Clerkship Syllabus

View a printable version of the full handbook through the link below.

Goals and Objectives

Representatives from the Department of Family and Preventive Medicine in Little Rock, the Central Regional Program Office and Regional Program Centers have developed meaningful goals, objectives, and strategies for delivering the Family Medicine Clerkship. Each site is unique and may expand on these core elements.

Goal #1: Medical Knowledge

The student will learn the diagnosis and management of common problems in Family Medicine.

Learning Objectives: At a level appropriate for a third-year medical student, the student will:

1. See a variety of patients from specific categories of diseases and document each encounter on their O2 requirement checklist.
2. Will demonstrate knowledge of diagnosis and management of acute and chronic health problems by scoring above a required minimum on final NBME test.

Assessment:

1. Students will have seen the required number of patients from each category that is listed on the O2 requirement checklist.
2. A Score on the final NBME test must be sufficient to receive a passing grade for the rotation.
3. Students will participate in six clinical didactic sessions with the clerkship faculty over the course of the rotation. These sessions will cover medical knowledge pertaining to select clinical scenarios.
4. Fund of knowledge is evaluated as a routine part of the clinical evaluation by preceptors.

Goal #2: Patient Care

The student will demonstrate a basic level of competency in gathering patient information, with an emphasis on problem-specific history taking, physical examination and problem-solving skills required to adequately assess and manage problems commonly encountered in Family Medicine.

Learning Objectives: At a level appropriate for a third-year medical student, the student will:

1. Obtain a problem-specific history, review past medical history and conduct an appropriately focused physical examination based on the patient’s reported complaint.
2. The students will be able to present history and physical exam finding with written documentation as well as in verbal presentations during encounters in the outpatient clinic.
3. Exhibit an appreciation for comprehensive, coordinated, culturally competent and continuous care for individuals and their families through participation in direct clinical care with patients of all age groups.
4. Investigate patient barriers to chronic disease management and overall health.

Assessment:

1. Patient care is evaluated by each preceptor as a routine part of the clinical evaluation.
2. Each student will be directly observed at least once by clinical faculty as they perform a history and physical examination.

Goal #3: Interpersonal and Communication Skills

The student will establish effective and ethically sound relationships with patients, faculty and staff that facilitate the provision of quality health care.

Learning Objectives: At a level appropriate for a third-year medical student, the student will:

1. Provide concise and accurate presentations to faculty and resident preceptors.
2. Communicate effectively and demonstrate caring, respectful and culturally sensitive behaviors when interacting with patients and their families.
3. Communicate effectively with members of the inter-professional team including nurses, physicians, office staff and consultants to provide patient-focused care.

Assessment:

1. Interpersonal and communication skills are evaluated by each preceptor as a routine part of the clinical evaluation.
2. Each student will be directly observed at least once by clinical faculty as they perform a history and physical examination.
3. Preceptors and clinical faculty will evaluate students as to their interpersonal relationships with peers.

Goal #4: Population Health and Preventive Medicine

The student will apply principles of wellness and health promotion in the provision of patient care.

Learning Objectives: At a level appropriate for a third-year medical student, the student will:

1. Demonstrate familiarity with appropriate resources for health promotion and disease prevention during discussions with clinical preceptors.
2. Examine the role of fitness, nutrition, and smoking cessation in health promotion.
3. Counsel patients about the effect of harmful personal behaviors and habits and appropriate health maintenance strategies.
4. Recommend appropriate immunizations based on age and risk factors.
5. Demonstrate familiarity with essential topics in population health.

Assessment:

1. Population health and preventive medicine are topics included on the NBME. A Score on the final NBME test must be sufficient to receive a passing grade for the rotation.
2. Counseling skills are evaluated as a routine part of the clinical evaluation by preceptors.
3. Regular attendance and participation in the Philosophy of Family Medicine online discussions.

Goal #5: Practice –Based and System-Based Healthcare

The student will be introduced to aspects of the organization and management of a family medicine clinic.

Learning Objectives: At a level appropriate for a third-year medical student, the student will:

1. Observe and discuss cost effective healthcare and resource allocation affecting the practice of family medicine.
2. Discuss billing and coding with preceptors during patient visits in the outpatient clinic.
3. Discuss principles of patient- and family-centered care.

Assessment:

1. Cost effectiveness, billing, and coding are discussed and assessed with preceptors during patient care. Student understanding is assessed as part of the routine clinical evaluation.
2. The performance of the student as part of the healthcare team is reported as part of the clinical evaluation.
3. Regular attendance and participation in the Philosophy of Family Medicine online discussions.

Goal #6: Professionalism

The student will demonstrate a commitment to excellence and ongoing professional development and will be provided feedback concerning their performance during the clerkship.

