Course Syllabus

Pre-Clerkship General Information | What’s New | Clerkship Goals & Objectives | Learning Experiences & Requirements  | Learning Materials & Resources | Grading/Assessment  | Clerkship Policies  | IU School of Medicine Honor Code & Policies  | IU School of Medicine Resources | Appendix | Assignments

DESCRIPTION/OVERVIEW

The Family Medicine Clerkship (FMC) is a required four-week clinical rotation for third-year medical students. It is designed and administered by the Department of Family Medicine at the Indiana University School of Medicine. The FMC provides opportunity to develop knowledge, skills and attitudes required to approach a patient and his/her diagnoses in the primary care setting.

The clerkship will introduce you to the principles and practice of Family Medicine. You will observe how family physicians provide for the ongoing medical needs of their patients within the context of the family and community setting. You will learn how to focus on discrete portions of a patient’s medical history and physical concerns within the confines of the patient’s total health. You will meet patients who present with acute medical problems, those who are chronically ill, some who may need preventive health education, and some who may simply be seeking the support of their physician to cope with the trials and stresses of everyday life. Most importantly, you will see patients interacting with their personal physician and witness firsthand the therapeutic power of the doctor-patient relationship.

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PRE-CLERKSHIP GENERAL INFORMATION

Student Site and Community Faculty Assignments

In the spring, second-year medical students preference their third-year clerkships schedule. The medical education division of the Department of Family Medicine receives from the registrar a rotation roster. Students are then placed with one of the 400+ community-based, family medicine physicians in Indiana.

Travel and Housing Accommodations

Travel expectations: Students should expect to travel up to 45 minutes from the assigned site to the community faculty office. As well, students traveling to distant cities should plan to report the day before the first day of clerkship.

Travel reimbursement: Travel costs are not reimbursed for the Family Medicine Clerkship.

Housing accommodations: Housing accommodations are provided for Indianapolis-based students assigned outside Indianapolis and surrounding counties. Campus-based students will be provided housing if assigned to a site outside their regional campus area. Housing information will be provided by the program site before the rotation begins. Housing amenities vary by site. Students should inquire at least 2 weeks prior to rotation start regarding site-provided amenities.

Housing requests: Housing must be requested by students at the beginning of the academic year. In the event of a change in personal circumstances requiring a need for housing, the housing request must be made 60 days prior to the rotation start date. Requests made less than 60 days prior to the rotation start date will not be considered; students will be responsible for obtaining their own housing and all expenses incurred. Students will not be reassigned to another program site based on housing issues.

Housing reimbursement: Housing reimbursement is not available to individual students, their families/friends or other individuals/entities where personal arrangements have been made.

Problems with housing accommodations: Non-emergency issues with accommodations must be reported to the program site director. Emergency issues should be reported to the housing authority contact listed in housing information provided by the program site director.

Hospital/Office Credentialing

Students may be required to provide immunization records, background checks, and other credentialing information, including any training (e.g., CPR), to assigned sites PRIOR to the start of the clerkship. Students are expected to respond to these requests promptly. Due to HIPAA regulations, students are required to obtain their own immunization records from their personal physician and/or campus health services. Direct and timely communications with the assigned site are required. Failure to comply with credentialing needs may result in inability to participate in the clerkship, and possible rescheduling in the next academic year and/or professionalism competency concerns noted on transcript.

First Day of Clerkship

Each training site will provide information to the student regarding when and where to report on the first day. Those students going to sites outside the Indianapolis area should plan to travel the night before the first clerkship day. Depending on the start day of the rotation, some sites may have a brief orientation before sending students to the community faculties’ offices.

CPR Training and Certification

It is expected your CPR certification is current throughout the Family Medicine Clerkship. If your CPR certification will not be current, please contact the IU Health Emergency Cardiac Care Programs at ecc@iuhealth.org. IU Health offers free CPR training to IU School of Medicine students. It is recommended students schedule this training at least two months in advance to assure certification is complete prior to clerkship.

Students at Fort Wayne, Muncie, South Bend, Gary, Bloomington, Evansville, and Terre Haute may wish to contact their campus coordinator for local CPR training options.

Adaptive Educational Services

Any student at any IUSM campus requesting accommodations for a disability must apply to the Indiana University School of Medicine Disabilities Accommodations Committee and must register with the adaptive educational services office at the host campus. Guidelines for applying along with a list of the adaptive services offices on each campus are available in the Student Handbook under the heading Diversity and Disabilities Services.

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What’s New

The family medicine clerkship is responsive to and values student concerns and feedback.  Based on student comments the clerkship experience has been improved. These changes include:

1. More streamlined and seamless Family Medicine Project and accompanying on-line modules
2. Test scores are reported typically within 3 business days of the examination
3. All assignments for each rotation have been organized and ordered on a single page found in Canvas so that students are able to easily track what assignments are due when.

Please do not hesitate to contact fmclerk@iupui.ed with any questions or concerns or feedback.

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CLERKSHIP GOALS AND OBJECTIVES

Clerkship Goals

The overall goal of the family medicine clerkship is to provide an outstanding learning experience for all medical students. At the completion of the clerkship, students will be able to effectively and competently evaluate a patient and produce a competent history and physical that facilitates differential diagnosis and the development of a treatment plan (Society of Teachers of Family Medicine National Family Medicine Clerkship Curriculum).

