Course Syllabus

Statewide Clerkship Director: Scott Renshaw, MD Office Phone: 317-278-0330 Email: fmclerk@iupui.edu*

Statewide Clerkship Coordinator: Miranda Benson Office Phone: 317-278-0330 Email: fmclerk@iupui.edu*

*Please note: fmclerk email is monitored Mon-Fri during regular business hours. This email address is not monitored on weekends or holidays.

Campus Contacts:		ACE Student Contacts:
Bloomington Site Leader: Melissa Hullinger, MD mhullinger@premierhealthcare.org
Evansville Site Leader: Stan Tretter, MD stretter@mhhcc.org
Fort Wayne Site Leader: Paul Blusys, MD pblusys@aol.com
Muncie Site Leader: Luke Ernstberger, MD lernstbe@iuhealth.org

What’s New | Pre-Clerkship General Information | 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, those who may need preventive health education, and those 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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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.edu with any questions or concerns or feedback.

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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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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

Upon completion of the Family Medicine Clerkship (Y730), learners will…	Instructional Method	Assessment Method
Demonstrate progressively more accurate, complete, and relevant clinical history-taking and physical examination skills in a variety of settings (PC1).	Perform and interpret relevant, problem-focused histories and physical examinations in patients with undifferentiatied and common chronic medical conditions.	Preceptor evaluation
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 (PC2).	Formulate and justify prioritized problem lists and differential diagnoses for both undifferentiated and common chronic medical problems.	Preceptor evaluation
Integrate data from a clinical encounter to develop a patient-centered plan of care based on up to date scientific information (PC3).	Formulate and justify plausible plans of patient care for both undifferentiated and common medical problems.	Preceptor evaluation
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 (MK1).	Differentiate normal and abnormal structure, function, growth, and/or development for both undifferentiated and common chronic medical problems.	Preceptor evaluation
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 (MK2).	Explain the etiology, progression, and/or prognosis of diseases, injuries, and functional deficits commonly seen in both undifferentiatied and common chronic medical conditions	Preceptor evaluation
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 (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.	Preceptor evaluation
Provide justifications for interventions to diagnose, prevent, treat, and manage a specific patient’s diseases, injuries, and functional deficits of organ systems (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.	Preceptor evaluation
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 (MK5).	Analyze and evaluate diagnostic and therapeutic options using principles of evidence-based medicine.	Preceptor evaluation
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 (PBLI1).	Respond to clinical questions by independently seeking, analyzing, and synthesizing evidence-based answers to advanced clinical decision-making.	Preceptor evaluation
Seek and accept feedback from colleagues, faculty, supervisors, advisors, and other health care professionals and incorporate this information into daily practice (PBLI2).	Seek, accept, and apply feedback to clinical practice.	Preceptor evaluation
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 (SBP1).	Identify the role and contributions of and establish respectful, effective relationships with the various members of the multi-professional health care team.	Preceptor evaluation
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 (SBP2).	Identify a patient’s social context and analyze how it relates to their current state of health.	Preceptor evaluation
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 (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.	Preceptor evaluation
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 (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. Act in a professional manner by demonstrating compassion, respect, honesty, integrity, and punctuality.	Preceptor evaluation
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 (P3).	Adhere to ethical and legal principles in all interactions	Preceptor evaluation
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 (ISC1).	Communicate effectively with members of the healthcare team by clearly presenting clinical questions and data from the patient encounter.	Preceptor evaluation
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 (ISC2).	Communicate effectively with patients and their families by listening attentively, allowing opportunities for questions, and maintaining appropriate eye contact.	Preceptor evaluation
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 (ISC3).	Modify communication style based upon patients’ reactions and ability to understand.	Preceptor evaluation
Share information accurately in academic and clinical settings both in oral presentations and written documentation including in the medical record (ISC5).	Construct oral presentations or written documents representing an organized, focused, account of the student-patient interaction.	Preceptor evaluation

 
Specific Family Medicine Clerkship Objectives

Upon completion of the Family Medicine Clerkship (Y730), learners will…	Instructional Method	Assessment Method
Incorporate health promotion and patient education on the basis of the patient’s or population’s needs (PC4).	Incorporate health promotion and disease prevention strategies into all patient visits based on health risk factors.	Community Health Partnership Project
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 (MK6).	Integrate biopsychosocial information into patient care in a manner which will improve patient outcomes.	Community Health Partnership Project
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 (MK7).	Identify and discuss the family, support system, community, cultural, ethnic, religious, occupational and economic factors influencing patient management and outcomes.	Community Health Partnership Project
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 (SBP3).	Describe the health issues faced by patients when accessing and utilizing health care that are rooted in the social determinants of health.	Community Health Partnership Project
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 (SBP4).	Describe methods of monitoring compliance with preventive services guidelines including concepts of population health.	Community Health Partnership Project
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 (SBP5).	Engage with other healthcare team members to develop strategies to meet specific patient care needs and healthcare barriers.	Community Health Partnership Project
Incorporate elements of shared decision making into communication with patients to facilitate their active participation in their health care (ISC4).	Apply the intermediate principles of motivational interviewing, specifically pre-contemplation and contemplation.	Online module scenarios

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

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.

