Acute, Chronic, and Preventive Care Curriculum

Authors: Mary Rubino, MD, Bruce Britton, MD, Ann Donnelley, MD, Craig Goodmurphy, PhD, Mark Rehfuss, PhD, and Amelia Wallace

Description: EVMS provides an 8-week required family medicine clerkship where students practice skills in patient centered communication and motivational interviewing. They evaluate two or three standardized patients in a simulated patient-centered medical home each week. This submission includes curricular materials for a series of three acute care cases that involve a mother and step-daughter. The complete curriculum provides a menu of 18 cases covering a spectrum of acute processes, chronic disease management and preventive care.Standardized patient demographics vary across age and gender to provide a comprehensive learning experience. Each case is designed to cover aspects of the STFM core curriculum and emphasize the skills necessary to provide excellent care to patients, especially those with barriers to achieving optimal outcomes. Complementing the current curriculum, cases are designed for simulations, individual or small group discussions or role play. The curriculum in this submission includes preparatory readings for students and teaching points for educators and standardized patients. Material highlights case-specific motivational interviewing goals and effective patient-centered communication techniques to meet those goals.

Curricular Resource Materials (download the following Word document):

• EVMS Curriculum (DOC)

Authors: Kelly Bossenbroek Fedoriw, MD, and Tommy Koonce, MD

Description: The Observed Patient Encounter focuses on clinical reasoning, encourages self-assessment, and increases direct observation of students during the Family Medicine clerkship. While in their preceptor's office, students video record a full encounter with a patient who presents with an acute complaint. The student records the history and physical, the precepting encounter, and the delivery of the assessment and plan to the patient. Students may record multiple encounters and choose the encounter that best represents their clinical skills, particularly their clinical reasoning. The recordings are then reviewed in a small group setting with 4–5 students and one faculty member. As the group watches each video, the presenting student leads with a brief self-evaluation and their peers and the tutor offer feedback. The faculty member evaluates the assignment using the Observed Patient Encounter Assessment form (Appendix A) and leads the group in a discussion. The utility of video feedback is well established. Numerous studies demonstrate the statistically significant, positive effect on interaction skills across multiple disciplines (Fukkink, Trienekens, and Kramer 2010). In medical education, video feedback has proven particularly helpful in teaching history taking skills, from teaching interviewing skills (Maguire et al. 1978), to evaluating communication skills (Irwin & Bamber 1984), to actually changing resident interview behavior (Bryson-Brockmann & Fischbein 1995). To date, no studies have endeavored to highlight the benefits of video feedback when teaching and refining clinical reasoning skills.

Curricular Resource Materials (download the following documents):

• OPE Curriculum (DOC)
• Appendix A: OPE Assessment Form (DOC)

Authors: Todd Felix, MD, F. Samuel Faber, MD, David Richard, MD, Jay Zimmerman, MD, Nancy Adams, MLIS

Description: "Coffee Talks" is a workshop started at Penn State College of Medicine in 2009 for all 3rd-year clerks rotating through our 4-week Family Medicine Clerkship. Seeking a novel approach to teaching Clinical Reasoning and Information Mastery, we established a case-based conference where students present a Clerkship case known to them but not the facilitators. The workshop includes 10–14 students and an inter-professional team of 2–4 faculty of clinicians and librarians with experience, interest and advanced training in these concepts. The thinking skills of medical students are enhanced by faculty-facilitated discussions of the cases during which the students formulate a working differential diagnosis that is assessed and modified after each segment of the presentation. This student-led process is collegial and non-threatening. In addition, each student is required to identify and answer a clinical question from any case seen during this clerkship, and to submit prior to the conference a 4–5 PowerPoint slide presentation utilizing the PICO format. These PICO presentations are reviewed by the faculty at the clinical site and by faculty at the workshop, and they are used as educational tools to highlight evidence based medicine (EBM) resources, proper formatting of clinical questions, and appropriate interpretation of guidelines and recommendations.

Curricular Resource Materials (download the following documents):

• Clinical Reasoning Curriculum (DOC)
• Appendix A: App 4 Orientation (PPT)
• Appendix B: App 6 Case (PPT)

Authors: Ryan Palmer, EdD, Lisa Dodson, MD, and Fran E Biagioli, MD

Description: There is a severe shortage of primary care physicians in the US, especially in rural areas. Telemedicine has the potential to address this shortage by making it easier for providers to connect with remote patients. To better prepare providers for this new practice mode, simulated telemedicine experiences should be incorporated in medical education. The Oregon Health & Science University (OHSU) Family Medicine clerkship telemedicine OSCE (TeleOSCE) places learners into the role of a rural physician consulting via telemedicine with a remote, rural patient. The TeleOSCE serves as a standalone experiential education activity during the required 5-week Family Medicine clerkship that exposes learners to a new model of rural care. It also logistically allows a clerkship to administer an OSCE activity to remote learners. The TeleOSCE can be easily adapted to meet the needs of different institutions and is administered using cost-effective, internet-based videoconferencing software. Materials included are the TeleOSCE case with checklist and implementation instructions as well as an informational guide with a video clip and setup guide.

