diagnosis for a patient presenting with symptoms of anxiety.
  2. Recognize the components of a focused history and physical exam.
  3. Differentiate among types of anxiety: generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), panic disorder and social anxiety disorder.
  4. Recognize the many presentations of anxiety in Family Medicine
  5. Identify validated screening tools for diagnosing anxiety
  6. Select appropriate diagnostic evaluation in a patient with anxiety
  7. Propose pharmacologic and non-pharmacologic management for patients diagnosed with an anxiety disorder.

Gale, Christopher K. and Mark Oakley-Browne. Clinical Evidence: A Publication of BMJ Publishing Group, Generalize Anxiety Disorder, American Family Physician, 2003 Jan 1; 67(1): 135-138.


Asthma And Allergic Rhinitis
  1. Create an appropriate differential diagnosis for patients presenting with symptoms of asthma and/or allergic rhinitis.
  2. Determine a patient’s stage of asthma based upon current guidelines.
  3. Identify risk factors that may aggravate asthma and allergies.
  4. Recognize the components of a focused history and physical exam.
  5. Demonstrate ability to instruct a patient on the use of a peak flow meter and inhalers.
  6. Select appropriate diagnostic tests to evaluate patients with asthma and/or allergic rhinitis, and accurately interpret these tests
  7. Propose pharmacologic and non-pharmacologic management both for asthma and allergic rhinitis, including maintenance and rescue treatment.

Treatment of Allergic Rhinitis
Overview of Changes to Asthma Guidelines: Diagnosis and Screening
The Role of Allergens in Asthma
Medical Therapy for Asthma: Updates from the NAEPP Guidelines


COPD
  1. Define Chronic Obstructive Pulmonary Disease (COPD).
  2. Create an appropriate differential diagnosis for patients presenting with symptoms of COPD.
  3. Discuss the pathophysiology of COPD and differentiate emphysema from chronic bronchitis.
  4. Determine a patient’s stage of illness based upon current guidelines.
  5. Recognize the components of a focused history and physical exam.
  6. Select appropriate diagnostic tests to evaluate patients with COPD, and accurately interpret these tests.
  7. Propose pharmacologic and non-pharmacologic management options for patients with COPD.

Diagnosis of Chronic Obstructive Pulmonary Disease
Management of COPD Exacerbations


COUGH-ACUTE
  1. Create an appropriate differential diagnosis for a patient presenting with acute cough.
  2. Differentiate among common causes of acute cough: acute bronchitis, influenza, pertussis and community acquired pneumonia.
  3. Recognize the components of a focused history and physical exam
  4. Recognize more serious signs or symptoms that should prompt more diagnostic evaluation.
  5. Select appropriate diagnostic tests to evaluate patients with acute cough and accurately interpret these tests.
  6. Propose pharmacologic and non-pharmacologic management options for patients with acute cough including appropriate antibiotic use.

Pertussis: A Disease Affecting All Ages
Acute Bronchitis
Diagnosis and Treatment of Community-Acquired Pneumonia


Depression
  1. Create an appropriate differential diagnosis for a patient presenting with depressive symptoms
  2. Recognize the components of a focused history and physical exam.
  3. Differentiate among types of depression, including: Major Depressive Disorder, Dysthymia, and Seasonal Affective Disorder
  4. Recognize the many presentations of depression in Family Medicine
  5. Identify validated screening tools for diagnosing depression
  6. Identify the patient at risk for suicide
  7. Select appropriate diagnostic evaluation in a patient with depressive symptoms
  8. Propose pharmacologic and non-pharmacologic management for patients diagnosed with a depressive disorder.

Pharmacologic Management of Adult Depression


Dizziness And Vertigo
  1. Define dizziness and clarify what patients mean when they report dizziness (e.g. vertigo, syncope/presyncope, disequilibrium, and lightheadedness).
  2. Create an appropriate differential diagnosis for patients presenting with dizziness and vertigo.
  3. Identify etiologies of dizziness and vertigo, and differentiate central from peripheral causes of vertigo.
  4. Discuss the pathophysiology of peripheral vertigo.
  5. Recognize the components of a focused history and physical exam.
  6. Select appropriate diagnostic testing in a cost-effective manner.
  7. Propose pharmacologic and non-pharmacologic management for peripheral vertigo.

