Brief Narrative:

Students will be assigned one of three Family Practice Clinics, have a patient roster, and be responsible for evaluating, treating and following a variety of out-patients with close staff supervision. Hours are 7:30 - 5:00, five days a week in the Clinic, plus hospital rounds if the student admits a patient. This rotation is offered specifically to students who have a keen interest in Family Medicine, intend to seek residencies in Family Medicine or wish to sharpen their skills and broaden their knowledge in a Primary Care area. In addition, fourth year clerks from other institutions may take this rotation in order to acquaint themselves with the Scott and White Family Medicine Residency program.

Goals — The faculty will strive to:

1. Provide a conducive learning environment for advanced experience in managing common ambulatory illness.
2. Expose the student to clinical learning situations that provide an opportunity for the students to enhance and improve the skills required of a family practitioner, including history, physical, differential diagnosis, evaluation and treatment programs.
3. Illustrate the broad aspects of the practice of Family Medicine as a specialty that strives for continuity of care, quality of care, and an emphasis on the patient with a disease in the context of his environment.
4. Give the student an understanding and ample clinical opportunities for the proper utilization of basic diagnostic laboratory and x-ray procedures and the correct interpretation of the results.
5. Allow the student to become comfortable with his assessments and develop confidence in his therapeutic decisions.
6. Bring to the students an awareness of the critical elements in organization and management of a typical family office situation.
7. Assist the student in recognizing and responding to the socioeconomic problems that influence delivery of health care.

Objectives — At the end of the rotation the students will be able to:

1. Demonstrate the ability to collect, organize, record and verbally communicate patient data in an ambulatory setting. These include skills in obtaining a medical history, efficiently performing an adequate and accurate physical exam, recording initial and follow-up data clearly, and selecting appropriate laboratory, x-ray and other diagnostic studies with an emphasis on cost effectiveness, patient convenience and safety.
2. Develop interpretation skills as the basis for clinical problem solving, with respect to their importance and immediacy.
3. Develop an understanding of the role of the family-oriented primary care physician in terms of responsibility for managing the patient's health problems, assuming responsibility for continuity of care, identifying potential effects of the patient's problems on other family members or on the family unit as a whole, and utilizing family relationships in managing patient's problems.
4. Develop an understanding of the role of appropriate specialty or subspecialty consultations and understanding indications for these consultation.
5. Develop the technical skills necessary in an ambulatory care setting, including familiarity with drugs commonly used in ambulatory care patients, performance of common office diagnostic and therapeutic procedures, ability to carry out patient education at an appropriate level, and be comfortable with communication skills.
6. Demonstrate an improvement in the general fund of medical knowledge.
7. Recognize in himself and others the qualities that not only make a competent physician, but one who is compassionate and humane as well.
8. Understand and appreciate the role of personality traits, situational disturbance, stress and how it impacts acute and chronic illness.
9. Have an understanding for office management issues through observation and participation of ongoing clinic, business office and nursing procedures.

Learning Activities:

1. The student will be responsible for evaluating ambulatory patients, will subsequently discuss with the family medicine faculty the pertinent history and physical features, the differential diagnosis and develop a plan of management of the ambulatory patients. If diagnostic or therapeutic procedures need to be performed, primarily, the student will be responsible for learning these procedures.
2. The student is expected to attend the Department of Family Practice Journal Club/Resident lectures.
3. The student will have reading assignments and self-teaching concerning individual patients seen and evaluated, and covering common ambulatory problems.
4. Accompany staff physician to meetings in the area of office management, nursing, physician interactions, and monthly staff meetings.
5. Accompany staff physicians on in-hospital rounds when patients were evaluated and admitted by the student from the outpatient clinic. The student will be expected to participate, yet not be totally responsible, for the care of these patients.
6. Ongoing exposure to interesting cases, physical findings, and common diseases.
7. Allow appropriate follow-up so that a continuum of health and disease can be experienced.
8. Participate in daily morning report on the Family Medicine Hospital Service.
9. The student will be expected to take call with the resident one night per week.
10. The student will be expected to make a presentation to the attending staff at his assigned clinic. The subject of this presentation to be determined by the student and staff.

Learning Resources:

1. Selected review articles with special emphasis on patients evaluated by the student.
2. Patient education materials, video tapes, pamphlets and nursing instruction provided for patient .
3. Textbook of Family Practice, Third Edition, Robert Rakel, Editor; W. B. Saunders, 1984 .
4. Clinic satellite libraries — Compilation of several resource volumes for the student's utilization.

Evaluation:

1. Clinical Evaluation Forms provide 100% of the grade. In addition, the student has the opportunity to evaluate his preceptors.