Family Medicine Clerkship Research Articles

Impact of an Inpatient Family Medicine Exposure: Changing Student Perception

Introduction: Currently there is a primary care physician shortage in the United States, and this shortage is expected to worsen into the foreseeable future. In 2023, only 7.5 % of US allopathic graduates entered family medicine (FM) residencies. Opportunities to create increased interest in family medicine as a career choice and address hidden curriculum messages in career choice must be explored to address shortages in family medicine. Methods: A 5-day inpatient experience with family medicine residents on a family medicine inpatient service was implemented during a required third-year core medical student clerkship in family medicine. Students who participated in this clerkship change were invited to complete a survey on how this experience altered their perceptions on the roles of family medicine physicians in inpatient medical care, intrapartum care, and care of the newborn, and how it affected their view of FM as a career choice. Results: Of the eligible students, 34% completed the survey. Participating in the FM inpatient experience significantly enhanced students’ perceptions about the depth of knowledge and skill needed for the specialty, increased students’ respect for the specialty, and contradicted students’ perceptions about the complexity of cases treated in the specialty. Conclusion: Adding an inpatient component to a third-year FM clerkship experience can significantly change the perceptions of medical students about the specialty of FM. Brief inpatient exposure to medical students has an impact on hidden curriculum messaging about family medicine.

Exploring Bias in Health Care: Using Art to Facilitate a Narrative Medicine Approach among Third-Year Medical Students.

Teaching medical students about biases in health care poses challenges due to the complexity of modifying preexisting beliefs and the possibility of triggering strong emotional reactions. Narrative medicine fosters reflection and discussion among healthcare providers, and visual thinking strategies (VTS) enable providers to improve diagnostic ability through close and methodical examination of art. This study investigated the effectiveness of a session integrating narrative medicine and VTS to enhance third-year medical students' understanding of bias in health care. A 90-minute "Narrative Medicine Rounds" session was implemented in the Family Medicine clerkship for all third-year medical students in the Florida International University Herbert Wertheim College of Medicine class of 2024. The session included a faculty-facilitated discussion of Robert Colescott's painting Emergency Room, an overview of narrative medicine principles, and a sharing of student narratives related to bias experienced in the healthcare setting. After the session, students wrote and submitted their narrative essays. Students also completed an anonymous, optional, computer-based evaluation with Likert-type and free-response questions. Likert questions were analyzed using descriptive statistics. For the short-answer questions, teams of two researchers (D.G. and S.E.S., E.E. and M.S.) analyzed responses for themes and subthemes, met to reach consensus on a codebook through discussion, and recoded data as needed until frequencies of themes were mutually determined. Of 101 students, 87 (86%) provided responses to the Likert questions. Seventy percent of respondents agreed that Robert Colescott's Emergency Room was a useful tool for discussing bias in medicine, whereas 25% were neutral. Fifty-one percent of respondents agreed that the session enhanced their understanding of bias in patient care, with 33% being neutral. Forty-seven percent of respondents agreed that the session made them more familiar with narrative medicine as a tool that they can use in patient care, with 28% being neutral. Students identified five themes for recognizing bias: empathy (16%), self-reflection (60%), active listening (17%), communication (13%), and education (7%). When addressing bias, students outlined five strategies: drawing from personal experiences (1%), self-reflection (64%), communication (29%), education (15%), and advocacy (26%). Combining narrative medicine and VTS in a single session offers a promising approach for discussing bias in healthcare education. Through reflective experiences and art interpretation, students demonstrated an awareness of often interconnected strategies to identify and mitigate bias while caring for patients. Future next steps for this study involve exploring longitudinal impacts and integrating narrative medicine strategies throughout the medical school curriculum.

Imprecise Clinical Assessments and Inaccurate Grades: Family Medicine Clerkship Director Perspectives.

As application to residency programs becomes increasingly competitive, educational leaders face growing student concern about imprecise clinical assessments and clerkship grades. As part of a large annual survey of family medicine clerkship directors (FMCDs), 10 questions were disseminated in May 2023 about perceived levels of imprecise assessments by faculty. We aimed to determine to what extent respondents felt their institution's evaluation system propagated inaccurate grading. A total of 52% of 169 FMCDs responded to the survey. Of these, 7% of respondents were completely confident that their preceptors would give two students of identical competence the same clinical evaluation rating. FMCDs estimated that an average of 38% of their preceptors inaccurately rate student performance. Most clerkships use an Honors/High Pass/Pass/Fail grading system. We found that 51% of FMCDs prefer to use a different grading paradigm than they currently use. We asked FMCDs to estimate the percentage of students that expressed concern over inaccurate preceptor ratings. Grading systems with more tiers were associated with a higher percentage of concerned students. Clerkship grades are widely used by residency program directors to classify and differentiate student applicants. We identified a significant concern from FMCDs that clinical evaluation ratings can vary greatly. Given the high stakes and perceived inaccuracy of clerkship grading, we recommend continued investigation into the appropriate weighing and usage of clinical evaluations. Continued exploration is recommended to develop grading paradigms centered on criterion-based assessment.