Common Clerkship Objectives

ILO	Full text	2017-2018 Draft Common Clerkship CLOs
PC1	Demonstrate progressively more accurate, complete, and relevant clinical history-taking and physical examination skills in a variety of settings.	TYO-PC1: Perform and interpret relevant, problem-focused histories and physical examinations in patients with undifferentiatied and common chronic medical conditions.
PC2	Justify a prioritized differential diagnosis in a variety of different clinical situations based on data discovered and interpreted from the patient encounter, medical record, and diagnostic testing.	TYO-PC2: Formulate and justify prioritized problem lists and differential diagnoses for both undifferentiated and common chronic medical problems.
PC3	Integrate data from a clinical encounter to develop a patient-centered plan of care based on up to date scientific information.	TYO-PC3: Formulate and justify plausible plans of patient care for both undifferentiated and common medical problems.
MK1	Apply knowledge of normal human structure, function, and development, from the molecular through whole body levels, to distinguish health from disease and explain how physiologic mechanisms are integrated and regulated in the body.	TYO-MK1: Differentiate normal and abnormal structure, function, growth, and/or development for both undifferentiated and common chronic medical problems.
MK2	Explain the causes (behavioral, degenerative, developmental, environmental, genetic, immunologic, inflammatory, metabolic, microbiologic, neoplastic, toxic, and traumatic) of diseases, injuries, and functional deficits affecting organ systems.	TYO-MK2: Explain the etiology, progression, and/or prognosis of diseases, injuries, and functional deficits commonly seen in both undifferentiatied and common chronic medical conditions.
MK3	Describe the altered structure and function resulting from diseases, injuries, and functional deficits affecting organ systems*, with an ability to interpret the clinical, histopathologic, laboratory, and radiographic manifestations commonly seen in practice.	TYO-MK3: Recognize clinical presentations and explain the underlying pathology and pathophysiology of diseases, injuries, and functional deficits commonly seen in both undifferentiatied and common chronic medical conditions.
MK4	Provide justifications for interventions to diagnose, prevent, treat, and manage a specific patient’s diseases, injuries, and functional deficits of organ systems.	TYO-MK4: Describe the diagnosis, prevention, treatment, or management of common of diseases, injuries, and functional deficits commonly seen in both undifferentiatied and common chronic medical conditions.
MK5	Explain the role of the scientific method in establishing the cause of disease and use principles of evidence-based medicine, including biostatistics, to evaluate the efficacy of diagnostic and therapeutic options.	TYO-MK5: Analyze and evaluate diagnostic and therapeutic options using principles of evidence-based medicine.
PBLI1	Engage in self-directed learning by identifying gaps and limitations in current knowledge and performance; setting individual learning and improvement goals; identifying multiple information resources to achieve those goals; critically appraising the quality and credibility of information resources used; and synthesizing relevant information to advance medical knowledge and patient care.	TYO-PBLI1: Respond to clinical questions by independently seeking, analyzing, and synthesizing evidence-based answers to advance clinical decision-making.
PBLI2	Seek and accept feedback from colleagues, faculty, supervisors, advisors, and other health care professionals and incorporate this information into daily practice.	TYO-PBLI2: Seek, accept, and apply feedback to clinical practice.
SBP1	Demonstrate effective team work through collaboration with diverse patients, their supporters, multi-disciplinary healthcare professionals and other staff in the delivery of respectful and patient-centered healthcare.	TYO-SBP1: Identify the role and contributions of and establish respectful, effective relationships with the various members of the multi-professional health care team.
SBP2	Evaluate the impact of a patient’s social context in health and disease and how factors, such as culture, socio-economic status, environment, religion, spirituality, sexuality, education, and health literacy impact patient-physician interactions, health care decision-making, and health outcomes.	TYO-SBP2: Identify a patient’s social context and analyze how it relates to their current state of health.
P1	Be responsive to the whole patient in a manner that supersedes self-interest by respecting the needs, dignity, privacy and autonomy of the patient, and by employing strategies to reduce the effect of their own needs, beliefs, values, interests, vulnerabilities, conflicts and biases on patient care.	TYO-P1: Demonstrate responsiveness to the whole patient by advocating for the patients’ and teams’ needs over their own and treating patients in a fair, unbiased, nonjudgmental manner.
P2	Demonstrate compassion, honesty, integrity, respect, responsibility, and self-discipline in relationships with all individuals, regardless of gender, age, culture, race, ethnicity, religion, sexual orientation, disability, socioeconomic status, native language, or role.	TYO-P2: Demonstrate responsibility for one’s own learning through daily preparation, full participation in learning activities, initiative in patient care, and timely completion of clerkship requirements. TYO-P2: Act in a professional manner by demonstrating compassion, respect, honesty, integrity, and punctuality.
P3	Adhere to ethical and legal principles governing medical practice, including maintaining patient confidentiality, gaining informed consent, the provision or withholding of care, identifying and managing conflicts of interest, complying with human subjects’ research protections, identifying, analyzing and addressing unethical and unprofessional behaviors, and maintaining appropriate boundaries in relationships with patients.	TYO-P3: Adhere to ethical and legal principles in all interactions
ISC1	Establish and maintain respectful relationships with members of the health care team (peers, faculty and inter-professional colleagues) to facilitate the provision of effective care to patients.	TYO-ISC1: Communicate effectively with members of the healthcare team by clearly presenting clinical questions and data from the patient encounter.
ISC2	Engage in respectful dialogue with patients, demonstrating active listening and the use of verbal and non-verbal skills to establish rapport and an effective physician patient relationship.	TYO-ISC2: Communicate effectively with patients and their families by listening attentively, allowing opportunities for questions, and maintaining appropriate eye contact.
ISC3	Modify communication styles in accordance with the clinical context and purpose of the conversation, demonstrating sensitivity to differences, values, and needs of others, with attention to one’s personal communication style.	TYO-ISC3: Modify communication style based upon patients’ reactions and ability to understand.
ISC5	Share information accurately in academic and clinical settings both in oral presentations and written documentation including in the medical record.	TYO-ISC5: Construct oral presentations or written documents representing an organized, focused, account of the student-patient interaction.

Specific Clerkship Objectives

PC4	Incorporate health promotion and patient education on the basis of the patient’s or population’s needs.	Incorporate health promotion and disease prevention strategies into all patient visits based on health risk factors.
MK6	Describe the epidemiology of common diseases affecting populations, including methods for prevention and early detection of disease and systematic, population-based approaches for reducing the incidence and prevalence of disease.	Integrate biopsychosocial information into patient care in a manner which will improve patient outcomes.
MK7	Explain how behavioral, cultural, economic, educational, environmental, lifestyle, and psychosocial factors impact and interact with health, disease, care-seeking, care compliance, barriers to care, and attitudes towards care.	Identify and discuss the family, support system, community, cultural, ethnic, religious, occupational and economic factors influencing patient management and outcomes
SBP3	Explain fundamental features of health care policy (including funding, legal and regulatory issues) both locally and nationally, the importance of physician advocacy in shaping healthcare policy, and the potential impact of policy changes on patients, underserved populations, and health care providers.	Describe the barriers faced by patients when accessing and utilizing health care that are rooted in health care policies and regulatory issues.
SBP4	Contribute to a culture of healthcare and patient safety through compliance with national and institutional guidelines and protocols in addition to reporting real and potential errors or threats and participating in quality improvement activities.	Describe methods of monitoring compliance with preventive services guidelines including concepts of population health.
SBP5	Apply the principles of high value health care to prioritize resource utilization, on behalf of individual and underserved populations, while preserving the delivery of high quality health care to ensure improved outcomes and just distribution of finite resources.	Engage with other healthcare team members to develop strategies to meet specific patient care needs and healthcare barriers.
ISC4	Incorporate elements of shared decision making into communication with patients to facilitate their active participation in their health care.	Apply the basic principles of motivational interviewing during a patient encounter.