Treatment of Vertigo
The Ten-Minute Examination of the Dizzy Patient


Dyspepsia
  1. Define dyspepsia.
  2. Create an appropriate differential diagnosis for a patient presenting with symptoms of dyspepsia.
  3. Recognize the components of a focused history and physical exam
  4. Recognize more serious signs or symptoms that should prompt more diagnostic evaluation.
  5. Select an appropriate work-up for individual patients with dyspepsia symptoms.
  6. Propose pharmacologic and non-pharmacologic management options for patients with dyspepsia.
  7. Discuss indications for referral of patients with dyspepsia to Gastroenterology.

Evaluation and Management of Nonulcer Dyspepsia


Dysuria
  1. Create an appropriate differential diagnosis for the following patient population with complaints of dysuria: children, women, men.
  2. Recognize the components of a focused history and physical exam.
  3. Identify the appropriate workup based on the history and physical findings.
  4. Interpret a urinalysis
  5. Identify indications for urine culture/sensitivity
  6. Propose management options including risks and benefits for each population with complaints of dysuria.

Diagnosis and Management of Uncomplicated Urinary Tract Infections
Evaluation of Dysuria in Adults
Urinary Tract Infection in Children


Fatigue
  1. Create an appropriate differential diagnosis for patients presenting with fatigue.
  2. Recognize the components of a focused history and physical exam
  3. Distinguish common from serious causes of fatigue.
  4. Select appropriate cost-effective diagnostic tests to evaluate patients with fatigue.
  5. Differentiate between sleepiness and fatigue.
  6. Define chronic fatigue syndrome.
  7. Propose pharmacologic and non-pharmacologic management for patients with common causes for fatigue.

Fatigue: An Overview


Insomnia
  1. Define insomnia.
  2. Create an appropriate differential diagnosis for a patient presenting with sleep disturbance
  3. Recognize the components of a focused history and physical exam.
  4. Demonstrate the ability to take a comprehensive sleep hygiene history
  5. Recognize more serious signs or symptoms that should prompt more diagnostic work-up.
  6. Select an appropriate work-up for individual patients with sleep disturbance
  7. Propose pharmacologic and non-pharmacologic management for patients with insomnia.

Treatment Options for Insomnia


Irritable Bowel Syndrome
  1. Define irritable bowel syndrome (IBS).
  2. Create an appropriate differential diagnosis for a patient presenting with symptoms of IBS
  3. Compare and contrast inflammatory bowel disease (IBD) with IBS
  4. Recognize the components of a focused history and physical exam.
  5. Select an appropriate work-up for individual patients with complaints of IBS symptoms.
  6. Propose pharmacologic and non-pharmacologic management options for patients with IBS.

Irritable Bowel Syndrome


Male Urinary Symptoms
  1. Create an appropriate differential diagnosis for men presenting with common urinary symptoms.
  2. Discuss the pathophysiology of common urinary symptoms, including benign prostatic hypertrophy (BPH), prostate cancer and prostatitis.
  3. Recognize the components of a focused history and physical exam.
  4. Select appropriate diagnostic tests to evaluate men with urinary symptoms.
  5. Identify risk factors for prostate cancer.
  6. Propose pharmacologic and non-pharmacologic management for men with common urinary symptoms. ,
  7. Discuss guidelines for and controversies of prostate cancer screening.
  8. Discuss indications for referral of men with urinary symptoms to Urology.

Prostatitis: Diagnosis and Treatment
Diagnosis and Management of Benign Prostatic Hyperplasia
Prostate Cancer Screening: The Continuing Controversy


Nutrition
  1. Define nutrition.
  2. Discuss components of a healthy adult diet.
  3. Demonstrate the ability to take a comprehensive nutrition history.
  4. Recognize the signs for poor nutrition during a physical exam.
  5. Discuss validated screening tools for identifying patients at risk for poor nutrition.
  6. Recognize the many presentations of poor nutrition in Family Medicine
  7. Select appropriate diagnostic tests to evaluate patients with poor nutrition and accurately interpret these tests.
  8. Propose pharmacologic and non-pharmacologic management options for patients with poor nutrition.

