FAMU-4013 - Family Medicine Ambulatory Community Elective

FAMU-4013 - Family Medicine Ambulatory Community Elective

Elective Title: Family Medicine Ambulatory Community Elective
Course Number: FAMU-4013
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 3
Additional Requirements: Site selection should be discussed with coordinators, Maricarmen Gonzalez-Montero (maricgon@utmb.edu) or Jessica Prescott (jlpresco@utmb.edu) 12 weeks prior to start date. Students encouraged to create own TX site where housing is available.
Responsible Faculty Director: Kyu K. Jana, MD Periods Offered: 1-10, 12-13 including holiday period 8 
Coordinator: Jessica Prescott Other Faculty:
Location to Report on First Day:
Onsite Location of the Preceptor's Office

1. To enhance student competency in diagnosing and treating chronic and complicated primary care problems in an ambulatory setting. 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.

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 preceptor's 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 preceptor's office.
5. Service Learning Objective: Participate in at least one community service activity in the preceptor's 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.

Description of course activities
The student and preceptor will jointly develop a schedule that will allow the student to participate in direct patient care for a minimum of 32 hours 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 listed above. Submit the report electronically to the course director, Dr. Kyu Jana (kkjana@utmb.edu), 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.

Students are encouraged to create their own sites in Texas where they have housing available.

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 (estimated schedule)  
Day of Week   AM   PM
Monday 7:30 (depending on preceptor clinic schedule) 5:30 (depending on preceptor clinic schedule)
Tuesday 7:30 (depending on preceptor clinic schedule) 5:30 (depending on preceptor clinic schedule)
Wednesday 7:30 (depending on preceptor clinic schedule) 5:30 (depending on preceptor clinic schedule)
Thursday 7:30 (depending on preceptor clinic schedule) 5:30 (depending on preceptor clinic schedule)
Friday 7:30 (depending on preceptor clinic schedule) 5:30 (depending on preceptor clinic schedule)

 Average number of patients seen per week: 20
 Call Schedule: no

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
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?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

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 course director, Dr. Kyu Jana (kkjana@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 student's written performance?
    Peer Assessment     Faculty Assessment     Other

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

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.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    To be determined by the Preceptor

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.