Consult the IUSM Competencies section for a description of each competency and the corresponding institutional learning objectives.

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LEARNING EXPERIENCES & REQUIREMENTS

Clinical Learning Experiences/Requirements:

Clinical Teaching

Approximately four days of each week on the Family Medicine Clerkship will be spent with the assigned community faculty in his/her office, in the hospital and engaging in other patient care activities. This participation provides students the opportunity for one-on-one involvement with a community-based family physician. Through interaction with the community faculty, as well as the nurses and other health team members, it is anticipated students will also acquire practical knowledge about personnel and other managerial aspects relevant to a group or solo practice.

It is expected that the preceptor observe the student doing a relevant portion of the history or physical examination within the first seven days of the clerkship. This will be documented on in PxDx as a verified encounter and in the mid-clerkship formative feedback form.

Professional Development Learning Experiences

Approximately 2-3 half days per rotation, students will participate in professional development learning experiences. These may include grand rounds at residency programs, community organization visits and/or independent learning. This time is meant to supplement learning in the clinical practice and to complete the Aquifer^® Family Medicine case-based curriculum. Additionally students should use this supplemental learning time to prepare and complete the Breaking Barriers Modules and Project. 

Participation

Patient Encounter Minimums. The Family Medicine Clerkship provides students opportunities to encounter the many aspects of primary care. To ensure all students are exposed to an adequate breadth of family medicine and progress in their participation in patient care, students are required to record a minimum number of Core Diagnoses as outlined in the table below.

Within the first seven (7) business days of the clerkship (please see "assignments" for rotation due date), all students are required to have completed an observed, focused history and physical (this is not a complete history). This is to be observed by the preceptor and includes only pertinent portions of each.   

Patient Type/Clinical Condition (things to see)	Procedure/Skill (things to do)	Description of Student Responsibility (learning objectives)	Level of Responsibility	Minimum Number Required	Verified (Yes, No)	Alternative Experience (if unable to complete in clinic)
n/a	Observed focus history	Perform a focused history while being observed by preceptor within the first 7 days of the family medicine clerkship.	Perform	1	Yes	Clerkship director finds time/location for student
n/a	Observed focus physical	Perform a focused history while being observed by preceptor within the first 7 days of the family medicine clerkship.	Perform	1	Yes	Clerkship director finds time/location for student
n/a	Musculoskeletal examination:  Head/Neck	Perform an examination of the head/neck while being observed by preceptor during the family medicine clerkship	Perform	1	Yes	Clerkship director finds time/location for student
n/a	Musculoskeletal examination:  Shoulder	Perform an examination of the shoulder while being observed by preceptor during the family medicine clerkship	Perform	1	Yes	Clerkship director finds time/location for student
n/a	Musculoskeletal examination:  Hand/Wrist	Perform an examination of the hand/wrist while being observed by preceptor during the family medicine clerkship	Perform	1	Yes	Clerkship director finds time/location for student
n/a	Musculoskeletal examination:  Low back/Hip	Perform an examination of the low back/hip while being observed by preceptor during the family medicine clerkship	Perform	1	Yes	Clerkship director finds time/location for student
n/a	Musculoskeletal examination:  Knee	Perform an examination of the knee while being observed by preceptor during the family medicine clerkship	Perform	1	Yes	Clerkship director finds time/location for student
n/a	Musculoskeletal examination:  Foot/Ankle	Perform an examination of the foot/ankle while being observed by preceptor during the family medicine clerkship	Perform	1	Yes	Clerkship director finds time/location for student
n/a	HEENT Examination	Perform an HEENT examination while on the family medicine clerkship	Perform	5	No	Clerkship director finds time/location for student
HEENT Disorders	n/a	Assist with the care of a patient presenting with an HEENT complaint including consideration of diagnostic work up and differential diagnosis and discussion of the case with preceptor while on the family medicine clerkship	Assist	10	No	Aquifer® Family Medicine case-based curriculum
Genitourinary Disorders	n/a	Assist with the care of a patient presenting with an Genitourinary complaint including consideration of diagnostic work up and differential diagnosis and discussion of the case with preceptor while on the family medicine clerkship	Assist	5	No	Aquifer® Family Medicine case-based curriculum
n/a	Gastrointestinal (abdominal) Examination	Perform an abdominal examination while on the family medicine clerkship	Perform	5	No	Clerkship director finds time/location for student
Gastrointestinal Disorders	n/a	Assist with the care of a patient presenting with an gastroinstenal complaint including consideration of diagnostic work up and differential diagnosis and discussion of the case with preceptor while on the family medicine clerkship	Assist	10	No	Aquifer® Family Medicine case-based curriculum
n/a	Cardiovascular Examination	Perform a cardiovascular examination while on the family medicine clerkship.	Perform	5	No	Clerkship director finds time/location for student
Cardiovascular Disorders	n/a	Assist with the care of a patient presenting with an cardiovascular complaint including consideration of diagnostic work up and differential diagnosis and discussion of the case with preceptor while on the family medicine clerkship	Assist	10	No	Aquifer® Family Medicine case-based curriculum
Endocrine Disorders	n/a	Assist with the care of a patient presenting with an endocrine complaint including consideration of diagnostic work up and differential diagnosis and discussion of the case with preceptor while on the family medicine clerkship	Assist	10	No	Aquifer® Family Medicine case-based curriculum
n/a	Pulmonary Examination	Perform a pulmonary examination while on the family medicine clerkship	Perform	5	No	Clerkship director finds time/location for student
Pulmonary Disorders	n/a	Assist with the care of a patient presenting with a pulmonary complaint including consideration of diagnostic work up and differential diagnosis and discussion of the case with preceptor while on the family medicine clerkship	Assist	10	No	Aquifer® Family Medicine case-based curriculum
Pyschiatric Disorders	n/a	Assist with the care of a patient presenting with a psychiatric complaint including consideration of diagnostic work up and differential diagnosis and discussion of the case with preceptor while on the family medicine clerkship	Assist	10	No	Clerkship director finds time/location for student
n/a	Neurologic Examination	Perform a nuerologic examination while on the family medicine clerkship	Perform	3	No	Clerkship director finds a time and location for student to fulfill
Neurologic Disorders	n/a	Assist with the care of a patient presenting with a neurologic complaint including consideration of diagnostic work up and differential diagnosis and discussion of the case with preceptor while on the family medicine clerkship	Assist	5	No	Aquifer® Family Medicine case-based curriculum
n/a	Dermatologic Examination	Perform a dermatologic examination while on the family medicine clerkship	Perform	5	No	Clerkship director finds time/location for student
Dermatololgy Disorders	n/a	Assist with the care of a patient presenting with a dermatology complaint including consideration of diagnostic work up and differential diagnosis and discussion of the case with preceptor while on the family medicine clerkship	Assist	5	No	Aquifer® Family Medicine case-based curriculum
Preventative Health	n/a	Assist with the care of a patient for well care/preventative health including consideration of preventative health interventions and discussion of the case with preceptor while on the family medicine clerkship	Assist	20	No	Aquifer® Family Medicine case-based curriculum
Chronic Pain	n/a	Assist with the care of a patient presenting with a chronic pain complaint including consideration of diagnostic work up and differential diagnosis and discussion of the case with preceptor while on the family medicine clerkship	Assist	3	No	Clerkship director finds time/location for student