Teaching multimorbidity to medical students.

Multimorbidity is a rising health care phenomenon and doctors require specific skill sets to effectively care for patients with multiple illnesses. Despite this, most medical education is taught using a single-disease, systems-based approach. Consequently, students can struggle to manage patients with multimorbidity. To help final year medical students manage patients with multimorbidity in clinical practice, we devised, taught, and evaluated a heuristic: collect, cluster and co-ordinate. Students attended a 1-hour online workshop during their family medicine clerkship. Using a flipped classroom design, students watched a podcast, followed by facilitated small-group work. Out of 132 final-year medical students, 102 participated in the evaluation. Students rated their confidence managing patients with multimorbidity, pre and post teaching on a Likert scale. Prior to teaching, 36% (n = 37) students rated their ability to manage a patient with multimorbidity as slightly confident. After teaching, 74.5% (76) students rated their ability to manage the same patient as fairly or completely confident. Prior to graduation students were surveyed to determine if they had applied the framework during clinical placements. Sixty-one students responded; 32 applied the heuristic during family medicine and in other clinical rotations such as paediatrics, obstetrics, emergency medicine and anaesthesia. Specific instruction on managing consultations with patients experiencing multimorbidity during undergraduate medical education increased learner confidence caring for these patients. The heuristic was relevant and applied in disciplines outside family medicine. Students indicated that earlier teaching on this topic would have prepared them better for clinical placements.

Efforts to Reduce Bias in Clerkship Evaluations: A CERA Study.

As the number of medical students who identify as underrepresented in medicine (URiM) increases, the disparities related to gender and URiM status persist. This study examines the current initiatives within family medicine clerkships to reduce bias in evaluations. Our 10-item survey was included as a module in the 2022 Council of Academic Family Medicine Educational Research Alliance national survey of family medicine clerkship directors. Our survey questions asked about whether programs had strategies to reduce bias in student evaluations, antiracism initiatives, perceptions on effectiveness of the initiatives, and type and cadence of faculty development on evaluations for preceptors. The overall response rate for the survey was 59.12% (94/159); all respondents completed our module. Seventy percent said they had implemented strategies to reduce bias in evaluations, 60% felt these were effective, and 80% felt that reducing bias in evaluations was a priority. The majority, 89/91(95%), indicated that their medical schools had a current social justice, diversity, or antiracism initiative. We identified a positive association between specific antibias medical school initiatives and clerkship directors undertaking practices to reduce bias in evaluations (P=.005). Most programs had implemented strategies to reduce bias and felt that doing so was a priority. Community-based preceptors were less likely to have faculty development around reducing bias compared to those in academics. Further improvements may need to prioritize including community preceptors in educational efforts to reduce bias.

Social Determinants of Health Education Within Family Medicine Clerkships: A CERA Study.

Social determinants of health (SDoH) education has gained popularity in undergraduate medical education; however, emphasis varies, and the curricula or assessment methods are not uniform. This study sought to examine the current SDoH teaching and assessment methods within family medicine clerkships and to identify characteristics associated with SDoH curriculum with multicomponent (two or more) teaching strategies and higher Kirkpatrick levels of assessment (Level 3-behavior change and Level 4-results). An online survey was conducted through the 2023 Council of Academic Family Medicine Educational Research Alliance (CERA) Clerkship Directors Survey. The survey response rate was 56.8% (96/169). The degree of SDoH emphasis in the medical school was positively associated with the number of teaching strategies (r=0.48; P<.001). We found a trend toward degree of SDoH emphasis being associated with higher Kirkpatrick levels of assessment (H[3]=7.83; P=.05). Having an SDoH faculty champion was associated with more teaching strategies (F[1,77]=8.73; P=.004), more types of assessments (F[1,78]=5.88; P=.018), and higher Kirkpatrick levels of assessment (H[1]=4.46; P=.035). Underrepresented in medicine clerkship director identity was not associated with the number of teaching strategies or higher Kirkpatrick levels of assessment. Greater degrees of SDoH emphasis and having a faculty champion were associated, or trended toward association, with multicomponent teaching strategies and higher Kirkpatrick levels of assessment, which prepare students to provide SDoH responsive care that could lead to reduction in health inequities.

