3rd YEAR CLERKSHIP PRECEPTOR MANUAL
UNDERGRADUATE MEDICAL EDUCATION
Department of Family Medicine
University of Ottawa
43 Bruyère Street, 356Jb
Ottawa, Ontario K1N 5C8
T: 613-562-6335 F: 613-562-6336
May 2017
PREFACE
This manual is a guideline for preceptors who agree to have third year medical students in their clinics. Third year clerkship is a core (mandatory) rotation of six weeks duration. This manual contains a description of the clerkship Learning Objectives and Learning Modules. It is also a guide for the preceptor on how to proceed with the student and what is expected of them. In addition, this manual contains documentation that will help you, the preceptor, assess the medical student’s behaviour and how to address any concerns.
Please take the time to familiarize yourself with it.
TABLE OF CONTENTS
3rd YEAR CLERKSHIP PRECEPTOR MANUAL
UNDERGRADUATE MEDICAL EDUCATION
PREFACE
TABLE OF CONTENTS
MESSAGE FROM THE CLERKSHIP DIRECTOR, ANGLOPHONE
MESSAGE FROM THE CLERKSHIP DIRECTOR, FRANCOPHONE
CONTACT PERSONS
Dr. Lina Shoppoff, MD, CFCP
Eoghan O’Shea, MD, CCFP, FCFP
Michelle Anawati, MSW, MD, CCFP
Donna Williams
Marthe Ménard
INTRODUCTION
LEARNING OBJECTIVES
FAMILY MEDICINE CLERKSHIP EXAM BLUEPRINT
LEARNING MODULES
SLM – Self Learning Modules (on line)
List of Possible Places to Visit as part of the Family Medicine Clerkship
POLICIES
PROFESSIONAL RESPONSIBILITIES
IN UNDERGRADUATE MEDICAL EDUCATION COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO (CPSO) POLICY
CPSO POLICY STATEMENT
Purpose
Scope
Definitions
Principles
College policy
Consent:
ACCIDENTS IN THE CLINICAL SETTING
When must the accident or incident report be completed?
APPROPRIATE APPEARANCE AT CLINICAL ENCOUNTERS
DRESS CODE POLICY (Short form)
ATTENDANCE POLICY
ATTENDANCE POLICY (Short Form)
General Principles
Pre-Clerkship
Clerkship
HARASSMENT AND DISCRIMINATION
HOW TO ADDRESS PROFESSIONAL BEHAVIOUR CONCERNS
EVALUATIONS
Evaluation of Student by Clinical Preceptor
Evaluation of Clinical Preceptor by Student
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Family Medicine Clerkship Preceptor Manual
Last revised: May 2017
MESSAGE FROM THE UNDERGRADUATE DIRECTOR
Dear Colleagues,
The Faculty of Medicine at the University of Ottawa offers a 6-week clerkship in Family Medicine. This rotation is completed in the third year of the curriculum and it is complementary to previous experiences in family medicine during the first and second year of medical school. It provides students with the opportunity to work in a community physician’s office as part of an interdisciplinary team or in a variety of ambulatory settings such as nursing homes, ER, hospital work, palliative care, and home visits in order to increase their understanding of the discipline of family medicine.
Clinical Clerkships form the foundation of student education during third year as the student becomes a participant in patients’ care. In order to structure this experience, clerkship goals and objectives must be clarified.
For this reason, the Department of Family Medicine created the Clerkship Preceptor’s Manual. It is a comprehensive manual for clerkship preceptors as well as other members of the teaching team. It provides our preceptors with information about learning objectives, school policies, and evaluations. Our learning objectives are based on the national family medicine guidelines and include the most common conditions for patients presenting for acute, chronic, or preventive-care visits.
As teachers, experts, specialists, and mentors, you are providing learning experiences to medical students. On a daily basis, you allow the students to take a glimpse into the daily life of a family physician in multiple and varied settings. Our rotation would not be possible without your tireless efforts and we value your excellent and ongoing commitment to this role. The success of the undergraduate program requires effectivecommunicationbetween the department and our preceptors. Your feedback and comments are always welcome and appreciated in order to improve our mandate together.
We hope, as you continue to enrich the lives of our students, that we provide you with the opportunity to enrich your career as a family physician and as a preceptor.