 

Patient Encounter Tracking. All students must record the minimum required diagnoses during the Family Medicine Clerkship. Patient encounter tracking is a school-wide requirement in MedHub. The Clerkship Director uses this data to help determine if students’ patient clinical experiences are appropriate for achievement of the Clerkship objectives. Therefore, students are expected to complete all information for patient encounters logged and should not consider any fields as optional. It is expected your preceptor will observe a focused history or focused physical and it will be logged in MedHub within the first 7 days of the clerkship.

Students should expect to interact with patients directly during the family medicine clerkship. If you experience the majority of your patient encounters are observation only, please contact the site director and email fmclerk@iupui.edu with this information. The site director and/or the clerkship director will attempt to resolve this issue or make other arrangements to provide an increased learning experience.

Each clerkship has been assigned specific core clinical skills that require validation. During the Family Medicine Clerkship, students are required to demonstrate skill proficiency in each of the following musculoskeletal (MSK) examinations:

1. Foot & Ankle Exam

• Inspection (swelling, deformity, toenails)
• Range of motion (active/passive, dorsi-/plantar-flexion, inversion/eversion)
• Palpation (Achilles tendon, malleoli, navicular, base of 5th MT, ankle ligaments)
• Special tests (anterior drawer, talar tilt)

2. Knee Exam

• Inspection (swelling, deformity, varus/valgus)
• Range of motion (active/passive, flexion/extension)
• Palpation (patella, patellar tendon, fibular head, MCL, LCL, joint line)
• Special tests (drawer tests, Lachman’s, patellar apprehension, ballottement of patella)

3. Back, Pelvis & Hip Exams

• Inspection (gait, stance for ASIS in horizontal plane, lateral side for slight lordosis, alignment, parallel height of shoulders and iliac crests, skin creases below buttocks)
• Palpation (ASIS, iliac crest, greater trochanter, PSIS, ischial tuberosity, sacroiliac joint, spinous processes, paravertebral muscles, costovertebral angles)
• Range of motion (flexion/extension, abduction/adduction, internal/external rotation, forward

4. Shoulder Exam

• Inspection (swelling, deformity, posture)
• Range of motion (active/passive, flexion/extension, internal/external rotation, abduction/adduction, Appley Scratch test)
• Palpation (clavicle, AC joint, humeral head, scapular spine)
• Special tests (rotator cuff evaluation, biceps)

5. Head, Neck & Eye

• Inspection (hair, scalp, neck, face, skin, eyes, pupil response, extraocular movements)
• Palpation (carotid pulse, trachea, salivary glands, lymph nodes, thyroid)
• Auscultation (carotid bruits, carotid radiation of murmurs)
• Range of motion (flexion, extension, rotation)

6. Special tests (visual acuity, visual fields, ophthalmoscopy)
   Hand, Wrist & Forearm Exam

• Inspection (swelling, deformity)
• Range of motion (active/passive, flexion/extension, ulnar/radial deviation, supination/pronation)
• Palpation (medial/lateral epicondyle, scaphoid, wrist, fingers)
• Special Tests (Phalen’s, Tinnel’s, Finkelstein’s)

Video and PDF resources are available on the Family Medicine Clerkship Canvas site in the “MSK Resources” tab. These MSK modules are provided as an optional resource and are not required.

Extra Credit

Before the end of your clerkship, please take a few minutes to complete this brief evaluation on the 3D print models and Augmented Reality (AR) app. By completing this evaluation, you may receive 1 extra credit point towards your final exam score. If you choose not to have your de-identified data used for our research, complete the survey for your extra credit. We will not use your evaluation information. In order to receive full points you must complete all relevant questions and provide thoughtful, thorough feedback in your short answer.

Non-Clinical Learning Experiences/Requirements

Professional Development Learning Experiences

Approximately 2-3 half days per rotation, students will participate in professional development learning experiences. These may include grand rounds at residency programs, community organization visits and/or independent learning. This time is meant to supplement learning in the clinical practice and the Aquifer^® Family Medicine case-based curriculum. Additionally students should use this supplemental learning time to prepare and complete the Breaking Barriers Modules and Project.

Family and Community Project

About the Family and Community Project

The Family and Community Project serves as a capstone event that has been designed to bring together what you have learned during your clerkship while also emphasizing the mission and values of Family Medicine. To successfully complete this project you will need to identify a patient or population that faces barriers to health or health care, interview a practicing health care professional who works with that patient or community, and collaboratively find resources that might help the patient or people group address one or more of those barriers.

More specifically, the goals of the Family and Community Project are for you to:

• Acquire a more comprehensive understanding about the impact of health and illness on a patient’s life and family/support systems;
• Use a biopsychosocial approach to consider biological, psychological, and social factors and their complex interactions to better understand health, illness, and health care delivery to improve clinical patient care;
• Describe how the integration of community agencies, organizations, and other healthcare providers into patient care can positively impact health care outcomes; and
• Develop strategies to use a team approach to develop a plan to improve health or health care outcomes.