Learning Objectives: At a level appropriate for a third-year medical student, the student will:

1. Actively seek and act upon feedback and constructive criticism about performance, application of medical knowledge and interpersonal interactions with staff from faculty and staff.
2. Demonstrate a commitment to ethical principles pertaining to the provision of clinical care, confidentiality of patient information and informed consent.
3. Demonstrate interest and eagerness to learn through review of medical literature and use of information technology.
4. Attend all required activities and complete all assignments in a timely manner.
5. Display proper dress, grooming, punctuality, honesty and respect for patients and all members of the healthcare team.
6. Demonstrate interest in personal growth and professional development.

Assessment:

1. Attendance, dress and punctuality are closely monitored by the site coordinator.
2. Eagerness to learn through review of medical literature and use of information technology is assessed by the student’s attendance and participation in online conferences and journal clubs offered during the rotation.
3. Commitment to ethical principles and response to feedback is assessed as a routine part of the clinical evaluation and during the mid-clerkship session with site directors.
4. Regular attendance and participation in the Philosophy of Family Medicine online discussions.

Goal #7: Medical Informatics

The student will effectively and efficiently use scientific studies to manage information and optimize patient care.

Learning Objectives: At an appropriate level for a third-year medical students, the student will:

1. Demonstrate the utility of a medical literature review, critique the quality of the information gathered, discuss an article, as well as the conclusion it draws.
2. Demonstrate the utility of the electronic medical record in quality patient care including a review of active problem list, flow sheet data and past medical history.

Assessment:

1. Objective 1 is assessed by the student’s attendance and participation in journal clubs offered during the rotation.
2. Use of EMR and guidelines for clinical care are assessed as a routine part of the clinical evaluation by preceptors.

Grades and Evaluations

The Department of Family Medicine will issue the grade “A”, “B”, or “C”, as defined in the UAMS College of Medicine’s grading policy. Under highly unusual circumstances, the department may issue the grade of “I” when work is incomplete at the end of the clerkship or academic year. If assignments are not completed in a timely manner, it may result in a grade of “F”.

The final grade for the clerkship will be calculated from the following components:

A) Clinical Performance Evaluations 55%
B) NBME Subject Exam (Highest score from the Pre-Rotation or
Post-Rotation exam and 5% or above) 30%
C) All other assignments completed 15%

All Assignments:

• Pre-NBME (secure browser) via Zoom
• Requirement Checklist – “Patient Log” (O2)
• Philosophy of Family Medicine Participation
• Family Medicine Clinical Didactic Sessions
• NBME Practice Vouchers (screenshot or email back)
• Submit evaluator list to site coordinator (end of clerkship)
• Final-NBME (secure browser) via Zoom
• Mid-Rotation Feedback Evaluation (O2)
• Duty Hours Compliance Evaluation (O2)
• LEP Survey Evaluation (O2)
• NAO Evaluation (O2)
• Faculty/Resident Evaluations (O2)

Grade Appeal Process

A student may appeal their clinical performance scores in the following order:

1. Clerkship Site Director
2. Course Director
3. Promotion Committee Board

Students at Risk of Failure

All Students will receive a mid-rotation evaluation approximately two weeks into the rotation. If a student is identified as performing unsatisfactorily in the Clerkship, they will be informed and a written improvement plan will be developed. Every effort will be made on the part of the instructor to assist the student in improving their performance.

Assignments and Evaluation Details

These assignments constitute 15% of the final grade for the clerkship.

Clinical Performance Evaluation (sample below)
Clinical performance evaluations will be requested from each clinical instructor (faculty or resident) who has had an adequate opportunity to work with the student in the clinic or in another significant capacity. The final clinical performance score will be based on the average of ratings from clinical instructors.

Clinical performance constitutes 55% of the final grade for the clerkship.

NBME Subject Exams
This web-based exam is required by the College of Medicine. We recognize that the comprehensive nature of Family Medicine makes this exam particularly challenging. To aid in preparation, we administer a Pre-Rotation NBME, and Post-Rotation NBME. The higher of the two NBME scores will be used in the grading matrix. A minimum National percentile rank of at least the 5th percentile for the quarter in which the test is administered will be required to pass the rotation.

Any student scoring less than the 5th percentile will be required to retake the exam and to achieve at least a 5th percentile score. Students who fail to achieve this score after one additional re-test (total of 3 chances) will receive a failing grade for the clerkship and will be required to repeat the clerkship
The NBME Subject Exam constitutes 30% of the final grade for the clerkship.

Requirement Checklist – “Patient Log” (O2)
The recording of patient encounters will be accessed through the Oasis (O2) software. The student will be required to record the patients seen, where seen, student’s level of involvement with the patient, key diagnoses addressed at the visit, and the preceptor (faculty or resident). The site director will review the checklist at the mid-clerkship evaluation and sign off at the end of the clerkship. The requirement checklist will also have a place to document when a faculty member observes student performance of a history and physical. This observation will be in person.

