Principles of Family Medicine Curriculum

Author: Wessam Labib MD, MPH

Description: This is a new curricular activity that involves the use of the simulation laboratory in medical students' education. Included in this curriculum is a way to evaluate the ethical training of the students and the practical applications of the learned ethical concepts. Also included is the evaluation of the effect of pharmacy residents and students' involvement on the clinical outcome of the simulation case and the overall experience of the medical students as well as the effect of this on their future decision regarding the utilization of pharmacist expertise. This curriculum is designed to train the student and evaluate their ability to manage a geriatric acute case and communicate with the patient and his/her family. Also we evaluate their team skills through their communication with other health care providers involved in the case including pharmacy and nursing students.

Curricular Resource Materials (download the following documents):

• Curriculum (DOC)
• Appendix A (DOC)
• Appendix B (DOC)
• Appendix C (DOC)

Principles of Family Medicine:

• The Biopyschosocial Model
• Comprehensive Care
• Contextual Care
• Coordination/Complexity of Care

Authors: Suzanne Minor MD, and Sarah Stumbar, MD, MPH

Description: Students perform a self-assessment for personal development during the Family Medicine Clerkship at the Florida International University Herbert Wertheim College of Medicine (FIU HWCOM).  Self-assessment is a necessary skill used throughout any physician’s career. Students are asked to assess their strengths and weaknesses, particularly in relation to interprofessional team work; discuss areas of self-improvement over the preceding months; and set goals for their professional development, along with an implementation strategy. Additionally students are asked to reflect on specific patient encounters that they have in relationship to the principles of Family Medicine, such as preventative care and continuity of care.

Curricular Resource Materials (download the following documents):

• Curriculum (DOC)
• Appendix A (DOC)
• Appendix B (DOC)

Principles of Family Medicine

• Biopsychosocial model
• Comprehensive Care
• Continuity of Care
• Coordination/Complexity of Care

Authors: Margit Chadwell, MD, and Juliann Binienda, PhD

Description: Many clerkship students are familiar with the "Stages of Change" model, yet most are unfamiliar with its' application in the clinical setting. The Brief Intervention for Risky Health Behaviors learning activity teaches students how to move the patient from one stage to the next along a continuum of behavior change using all components of the brief intervention technique (Ask, Assess, Advise & Assist, and Monitor). Students complete an assignment that is conducted in the outpatient setting in two parts. Within the first week of the clerkship, students select a patient who displays any type of risky health behavior with the guidance of the preceptor and conduct the brief intervention. Part two of the assignment is designed to assess the patient's progress per the agreed-upon action plan during follow-up either in person or by phone. Students re-assess the patient's stage of change and reflect on the effectiveness of the brief intervention on the targeted risky health behavior. The Family Medicine Clerkship is a prime setting to practice this strategy and a key skill that students can use and refine throughout their medical career. It is part of the 4-week family medicine ambulatory clerkship at Wayne State University School of Medicine

Curricular Resource Materials (download the following documents):

• Curriculum (DOC)
• Appendix A: Background and Description (DOC)
• Appendix B: Learning Activity Part I (DOC)
• Appendix C: Learning Activity Part II (DOC)

Principles of Family Medicine:

• The Biopyschosocial Model
• Continuity of Care
• Coordination/Complexity of Care

Authors: Mandi Sehgal, MD, Robert Ellis, MD, and Barbara Tobias, MD

Description: "What's wrong with Mom?" is an innovative Family Medicine Clerkship longitudinal teaching module developed by the University of Cincinnati (UC) Department of Family and Community Medicine in collaboration with the UC Division of Geriatrics, UC College of Pharmacy and the Alzheimer's Association of Southwestern Ohio. Students learn the evaluation and management of the older adult and caregiver with a focus on Alzheimer's Disease. This module consists of two large group sessions (week 1 & 4) and individualized assignments (weeks 2 & 3). In the first session, students interview a standardized patient and caregiver dyad and discuss initial diagnosis and management of Alzheimer's Disease. Students receive real time feedback from the standardized dyad and observing faculty. In weeks 2 & 3, students individually receive questions from the caregiver of the patient they interviewed. These questions reflect real life challenges commonly faced by families of patients with Alzheimer's as the disease progresses. During week 4, course faculty participate in a panel discussion with the students on their responses and follow up management of the patient and caregiver. Evaluative components consist of: online post test assessment, Standardized Patient Student Feedback (verbal and written), student email responses to caregivers, final student self assessment.