The Family and Community Project will help you to achieve proficiency in the Systems Based Practice (SBP) competency. In addition, the Family and Community Project will give you opportunities to collaborate with other health care professionals and community resources in the context of care provided in an ambulatory primary care setting.

Tips

Ask your community faculty what he/she wants you to prepare for your presentation. You may be confused about how you are to work with the patient and family. You may find that family members and/or the patient take you into their confidence, telling you important pieces of information about their family, their habits, their thoughts and feelings, and their reactions to their medical care. You should be prepared to listen carefully, as this listening may be very helpful, even therapeutic, for the patient and family members. You may also want to talk with your community faculty about any confidential or important information given to you, especially if you think it would change the care of the patient. You may be asked to give explanations of medical treatments, answer questions about the disease or treatment; if you are certain of the answers, from review of the chart or working with your community faculty, help the family or patient understand the answers to their questions. If you are not sure, convey the questions to your community faculty. Think about how the information you gather on your home visit would change what you would do as the patient’s family physician

Suggestions for Preparation

Students are advised to solicit the assistance and guidance of the community faculty to select an appropriate patient who faces a barrier to health care such as affordability, acceptability, accessibility, appropriate and availability. Student will identify and may visit a community organization/agency which has the potential to benefit this patient and family. Successful students are able to present an understanding of the biopsychosocial issues related to a person/family who have barriers to healthcare and identify a resource to aid individual/family in overcoming the barrier. This project will require time investment over the entire clerkship.

Students should schedule the visit prior to the midpoint of their clerkship. It is recommended but NOT required students visit patient homes to have a greater understanding of the family unit. This is not a requirement. Students may elect to visit with patients during an extended visit in the office. The latter should be scheduled in advance of the appointment. Alternate community based projects may be completed in lieu of the Family and Community Project.

Those interested in this option must receive prior approval from the Clerkship Director. Past examples include the programming and implementation of health fairs and vaccination clinics. In addition, the professional development portion of the clerkship can and should be used to meet with community organizations and other healthcare professionals to facilitate completion of this project.

EASEL App

The EASEL app a new app that will facilitate the interview process for the Family & Community project. EASEL was developed to help you reflect on the interview you conduct with a healthcare professional. You will be using EASEL for one of your interviews with either the patient or healthcare professional.  Because the app is in beta testing, unfortunately only iPhone users will have access. Please only use the app for one interview--this will help you decide when completing the extra credit survey (see below) whether the app should be further developed for all platforms.Follow the below steps to download the app. Once you have downloaded the app, please watch this brief tutorial video:

To access the app:

• Go to https://itunes.apple.com/us/app/easel-experiential-education/id1313728782?mt=8 on your iPhone or search “easel - experiential education” in the app store.
• Download the app. When prompted to use location services and notifications, please choose allow to both.
• Once downloaded, log in with the following information
  Username: Your email address
  Password: easel2017l
• Click on the round "sign in" button (do not select register).
• Once logged in click on “IU Family Medicine” and then "Family Medicine Clerkship"

Interprofessional Practice

The World Health Organization defines interprofessional collaborative practice occurring when two or more providers from different professional backgrounds provide comprehensive health by working with patients, their families, caregivers and communities to deliver the highest quality of care across settings. Interprofessional collaborative practice can actually take place in many environments. For example, it can occur in hospitals, ambulatory clinics, transitional care units, community agencies, home health care and even a patient’s home.

Interprofessional teams are characterized by collaboration across team members, sharing information and coordinating processes and interventions to provide services and programs. In fully functioning, mature collaborative teams, the patient and family are key members. An example of interprofessional collaboration would be a nurse, physical therapist, physician, occupational therapist and pharmacist working together with a patient or client who is living with diabetes, to carry out an individualized plan of care in order to improve his or her health status.

Another example of interprofessional collaboration would be a public health professional working with dentist, nurse practitioner, community representatives, and a service organization to implement a program to support smoking cessation or healthy food choices as part of a community health improvement plan. Nestor (2016) noted that the health care field has recognized that in the current model, physicians are unable to provide all of the clinical and educational services required for effective patient care. “[Interprofessional] teams do not replace the physician-patient relationship, but rather enhance it—creating a more comprehensive, efficient, and tailored health care experience”.

Assignment Specifics

The Family and Community Project consists of four (4) required sections:

Section I: The Patient’s Story:

This section should capture information about the patient, his or her health conditions and function, environmental factors, and personal factors such as activities and engagement; in the context of his or her family and the community where he or she lives (see the ICF model for more information, at https://www.cdc.gov/nchs/data/icd/icfoverview_finalforwho10sept.pdf).

Your site director may suggest a list of questions to guide your presentation; we have included the following questions to guide your conversation with your patient and/or his/her family.

• What is your patient’s primary health or health care concern?
• When and how did this concern emerge for your patient and what impact has this had on him or her? How has it impacted family members? (What is it like for each of them?)
  • How do your patient's symptoms influence the family?
  • How does your patient’s family influence his or her symptoms?
• How do your patient’s family communicate during this time; with each other, between them and the patient, etc.?
  • What do your patient’s family do to keep things on an even keel during this time?
  • Who is in charge of this family?
  • How do you know?
  • Does it seem appropriate?
  • What types of medical services were received; what were the patient's and family's perception of these medical services?
  • Problems?
• Ask your patient what he/she would have liked to be different regarding this entire medical illness (i.e., If they could change anything about their illness or the conditions around their illness, what would that be?)
• Ask your patient what surprised him/her about how he/she or family responded to the diagnosis or medical problem? What surprised other family members?
• What was hardest for your patient or family as a result of this diagnosis or medical problems?
  • Who is the family expert on health and illness?
• What are the strengths in this family? What are the weak areas in this family?
  • What resources do they have as a family that helps them?
• Suggestion: It is recommended that you complete a genogram.

Notes on Preparing a Genogram

The genogram is essentially a family map. It is usually three generational but can include more generations if the client can provide the data and the practitioner finds it useful. The genogram is also referred to as a family tree.

The use of the genogram has largely developed out of the work of family therapists such as Murray Bowen who realized the value and importance of recurring patterns in a family's history and the influence of one generation on another. The purpose of the genogram is to provide a graphic record of three generations on both sides of the family. The generations usually included are children, parents and grandparents. The basic procedure is simple and can be done at the first and, if need be, subsequent interviews. It can be done with a single patient acting as informant although more information will emerge if the whole family is present.

