SOM Elective Brochure
 

Electives Type:  Clinical

Elective Title
Family Medicine Ambulatory Community Elective
Course Number
FAMU-4013
Duration/Weeks
4
Prerequisites: Successful completion of Year 3 
      Additional Requirements:
Site selection must be discussed with course coordinator, Layne Dearman (lmdearma@utmb.edu) at least 12 weeks prior to beginning the elective. Students are encouraged to create their own sites in Texas where they have housing available.
Responsible Faculty Director:
Kyu K. Jana, MD
Other Faculty:
Victor S. Sierpina, MD
Location to Report on First Day
Onsite Location of the Preceptor's Office
Periods Offered
2,3,4,5,6,7,8
NOT including Period 12 (June), NOT including the holiday vacation Period 13 (Dec)
Maximum Enrollment
5

Goals
 1. To enhance student competency in diagnosing and treating chronic and complicated primary care problems. 2. To develop an appreciation of the role of the family medicine physician in the context of the community, including working with consultants and with community health resources. 3. To foster student understanding of family dynamics and family-centered care, particularly in relation to complex and difficult patient management issues. 4. To understand the importance of practice management issues. 5. To develop an appreciation of the patient-centered medical home (PCMH) model in a primary care practice.

Objectives
 1. Medical Knowledge and Skills Objective: (A) Demonstrate competency in managing chronic and complicated primary care problems encountered by the family physician. (B) Demonstrate skill in diagnosing and treating conditions often managed by family medicine physicians, incorporating the psychosocial, spiritual, and cultural perspectives of the patient. The student will select 3 chronic and complicated problems for in-depth study. (Refer to the list in the course information. (C) Demonstrate the ability to assist in the management of the 3 selected chronic and complicated problems, utilizing medical, family, and community resources. (D) Identify the ICD-9/ICD-10 and CPT codes used for billing the office visits of the patients with the problems you selected. 2. Career Development objective: Describe the ways in which your preceptor is involved in the community and in local, state and/or national professional associations. 3. Advocacy Objective: (A) Visit on-site the directors of at least 3 community health resources in your preceptorís community to learn how the services would be useful in addressing the needs of patients with the 3 selected problems. Visit one resource per problem. For example, if you selected diabetes as one problem, you may want to visit a dialysis center or a nutritionist. (B) Discuss with your preceptor ways in which family medicine physicians may use their expertise to serve the community in patient advocacy, public education, and/or political involvement. 4. Health Care Systems/Practice Management Objective: (A) Discuss with the office manager and the preceptor the impact of correct coding on the practice. (B) Discuss with the office manager and the preceptor the effect of the different models of patient health care financing (eg. various private insurances, Medicare, Medicaid, CHIPS, Medicare replacement programs) on patient care and practice income. (C) Describe briefly the PCMC principles displayed in your preceptorís office. 5. Service Learning Objective: Participate in at least one community service activity in the preceptorís community. Select one: A. Schedule and make a health education presentation to a community group; this can be a group of senior citizens, high school students, a service club, etc. Topics to consider for your presentation are diabetes, hypertension, obesity, prevention of illness and accidents in children, Affordable Care Act (ACA),the pros and cons of using genetic testing for diagnosing Or, B. Participate in medical service delivery in a clinic that provides care to underserved, at-risk patients. 6. CAM Objective: Complementary and Integrative Medicine: Successfully complete the on-line modules entitled "Environmental Medicine: An Integrative Approach" from The University of Arizona. (Students who have completed these modules in another Family Medicine Selective will receive full credit and will not be required to complete them for this course.) For instructions for logging into the modules refer to the course information attached above. 7. Other Objectives: There are no additional Objectives.

Description of course activities
 The student and preceptor will jointly develop a schedule that will allow the student to participate in direct patient care in the office for a minimum 2.5 days each week. The focus should be on seeing patients with chronic and complicated problems. The remainder of the time each week should be devoted to accomplishing the other course objectives, specifically, maintaining a Family Medicine Ambulatory Community Elective Report (FM ACE Report), conducting independent study, and participating in practice-related activities in which the preceptor is involved. Examples are: nursing home care, house calls, continuing medical education programs, emergency room call, outpatient procedures, medical staff meetings, and civic activities. The student will create a 4-6 page FM ACE Report that describes the experiences in accomplishing the course objectives. Guidelines for the Report are in the course information are attached above. Submit the Report electronically to Layne Dearman, ACE Coordinator, by the end of the rotation. NOTE: Clerkship students get preference for all clerkship sites. Students will not be assigned to Galveston-Houston area preceptors, as they are reserved for the Family Medicine Clerkship course.

Type of students who would benefit from the course
 This course will be of high value to any future physician entering a primary care specialty or who plans to practice in a community similar to the one in which the elective is located.

Weekly Schedule
  Clinical Activities (please insert estimated schedule here)
   
  Day of Week AM PM
  Monday 7:30 (depending on precptor clinic schedule) 5:30 (depending on precptor clinic schedule)
  Tuesday 7:30 (depending on precptor clinic schedule) 5:30 (depending on precptor clinic schedule)
  Wednesday 7:30 (depending on precptor clinic schedule) 5:30 (depending on precptor clinic schedule)
  Thursday 7:30 (depending on precptor clinic schedule) 5:30 (depending on precptor clinic schedule)
  Friday 7:30 (depending on precptor clinic schedule) 5:30 (depending on precptor clinic schedule)
  Saturday
  Sunday
       
  Average number of patients seen per week: 20  
  Call Schedule:   no  

  Research Activities (please insert estimated schedule here)
   
  Activity Hours per Week
  Faculty contact time

  Self-directed study

  Data collection/analysis

  Other


Method of student evaluation
Check all that apply - complete appropriate section(s) only:
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    At least 2.5 days per week during the course of clinical activities
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    The assigned preceptor
  B. Frequency / duration of presentation(s)?
    For all patients evaluated by the student; other presentations at least weekly to the preceptor to report progress in meeting course objectives
  C. Format - What guidelines are set for the student's presentation?
   
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
   
  B. Format - What guidelines are set for the student's written work?
    The Family Medicine (ACE) Report will be due by the end of the rotation. In it the student will briefly address issues in the course objectives. Guidelines for the content are given in the information that will be sent to you via UTMB e-mail before the beginning of the rotation. The FM ACE Report should be submitted electronically to the ACE Coordinator, Layne Dearman (lmdearma@utmb.edu).
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
   
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
   
  F. Audience - Who assesses the studentís written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    A grade of Satisfactory or Fail will be awarded. The grade will be determined by written evaluation of the student by the preceptor and successful completion of the FM ACE Report, as determined by the Family Medicine Ambulatory Community Elective course directors. Both components of the course must be passed in order to receive a grade of Satisfactory for the course.

6.  Other Modes of Evaluation
  Please explain below.
    to be determined by the Preceptor
 
7.  If this course is an Acting Internship, please complete the following:
   
  A. Specify how the student will be given formative feedback on their clinical skills.
   
B. List advanced clinical skills that a student will be assured an opportunity to practice.
   
C. List other advanced clinical skills that a student may be exposed to depending on clinical case availability.
   
  D. How will the acting intern student have responsibilities similar to a PGY1 resident? How will their responsibilities differ?
   
  E. How will this course help prepare a student enter an internship in this field or a related field?
   
  F. How will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
   
  G. Acting Internship students often seek letters of recommendation following their experience. How many different faculty are they likely to encounter during this course? What is the usual number of working days they can expect to encounter the same individual faculty member? Describe the degree of supervision and interaction with faculty vs. residents or other providers.
   

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