Working with the Instructor at the Clinic
The following are suggested guidelines for how students should progress in the family medicine clerkship. Students will use a checklist to monitor their clinical experience.
First Week: Students should discuss with the instructor the characteristics of their rotation in the clinic. During this first week they should “follow the steps" of the instructor to see how he/ she works. At this stage the student has a passive role, sitting at the instructor's office, watching how they interview and interact with their patients, and getting to know his/ her style and expectations. By the end of this week, many students will begin seeing some patients on their own, first under the instructor's observation and then in a separate room. Patients should be introduced to the clerk by the physician to ensure that they accept being seen by a student. Supervised patient care contact will be the basis of the student's experience. They will be assigned patients and be the first contact on that occasion. After taking a history, doing a physical examination, and thinking about what would be an appropriate management plan, they will discuss their findings and decisions with the instructor. The instructor, after going over their findings and decisions and modifying them if necessary, will attend to the patient along with the student, helping them in developing the management plan after ensuring the patient's consent and cooperation.
Second Week: During their second week in clinic, the number of patients seen by the student may grow to three/ four each day. By the end of this week students should be seeing patients independently. They should then give a concise oral presentation to the instructor and complete the visit with the instructor's assistance. Instructors may change the format used in their offices according to their own teaching styles. Beginning on this week, students will start looking for appropriate clinical cases to present on their final exam. This will include a child and an adult with chronic conditions and a house-ridden patient seen during a home visit.
Third Week: At the beginning of this week (Mid Clerkship), students should discuss with their instructors their experience during the first half of the program in order to detect any problem that could be solved and improved during the second half. The number of patients seen by the student increases in the third week, together with the responsibility taken by the student (as their progress and the instructor's feedback allows). Students should not be expected to see more than five patients per day. Some of these patients should be invited for follow-up of chronic diseases such as Diabetes Mellitus and Hypertension, or for Periodic Health Examination porpoises. The student will see the same group of patients as often as needed. This will help the student follow the course of a patient's illness, see the value of their investigations in making diagnoses and assessing the progress of the condition and the value of the various therapies. After choosing the cases for their final exam, students will visit these patients in order to perform a complete clinical history, a genogram, and a list of life events. They will create a sham file with all this data, to be used during their final exam.
Fourth Week: Part of this week will be used for the preparation of the final exam. Students will have follow-up interviews with patients seen during the first three weeks for continuing evaluation and work-up. At the end of this week, the instructor should complete the "Instructor's Final Clerkship Evaluation".