Curricular Resource Materials (download the following documents):

Chronic Care Evaluation and Management Curriculum (DOC)
Appendix A: Background Content Information (DOC)
Appendix C: Quiz on Background Materials (DOC)
Appendix D: MOCA Scoring Instructions (PDF)
Appendix E: MOCA Scored (PDF)
Appendix F: MOCA Unscored (PDF)
Appendix G: Overview Geriatrics Session 1 (DOC)
Appendix H: Goals and Objectives Session 1 (DOC)
Appendix I: Standard Patient Dyad Script (DOC)
Appendix J: Father-Son Dyad (PDF)
Appendix K: Father-Daughter Dyad (PDF)
Appendix L: Mother-Daughter Dyad (PDF)
Appendix M: Mother-Son Dyad (PDF)
Appendix N: Patient Assessment and Plan (DOC)
Appendix O: Patient Feedback Form (DOC)
Appendix P: Virtual 12 Month Follow Up (DOC)
Appendix Q: Unique 12 Month Email (DOC)
Appendix R: Expert Answers 12 Month Email (DOC)
Appendix S: Sample Student Email Responses (DOC)
Appendix T: 36 Month Follow Up (DOC)
Appendix U: Unique 36 Month Email (DOC)
Appendix V: Expert Answers 36 Month Email (DOC)
Appendix W: Grading Rubric 12 and 36 Month Email (DOC)
Appendix X: Panel Discussion Overview (DOC)
Appendix Y: Panel Discussion (PPT)
Appendix Z: Student Self Assessment (DOC)
Appendix AA: Overall Grading Scale Geriatrics Curriculum (DOC)

Principles of Family Medicine:

• The Biopyschosocial Mode
• Comprehensive Care
• Contextual Care
• Continuity of Care
• Coordination/Complexity of Care

Authors: Christopher W Bunt, MD, and Kismet T Roberts, MD

Description: While background clinical questions can be answered utilizing resources like Up-to-Date or textbooks, foreground clinical questions require Evidence Based Medicine (EBM) resources and knowledge of how to critically appraise the literature and apply the evidence to your patient. This curriculum helps learners ask answerable foreground clinical questions using the PICO model. This model builds the question using the Patient, Intervention, Control and Outcome (patient-oriented) method. The curriculum guides the learner through the process of creating a question, answering it using appropriate EBM resources, and then applying that evidence to their patient. Each learner completes four PICO assignments, one their first week, two during their second week and then a fourth during their third week. In week four of their rotation, the learner presents two PICO assignments during a noon conference session. This curriculum was designed for 4th year medical students completing a rotation at the Ehrling Bergquist Family Medicine Residency, which is affiliated with The University of Nebraska Medical Center in Omaha, NE. It is appropriate for use in MS3 clerkships as well.

Curricular Resource Materials (download the following documents):

• Curriculum (DOC)
• Appendix A: Asking Answerable Clinical Questions (PPT)
• Appendix B: Handout Asking Answerable Clinical Questions (DOC)
• Appendix C: PICO Template (DOC)
• Appendix D: Evaluation (DOC)
• Appendix E: Presentation Evaluation (DOC)
• Appendix F: Example Assignments (DOC)

Principles of Family Medicine

• The Biopyschosocial Mode
• Comprehensive Care
• Coordination/Complexity of Care

Author: Paul Paulman, MD

Description: Given the importance of understanding the population health role of family medicine, students in this required 8-week rural clerkship have the option to complete a project on quality improvement. Students select a topic, review the literature, do background data collection, and plan but do not implement the intervention, given the short timeline of the clerkship. Students present their findings and recommendations. A description of this curriculum was published in the Journal Family Medicine in 2002.

Curricular Resource Materials (download the following documents):

• Curriculum (DOC)
• Appendix A (DOC)
• Appendix B (PDF)

Principles of Family Medicine:

• Coordination/Complexity of Care

Author: Joshua David Steinberg, MD

Description: Students are typically taught history taking itself and conduct of a patient visit with the acute problem visit. But do they know the principles and content of health maintenance visits nearly as well? This simple curriculum bundle tries to address this issue.

How to Do an Excellent Health Maintenance Visit discovers, develops, and validates the principles that underlie all such visits. The package starts with well child checkups but then extends the principles to adult health maintenance visits and even prenatal care. If delivered in the socratic, discovery style scripted in the lecture slides, students start with what they’ve already seen in health maintenance visits, build the concepts, explore how they describe all health maintenance, learn the concrete workflow of what to get done in a room with a patient, and come away with support for retention and recall during future health maintenance visits.

Curricular Resource Materials (download the following documents):

• Curricular Resource (DOC)
• Appendix A (PPT)
• Appendix B (DOC)
• Appendix C (DOC)
  
• Appendix D (DOC)

Authors: Suzanne Minor MD, and Sarah Stumbar, MD, MPH

Description: Students learn firsthand about community resources during the Family Medicine Clerkship at the Florida International University Herbert Wertheim College of Medicine.  Each student is expected to attend a total of two community resources (one open Alcoholics Anonymous 12 step meeting and one yoga or tai chi exercise class). The purpose of this activity is to give the student a first-hand experiential learning opportunity about community resources that may be incorporated in chronic disease management. Twelve step meetings are groups for individuals with addictions or other issues that can be addressed in the group setting. There is a growing body of scientific evidence that the practice of yoga, tai chi, and qigong have significant health benefits for chronic diseases such as depression, arthritis, diabetes, and heart disease.