The genogram can serve a number of purposes:

1. It can be used solely as a means to collect and record medical and social data for the practitioners' files. The process of doing a genogram is also a useful strategy for developing rapport with an individual or family.
2. Often it is used as a source of learning for the family. Patterns can be identified with them, explored and the family helped to restructure their relationships.
3. Increasingly it is being used as a way to help students learn family dynamics' concepts and to help them learn about themselves.

The latter is an often‐underemphasized area for those learning family dynamics. Each of us learns about families first in our own family of origin. We often carry unrecognized assumptions and perceptions about families, from our initial family experience. This may affect the way we interact with families we see in clinical practice. Doing our own genograms may help us to uncover and begin to deal with these perceptions and assumptions before they can impair or interfere in therapeutic relationships with patients. Mapping your own genogram can also be an exciting voyage of discovery.

A wide variety of data can be simply recorded through the use of symbols and a minimum of words. Information regarding generational relationships, interpersonal relationships (coalitions, cutoffs, triangles), nicknames and characteristics, roles in family ("white knight") and healthillness data can all be outlined.

A glossary of symbols is provided to start you off. Different practitioners tend to develop their own refinements to a common basic set of symbols. Also provided is a list of questions to think about while developing your genogram and sample genograms of fictitious and real families.

Section II: Barriers to Care:

Describe at least one barrier to health or health care faced by your patient and his/her family. Describe the barrier, how the barrier impacts his/her health, and any strategies already in place to overcome the barrier. Clearly state the gap between what is happening today and the desired state described by the patient. Consider community resources and health care providers who, if engaged, might be able to help mediate this barrier

Section III: Improving Health Outcomes:

• Discuss how eliminating or mediating one or more of the barrier(s) can improve your patient’s health or health outcomes.
• Interprofessionally collaborate with at least one other health professional or community resource person that interacts or could interact with the patient or caregiver (i.e., pharmacist, social worker, nurse, teacher, daycare provider, dentist, etc). Work together with the health professional to:
  • Learn about their role within the health care team and how, when, why s/he interacts with your patient and what ideas s/he has to help address the barriers identified.
  • Work in partnership to identify at least one realistic way his/her role on the health care team is instrumental in your patient’s improvement plan and to identify one community resource that could be helpful to addressing the barrier or challenge identified by your patient. For example, one strategy may include using assistance from a community partner. As such, you may include information gathered from your Community Resource Profiles as part of the Breaking Barriers Curriculum.
  • Together, identify the clinical and social relevant facts of the patient.
  • List the options open to your team (e.g., “what could the team do?” and “what should the team do?”)
  • How will your team approach the conversation? Who else should be there?
• Write a brief description (50‐100 words) about how your patient’s health outcomes might improve as the result of the coordinated care plan. Be sure to include in your presentation/submission how your patient’s outcomes might improve as a result of the coordinated care plan you are proposing.
• If possible meet with your patient to go over the improvement plan. Get his/her feedback to determine if the improvement plan is feasible for your patient. If this is not an option, then comment what might remain a challenge for the patient to adhere to the proposed improvement/intervention plan. Think about that interaction, what went well, what you might do differently if the interaction were repeated.

Section IV: Critical Thinking:

Document and reflect on your interaction with the patient and on your collaboration with the healthcare professional. Use the following to guide your reflections.

• The What?
  • Describe what happened/what you did.
  • Describe how you worked with another profession to accomplish the assignment.
  • Describe the barrier/barriers you addressed.
  • How did the community in which your patient lives influence his or her access to care and or resources?
• So What?
  • Describe how working with someone from another profession informed/affected the outcome of your project?
  • What was as you expected about the experience what was different?
  • What did you like or dislike about the experience?
  • Why does that matter? To you? To the patient?
  • What resources did you identify to help your patient?
  • If you met with your patient, how did the interaction with your patient go?
• Now what?
  • What have you learned?
  • What seems to be the root cause of the barrier you addressed?
  • How will this experience inform or influence your patient care going forward?

Evaluation

All medical students are required to complete a Family and Community Project. Students will present their final project to his/her community faculty member and office staff during the last week of the clerkship. Documentation of the Family and Community Project must be uploaded into Canvas. This may include a copy of your PowerPoint, Prezi, Word file (typed speaking notes, photographs), etc. Upload your final project to the Canvas assignment. Please be sure to review the rubric located within this assignment (as well as in the syllabus appendices). The Family & Community project will not be formally evaluated by your preceptor, but instead online by clerkship faculty. Be sure to review the rubric for the evaluation standards.

Extra Credit - EASEL App

After your Family & Community project, please take a few minutes to complete this brief evaluation. By completing this evaluation, you may receive 1 extra credit point towards your final exam score. If you choose not to have your de-identified data used for our research, complete the survey for your extra credit. We will not use your evaluation information. In order to receive full points you must complete all relevant questions and provide thoughtful, thorough feedback in your short answer. Even though the app is only available for iPhones, all students can still complete the survey for the extra credit point. Please do not submit this survey until after you have completed your Family & Community project. Early submissions will result in 0 points. 

 

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LEARNING MATERIALS AND RESOURCES

Aquifer^® Family Medicine case-based curriculum

There is no required textbook to purchase for the Family Medicine Clerkship. Instead the clerkship utilizes a case-based, on-line curriculum called Aquifer^® Family Medicine. The Aquifer^® Family Medicine case-based curriculum has 40 interactive virtual patient cases which build clinical competency, fill educational gaps, and help instill the core values and attitudes of family medicine. Aquifer^® Family Medicine fosters self-directed and independent study, builds clinical problem-solving skills, and teaches an evidence-based and patient-centered approach to patient care. This online “textbook” is used by most family medicine clerkships nationally as the best example of the family medicine discipline. The final clerkship exam is based on these cases. Students must register with Aquifer^® Family Medicine (see instructions below) in order to take the final exam. This registration must occur by the end of Week 1.

Instructions to register for Aquifer^® Family Medicine

1. Click on the Aquifer^® Family Medicine link (http://www.med-u.org/fmcases)
2. Click “Sign In” at the top of the page
3. Go to "Register" in the upper right hand corner.
4. On the next screen select "Student” then “OK."
5. Complete the registration form. PLEASE NOTE: You must use your username@iupui.edu, username@iu.edu, or username@indiana.edu email address. 
6. An email with a link will be sent. You will be required to click on the link in order to complete your registration.
7. Once that is done, you may log in any time to the cases. This will work with all Aquifer^® products.