Sincerely,
Dr. Lina Shoppoff, MD, CCMF
Director of Undergraduate Medical Education
Department of Family Medicine
University of Ottawa
MESSAGE FROM THE CLERKSHIP DIRECTOR, ANGLOPHONE
Dear colleagues and friends,
In my role as undergraduate clerkship director (Anglophone stream) I wish to thank you for your commitment to this important role as clerkship preceptors. Some of you are new to the role of preceptor while others have been involved for many years. Regardless of your experiences, this is a first for each of our medical students, an opportunity to introduce them to our role in health care and a potential recruiting strategy to the role we love as family doctors. This is a win-win situation for all involved.
The medical students are keen to get to see patients after all the years of studying, eager to make the early steps of applying theoretical knowledge to the real world of family medicine. They learn to appreciate the complexity of being family doctors. It has never been easy to be a good family doctor and your role includes exposing them to this reality.
I welcome feedback on every aspect of the program. I thank you in advance for completing the required forms to help keep our program running.
Eoghan O’Shea, MD, CCFP, FCFP
AssistantProfessor
Director of Clerkship, Anglophone Stream
Department of Family Medicine
University of Ottawa
MESSAGE FROM THE CLERKSHIP DIRECTOR, FRANCOPHONE
Chers collègues,
C'est avec grand plaisir que je vous souhaite la bienvenue au stage d'externat en Médecine Familiale de l'Université d'Ottawa (volet francophone). Les six semaines du stage sont vites passées pour nos étudiants, mais il demeure l'un des stages les plus importants à la formation de médecins compétents ainsi qu'au recrutement de nos futurs collègues. C'est un stage riche en expériences cliniques dans lequel les étudiants ont l'opportunité d'être exposés à de populations, patients et contextes variés. C'est à travers ces expériences qu'ils pourront apprécier la richesse et la diversité possible en médecine de famille ainsi que les défis à relever.
Le stage ne pourrait pas fonctionner sans vous, les précepteurs, et nous vous félicitons de votre dévouement et travail envers la formation médicale. L'un de mes buts, en tant que directrice de stage, est de vous appuyer dans votre rôle de superviseur et d'enseignant, afin de maximiser non seulement l'apprentissage de nos étudiants mais aussi votre expérience.
Ce guide de préceptorat inclus des informations importantes qui vous aideront à encadré vos étudiants. Vous trouverez ci-inclus: les objectifs d'apprentissage, le blueprint pour l'examen de fin de stage, l'information sur les modules d'apprentissage en ligne, comment gérer des problèmes avec le professionnalisme, et les formulaires d'évaluations.
Si vous avez des questions ou commentaires par rapports à un étudiant, ou plus généralement comment nous pouvons améliorer le stage, n'hésitez pas de communiquer avec moi.
Michelle Anawati, MSW, MD, CCFP
AssistantProfessor
Director of Clerkship, Francophone Stream
Department of Family Medicine
University of Ottawa
CONTACT PERSONS
Dr. Lina Shoppoff, MD, CFCP
Director of Undergraduate Medical Education
Department of Family Medicine
University of Ottawa
43 Bruyère St.
Ottawa, ON, Canada
K1N 5C8
613-562-6335 ext. 1574
1
Family Medicine Clerkship Preceptor Manual
Last revised: May 2017
Eoghan O’Shea, MD, CCFP, FCFP
AssistantProfessor
Director of Clerkship, Anglophone Stream
Department of Family Medicine
University of Ottawa
43 Bruyère St.
Ottawa, ON, Canada
K1N 5C8
613-562-6335 ext. 1574
Michelle Anawati, MSW, MD, CCFP
AssistantProfessor
Director of Clerkship, Francophone Stream
Department of Family Medicine
University of Ottawa
Tel: (613) 746-4621 poste 6002
1
Family Medicine Clerkship Preceptor Manual
Last revised: May 2017
Donna Williams
Coordinator, Anglophone Stream
Undergraduate Medical Education Program
Department of Family Medicine,
University of Ottawa
43 Bruyère St.
Ottawa, ON, Canada
K1N 5C8
613-562-6335 ext. 1441
Marthe Ménard
Adjointe, volet Francophone
Direction des affaires universitaires
Hôpital Montfort
713, ch. Montréal,
Aile D - Pièce 124 - 2ième étage
Ottawa (Ontario) K1K 0T2
Téléphone : 613-746-4621 poste 6002
Télécopieur : 613-748-4922
Courriel :
1
Family Medicine Clerkship Preceptor Manual
Last revised: May 2017
INTRODUCTION
The goal of the Department of Family Medicine’s Undergraduate program at the University of Ottawa is to offer a third year clerkship rotation in which students learn the principles of Family Medicine in a community-based clinical context.
