Rural Family Medicine Preceptorship

Required

PGY2

GOALS:

The required preceptorship in Family Medicine will enable the resident to gain experience in a Family Medicine practice in arural community setting. Residents will become familiar with the variety of medical conditions encountered in a rural practice, and their management in a time-efficient manner. Emphasis will be placed on the unique needs of a rural population, including psychosocial issues that are different from those of a urban and suburban community.

OBJECTIVES:

Medical Knowledge:

  1. Resident will recognize common outpatient diagnoses and learn management of chronic conditions in an office setting.
  2. Resident will learn the commonly-encounters health systems management challenges of a family physician office.
  3. Internalize how rural culture and context shapes rural health through patient encounters, study of traditional text, and reflection on the prose and story-telling of rural health providers

Patient Care:

  1. Resident will learn to manage an office schedule.
  2. Resident will perform commonoutpatient exams and procedures.
  3. Care for patients in a variety of settings – outpatient, inpatient, in-home, and/or community settings. At least one home-visit will be completed during thisrotation.

Interpersonal and Communication Skills:

  1. Resident will develop skills in providing office care through communication and teamwork with an office staff.
  2. Resident will develop skills in discussing all aspects of medical care with typical office patients.

Professionalism:

  1. Resident will accept responsibility for the care of patients and commitment to the performance of the required duties.
  2. Resident will accept and utilize feedback appropriately.

Practice-Based Learning and Improvement:

  1. Resident will reflect on individual learning needs and engage in self-directed learning.
  2. Resident will demonstrate the ability to utilize technology to obtain and manage medical information.

Systems-Based Practice:

  1. Resident will utilize system resources to provide appropriate care and overcome obstacles in the management plan. This will include the use of consultants and community agencies.
  2. Resident will recognize the community physician’s role in community affairs.
  3. Discuss concepts of professional isolation, management of conflicting roles, blurring of professional and personal boundaries, & need for periodic, accurate self-assessment and reflection.

Methods:

Rotation activities will be centered at the Columbiana Family Health Center that serves both suburban and rural areas of Columbiana and Mahoning counties. Emphasis will be placed on the care of ambulatory patients, although care in other settings, including at least one home visit, will be provided as well. Most of the in-office rotation time will be utilized gaining clinical experience, allowing the resident to apply previously learned knowledge to real-life patient scenarios. The precepting physician(s) will teach between patient encounters using the One-Minute Preceptor Method, providing feedback and medical knowledge in a time efficient manner. The resident will have a series of recommended readings pertaining to common ambulatory family medicine diagnoses and management of those conditions. This reading material will supplement the resident’s medical decision making during clinical encounters with patients in office. Additionally, residents will be expected to complete a series of weekly readings about rural health, culture, and context, which will accompany the goals and objectives provided at the beginning of the rotation. The resident will be expected to reflect upon these readings during the course of each week, looking for parallels in their patient encounters and any overall consequences on patient health and well-being. At the end of the week, resident-preceptor discussion will be held regarding the weekly readings over lunch. Supervision during the rotation will be provided by a board certified family physician who will complete the rotation-specific evaluation at the end of the rotation. Some activities may take place during “atypical office hours.” ACGME Duty Hour restrictions will supersede any activities whenever necessary.

Required reading:

It is recommended that the resident utilize several texts/journals in addition to the required readings. Suggestions include:

Current Diagnosis and Treatment in Family Medicine

American Family Physician (AFP)

Family Practice Management (FPM)

The following readings are from a variety of references. They are not meant to be inclusive. The resident should do additional reading as indicated by patient care needs or the recommendations of supervising physicians. All of the following readings may be accessed through various sources, but the links given are freely available to all residents. Readings from other textbooks could be substituted for the listed one.

Cholesterol

AFP, August 15, 2014 ACC/AHA Release Updated Guideline on the Treatment of Blood Cholesterol to Reduce ASCVD Risk

Hypertension

JNC VII, Summary

“JNC VIII” Summary

AFP, May 15 2009, Evaluation and Management of the Patient with Difficult to Control Hypertension

Depression and anxiety

AFP, May 1, 2009, Generalized Anxiety Disorder: Practical Assessment and Management

AFP, June 1 2006, Depressive Disorders

AFP, March 15 2008, Pharmacologic Management of Adult Depression

Preventive Care

USPSTF, Guide to Clinical Preventive Services

AFP By Topic: Health Maintenance and Counseling

Obesity

AFP, June 15, 2010; Office-Based Strategies for the Management of Obesity

Patient Counseling

FPM, Sept-Oct 2009; Five Communication Strategies to Promote Self-Management of Chronic Illness

Practice Management

FPM, Oct 2003, How to Get All the 99214s You Deserve

FPM, April 2007, How Many Patients Can One Doctor Manage?

FPM, July/August 2008, A New Approach to Making Your Doctor-Nurse Team More Productive

FPM, Feb 2004, The Outcomes of Open-Access Scheduling

FPM, July/August 2009, The Patient-Centered Medical Home

House Calls: Stories from Thirty Years of Rural Medicine Among the Amish and English. Gary Yarbrough, MD

Week 1 - Breath Sounds

Week 2 - First Swiss

Week 3 - Values

Week 4 - Looking Amish

The Country Doctor Revisited: A Twenty-First Century Reader. Therese Zink

Week 1- Introduction

-Who We Are – Synopsis, Godfrey Onime

-Boundaries, Megan Wills Kullnat

-If You Don’t Have What You Want, Joseph Gibes

-Mashkikiwinini: Thanking Sylvester for His Unconditional Smile, Arne Vainio

-Indian Dinner in Johnson City, Abraham Verghese

Week 2 - Where We Are – Synopsis, Tom Bibey

-Learning from an Amish Birth, Emily Kroening

-A Vow of Connectedness: Views from the Road to Beaver’s Farm, David
Loxterkamp

Week 3 -Whom we Serve – Synopsis, Therese Zink and Tara Ferks

-Cord, Holly Farris

-The Brothers, Ann NeuserLederer
-The Sisters – Written in Love, Anthony Fleg

-Good Will, DonaldKollisch

Week 4. -Our Resources and Challenges – Synopsis, Gwen WagstromHalaas

-Everyone Did Their Part, But, Therese Zink
-Local Medical Doctors: State-of-the-Art Healers, Gwen WagstromHalaas

-Inside the Mind of a Modern Country Doc, Tom Bibey

Rural Populations and Health: Determinants, Disparities, and Solutions. Crosby, Wendel, Vanderpool, Casey.

Week 1 - Chapter 1 Understanding Rural America: A Public Health Perspective

Week 2 - Chapter 2 Defining Rurality

Week 3 - Chapter 3 History of Rural Public Health in America

Week 4 - Chapter 4 The Depth of Rural Public Health Disparities in America: The
ABCDEs

Rural Primary Care Preceptorship, Revised 9/15