Appendix E-1: Major Conclusions
Part A: Executive Summary


Osteoarthritis And Gout
  1. Create an appropriate differential diagnosis for patients presenting with arthralgias.
  2. Differentiate between degenerative and inflammatory arthritis.
  3. Identify risk factors associated with osteoarthritis and gout.
  4. Recognize the components of a focused history and physical exam
  5. Select appropriate cost-effective diagnostic tests to evaluate patients with arthralgias.
  6. Identify radiographic features of osteoarthritis and gout.
  7. Propose pharmacologic and non-pharmacologic management and preventive strategies, including risks and benefits for osteoarthritis and gout.

Gout: An Update

Pharyngitis And Ear Pain
  1. Create an appropriate differential diagnosis for a patient presenting with sore throat and/or ear pain.
  2. Differentiate among common causes of sore throat and ear pain: viral pharyngitis, streptococcal pharyngitis, mononucleosis, otitis media, otitis externa and serous otitis.
  3. Recognize the components of a focused history and physical exam
  4. Recognize more serious signs or symptoms that should prompt more diagnostic evaluation.
  5. Select appropriate diagnostic tests to evaluate patients with sore throat and accurately interpret these tests.
  6. 6. Propose pharmacologic and non-pharmacologic management options for patients with sore throat and/or ear pain including appropriate antibiotic use.
  7. Discuss indications for referral of patients with sore throat and/or ear pain to ENT.

Diagnosis of Ear Pain
Diagnosis and Treatment of Streptococcal Pharyngitis
Peritonsilon Abscess


Upper Respiratory Symptoms
  1. Create an appropriate differential diagnosis for a patient presenting with upper respiratory symptoms.
  2. Differentiate among common causes of upper respiratory symptoms: acute bacterial sinusitis, viral upper respiratory tract infections and the common cold.
  3. Recognize the components of a focused history and physical exam
  4. Select an appropriate diagnostic evaluation for a patient with upper respiratory symptoms.
  5. Propose pharmacologic and non-pharmacologic management options for patients with upper respiratory symptoms including appropriate antibiotic use.

Acute Bacterial Rhinosinusitis in Adults: Part I. Evaluation
Acute Bacterial Rhinosinusitis in Adults: Part II. Treatment
Treatment of the Common Cold
Guidelines for the Use of Antibiotics in Acute Upper Respiratory Tract Infections

Vaginitis
  1. Create an appropriate differential diagnosis for a patient presenting with vaginitis.
  2. List the etiology of the most common types of vaginitis.
  3. Recognize the components of a focused history and physical exam.
  4. Recognize more serious signs or symptoms that should prompt more diagnostic work-up.
  5. Select appropriate diagnostic evaluation in a patient with vaginitis.
  6. Propose pharmacologic and non-pharmacologic management for common causes of vaginitis.

Vaginitis: Diagnosis and Treatment


Well Adolescent Exam
  1. Assess the developmental stages of children ages 12-18.
  2. Recognize physical and cognitive developmental delay and propose treatment options, including appropriate referral.
  3. List immunizations appropriate between ages 12-18 and review contraindications.
  4. Recognize the components of the history and physical exam.
  5. Choose anticipatory guidance counseling topics appropriate to individual families including, but not limited to, diet, exercise, school, work, safety, sexuality, and substance abuse.
  6. Recognize signs and symptoms of mental illness (including suicidal and homicidal ideation) and recommend diagnostic approach and subsequent treatment options.
  7. Discuss confidentiality and how it applies to adolescents and their guardians.

Implementing the Guidelines for Adolescent Preventive Services


Well Child Exam
  1. Assess the developmental stages of children ages 3-11.
  2. Recognize developmental delay and propose treatment options, including appropriate referral.
  3. List immunizations appropriate between ages 3-11 and review contraindications.
  4. Recognize the components of the history and physical exam.
  5. Choose anticipatory guidance counseling topics appropriate to individual families including, but not limited to, diet, exercise, safety, school, behavior concerns, and abuse.


Guidelines on Identification of Children with Autism Spectrum

Health Maintenance in School-aged Children: Part I
Health Maintenance in School-aged Children: Part II