Teaching Population Panel Management: A Patient Outreach Activity in a Family Medicine Clerkship.

The delivery of population health education in medical school can be challenging. We developed a patient outreach activity for third-year students to teach them the role of population panel management in primary care. The family medicine undergraduate medical education and population health teams collaborated to develop an educational patient outreach toolkit. After an orientation, family medicine clerkship students were assigned to call patients on their faculty adviser's patient panel to discuss care gaps and identify barriers and potential strategies to improve care. After the experience, students completed reflection questions, which we analyzed. From February to August 2022, 82 third-year medical students participated in the patient outreach activity during their 6-week clerkship. Of the 1,235 total attempted calls, 24% of the patients scheduled their appointments afterward. After analyzing the reflective student feedback, we identified six main takeaways, which focused on the importance of population health, the identification of barriers to care, positive and negative feelings that students experienced when making calls, student self-identified areas of growth, and the fragmentation/inefficiency of the health care system. An opportunity exists to continue to teach students about how to communicate with patients about their health and how to address and improve social determinants of health. This curricular activity can be a step toward efforts to align population health and clinical practice and a way for medical students to add value by educating patients.

Family Medicine Clerkship Directors' Perspectives on USMLE Pass/Fail Scoring: A CERA Study.

Reports on the effects of changing the United States Medical Licensing Exam (USMLE) Step 1 examination scoring to pass/fail are evolving in the medical literature. This Council of Academic Family Medicine Educational Research Alliance family medicine clerkship directors' study seeks to describe family medicine clerkship directors' perceptions on the impact of incorporation of Step 1 pass/fail score reporting on students' family medicine clerkship performance. Ninety-six clerkship directors responded (56.8% response rate). After exclusion of Canadian schools, we analyzed 88 clerkship directors' responses from US schools. We used descriptive statistics for demographics and responses to survey questions. We used ꭓ2 analysis to determine statistically significant associations between survey items. Clerkship directors did not observe changes in students' overall clinical performance after Step 1 pass/fail scoring (60.8%). Fifty percent of clerkship directors reported changes in Step 1 timing recommendations in the past 3 years. Reasons included curriculum redesign (30.5%), COVID (4.5%), change in Step 1 to pass/fail (11.0%), and other reasons (3.7%). Forty-five percent of these clerkship directors did not observe a change in students' clinical medical knowledge after Step 1 went to pass/fail. Eighty-four percent of these clerkship directors did not compare student performance on clerkship standardized exams before and after Step 1 score changes. We found no significant relationship between Step 1 timing and student performance. This study represents an early description of family medicine clerkship directors' perceived observations of the impact of Step 1 scoring changes on student performance. Continued investigation of the effects of USMLE Step 1 pass/fail scoring should occur.

Effect of the COVID-19 Pandemic on Medical Student Performance and Evaluation Scores.

In March 2020, the University of Hawaii John A. Burns School of Medicine suspended in person clinical teaching due to the SARS-CoV-2 (COVID) pandemic. During this period, virtual cases, telehealth participation, and online cases were incorporated into medical education. We have examined the effects of educational outcomes of third and fourth year students throughout clerkship performance, national standardized test scores, and our local fourth year OSCE examination. We found that USMLE step 2 scores were higher in the COVID-affected group. Patient logs in the COVID-affected group were lower for internal medicine, family medicine, OBGYN, and psychiatry clerkships. Clerkship performance grades in the COVID-affected group were lower for OBGYN and higher for surgery and psychiatry, but not different in other clerkships. USNBME subject specific examination scores in the COVID-affected group were higher for internal medicine, surgery, family medicine and psychiatry, but not different in all other specialties. For the fourth year OSCE, students in the COVID-affected group performed better on note taking and worse on physical examination. Future investigations will be needed to explore how our COVID-affected medical students perform in residency and beyond.

Evaluating Student Clerkship Performance Using Multiple Assessment Components.