Required Clinical Encounters/Skills

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 "Specific Clerkship 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.

Required Clinical Experience	Level of Responsibility (Observe, Assist, Perform)	Required Number	Verified by faculty
Observed Focus History	Perform	1	Yes
Observed Focus Physical	Perform	1	Yes
Musculoskeletal Examination: Head/Neck	Perform	1	Yes
Musculoskeletal Examination: Shoulder	Perform	1	Yes
Musculoskeletal Examination: Hand/Wrist	Perform	1	Yes
Musculoskeletal Examination: Low Back/Hip	Perform	1	Yes
Musculoskeletal Examination: Knee	Perform	1	Yes
Musculoskeletal Examination: Foot/Ankle	Perform	1	Yes
HEENT Examination	Perform	5	No
HEENT Disorders	Assist	10	No
Genitourinary Disorders	Assist	5	No
Gastrointestinal (Abdominal) Examination	Perform	5	No
Gastrointestinal Disorders	Assist	10	No
Cardiovascular Examination	Perform	5	No
Cardiovascular Disorders	Assist	10	No
Endocrine Disorders	Assist	10	No
Pulmonary Examination	Perform	5	No
Pulmonary Disorders	Assist	10	No
Psychiatric Disorders	Assist	10	No
Neurologic Examination	Perform	3	No
Neurologic Disorders	Assist	5	No
Dermatologic Examination	Perform	5	No
Dermatologic Disorders	Assist	5	No
Preventive Health	Assist	20	No
Chronic Pain	Assist	3	No

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:

Back, Pelvis & Hip Exams

• Inspection
• Palpation
• Range of Motion
• Special Test: FABER
• Special Test: FADIR
• Special Test: Ober
• Special Test: Stork
• Special Test: Trendelenburg

Foot & Ankle Exam

• Inspection
• Range of Motion
• Palpation
• Special Test: Anterior Drawer
• Special Test: External Rotation
• Special Test: Squeeze
• Special Test: Thompson Test
• Special Test: Talar Tilt

Hand, Wrist & Forearm Exam

• Inspection
• Range of Motion
• Palpation
• Special Test: Tinel's
• Special Test: Phalen's
• Special Test: Finkelstein's
• Special Test: Watson’s

Head, Neck & Eye

• Inspection (eyes, head & neck)
• Palpation (head & neck)
• Range of motion (neck)
• Auscultation (neck)

Knee Exam

• Inspection
• Range of Motion
• Palpation
• Special Test: Anterior/Posterior Drawer
• Special Test: Ballottement
• Special Test: J Sign
• Special Test: Lachman’s
• Special Test: McMurray
• Special Test: Nobles Compression
• Special Test: Patellar Grind
• Special Test: Sag Sign
• Special Test: Varus Stress

Shoulder Exam

• Inspection
• Range of Motion
• Palpation
• Special Test: AC Load
• Special Test: Apprehension/Relocation
• Special Test: Cross-Arm Adduction
• Special Test: Empty Can
• Special Test: Hawkin
• Special Test: Internal/External Rotation
• Special Test: Neer
• Special Test: O'Brien
• Special Test: Speed's
• Special Test: Sulcus Sign
• Special Test: Yergason

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.

Practice-Based Learning and Improvement for Clinical Clerkships: This assignment is to assess your ability to take a clinical case, identify a knowledge gap you have in the management of this patient's problem, and fill that knowledge gap with evidence from the medical literature. You must have a minimum score of three (3) points in order to pass. Any scores 6 or lower will require a re-submission. This is due during Week 3 of your rotation (See "Rotation Specific Checklist" for your specific due dates)

Non-Clinical Learning Experiences/Requirements

In addition to clinical time, 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 Practice-Based Learning & Improvement for Clinical Clerkships assignment, Social Medicine & Community Health and Motivational Interviewing modules located within Canvas.