Online Learning Modules

While Aquifer^® Family Medicine is the “textbook” for the clerkship, not everything is covered to the extent the clerkship leadership believes is important. Several online learning modules have been developed to aid in both your education and growth as a physician.

Breaking Barriers Module (REQUIRED)

Medical students will complete a required curriculum on medically underserved populations. The curriculum is titled Breaking Barriers. There are four (4) individual modules in the Breaking Barriers curriculum.

1. Module 1: Understanding Barriers to Healthcare [Required]
2. Module 2: Affordable
3. Module 3: Accessible & Available
4. Module 4: Appropriate & Acceptable

Module 1, which serves as an overview to the Breaking Barriers curriculum, is required of all students. After completing Module 1, you must complete 1 of the remaining 3 modules. In summary, you must complete a total of two (2) modules before the completion of your Family Medicine rotation. The goals of this learning experience include:

• To introduce students to the barriers facing medically underserved populations in obtaining primary healthcare services.
• To motivate students to engage in actions that will help patients overcome these barriers thus improving patient care.

The Breaking Barriers module is located on the Family Medicine Clerkship Canvas site. Each module takes approximately 60 minutes to complete. Satisfactory completion of this module is required.

Motivational Interviewing Module (REQUIRED)

The Motivational Interviewing (MI) module is a required online assignment for the clerkship. The objectives of this module are for the learner to:

• Define key principles of Motivational Interviewing
• Recognize how principles of Motivational Interviewing can be applied
• Compare and contrast language used by physicians during patient encounters as being consistent with Motivational Interviewing

The Motivational Interviewing module is located on the Family Medicine Clerkship Canvas site. The entire module will take approximately 80 minutes to complete. However the module is broken down into brief learning components. Satisfactory completion of this module is required, based upon the rubric provided in Canvas.

Musculoskeletal Exam Resource (NOT REQUIRED)

The Musculoskeletal (MSK) Exam resource is a supplemental learning tool. The MSK Exam resource is comprised of several video segments demonstrating the required MSK physical exams. This resource is located on the Family Medicine Clerkship Canvas site. This online module is not a requirement of the clerkship. It is an optional video resource.

Extra Credit

Before the end of your clerkship, please take a few minutes to complete this brief evaluation on the 3D print models and Augmented Reality (AR) app. By completing this evaluation, you may receive 1 extra credit point towards your final exam score. If you choose not to have your de-identified data used for our research, complete the survey for your extra credit. We will not use your evaluation information. In order to receive full points you must complete all relevant questions and provide thoughtful, thorough feedback in your short answer.

NOTE: Any student at any IUSM campus requesting accommodations for a disability must apply to the Indiana University School of Medicine Disabilities Accommodations Committee and must register with the adaptive educational services office at the host campus.  Guidelines for applying along with a list of the adaptive services offices on each campus are available in the IUSM Disability Accommodation Policy.

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GRADING/ASSESSMENT

Final grades are determined by several indicators of student performance on the Family Medicine Clerkship: 1) the Community Faculty Evaluation; 2) the Family and Community Project Evaluation; 3) the Final Exam; and 4) appropriate and full completion of all assignments/requirements. The community faculty does not assign the student’s final grade. 

The Family Medicine Clerkship grading policy is designed to include both criterion based (competency grading) and normative based (curve grading) information. An acceptable grade distribution for the entire class is 15-20% Honors, 30-50% High Pass, 40-60% Pass and less than 3% fail.

Evaluation Comments

Late or unsatisfactory completion of assignments/requirements may be noted in the comments section of the student’s final evaluation.

Exam (25%)

Description

All clerkship students will take the Aquifer^® Family Medicine exam as the final exam for the course. The questions on the exam come from the 40 cases in the Aquifer^® Family Medicine case material. The exam is administered at the regional campuses and in Indianapolis. This is a computer based exam using a secured examination platform.

Students scoring less than 60% on the final exam must re-take the exam. The exam failure will be recorded with the school evaluation system as an ID-MK with the required retake remediation noted. A student may not retake the exam during any other clerkship rotation. This decision and schedule for a retake will be made per school policy.  If the student passes the retake exam, a grade of ID-MK/P will be granted (pending he/she passes the community faculty and project components of the evaluation). If the student does not pass the re-take, he/she will be issued an ‘F’ and must retake the entire clerkship.

Suggestions for Preparation

Take the optional Aquifer^® Family Medicine mid-clerkship practice exam. From national and Indiana University School of Medicine data, students who study each case for 45-55 minutes have a great likelihood of passing the exam. 

Midway through the Family Medicine Clerkship, you will have the opportunity to complete an optional, practice 25-question online exam using questions from the Aquifer^® Family Medicine test question bank. This exam will open during a specified time-frame within the clerkship and be accessible through Canvas. Within 2 working days of the exam closing, you will receive individual feedback on your results. Based upon your incorrect responses, you will be encouraged to review specific Aquifer^® Family Medicine in preparation of the final exam. An example of the Canvas feedback is below.

Dear Student –

Thank you for completing the Aquifer^® Family Medicine Practice Exam. Our records indicate it took you approximately 42 minutes to complete the examination. Your score for the practice exam was 19/25 (76%). As a reminder, students in Block II need a score of 63% or higher to pass the FM final exam.

For comparison purposes, the average score for this rotation was 17.23 (71.12%). The average score for all students in Block I was 14.74 (62.51). The average gain between the practice and final exams was +11.47%. Based upon your incorrect responses, we recommend that you review the following cases:

  - Case #2
  - Case #9
  - Case #15
  - Case #18
  - Case #22
  - Case #25

To help with your preparation of the final exam, you will find attached to this e-mail a document connecting the above mentioned cases to specific topics. Should you have any questions or concerns, please do not hesitate to contact us.