Family medicine clerkships utilize a broad set of objectives. The scope of these objectives cannot be measured by one assessment alone. Using multiple assessments aimed at measuring different objectives may provide more holistic evaluation of students. A further concern is to ensure longitudinal accuracy of assessments. In this study, we sought to better understand the relevance and validity of different assessment tools used in family medicine clerkships. We retrospectively correlated family medicine clerkship students' scores across different assessments to evaluate the strengths of the correlations, between the different assessment tools. We defined ρ<0.3 as weak, ρ>0.3 to ρ<0.5 as moderate, and ρ>0.5 as high correlation. We compared individual assessment scores for 267 students for analysis. The correlation of the clinical evaluation was 0.165 (P<.01); with case-based short-answer questions it was 0.153 (P<.01); and with objective structured clinical examinations it was -0.246 (P<0.01). Overall low levels of correlations between our assessments are expected, as they are each designed to measure different objectives. The relatively higher correlation between component scores supports convergent validity while correlations closer to zero suggest discriminant validity. Unexpectedly, comparing the multiple-choice questions and objective, structured clinical encounter (OSCE) assessments, we found higher correlation, although we believe these should measure disparate objectives. We replaced our in-house multiple-choice questions with a nationally-standardized exam and preliminary analysis shows the expected weaker correlation with the OSCE assessment, suggesting periodic correlations between assessments may be useful.

Trends in Point of Care Ultrasound Familiarity Among Undergraduate Medical Clerkship Educators.

Despite growing use of point of care ultrasound (POCUS), there remains a paucity of data about familiarity with POCUS among educators who dictate curricular content in undergraduate medical education. This paper aims to longitudinally characterize the level of comfort and frequency of POCUS use among faculty involved in undergraduate clerkship education. A web-based cross-sectional survey assessing comfort, frequency of use, and awareness of indications for POCUS among faculty involved in Internal Medicine, Family Medicine, and Surgery undergraduate clerkship education in a single urban academic medical center in 2016 and again in 2022. A total of 45 responses from 2016 and 30 responses from 2022 are included. The percentage of faculty "not comfortable" with performing POCUS decreased from 78% to 46%, although the overall change in comfort was not statistically significant. Comfort interpreting POCUS images, frequency of POCUS use, and familiarity with the clinical applications of POCUS all improved. Faculty identified multiple barriers to more frequent POCUS use. Over a six-year period at one urban, academic medical center, comfort with POCUS and frequency of use have increased slightly but remain low among core faculty responsible for clerkship education. There are still large gaps in knowledge and very few faculty regularly use POCUS, which can be attributed to multiple different barriers.

HIV Pre-Exposure Prophylaxis Education in Family Medicine Clerkships: A CERA Study.

Little is known about human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) education in family medicine clerkships during medical school. Our study aimed to describe coverage of PrEP education in family medicine clerkships and explore barriers if this education was absent. Data were collected through the 2023 Council of Academic Family Medicine (CAFM) Education Research Alliance (CERA) Family Medicine Clerkship Director Survey. We inquired about provision of PrEP to patients, faculty expertise with PrEP, PrEP curriculum in the clerkship, barriers to including PrEP in the clerkship curriculum, and willingness of directors to add PrEP online modules to the clerkship if available. The response rate was 56.8% (96/169). Nine participants did not complete the PrEP questions and were excluded from analyses. Nearly two-thirds of clerkship directors perceived PrEP as an important topic in the family medicine clerkship; however, only one-third of clerkships included PrEP curriculum through clinical experiences (58.5%), didactics (17.1%), or both (14.6%). Barriers to including PrEP were lack of time in the curriculum (63.5%) and having other more important topics to cover (25.7%), but 38.9% said they would include PrEP in the clerkship if free online modules were available. Clerkships were more likely to include PrEP curriculum in the family medicine clerkship if they had faculty with sufficient expertise or if clerkship directors believed it was important to teach PrEP in the curriculum. Offering accessible educational content can enhance educational opportunities on PrEP for medical students.

Motivational interviewing skills practice enhanced with artificial intelligence: ReadMI

BackgroundFinding time in the medical curriculum to focus on motivational interviewing (MI) training is a challenge in many medical schools. We developed a software-based training tool, “Real-time Assessment of Dialogue in Motivational Interviewing” (ReadMI), that aims to advance the skill acquisition of medical students as they learn the MI approach. This human-artificial intelligence teaming may help reduce the cognitive load on a training facilitator.MethodsDuring their Family Medicine clerkship, 125 third-year medical students were scheduled in pairs to participate in a 90-minute MI training session, with each student doing two role-plays as the physician. Intervention group students received both facilitator feedback and ReadMI metrics after their first role-play, while control group students received only facilitator feedback.ResultsWhile students in both conditions improved their MI approach from the first to the second role-play, those in the intervention condition used significantly more open-ended questions, fewer closed-ended questions, and had a higher ratio of open to closed questions.ConclusionMI skills practice can be gained with a relatively small investment of student time, and artificial intelligence can be utilized both for the measurement of MI skill acquisition and as an instructional aid.

