Family Medicine Clerkship Research Articles

Loma Linda University School of Medicine.

Loma Linda University School of Medicine.

University of Utah School of Medicine.

University of Utah School of Medicine.

The Brody School of Medicine at East Carolina University.

The Brody School of Medicine at East Carolina University.

University of Rochester School of Medicine and Dentistry

University of Rochester School of Medicine and Dentistry

University of Alberta Faculty of Medicine and Dentistry.

University of Alberta Faculty of Medicine and Dentistry.

Carle Illinois College of Medicine.

Carle Illinois College of Medicine.

University of Nebraska Medical Center College of Medicine.

University of Nebraska Medical Center College of Medicine.

Dell Medical School at the University of Texas, Austin.

Dell Medical School at the University of Texas, Austin.

The University of Kansas School of Medicine.

The University of Kansas School of Medicine.

Penn State College of Medicine.

Penn State College of Medicine.

Keck School of Medicine of the University of Southern California.

Keck School of Medicine of the University of Southern California.

Narrative Medicine Rounds: Promoting Student Well-Being during the Third Year of Medical School.

Narrative medicine allows physicians and other health providers to share stories and reflect on the practice of medicine. Through the process of reflection and shared storytelling, narrative medicine may promote strategies for well-being and the prevention of physician burnout. Designed to foster skills to promote physician wellness, the required narrative medicine rounds activity during the family medicine clerkship at the Herbert Wertheim College of Medicine at Florida International University includes a written assignment and a small group session, during which students share their stories with their peers. During the 2018-2019 academic year, a postsession survey asked students to identify strategies learned in the session that could be applied to future patient care and personal well-being; a thematic analysis of students' responses was conducted using inductive coding. Likert-style questions asked whether students learned something about themselves in this session, believed that they would write in the future, and understood the value of discussing significant patient encounters with peers. Identified themes for strategies for patient care fell into two categories: approaches to improve the patient care experience and methods for reflecting on patient interactions. Themes for strategies for future well-being fell into three categories: strategies to promote mental health, changes to interpersonal interactions, and self-reflection. Most students "strongly agreed" or "agreed" that this session taught them something about themselves and showed them the value of discussing significant patient encounters with peers, and that they would be likely to write about patient cases in the future. There was significant overlap in the themes related to strategies for personal well-being and those for patient care. Students were able to identify multiple, specific strategies to promote their own future well-being. These findings suggest that even a brief narrative medicine session may have an impact on students' understanding of strategies to prevent burnout and improve future patient care.

Moving Toward a Standardized National Family Medicine Subinternship Curriculum: Results From a CERA Clerkship Directors Survey.

Although the subinternship (sub-I) is considered integral in many medical schools' curricula, family medicine does not have standardized course recommendations. Given the variable nature of this clinical experience, this study investigated the potential role of a standardized sub-I curriculum in family medicine. Questions about sub-Is were created and data were gathered and analyzed as part of the 2019 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey of family medicine clerkship directors. The survey was distributed via email to 126 US and 16 Canadian recipients between June 19, 2019 and August 2, 2019 through the online program SurveyMonkey. A total of 101 (71.1%) of 142 clerkship directors responded to the survey. Most (84.2%) schools require sub-Is. There was a positive association between students matching into family medicine and having family medicine sub-Is at residency programs (P<.001). There was no relationship between higher family medicine match rates and the presence of family medicine sub-Is at nonresidency sites (P=.48) or having an advanced ambulatory rotation requirement (P=.16). A sub-I is a way to further expose students to family medicine, and increasing sub-I positions at residency programs may influence the number who pursue the specialty. Creation of a standardized sub-I curriculum presents an opportunity to enhance a critical educational experience in family medicine.

The Effect of Teaching Family Medicine Clerkship Students on Preceptor Productivity.

High-quality, experiential learning in outpatient settings is indispensable for medical student education; however these settings are difficult to recruit and retain. The majority of primary care physicians are employed by organizations and are under pressure to increase their relative value unit (RVU) production. Although the common perception that teaching medical students decreases productivity is unproven, it is likely a barrier for primary care physicians pursuing clinical teaching. We sought to investigate whether medical student teaching affects clinical productivity. We recruited 15 family medicine (FM) clerkship sites to participate in our study via email and at an in-person meeting. For each preceptor, we collected billing data in the form of current procedural terminology (CPT) codes for all patient encounters and the number of patients seen per half-day for when the preceptor had a student and when they did not. We converted CPT codes to RVU data. We compared differences in productivity for each individual preceptor, and we used a paired t test to examine collective data with and without a student. Ten preceptors at six FM clerkship sites provided reliable data. The average RVU per half-day without a student was 10.84, and it was slightly higher at 11.25 when a student was present (P=.74). The average number of patients seen per half-day without a student was 8.32 and it was slightly lower at 7.87 when a student was present (P=.58). This study shows promising data that teaching students in the outpatient setting does not decrease preceptor productivity. This pilot study can lead to a larger-scale exploration of family medicine preceptor productivity in different settings and institutions.