You are required to fill in all sections, not leaving any blanks.
We ask that you do not provide a full note under the “Diagnosis” section.
We just want a synopsis of the visit (Chief Complaint), two – five sentences.

Chief Complaint
1. Why the patient came to the hospital. Include age, reason for coming to the hospital, and relevant PMHx that impacts chief complaint.
2. Example: Ms. Jones, 63 yo female, with HTN and known CAD, that presents for chest pain.

Please remember the diagnostic guidelines for this assignment.
The chief complaint is a concise statement describing the symptom, problem, condition, diagnosis, physician-recommended return, or other reason for a medical encounter. Although, this should be concise, a few words in this section will not get you a passing grade.

Please do your best to communicate the chief complaint, as if you were presenting to an Attending. DO NOT add the patient’s actual MRN number.
Instead, use the name of the faculty, resident or community-based physician that you worked with on the patient. When you neglect to fill in a section, or simply put N/A as an answer, you will not pass. We review your log to ensure that your notes are acceptable.

Remember: No Response = No Grade

Philosophy of Family Medicine

To introduce to third-year medical students the philosophical concepts that have guided the development of Family Medicine since its inception as a generalist specialty in the late 1960s. The sessions that are discussed in the Philosophy of Family Medicine (POFM) will be conducted virtually. Students will be placed into smaller teams to ensure adequate topic coverage and a greater student understanding.

Virtual Sessions allow every student to stay present at their site, while obtaining the valuable information provided. At the completion of this educational program, students will be able to:

1. List at least five concepts that form the basis of a Family Medicine philosophy;
2. Identify at least five concepts that originated in Family Medicine and have made their way into the broader practice of medicine;
3. Describe how these Family Medicine concepts can enrich one’s practice of medicine, regardless of specialty choice.

Family Medicine Clinical Didactic Sessions
Because the Family Medicine field is so broad and this clerkship is only a few weeks long, we have established a way to present the “greatest hits” of Family Medicine during your scheduled time with us. We will have a variety of physicians presenting on a number of topics that will help accelerate student’s learning experience. There will be set days during your clerkship that students will be expected to attend virtually to receive credit.

NBME Practice Vouchers (screenshot dates or email back)
Students will receive two (2) vouchers for the NBME Practice tests. These are optional for competition. However, because we do pay for each of these vouchers we need a record of when they were completed. Please send the date of completion to the Overall Clerkship Coordinator. If you have not used, or do not intend on using these vouchers, please notify the Overall Clerkship Coordinator of this. The Overall Clerkship Coordinator will make a note of this in their records.

Mid-Rotation Feedback Evaluation (O2)
The Mid-Clerkship Feedback is there to ensure that you were presented the opportunity to receive and provide feedback during your clerkship. This is usually conducted by the Clerkship Director near the middle of your clerkship.

Course Evaluation (O2)
Evaluate your experience during the clerkship. This process is anonymous and helps us improve the clerkship annually. This feedback from students informs the Overall Clerkship Coordinator about student concerns so that the clerkship can improve from year to year. We appreciate your honest input, but expect your statements to be made in a professional manner.

Duty Hours Compliance Evaluation (O2)
The Duty Hour Evaluation asks if you ever exceeded the limit number of hours worked while on duty for this clerkship. Due to the way this clerkship is structured, you should never exceed the duty hour limit, but we have to ask you anyway.

LEP Survey Evaluation (O2)
The LEP Survey helps you evaluate the professionalism of the faculty and staff towards students and patients. This evaluation is crucial to ensure a safe, fair, and professional environment.

NAO Evaluation (O2)
The NAO Core Outcomes survey is to evaluate your intent to practice in rural, primary care, and/or medically underserved communities.

Faculty/Resident Evaluations (O2)

Evaluate your experience with the individual faculty and other physicians you worked with. The purpose of this evaluation is to help gather information in order to evaluate the effectiveness of our clinical preceptors. If this information results in reporting, all evaluations will be submitted anonymously.

Check Out With Your Site Coordinator
Some sites have specific instructions before you leave the site. Please ensure that you return any rented materials or keys to the coordinator before leaving the site.

Clerkship Policies

Please review the UAMS Student Manual policies for all topics.

Attendance Policy:
Clinical training is an essential part of medical education and represents a critical phase of the medical student experience. Given this, any absence from clinical duties (ACD) is considered a serious matter. Clerkship directors understand that circumstances will sometimes require a student to be absent from clinical duties. The following are responsibilities and general guidelines for a medical student considering an ACD:

Absence from Clinical Duties (ACD):
This is an absence that occurs during scheduled duty hours, and does not occur during mandatory time off or on additional scheduled days off from clinical service. An ACD will decrease the total amount of time that a student is able to invest in clinical service activities. A student who has an ACD may be required to make up the time absent, depending on what activities were missed.