Canadian family physicians work in a variety of clinical settings. They usually see common problems, yet must frequently consider less common illnesses in their differential diagnosis. They are frequently the first physicians consulted and often see problems at an early stage. Because of this, they need to be prepared to deal with the uncertainty of undifferentiated symptoms and problems. To be effective in different settings, with common problems and illnesses presenting at various stages of development in all age groups, family physicians require a broad base of knowledge and experience.
The Department of Family Medicine has designed a clerkship which exposes students to the diversity of clinical settings; a clerkship which promotes respect for the Family Physician; a clerkship which helps students deal with uncertainty; and a clerkship in which students learn to diagnose and treat the kinds of problems we see most frequently in a humane and compassionate way.
Through the lottery (second year) students will be assigned to either a rural community in South Eastern Ontario, or a community practice in Ottawa. The rural rotations are organized through our closest rural network, the Eastern Regional Medical Education Program (ERMEP), who takes care of all the details including lodging. As well two students from each block can choose to work with a different rural network in Ontario (ROMP or NOSM) and one student can choose Moose Factory.
The Family Medicine Clerkship (Anglophone stream) is scheduled as follows for everyone, both
Week One: All students are in Ottawa attending learning modules and doing allied health care provider visits. Details on exact schedules will be available closer to the beginning of the rotation. The Learning Modules are meant to expose medical students to different clinical scenarios that meet UGME Learning Objectives. They are described in more detail in this manual under LEARNING MODULES. Medical students are also expected to spend two half days with an Allied Health Care Provider in order to complete their Family Medicine rotation. The list of suggestions is under MEDICAL STUDENT ALLIED HEALTH CARE PROVIDER VISITS, please feel free to help your students make these choices.
Weeks Two - Six: All students spend all of this time with their assigned preceptor. The expectation is that the student is to experience the full scope of their preceptor’s practice including hospital call, nursing home care, Emergency Room shifts, deliveries, etc.
If your usual practice involvesother areasof Family Medicine, such as visits to nursing homes, Emergency Room shifts or even the Labor and Delivery Unit, by all meansbring the medical student along with you, as we are trying to feature Family Medicine as it truly exists within your weekly practice.
Evaluations are a crucial part of the clerkship rotation, as they are a tool to ensure that the rotation meets its objectives. University policy demands that all students receive both a mid rotation and final evaluation. We strongly urge preceptors to meet with their students for these two sessions. Any student experiencing difficulties at the mid rotation evaluation needs clear documentation, and a remedial plan that we would ask you to discuss with us. In fact, any time you have concerns about a student, academic or otherwise, please feel free to pick up the phone or send us an E-mail.
To encourage success, the UGME program offers annual awards for Undergraduate Community Teacher of the Year, presented during the Department of Family Medicine Annual Retreat, and for Outstanding Clinical Performance to medical students in their rotation.
LEARNING OBJECTIVES
Medical students doing a third year clerkship in Family Medicine should be familiar with all of the problems listed below. These problems were selected because of their high prevalence and importance in Family Medicine practice. Medical students should therefore make sure to familiarize themselves with these health problems during their family medicine clerkship.
Abdominal Pain - Acute (A01)
12471 Perform a patient-centered interview and focused physical exam, and list and interpret clinical findings.
12472 Identify the signs and symptoms of a surgical abdomen.
12473 Identify red flags of potential serious causes of abdominal including referred pain from the chest.
12474 Identify psychosocial factors associated with chronic and recurrent abdominal pain.
12475 Propose a relevant differential diagnosis that includes common causes of abdominal pain and less common but important causes of abdominal pain.
12476 For patients with acute abdominal pain, propose an initial management plan that includes appropriate and timely referral/investigation for potentially serious causes.
12477 For patients with chronic/recurrent abdominal pain, propose a management plan that highlights initial investigations and basic management.
AnxietyDisorders (A02)
12482 Elicit the common symptoms associated with anxiety (as per the most current DSM criteria e.g., tenseness, fatigued, reduced concentration, irritability).
12483 Elicit the contextualand other factors contributing to the anxiety symptoms and probe for/describe impact of anxiety on patient's function.
12484 Differentiate between situational anxiety and anxiety disorders: including general anxiety disorder (GAD), obsessive-compulsive disorder (OCD), phobias, and post-traumatic stress disorder (PTSD).
12485 Identify and describe other conditions that can present with anxiety, co-morbid or more seriousconditions, e.g. substance abuse, dementia, delirium, hyperthyroidism, arrhythmias personality disorders.