Professionalism and Timely Completion of Assignments (5%)

Description:

Students are expected to complete assignments on time and with concerted effort. Students exhibiting consistently late or unsatisfactory completion of assignments/requirements may receive an ID-P. Additionally, students are expected to respond promptly to communication from Family Medicine Clerkship staff and affiliates. Consistent failure to do so may result in documented competency concerns. This includes successful completion uploaded into Canvas of:

• Seven Day Focused History (due by Day 7 of the clerkship - see "assignments" for specific due date)
• Practice-Based Learning & Improvement for Clinical Clerkships (due during the third week of the clerkship - see "assignments" for specific due date)
  
• All required assignments within the Motivational Interviewing (MI) module (due by 11:59pm of last day of clerkship).
• All required assignments with the Breaking Barriers module (due by 11:59pm of last day of clerkship).
• Family & Community Project (due by 11:59pm on last day of clerkship)

Graded/Verified Components (20%)

Description:

• Community and Family Project and Breaking Barriers Module (15%)
• Practice Based Learning and Improvement (5%)

Preceptor Evaluation of Student (50%)

Description:

The community faculty completes an objective, competency-based evaluation designed to measure specific knowledge, skills and attitudes. Written comments offered by the community faculty may be paraphrased on the final IUSM Clinical Performance Evaluation form. If a student is evaluated poorly on any area of the community faculty evaluation, the student’s overall clerkship performance will be reviewed by the clerkship director to determine the appropriate course of action. This may include remediation in specific content, repetition of all or part of the clerkship, or assignment of a grade of “Fail”.

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Mid-Clerkship and Formative Feedback

Mid-Clerkship Feedback

During the second week of the clerkship, community faculty will complete the Family Medicine Mid-Clerkship Feedback form. A link will be sent directly to the community faculty via e-mail. The Mid-Clerkship Feedback provides an opportunity for the student and the community faculty to: 1) review the student’s progress; and 2) set goals for the balance of the clerkship. Students should identify areas where assistance is still needed (i.e., what encounters do you still need to cover to meet your minimum requirements), as well as review history taking, physical exam, and problem assessment skills. This is also a good time to review a copy of the community faculty’s evaluation of the student to understand how he or she will be evaluating the student at the end of the clerkship.

Formative Feedback

During the second week of the clerkship, the site director will meet with student to discuss the requirements for successful completion of the clerkship. Students should discuss with the site director anticipated difficulty regarding successful completion of requirements. For example, if the community faculty rarely sees female disorders, the student should talk with the site director to identify other resources to meet the required minimum. Additionally the site director will identify any concerns with student performance not addressed through the community faculty. Any modifications to the student’s clerkship assignments or areas for improvement will be noted on the formative feedback form. Completion of this form is required and must be signed by evaluator and student. Students may consult with site directors through telephone conversations and verify receipt of feedback via email. Documentation will be provided to the main clerkship office for compliance purposes.

Fail – Repeat Family Medicine Clerkship

A grade of Fail will be reported for students who score less than Pass on the Community Faculty or score less than Pass on the final exam twice. The first time a student fails the final exam, the student will receive an ID-MK and be required to retake the final exam. The highest final grade for the Family Medicine Clerkship after one failure of the final exam is an ID-MK/Pass.

The Department of Family Medicine reserves the right to assign a failing grade for the entire clerkship if a student has performed in an unsatisfactory, unprofessional or unethical manner in terms of behavior with the community faculty, one of his/her health care team members or patients, the site director, or the statewide office staff.

Final Grade Communication

After final grades are submitted to Medical Student Affairs System (MSAS), students will receive a follow-up email communication from the clerkship director (via the FMCLERK@iupui.edu email). The below email example will illustrate how your final grade was calculated and how you performed in comparison to your peers.

Dear Student,

The Family Medicine Clerkship provides each student with a breakdown of how his/her final grade was determined. This information is provided below.

As a general rule and in accordance with IUSM policy, the top 20% of students are eligible for Honors and the top 55% of each rotation are eligible to receive a High Pass.

	Your Score	% of final grade
Final Examination	XX.X	25
Community Faculty Evaluation	XX.X	50
Professionalism and Timely Completion of Assignments	XX.X	5
Graded Components	XX.X	20

The highest exam score for your cohort was XX.X% and the average was XX.X%. Your ranking was #XXX of #### students. 

If you have further question about your final grade, please do not hesitate to contact me.
Scott Renshaw, MD

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CLERKSHIP POLICIES
(Consult the IUSM Policies section for all other policies.)

Community Faculty-Student Incompatibility

It is possible that a good community faculty and a good student simply do not work well together. If you sense this is the case, bring the situation to the attention of your site director immediately. He/she will recommend a strategy for handling the situation or intervene directly.

Attendance

Clerkship attendance is required unless approved by the clerkship director.

Consult the Schedule Conflicts, Absences, and Vacations policy and the Adverse Weather procedure prior to completing a request form.

Late or Unsatisfactory Work

No late assignments will be accepted unless prior approval has been granted by the clerkship director.  There is a list of all assignments and all due dates in the Family Medicine Clerkship Canvas Site in the Assignments tab. 

Professionalism

[Description of professional communication (including adherence to HIPAA guidelines) and behavior standards (including civility expectations) governing clinical experiences, classroom discussions, etc. both the professionalism expectations as well as the Honor Code are listed below for reinforcement, if needed.]

Consult the IUSM Mission and Vision and IUSM Honor Code that provide the foundation for the culture of professionalism expected at IUSM

Student Evaluation of the Clerkship

Students will have an opportunity to evaluate the Family Medicine Clerkship after taking the final exam.

Consult the Evaluation of Curriculum by Students policy described in the Student Handbook.

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IU SCHOOL OF MEDICINE HONOR CODE & POLICIES

• Academic Dishonesty
• Area of Concern Policy
• Disabilities Accommodations Policy
• Documenting Electronic Medical Record Policy
• Exam Rescheduling Policy
• Grade Appeal Policy
• Grade Policy for Courses, Clerkships, and Electives in the Clinical Years
• Policy Statement on Medical Students and Care of Patients
• Professional Conduct Policy
• Professional Dress Code
• Required Clinical Experiences Policy
• Schedule Conflicts, Absences, and Vacation Policy
• Student Duty Hours
• Supervision and Scope of Practice Policy
• Teacher- Learner Conduct Policy (with mechanisms for reporting)
• Transportation Policy and Medical Student Travel Guidelines
• Universal Precautions

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IU SCHOOL OF MEDICINE RESOURCES

Please note that you have access to these and many other IUSM Resources via the IUSM Resources link found on the left side menu of your Canvas site.

• IUSM Academic Calendar
• IUSM Student Handbook
• MSE Mentoring and Advising
• MSE Resources for 3^rd Year Students OR MSE Resources for 4^th Year Students
• Ruth Lilly Medical Library

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APPENDIX

[Include assessment tools such as rubrics, peer assessment forms, self-assessment forms, assignments that are to be handed in on the first day of the course/clerkship, etc.]

Rubrics (links)

 

IUSM v.05092017
FMC v.06112017

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