FM Clerkship Expectations

The students anticipate an interesting, enjoyable and educationally challenging clinical experience in a Family Medicine practice. This experience will be enhanced by the establishment of a collegial relationship between you and the student and frequently begins with a successful orientation to your practise. Please consider using the Preceptor-Learner Orientation Checklist in the Clinical Teaching Handbook (a copy of which you will have for your office). Much of this information could be provided in written form or supplied by support staff, in addition to your Day 1 meeting with your student. Please review and assist students to completing their Clinical Calendar, which must be submitted by students at the end of rotation.

The Clerkship is a clinical rotation and should involve as much student/patient interaction as possible. Since students are at various stages in their training, depending upon the time of year in which they do their Family Medicine clerkship, you will need to monitor each student's clinical skills and arrange patient care responsibilities at an appropriate level. Within the 6 week rotation, as student's skills and comfort improve, supervision should be adjusted accordingly.

Preceptors are also encouraged to teach students how to carry out various clinical procedures. Students should first observe these procedures being done and then attempt them, under your direct supervision. The student is not a licensed Physician; therefore it is your responsibility to countersign each and every medical order and/or prescription. In addition, you should see each and every patient during some part of the visit.

Although we are no longer using a formal learning plan, just as you naturally do, please continue to guide and support students in their efforts to identify daily learning issues based on identified gaps in their knowledge and clinical cases seen. Taking this a step further and enquiring a day or two later about specific, previously identified learning issues will help students to ensure they follow through on their planned learning.

In order to help you to assist students to link new, clinically experienced knowledge to their pre-clerkship learning, you will receive a copy of "The Calgary Black Book". This is the collection of "schemes" or clinical reasoning pathways developed at UofC and used in all of the "Core" systems-based pre-clerkship courses.

The nurse or support staff who escorts patients to the examining room should tell the patient that there is a senior medical student working with the physician and that the patient may be seeing a student as well as the physician. The patient should be given a choice as to whether they want to participate in the student's education. The student should introduce themselves, making it very clear what they will be doing (history, physical exam etc) and reassuring the patient that everything will be discussed and reviewed with you during the visit.

You may find the Department of Family Medicine's recently developed brochure: "What is a Clinical Clerk" helpful in clarifying the role and skills of clerks for your staff and patients. Please contact us if you need more.

This Clerkship is intended to provide the student with further training in the context of the community. In order to understand how a physician is responsible to the community, the student needs to make an effort to understand local health needs, the existing health care delivery system, the available resources and the preceptor's relationship with the community. When feasible, the preceptor should invite the student to share experiences the preceptor would consider integral to the life of a family physician in the community, whether it is in a rural or urban setting. These activities could include call, house calls, evening rounds, and meetings at local clubs, school boards, continuing medical education activities, and any other social activity felt appropriate.

The topics and objectives, in addition to the Evaluation criteria have been revised based on student and faculty feedback, in an effort to guide students through the comprehensive, patient-centred approach that is integral to family medicine. In order to encourage students to focus on the project CONTENT, templates for slides are being provided (in addition to the PDF's, students will be given a ppt file to use directly). Presentation skills will be assessed formatively and the summative mark will be entirely for content.

Projects resulting in greater utility to patient care in the individual practice and community have usually involved active interest, guidance and encouragement on the part of the preceptor(s). Please encourage and support the student in their project and help arrange the presentation of this project, prior to their Academic Day (Week 4 Fri, 0830 to 1600h, when they present to their peers/faculty), if possible.

Please note that the student is entitled to 4 half days of protected time to work on their project. The student should not take more than 2 of these half days off in the same week. Wherever possible, this should not get in the way of important learning opportunities and the timing of this should be by agreement between the student and the Preceptor.

Students learn best when they are told specifically what behaviours they have done which are effective, and what behaviours need improvement. Students should be directly observed and feedback should be given daily, as descriptions of a specific behaviour with both positive and negative statements. Feedback needs to be given in a private setting...not in front of patients or staff.

Passport

It is really important that the clerk is directly observed, at various times during the rotation, directly e.g. when taking a history or carrying out a physical examination of a patient. This is essential in being able to give objective, specific, descriptive feedback to the student on their performance. Please observe and sign-off on the student conducting:

• Focused History
• Focused Physical Exam
• Patient Education
• Blood pressure (accurately taken)

The remaining Procedural Skills listed on the Passport are not mandatory but usually very much of interest to students. Your support in providing exposure is very appreciated! Opportunities for practice will also be available at our week 4 Procedural Skills teaching session, following the FM Project presentations.

The student should have a "protected time" 15-30 minute mid-point review, with you, to review progress and agree on how best to utilise the remaining time on the rotation. This review should include reference to the student's logbook, to help identify clinical presentations not seen by the student up until that. The on-line mid point ITER also needs to be completed at this point and should reflect your discussion with others involved in the student's teaching. Please note that, at the time of this mid-point review, i) reference to the student's completed logbook ii) review of the student's Clinical Calendar, and iii) a completed on-line mid-point ITER, are required elements of the student's Learning Portfolio. If any of these elements are missing, the student may receive a "Performance deficiency" for the rotation.

Your assessment of the student, at the end of block, using the Clerkship Evaluation Form (ITER) is very important and will be a major factor in the determination as to whether the student has successfully completed the Family Medicine Clerkship, or not. As for the mid-point review, it is helpful if you have discussed the student's performance with others involved in teaching, during the rotation. It is also recommended that your final assessment be discussed with the student, at the exit interview. After discussing the ITER with the student, at the end of the block, you are expected to submit this assessment on-line, using the "one45" system, provided for the Clerkship. A few days before the last day of the clerkship you will be reminded about this, by email.