Student Responsibilities:
Students should attempt to schedule non-clerkship related activities outside of normal duty hours for that clerkship (e.g., late afternoons/evenings and weekends or scheduled time off).

Students must communicate all requests with advance notice (as soon as the need is known to the student) to the clerkship director, clerkship coordinator, and the attending/resident on the team they are assigned.

Students who are ACD are required to collect any didactic materials/notes from lectures that they may have missed during their time away.

Guidelines

Advance communication with the clerkship director and clerkship coordinator is required for any requested activity that could result in an ACD. These types of activities include:

1. Doctor/healthcare Appointments
2. Meetings or conferences at which the student is presenting (poster or podium)
3. Residency interviews
4. Religious observances
5. Sitting for a USMLE exam
6. Unusual and extenuating circumstances at the discretion of the course/clerkship director

Any planned absence from a mandatory activity must be approved at least one week in advance (before the planned absence) by the clerkship director. If the absence is required during the first week of the clerkship, the student must contact that clerkship director one week before the start of the clerkship, if not earlier. Planned absences that may qualify as excused include attending a conference, attending interviews and taking USMLE Exams. Beyond these, it is up to the clerkship director to qualify anything other planned absence as excused.

With advance notice, the clerkship directors will work with the student to avoid an ACD. This may include arranging rotations or shifts to accommodate the request or helping the student select the best days/times to attend their activity and limit time away from clinical duties. If accommodations can be made to align the student’s scheduled time off with their activity, the absence will not be considered an ACD. However, clerkship directors may not always be able to accommodate these requests. In this case, if the clerkship director permits the student to attend the activity, this will result in an ACD.

Emergency requests for ACD such as student illness, personal injury, or injury/illness/death of a family member should be communicated as soon as possible to the attending/resident on the assigned team and the clerkship director and clerkship coordinator.

In cases of ACD without prior communication with the clerkship director, a negative noncognitive evaluation may be filed by the clerkship director. This includes unauthorized extension of a previously authorized ACD.

Further information about common reasons for missing required educational events:

Excused Absences for Personal Medical Care

Medical students are strongly encouraged to maintain their own physical and mental health and well-being. Whenever possible, students should schedule non-emergent healthcare appointments during times that do not
conflict with classroom and clinical activities. In the event an appointment must be scheduled during a required educational activity, students must request permission to be excused from the course/clerkship director and the request will be granted.

Religious Observances

The UAMS College of Medicine recognizes and respects the importance of individual religious beliefs and practices. While the college calendar includes only religious observances recognized as U.S. federal holidays, the school seeks to accommodate student religious needs reasonably and within the requirements of the academic schedule. There shall be no adverse or prejudicial effect resulting to any student requesting excused absences for religious observances. Students assigned to patient care educational activities may request assignments that allow the student to meet their religious needs; on occasion, students may be asked to attend patient care activities that cannot be reasonably re-scheduled, such as on-call time with a care team. Required academic work missed as part of an excused absence must be made up to the satisfaction of the supervising faculty member.

Residency Interviews

During clinical clerkships, students MAY be granted excused absences for residency interview at the discretion of the clerkship director. This may vary on rotations that schedule shift clinical duties (e.g., Emergency Medicine). If a student must be absent from a clerkship due to a residency interview, the student must forward electronic documentation of the interview invitation and date to the clerkship director for approval. Approval should be sought prior to making travel arrangements.

Repeat NBME

If a student fails an NBME (fails pre & final), the following should occur:
The Clerkship Director and student will meet to attempt determine the reason. The student will be referred to Student Resource Center as applicable. An “I” will be entered in the gradebook and the NBME will be schedule for the next appropriate pre-determined date. Please contact the Overall Clerkship Coordinator for the upcoming dates available. Please see full policy in the student handbook.

Dress Code

The College of Medicine believes it is enough to point out that students are in a professional school to become physicians, and the need for appropriate dress and appearance should be self-evident. Patients expect professional attire to be worn by physicians and medical students.

While you are on your Family Medicine Clerkship, you are a representative of the facility you are working in, but to a greater degree, you are a representative of the entire University of Arkansas for Medical Sciences.

You are expected to dress in business casual, unless directly told by your site coordinator or site director otherwise. Revealing clothing, jeans, t-shirts, open-toe or open-heel shoes are not permitted during your clerkship. Always wear your white coat, again, unless strictly told not to by your site coordinator or site director. Remember, every day is an interview for you, so we ask that you dress like it.