Curricular Resource Materials (download the following documents):

• Telemedicine OSCE Curriculum (PDF)
• Appendix A: Telemedicine OSCE Case (PDF)
• Appendix B: Telemedicine OSCE Information Guide (PPT)

Authors: Suzanne Minor MD, Sarah Stumbar, MD, MPH, Irmanie Hemphill MD, Christine Dalton MD, John Delzell MD, MSPH, and Ebony Whisenant, MD

Description: This is a case-based learning session on common dermatoses that can be used during the Family Medicine Clerkship (FMC). At the Florida International University Herbert Wertheim College of Medicine, the FMC is a required -week outpatient clinical experience consisting of approximately 20 students during each block. Students are in an outpatient clinic Monday through Thursday and have on-campus didactics on Fridays. This didactic session is led by one faculty member and may take from 1–2 hours (2 hours earlier in the third year and 1.25-hour in the later rotations). Contents of this posting include a facilitator guide and the core case excerpt from our syllabus.

The goal of this didactic is to increase student understanding and application of dermatology knowledge. This didactic takes the student through a case in which a 29-year-old female comes to the clinic with a new skin lesion on her leg. The students are asked to develop differential diagnoses, obtain a hypothesis-driven history, define dermatology terms, use dermatology terms to describe a skin lesion, and recommend treatment options.

Curricular Resource Materials (download the following document):

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

Authors: Mary Spalding, MD, Charmaine Martin, MD, and Oscar Noriega, MD

Description: During the required Third Year Paul L Foster School of Medicine at TTUHSC-El Paso Family Medicine--Surgery Clerkship 15-week Block Rotation each student rotates through weekly 4-hour sessions in assigned Longitudinal Selectives, a commitment honored whether the student is rotating on Family Medicine or Surgery. The goal of the Chronic Disease Management Selective is for students to develop and demonstrate competency in investigating and utilizing evidence-based clinical support systems for the chronic condition being considered and in assisting patients develop their own self-management skills. This is accomplished through clinic sessions with faculty, assigned readings, a series of home visits with a selected patient, neighborhood "windshield" tours and identification of social and community resources. Students are expected to submit a complete report by the end of the Selective to the supervising faculty for their end of selective evaluation. Any patient comments from the home visit or clinic sessions are included in the final assessment of the student. During Orientation, students review the presentation "Improving Chronic Illness Care: Chronic Care Model" (Appendix A) with faculty. The STFM Family Medicine Clerkship Curriculum (Appendix B) section on Chronic Illnesses is used for the course. Students are then paired with experienced clinicians during continuity clinics one afternoon each week at the beginning of the selective to learn chronic disease management. They receive current reading assignments on evidence-based guidelines on conditions to be covered. During the first few weeks, students choose patients that they identify as needing help in self-management for a chronic condition. Faculty obtain verbal permission from the selected family. Thereafter, the student makes his/her own arrangements for the home visit.

Curricular Resource Materials: (download the following documents

• Chronic Disease Management Curriculum (PDF
• Appendix A: Improving Chronic Illness Care (PPT)
• Appendix B: Clerkship Currriculum (PDF)
• Appendix C: Student Guide (DOC)
• Appendix D: Student Survey (PDF)

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: 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: 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)

Authors: Kristen Hood Watson, MD, Anita Ramsetty, MD, and Cristin Adams, DO

Description: At Medical University of South Carolina (MUSC), we have a disseminated Family Medicine clerkship with students located throughout the state of South Carolina. The required clerkship is six weeks long and takes place during the 3rd year. Students recognized a deficiency in the area of counseling patients regarding diet and exercise and provided this feedback. In response to this, three faculty members at MUSC created a case-based lifestyle medicine curriculum. The cases are reviewed in a small group setting using an online video conferencing service. There are associated questions that the students are assigned to complete and students then educate each other, with time allowed for discussion. This submission includes the current iteration of the cases, associated questions, as well as the facilitator guide used.

Curricular Resource Materials (download the following documents):

• Eat This! A Distace Lifestyle Medicine Curriculum (DOC)
• Appendix A: Cases With Questions and Corresponding Facilitator Guides (DOC)