Family Medicine Clerkship Preceptors’ Experiences Welcoming and Supporting Medical Students of Color

Purpose: Medical students of color (MSoC) regularly experience discrimination and mistreatment during medical school. Preceptors have the potential to provide meaningful support for MSoC while on their family medicine clerkship rotation. This mixed-method study explores family medicine clerkship preceptors’ challenges, current practices, and institutional needs related to welcoming and supporting MSoC. Methods: Any lead preceptor at a University of Washington-affiliated Family Medicine clerkship teaching site was eligible for this study. From June to September 2022, 7 focus groups were conducted with a total of 32 participants. Study team members coded transcripts for key themes related to participants’ experiences of working with MSoC. All participants were asked to complete a short survey, which included both demographic questions and questions regarding their beliefs and abilities to welcome and support MSoC. Results: Many preceptors felt underprepared and unsure about when and how to support MSoC. Current strategies employed by participants included adding a semi-scripted orientation conversation to discuss how they will be supported during the rotation and who they can talk to if they encounter any discrimination and/or microaggressions. Participants also suggested that the medical school should offer additional trainings for preceptors, such as mitigating microaggressions toward students. Conclusions: Lead preceptors are well positioned to empower and support the students they teach. This exploratory, single-institution study offers some insights into the challenges, current practices, and suggestions for institutions to support MSoC during clinical rotations. We recommend additional research to help validate our findings.

Enhancing Medical Students' Understanding of Team-Based Care to Address Social Determinants of Health: A Case-Based Experience.

Social and structural factors play a critical role in driving inequitable health outcomes, resulting in the need for undergraduate medical education to include important care components such as team-based care to address social determinants of health. Research shows that learning strategies such as case-based initiatives are valuable opportunities to impact knowledge of population health, health disparities, and social determinants that impact care. The purpose of this study was to assess the impact of a clinical case-based experience on medical students' self-efficacy and future intent to use the team-based care necessary to address social determinants of health. We used a retrospective analysis of program data from 640 third-year medical students who engaged in a case-based experience and small-group debriefing around the impact of team-based care and social determinants of health on patient care during their family medicine clerkship between July 2020 and April 2022. We found a statistically significant improvement in students' reported self-efficacy and intent to collaborate with other health care workers (team-based care) to address patient care needs in rural and urban underserved community settings. Our students reported that a case-based experience coupled with a small-group debriefing was an effective method for teaching them how to use a team-based approach to address social determinants of health.

Motivational Interviewing Education in North American Family Medicine Clerkships: A CERA Study.

Many health conditions are preventable or modifiable through behavioral changes. Motivational interviewing (MI) is an evidence-based communication technique that explores a patient's reasons for behavioral changes. This study assesses the current landscape of MI training in North American Family Medicine (FM) clerkships. We analyzed data gathered as part of the 2022 Council of Academic Family Medicine's Educational Research Alliance (CERA) survey of FM clerkship directors (CDs). The survey was distributed via email invitation to 159 US and Canadian FM CDs in June 2022. Of the 94 responses received, 61% indicated that MI training is provided in their FM clerkship. Medical school type, class size, and location were associated with MI training priority, offerings, and duration in the clerkship, respectively. CD experience correlated with MI training duration; student MI skill training level was associated with MI training duration and priority; the rigor of student MI skills evaluation was correlated with MI teaching methods and training duration; self-reported student MI competency was associated with the length of time students spent with FM community preceptors as well as MI training priority and teaching methods; and several items emerged as predictors of student, CD, and FM faculty MI training expansion. Opportunities exist to enhance the volume, content, and rigor of MI training in North American FM clerkships as well as to improve self-reported student MI competency within those clerkships.

Response to "Point-of-Care Ultrasound and Procedural Instruction in the Family Medicine Clerkship: A CERA Study".

Response to "Point-of-Care Ultrasound and Procedural Instruction in the Family Medicine Clerkship: A CERA Study".

The Impact of Tele-Education on Family Medicine Clerkship Students' Learning Outcomes.