Teaching Chronic Pain in the Family Medicine Clerkship: Changes From 2014.

The management of chronic pain is an important topic for training competent family physicians. The purpose of this study was to determine factors in teaching about chronic pain and whether state overdose death rates were associated with teaching chronic pain topics. Data were collected as part of the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) Clerkship Directors' Survey. The response rate was 71%. Respondents answered questions about the amount of time spent teaching about chronic pain diagnoses, approach to chronic pain, opioid medications, nonopioid medications and nonpharmacologic treatments for chronic pain. The most frequent topic was chronic pain diagnoses, taught by 64% of clerkships with an average of 92 minutes spent on the topic. Each chronic pain topic was taught by nearly 50% of clerkships, and 72.3% of clerkships taught at least one topic. More clerkships were teaching about opioids, nonopioids, and nonpharmacological treatments for chronic pain than in 2014. Time currently spent teaching about opioids was positively correlated with clerkships' state 2014 drug overdose death rate. The majority of family medicine clerkships teach about chronic pain, and the amount of time dedicated to this topic has increased over the last 5 years. A state's opioid overdose rate correlates with the amount of time spent teaching about opioids, but does not correlate with the amount of time teaching about other chronic pain subtopics. It is possible that the opioid crisis is causing a shift in the subtopics of chronic pain teaching.

Family Medicine Clerkship Directors' Handling of Student Mistreatment: Results From a CERA Survey.

Little is known about how family medicine clerkship directors (FMCDs) handle reports of student mistreatment. We investigated FMCDs' involvement in handling and resolving these reports. We collected data as part of the 2019 CERA survey of FMCDs. FMCDs provided responses on how they handled student mistreatment reports and their comfort level in resolving these reports. Ninety-nine out of 142 FMCDs (69.7%) responded to the survey. Regarding mistreatment reports, 24.2% of FMCDs had received at least one report of student mistreatment about full-time faculty in the past 3 years, compared to 64.6% of FMCDs receiving at least one report about community preceptors (P<.001). Regarding who determined the response to the mistreatment, 13.1% of FMCDs were the highest level of leadership responsible for stopping use of a full-time faculty member for mistreatment concerns, while 42.4% of FMCDs were the highest level of leadership responsible for stopping use of a community preceptor. Regarding their comfort level in resolving mistreatment reports, 59.1% of FMCDs were either somewhat or very comfortable resolving a mistreatment report about a community preceptor, while only 48.9% reported those comfort levels for full-time faculty. FMCDs who had previously stopped using full-time faculty and/or community preceptors due to mistreatment reports were less likely to feel comfortable with resolving reports about full-time faculty compared to those who had no such experience (P=.03). FMCDs more frequently receive mistreatment reports about community preceptors than full-time faculty and are more likely to be the highest decision maker to stop using a community preceptor for mistreatment concerns. Further study is needed to elucidate factors that affect FMCDs' comfort in handling student mistreatment reports.

Essential Anatomy for Family Medicine in the Undergraduate Medical Curriculum

IntroductionTo prepare medical students for clinical training and practice, it is critical to understand the anatomical knowledge considered most important for different clinical specialties.AimTo address this issue, a consortium of anatomists in the US and Canada is collecting data from clinical educators in Family Medicine clerkships and electives to identify the anatomy they consider essential.MethodsAn IRB‐approved, online survey (Qualtrics, Seattle, WA) was used to assess the importance of 98 anatomical topics in seven body regions. The study first examined the percentage of Family Medicine clinical educators (clerkship/elective directors and attending physicians) that considered each anatomical region important to their specialty. Second, the study examined the rank assigned to each anatomical topic using an ordinal scale from 1 (not important) to 4 (essential).ResultsAt the time of abstract submission, data had been collected from 93 Family Medicine clinical educators at 19 medical schools. The percentage of Family Medicine clinical educators that considered each anatomical region important to their specialty were (highest‐to‐lowest): Back (99%), Upper Limb (99%), Lower Limb (99%), Head & Neck (98%), Thorax (96%), Abdomen (96%), and Pelvis & Perineum (95%). Further data analysis has identified the highest ranked anatomical topics in each body region for the Family Medicine clerkship/elective.Discussion and ConclusionThis database provides detailed information regarding the most clinically relevant anatomical topics as identified by Family Medicine clinical educators. This information can aid in focusing preclinical learning to best prepare medical students for success in their undergraduate and graduate clinical experiences.

