AC507M.J

Family Medicine - Advanced Primary Care

Sites: CHA, BIDMC, APG, MTAH, MGH
Director(s): Katherine Miller
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: January and June
Location: MULTI - Multi-site (J)
Open to Exclerks: No (HMS only)
Description: This four-week sub-internship level outpatient course will provide an immersive outpatient family medicine experience, with emphasis on evaluation and development of Entrustable Professional Activities for Residency, numbers 1-7 and 9. Students will be placed in community practices, and will independently evaluate patients who present for acute visits, health maintenance visits, hospital follow up, and follow up of chronic conditions. In addition to obtaining history and performing physical exam, students will develop and prioritize a differential diagnosis for each patient, provide written and oral presentations of each patient, place orders for appropriate treatment and evaluative testing (to be reviewed by the preceptor) and, with the guidance of their preceptor, discuss assessment and treatment plans with the patient, deliver patient education and practice shared decision-making models. Students will be expected to interpret all testing results, and after discussion with preceptor communicate the results to their patients. Students may also follow prenatal patients, and participate in outpatient procedures such as IUD placements and skin procedures including pre-procedure counseling and informed consent. Students will participate in care team meetings and coordinate their patient care activities with other members of the team. Students will also participate in 3 day-long group learning sessions, where a combination of lecture, small group and hands on learning will be used to review a selection of high-yield primary care topics including pain management, point-of-care Evidence Based Medicine, substance abuse treatment, primary care and mental health, care of the geriatric patient with a focus on polypharmacy, end of life discussions, and immigrant health. Each week students will submit a brief Evidence Based Medicine assignment, and there will be a final project - a community study based on a complex patient from the practice.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Participants will participate in weekly evidence based medicine brief presentations based on real time patient contacts. Basic science will be reviewed within the didactic sessions, including pharmacology for the polypharmacy and substance abuse treatment sessions, anatomy for the sports medicine in family medicine office session, epidemiology for the travel medicine and immigrant health session and the preventive medicine session.
Grade Criteria:
Honors with Distinction: Student is independently evaluating and proposing feasible and comprehensive evaluation and management plans for the majority of patients they see, four or more patients per session. Student is considered an entrustable learner to gather a history and perform a physical exam, prioritize a differential diagnosis after each clinical encounter, recommend and interpret common diagnostic and screening tests, enter and discuss orders and prescriptions, and document clinical encounters. Student is also an entrustable learner for concise and complete oral presentation, independent learning and retrieval of evidence, collaboration with an interprofessional team. Assessments are concise and also complete, as are written communications. Student follows up independently on all ordered consultations, studies and labs, and incorporates the results into an evolving treatment plan which they review with the preceptor and then communicate to their patients. Student consistently uses online resources to aid in treatment planning including evidence based medicine resources, independently reviews appropriate literature pertaining to their patients, and brings those results to the team and to bear on patient care planning. Student also performs pre-work, reading about the upcoming patients and reviewing their medical records. Student may follow a patient through an outpatient consultation or an inpatient experience. Honors: Student is independently evaluating and proposing reasonable evaluation and management plans for the majority of patients they see, 3-4 per session. Most of these plans include psychosocial elements of care. Student is considered an entrustable learner for most of the following: gather a history and perform a physical exam; prioritize a differential diagnosis after each clinical encounter; recommend and interpret common diagnostic and screening tests; enter and discuss orders and prescriptions, and document clinical encounters. Student is also an entrustable learner for concise and complete oral presentation, independent learning and retrieval of evidence, collaboration with an interprofessional team. Student follows up on test and consultant results, adjusting their plans based on the results, and communicating these results to the preceptor and to the patient. Student uses online resources to aid in evidence based clinical decision making, and reads about patient conditions both during and after the patient encounters. Student performs pre-work, reviewing the charts of upcoming patients. Satisfactory: Student is independently evaluating and proposing evaluation and management plans for all patients they see, at least 3 per session. Some of these plans include psychosocial aspects of care. Student is considered an entrustable learner for some of the following: gather a history and perform a physical exam, prioritize a differential diagnosis after each clinical encounter, recommend and interpret common diagnostic and screening tests, enter and discuss orders and prescriptions, and document clinical encounters. Student may also be an entrustable learner for concise and complete oral presentation, independent learning and retrieval of evidence, collaboration with an interprofessional team. Students follow up on all ordered consultations, studies and labs, and review with the preceptor how these will shape the treatment plan, prior to communicating them with the patients. Student uses on line resources to aid in treatment planning at the time of care. Unsatisfactory: Student is unable to manage time sufficiently to see at least 3 patients per session, student does not demonstrate skills as an entrustable learner in any of the Core Entrustable Professional Activities. The student is unable to independently evaluate patients and provide an evaluation and management plan. Student does not follow up on ordered tests, studies and consultations for their patients.