The COVID-19 pandemicnecessitated rapidchanges to medical educationfor student and patient protection. A dearth of published US studies examineresultingclinical education outcomesdue topandemic-induced curricula changes.We describe adaptations made toafamily medicine clerkship to move itfrom traditional in-person delivery to virtualonly,and then from virtualto hybrid;and compareeducationaloutcomes of students across delivery types. We stratified 386 medical students in their third year completing their 8-week family medicine clerkship bytype of content delivery,including in person, virtual only,and hybridinstruction.We examined the impact of these changes on three clerkship learning outcomes: the midblock assessment score,the National Board of Medical Examiners (NBME)exam score,and the final numeric score(FNS). In our sample, 164 (42.5%) received content in person, 36 (9.3%) received virtual only, and 186 (48.2%) received hybridcontent.Studentsreceivingvirtual only (M=76.4, SD=9.1) had significantly higher midblock assessment scores (F=8.06,df=2,P=.0004) than studentsreceivinghybrid (M=71.7, SD=8.8) and in-person training (M=74.5, SD=7.2).Nosignificant differences existed in students' NBME exam scores or FNSs across deliverytypes. Students receiving virtual-onlyor hybrid contentperformed at least as well on threeclerkship-relatededucationaloutcomesas their pre-COVID peers participating in person.Further research is needed to understand how changes to medical education affected student learning and skill development.

Training future clinicians in telehealth competencies: outcomes of a telehealth curriculum and teleOSCEs at an academic medical center.

This study describes the program and learning outcomes of a telehealth skills curriculum based on the Association of American Medical Colleges (AAMC) telehealth competencies for clerkship-level medical students. A total of 133 third- and fourth-year medical students in a required family medicine clerkship at Stanford University School of Medicine participated in a telehealth curriculum, including a telehealth workshop, site-specific telehealth clinical encounters, and telemedicine objective structured clinical examinations (teleOSCEs) between July 2020 and August 2021. Their workshop communication and physical examination competencies were assessed in two teleOSCEs utilizing a novel telehealth assessment tool. Students' attitudes, skills, and self-efficacy were assessed through voluntary pre-clerkship, post-workshop, and post-OSCE surveys. Most learners reported low confidence in their telehealth physical examinations [n = 79, mean = 1.6 (scale 0-5, 5 = very confident, SD = 1.0)], which improved post-workshop [n = 69, 3.3 (0.9), p < 0.001]; almost all (97%, 70/72) felt the workshop prepared them to see patients in the clinic. In formative OSCEs, learners demonstrated appropriate "webside manner" (communication scores 94-99%, four items) but did not confirm confidentiality (21%) or review limitations of the visit (35%). In a low back pain OSCE, most learners assessed pain location (90%) and range of motion (87%); nearly half (48%) omitted strength testing. Our telehealth curriculum demonstrated that telehealth competencies can be taught and assessed in medical student education. Improvement in self-efficacy scores suggests that an 80-min workshop can prepare students to see patients in the clinical setting. Assessment of OSCE data informs opportunities for growth for further development in the curriculum, including addressing visit limitations and confidentiality in telehealth visits.

Point-of-Care Ultrasound and Procedural Instruction in the Family Medicine Clerkship: A CERA Study.

Point-of-care ultrasound (POCUS) education has become a mainstay in resident education in multiple specialties, including family medicine (FM), but literature regarding the use of POCUS during clinical medical student education is lacking. The purpose of this study was to investigate whether and how POCUS education is conducted in FM clerkships in the United States and Canada and how it compares to more traditional FM clinical procedural instruction. As part of the 2020 Council of Academic Family Medicine's Educational Research Alliance survey of FM clerkship directors, we surveyed clerkship directors in the United States and Canada about whether and how POCUS education, as well as other procedural instruction in their institutions and FM clerkships, was conducted. We included questions regarding POCUS and other procedural use by preceptors and faculty. We found that 13.9% of clerkship directors reported structured POCUS education during clerkship, while 50.5% included other procedural training. The survey revealed that 65% of clerkship directors felt that POCUS was an important component of FM, but this was not a predictor of POCUS use in personal or preceptor practice nor of its inclusion in FM clerkship education. Structured POCUS education is a rare component of FM clerkship education; while more than half of clerkship directors felt that POCUS was important for FM, few used it personally or included it in clerkship education. As POCUS continues to be integrated into medical education in FM, the clerkship may represent an opportunity to expand POCUS exposure for students.