Success Predictors For Third-Year Osteopathic Medical Students on National Standardized Examinations: A Family Medicine Clerkship Course Study.

Medical education institutions often use community-based sites and preceptors during students' third and fourth years for clinical training. However, differences in the sites, preceptors, assessment methods, and students may result in variations in clinical training, potentially affecting educational outcomes. During clerkships at A.T. Still University School of Osteopathic Medicine in Arizona, all students are evaluated by several methods for each required clerkship course. Required assessments include the clinical preceptor's evaluation, online coursework specific to each clerkship, patient log documentation, and the Comprehensive Osteopathic Medical Achievement Test (COMAT) relevant to that clerkship. To evaluate which methods of student assessment in a family medicine clerkship course were most predictive of the future success of students on national standardized examinations. Third-year osteopathic medical students from a single class who had completed the Comprehensive Osteopathic Medical Licensing Examination (COMLEX)-USA Level 2-Cognitive Evaluation (CE) and 2-Performance Evaluation (PE) and the COMAT were included in the study. Scores on the examinations were used as success benchmarks. Analysis of 4 categories of predictor variables-clerkship site, previous student performance, preceptor evaluation, and clerkship coursework assessment (ie, assignment scores and log numbers)-was used to predict success on the national standardized examinations. Ninety-nine of 105 students were eligible for inclusion. No associations were found between examination scores and clerkship site or log numbers (all P≥.10). Correlations were found for previous student performance (ie, grade point average for first-year and second-year coursework) and all examinations except COMLEX-USA Level 2-PE (r=0.56-0.74, all P<.001), and between total score in family medicine clerkship coursework and COMLEX-USA Level 2-CE and COMAT scores (r=0.28-0.39, all P≤.006). Correlations were also found between preceptor evaluation (total score and subscore on medical knowledge) and all assessed national standardized examinations (r=0.20-0.34, all P<.049). Our results suggest that analysis of predictor variables in clerkship courses can reasonably predict success on national standardized examinations and may be useful for early identification of struggling students who may need additional support to perform well on the examinations.

Evaluation of Multifaceted Assessment of the Fifth-Year Medical Students in Family Medicine Clerkship, Saudi Arabia Experience.

BackgroundThere are few data on assessment methods in the field of family medicine in Arab countries. Imam Abdulrahman Bin Faisal University (IAU) in 2017 established the family medicine clerkship rotation for the fifth-year medical students. The objective of the study is to evaluate the multifaceted assessment of family medicine clerkship and their correlation to each other among fifth-year medical students in IAU.MethodsWe examined the performance of 455 fifth-year medical students from two batches (2018 and 2019) in the continuous course assessment, Objective Structured Clinical Examinations (OSCE), extended matching questions (EMQ), and multiple-choice questions exams (MCQ).ResultsThe students’ total mark range was 55.16 to 95.64. Batch 2018 and females had significantly higher marks (p=0.000). On the other hand, no significant associations were seen between the total marks and the semester in which the clerkship was taken or the order of group in each semester (p= 0.464 and 0.980 respectively). Significant positive correlations were seen between all forms of assessment during the family medicine clerkship (p=0.000).ConclusionThis study demonstrates that different assessment methods used to evaluate medical students during the family medicine clerkship were correlated. The performances of the female and the first batch were superior. This finding is the basis for introducing a platform for developing modern learning and the improvement of the assessment standards in family medicine clerkship rotation.

Learning Outcomes From Lecture and an Online Module in the Family Medicine Clerkship.

With younger generations of learners and readily available technology, medical educators are challenged to include active learning methods that may be better for student learning than traditional lecture. Some of these methods, like online modules, can also reduce the demands on clerkship faculty time. We examined how content delivered via interactive, online module compared to traditional lecture for student learning and satisfaction. Third-year family medicine clerkship students completed questionnaires following either an online module or lecture on orofacial pain. We conducted the study over four consecutive rotations, alternating who received the content via classroom lecture or interactive online module. Students completed a questionnaire comprised of six multiple-choice knowledge questions, five questions with a clinical vignette format to assess application of knowledge, and six questions to assess satisfaction with elements of the course. The Centers of Excellence in Pain Education developed the online module and questionnaire. We found no differences in knowledge between the in-person lecture and the online module. However, students who completed the online module performed better on the application questions. Students in the lecture group reported greater satisfaction with the course than students in the online group. Lecture resulted in adequate knowledge recall, but the interactive method resulted in better scores on applying knowledge to new situations. Providing an online module where students can practice applying knowledge is important for higher levels of learning, but it should be noted that satisfaction ratings may decline.