12486 Describe blended conditions ie: anxiety-depression, dual diagnosis.
12487 Identify and describe high risk groups for anxiety disorder (e.g. post-trauma, bereavement, malignancy or other serious illness diagnosis (in self or family member), dysfunctional families (abuse, separation, etc.), family history)
12488 Propose non-pharmacologic and pharmacologic management options for patients with anxiety, including risks, benefits and limitations of the method(s) used.
12489 Identify locally available resources which can provide support or help with ongoing management of anxiety disorder.
Asthma(A03)
12490 Demonstrate how to accurately diagnose asthma through a focused history and physical exam, including family, occupational and environmental history.
12491 Identify the non-asthma causes of wheezing.
12492 Explain the underlying pathophysiology of asthma to patients and/or family members, including acute and recurrent episodes, prophylaxis principles, mechanism of action of relevant medications, and red flags of impending asthma crises.
12493 Demonstrate how to assess asthma control at follow-up visits and how to identify modifiable triggers for patients.
12494 Describe the different medication delivery methods (and relevant compliance / educational issues).
12495 Describe the major medication categories, including mechanism of drug action (particularly SABA and ICS), benefits, risks, limitations, use patterns, compliance, and device use.
12496 Propose a management plan for patients with acute exacerbations of asthma.
Chest Pain (A04)
12497 Conduct a rapid assessment of a patient with chest pain to identify whether the patient requires emergency care or not.
12498 Describe the family physician’s role in the stabilization and initial management of patients identified to require emergent care.
12499 Conduct a focused history (including cardiac risk factors) and a relevant physical exam on a patient with chest pain.
12500 Develop a concise differential diagnosis for patients with chest pain including cardiac and non- cardiac causes.
12501 Describe the key clinical characteristics of the following chest pain etiologies: angina, embolism, gastroesophageal reflux, costochondritis, anxiety, and pneumonia.
Contraceptive Counselling(A05)
12507 Obtain an appropriate medical and sexual history on a patient requesting contraception (e.g. migraines, unprotected intercourse, smoking, depression, contraindications for common contraceptive methodologies)
12508 List and explain the absolute contraindications for hormonal contraception.
12509 Counsel a patient on contraceptive options including: patient preferences and values, risks and side effects, contraceptive methods and devices (both permanent and non-permanent), benefits and relative efficacy, barriers to access (e.g. cost), proper use including initiation, potential drug interactions, emergency contraception.
12510 Counsel a patient on sexually transmitted infection (STI) prevention and screening.
12511 Describe the role of family physicians in caring for patients with unintended pregnancy.
Cough (A06)
12512 Conduct a patient interview and appropriate focused physical examination to identify the common and important causes of cough.
12513 Describe the causes of acute cough: infectious (viral/bacterial), exacerbation of asthma, exacerbation of COPD, post-viral cough and exacerbation of CHF.
12514 Describe the causes of chronic cough (including screening for red flags, e.g., weight loss, hemoptysis): post-nasal drip, GERD, asthma, COPD/Smoking, infection (e.g., tuberculosis), medication (e.g. ACE Inhibitor), congestive heart failure, and neoplasm.
12515 Demonstrate how to perform an appropriate environmental, occupational, and travel history as part of the interview in a patient with cough.
12516 Propose a relevant initial investigation plan (e.g. chest xray, spirometry) for a patient with cough.
12517 Recognize a patient with respiratory distress (e.g. hypoxia, tachypnea, etc.) and seek immediate help.
12518 Suggest a preliminary/initial management plan for patients with cough, particularly for the acute and chronic causes, avoiding unnecessary use of antibiotics.
Mental Diseases and Disorders(A07)
12519 Demonstrate how to screen for and diagnose depression including: using current criteria and other diagnostic and functional assessment tools, mental status exam (including assessment of suicide/homicidal risk and taking appropriate action where necessary).
12520 Identify high risk factors for depression and suicide.
12521 Describe variant presentations of depressed patients.
12522 Propose a differential diagnosis for patients with depressed mood to rule out important secondary causes and an initial plan for investigation & management.
12523 Describe non-pharmacologic (community resources, effect of/on family & social supports) and pharmacologic approaches (mechanism of action, medication classes & interactions) to management of depression, including: risks, benefits and limitations of the method(s) used.
Diabetes Mellitus (A08)
12527List the risk factors for diabetes mellitus type 2 (DM2).
12528List the criteria needed to diagnose diabetes mellitus type 2.