Role of Family Medicine Curriculum

Author: Margit Chadwell MD, and John Boltri MD

Description: While some students entering the clerkship have a basic understanding of the specialty, most are unfamiliar with family medicine's pivotal role in and impact on the health care system at large. This curricular component introduces students to the fundamental value of family medicine by exploring its' foundational role in the delivery of primary care. Following a brief pre-test (appendix A), an introductory lecture (appendix B) during the clerkship orientation session presents students with information in two topic areas that together, provide the backdrop for family medicine's proven value and effectiveness in healthcare delivery: 1)a discussion of medical outcomes and health expenditures in countries with and without a primary care base and; 2) the relationship of access to primary care and health disparities. The material gives students a solid context for experiencing their subsequent clinical rotation. Students complete further reading on the topic during the clerkship by selecting one article from a resource list (appendix C) and complete their self-study with a short post-test online (appendix D). The clerkship concludes with a reflection session where students share their observations of family medicine's role during their own 4-week ambulatory block in year 3 at Wayne State University School of Medicine (WSUSOM).

Curricular Resource Materials (download the following documents):

• Role of Family Medicine Curriculum (DOC)
• Appendix A: Pre-test (DOC)
• Appendix B: Presentation (PPT)
• Appendix C: Self Study (DOC)
• Appendix D: Post-test (DOC)

Authors: Cynthia G Olsen MD, and Amanda Bell MD

Description: Demonstrating the depth and breadth of the specialty of Family Medicine, revealing the complexity of the care that family physicians provide and covering topics that may not fit into traditional curriculum are monumental tasks in the educations system. The "Chair's Challenge" is a case-based, optional activity offered to third year medical students during a family medicine clerkship. It is prepared and presented by the chairperson of the department and represents memorable, complex cases that cover topics and areas such as rural medicine, special populations, pharmacogenetics and interdisciplinary collaboration. Students are asked to answer questions related to clinical cases and are given rewards for the correct answers. They can read full descriptions of the cases the following week. The Challenge is meant to be fun, thought-provoking and demonstrate the senior faculty member's involvement in community and scholarship.

Curricular Resource Materials (download the following Word document):

• Chairs Challenge Curriculum (DOC)

Authors: Rick Henriksen MD, MPP, and Susan Cochella MD

Description: American's receive medical care within a complex network of resources services. It is important for physicians of all disciplines to understand the structures and effects of these systems. At the University of Utah School of Medicine all medical students complete a four-week Family Medicine Clerkship which includes a structured curriculum on health policy and the role of Family Medicine in the American health care system. The curriculum uses serial reflective student dialog and student presentations informed by readings, videos, and faculty presentations to challenge and hone student understanding. Faculty present initial information, ask questions, facilitate dialog, and provide feedback. Health systems within the US and between countries are compared. Hot spotting, the patient centered medical home, access to care, and primary care impact data are introduced. Students are encouraged to challenge the data presented. This submission includes presentations, readings, references, and directions for use.

Curricular Resource Materials (download the following documents):

• Health Care System Curriculum (PDF)
• Appendix A: Presentation 1 (PPT)
• Appendix B: Presentation 2 (PPT)
• Appendix C: Presentation 3 (PPT)
• Appendix D: Assignment Examples (DOC)
• Appendix E: Grading Rubric (XLS)

Authors: Harry Heiman MD, MPH, and Dolapo Babalola, MD

Description: This is a best resource for the STFM's National Clerkship Curriculum under The Role of Family Medicine. A strong primary care foundation is a core feature of high-performing health care systems and a critical bridge to public and community health. The United States health care system is the most expensive in the world, yet problems persist related to access, quality of care, and health disparities. These continuing challenges, compounded by the aging of the U.S. population and the increased number of people with chronic medical problems, demand realignment of our health care delivery system around care that is value-driven, well-coordinated, and patient-centered. Family Medicine is a critical leader and partner in this needed health care system transformation. This four-session curriculum will provide medical students with a broad understanding of the U.S. health care system and the critical role played by primary care and family medicine. Each session will include background reading to prepare students for interactive discussions, providing an important framework for their clinical rotations and their careers as physicians. Topics include: Health Care Organization, Health Disparities and Health Equity, Primary Care and Family Medicine, and New Models of Care: Patient-Centered Medical Home and Accountable Care Organizations.

Curricular Resource Materials (download the following documents):

• Primary Care as the Foundation Curriculum (DOC)
• Appendix A: Session 1 Health Care Organization (DOC)
• Appendix B: Session 2 Health Disparities (DOC)
• Appendix C: Session 5 Primary Care and Famiy Medicine (DOC)
• Appendix D: Session 6 New Models of Care (DOC)
• Appendix E: Sample Agenda for Lesson Plan (DOC)
• Appendix F: Project Evaluation Rubric (DOC)

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: Amy Clithero-Eridon, PhD, Cameron Crandall, MD, and Elena Bissell, MD

Description: Embedded within the 8-week University of New Mexico Family Medicine Clerkship, required for all 3rd year medical students, are 24 hours of health policy and health system education. One component is 4-hours of instruction on access, costs and value in healthcare. The session adapted and built upon the American College of Physician’s MedEd Portal publication “Teaching the Cost of Hospital Care to Medical Students.”¹ It is intended to be an overview to give students knowledge of the issue. During year four, students apply this knowledge.

In addition to didactic presentations students are required to:

1. Critically analyze their personal health insurance and articulate the basics of health insurance coverage. (Appendix A)
2. Participate in large and small group discussions that compare the large variations in out of pocket costs that occur depending on insurance.
3. Using clinical vignettes, consider patients’ insurance coverage when selecting a treatment plan, demonstrate knowledge of local resources, apply cost/value decision tools and evaluate downstream effects. (Appendix B, C and D)
4. Watch the movie Escape Fire
5. Read three articles prior to the cost and value session

Outcomes include student’s rebalancing their beliefs and reporting greater ability to weigh costs and benefits for diagnostic tests.

¹AAgaard E, Wagner R, Jackson D, Earnest M. Teaching the Cost of Hospital Care to Medical Students. MedEdPORTAL Publications; 2010. Available from: https://www.mededportal.org/publication/7787.

Curricular Resource Materials (download the following documents):

• Curriculum Document (DOC)
• Appendix A (DOC)
• Appendix B (DOC)
• Appendix C (DOC)
• Appendix D (DOC)
• Appendix E (DOC)
• Appendix F (DOC)
• Appendix G (DOC)
• Appendix H (DOC)
• Appendix I (DOC)
• Appendix J (DOC)

Authors: Deborah Erlich, MD, Molly Cohen-Osher, MD, and Wayne J Altman, MD

Description: This material supports a session teaching key principles in geriatrics including change in mental status and polypharmacy. This session was taught at Tufts University School of Medicine, Boston MA, in a 6-week block core FM clerkship. The 60-75 minute session centers on a case of an 80 year old female presenting with change of mental status and uses a Team Based Learning approach for students to general a differential diagnosis, perform physical exam, "order" labs and interpret results, work through the pathophysiology of how the delirium developed, and create a treatment plan for the patient. 

Learning Outcomes include student quantitative ratings as well as qualitative evaluations, which have been overwhelmingly positive. Mandatory anonymous student ratings of the session averaged 3.89 out of 4.00 over 2 years. Themes of anonymous qualitative data include student appreciation of the holistic approach to this ill patient, family physician faculty teaching complex cases, and a fun interactive way to learn and engage with the dense material covered

Curricular Resource Materials (download the following documents):

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

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)

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)