Curricular Resource Materials: (download the following documents)

• Curriculum (DOC)
• Appendix A (DOC)
• Appendix B (DOC)

Authors: Joanna Drowos, DO, MBA, Terry Eggenberger, PhD, RN, and Eugenia Millender, PhD, RN, MS

Description: This program offers an educational elective engaging students in the care of homeless patients as part of an interprofessional team. Third year medical students participating in a primary care longitudinal intergrated clerkship (48 weeks) from Florida Atlantic University’s Charles E. Schmidt College of Medicine are invited to join an interprofessional clinical elective at a community health center. Experience components are outlined in the How the Program Works Appendix, and include reviewing the TeamSTEPPS Outline for Clinical Experience with students presented by a TeamSTEPPS Master Trainer, followed by providing primary care at a homeless shelter clinic. Medical students join the interdisciplinary team with other learners modeling interprofessional practice and TeamSTEPPS skills. The team participates in comprehensive reviews, team briefs, huddles, and debriefs while providing care to complex patients. Student Successful completion of this program results in students earning a certificate of Advanced Interprofessional TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) Training in the Primary Care Setting for students. Outcomes of the program include changes in the Attitudes towards Interprofessional Health Care Teams scale (ATHCT) and the Readiness of health care students for Interprofessional Learning Scale (RIPLS).

Curricular Resource Materials: (download the following documents)

• Curriculum (DOC)
• Appendix A (PDF)
• Appendix B (PDF)
• Appendix C (PDF)
• Appendix D (PDF)
• Appendix E (PDF)
• Supplemental Material (PDF)

Author: Rebecca Cantone, MD

Description: This interactive workshop, presented at STFM MSE 2018, includes a discussion of the importance of addressing LGBTQIA healthcare disparities and allows students to practice taking a sensitive sexual history and work through a case in groups to learn the standards to consider affirmative care options for individuals seeking gender affirmation (including socialization, hormones, procedural and surgical options). It is meant to expand the basic science knowledge of gender identity and early clinical skills of taking a history to a more patient-centered approach for gender diverse individuals. It is given during a four-week required Family Medicine Clerkship on a monthly basis to a large group of 10-25 clinical medical students at a time (2nd, 3rd or 4th years in our curriculum at Oregon Health & Science University), and therefore exposes nearly all medical students to this knowledge (those at rural sites do not receive the workshop but the materials are available). The workshop has been highly rated as part of the weekly didactic activities that occur every Thursday morning during the month long clerkship.​

Curricular Resource Materials: (download the following documents)

• Curriculum (DOC)
• Appendix A (DOC)
• Appendix B (PPTX)

Authors: Deborah Erlich, MD, and Wayne Altman, MD

Description: Taught at Tufts University School of Medicine, Boston MA, this session on pediatric immunizations occurs during the mandatory 6-week 3rd year core Family Medicine clerkship.

The session teaches advanced communication and shared decision making about vaccination of a baby. The case (Appendix A) describes a mother who gave birth with a midwife via an unmedicated vaginal delivery, breastfeeds, gives her family organic food, and embraces a "natural" lifestyle. The mother has brought her baby in for a well child check and has concerns and hesitations about immunizing her child.

A standardized patient (SP) and his/her baby are physically present in the classroom. Via a fishbowl technique, in which one student at a time interviews and counsels the parent while the other students actively observe, a few students experience the “hot seat” (direct interview with the SP) for the benefit of the large group. The faculty facilitator then role models approaches such as shared decision making, empathic listening, and humble patient education.

Learning outcomes of the session include anonymous quantitative student ratings and qualitative student feedback about the session. Over the past year, the average numeric student rating has been 3.87 out of 4.00, a very high score. Descriptive data have also been overwhelmingly positive; themes include appreciation of the opportunity to practice advanced communication skills and gaining more knowledge on the CDC vaccine schedule and its components.

Curricular Resource Materials: (download the following documents)

• Curriculum (DOC)
• Appendix A (DOC)
• Appendix B (DOC)
• Appendix C (DOC)
• Appendix D (DOC)
• Appendix E (PDF)

Authors: Molly Cohen-Osher, MD, and Miriam Hoffman, MD

Description: Boston University School of Medicine 6-week required Family Medicine Clerkship developed an interactive workshop to enable students to identify the typical signs and symptoms, discuss the differential and work up, and identify evidence-based treatments for common acute respiratory infections. Students are divided into three teams of 6–8 students and each team is given a case to work through. Case one explores the differential of a sore throat and fever, case two explores the differential of cough, and case three explores the differential of nasal symptoms, facial pain and ear pain. After each group works through their case, they present it to the class with a commitment to their differential, leading diagnoses, and answers to a few multiple choice questions written to generate conversation. Cases are presented one at a time and after each case, there is a brief PowerPoint presentation on the conditions in the differential of each case focusing on common signs and symptoms, how to distinguish one condition from another, and the typical diagnostic work-up. Following this, the whole class goes back to the case and decides which answers they want to change. Finally students use point-of-care resources to answer questions about management. All cases, the PowerPoint and a faculty guide are included. Learning outcomes include the pre-and-post answers to the cases, an information mastery project, student evaluation data and shelf scores.

Curricular Resource Materials: (download the following documents)

• Curriculum (DOC)
• Appendix A (DOC)
• Appendix B (DOC)
• Appendix C (DOC)
• Appendix D (PPT)
• Appendix E (DOC)
• Appendix F (DOC)
• Appendix G (DOC)