Social Medicine and Community Health Module: All third-year medical students are required to complete a curriculum on public health. This curriculum builds on concepts learned in FCP1 and 2 regarding the social determinants of health (SDOH) and the various barriers to health that patients face. Taking a big picture approach, students will learn about the practice of public health and ways that family doctors and other primary care providers can play an important role in influencing population health.

Social Medicine and Community Health (SMCH) happen at the interface of public health and primary care. They challenge us to think beyond prolonging life and curing disease. Social Medicine and Community Health specifically work to take our role as physicians beyond the clinic environment and into the communities in which we live and serve, to address health disparities. The goal of this work is to improve the equality of opportunity for health for all community members.

Goals of the SMCH Modules

• Review concepts around the social determinants of health (SDOH) and other non-medical factors that play important roles in patient health and well-being.
• Motivate the student to use this understanding to develop strategies for alleviating health disparities and reducing inequity at the community level.

SMCH Curriculum Objectives

After completing the SMCH curriculum, the student will be able to:

• Understand how Social Medicine and Community Health can help us overcome inequities.
• Identify ways that the medical and public health communities can partner to promote better community health and reduce disparities.
• Better use their voice to advocate on behalf of their community and their patients when it comes to public health concerns.
• Take into account an understanding of non-biological factors when partnering with patients in treatment plans.

This assignment partially satisfies the requirements for Evaluation of Interprofessional Teamwork (the fifth learning anchor of Indiana University’s Teamwork Education Advancing Collaboration in Healthcare). For a description of the Interprofessional Collaborative Practice Competencies (IPEC, 2016) corresponding to these objectives, go to https://ipe.iu.edu/wp-content/uploads/2018/04/TEACH-2.0-Curriculum-Plan.jpg.

About the Modules

You are required to complete two sub-modules of this learning unit. You are required to complete Mod 1 and one of the remaining three modules (complete either Mod 2, Mod 3 or Mod 4). Total amount of work on this module should not exceed 3 hours. Each module has an assignment. You are required to complete the Mod 1 assignment and the assignment for whichever module (Mod 2, Mod 3 or Mod 4) you select. By the last day of the clerkship you are to have submitted a total of three assignments:

1. Module 1 assignment
2. Module 2, Module 3 or Module 4 assignment
3. Community Health Partnership Project

Each of the modules, require you to identify a health issue with a patient, including the final Community Health Partnership Project. You are encouraged to identify your patient and health issue early in your rotation. You can use that same patient and health issue throughout this entire module. We strongly suggest that you read the SMCH Introduction early in your rotation as well. This will help you as you prepare to complete this module. See "Rotation Specific Checklist" for your specific due dates.

EASEL App

The EASEL app a new app that will facilitate the interview process for the Community Health Partnership Project. EASEL was developed to help you reflect on the interviews you conduct. You will be using EASEL for only one of your interviews. 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. By completing this survey in full, you will receive two (2) extra credit points towards your final exam. If you do not have an iPhone, you are still eligible to receive the extra credit. Please complete as much of the survey as you can. 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 IU email address
  Password: easel2018
• Click on the round "sign in" button (do not select register).
• Once logged in click on “IU Family Medicine” and then "Family Medicine Clerkship"

Motivational Interviewing: An In-Depth Look at the Stages of Change Module: During FCP2, you were introduced to basics of motivational interviewing (MI). As you may recall, MI is a collaborative person-centered form of guiding your patient to elicit and strengthen motivation for change, in order for them to improve their health outcomes. This module will go into more depth, focusing on stages of change, so that you can be more competent when working with your patients.

Thinking back to some of your previous clinical settings, you have likely seen patients whose behaviors negatively impact their specific medical conditions or their overall health. Perhaps you’ve talked with a patient and encouraged them to take their medications, quit smoking or eat healthier foods. But, did the patient's actually make any lifestyle changes?

In this module, we are going to focus on the stages of change and teach you clinical strategies for creating an internal desire for change from your patient. It is important to remember that behavior change is rarely a discrete, single event. Sometimes you will see a patient who readily complies to changing behavior after suffering a medical crisis. However, more often than not, you will see patients who seem unable or unwilling to change (AAFP, 2000).

We are going to spend the majority of this module on two stages of change: pre-contemplation and contemplation. For physicians, patients at either of these two stages can be especially challenging. See "Rotation Specific Checklist" for your specific due dates.

Learning Objectives

After completing this module, students will be able to:

• Describe the appropriate responses to patients, based on the patient’s stage of change.
• Identify how to assist a patient with making changes, including identifying specific goals for future health.

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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 (aquifer.org/courses/aquifer-family-medicine)
2. Click “Sign In” at the top of the page
3. Click "Register" at the bottom of the page. Enter your IU email address (username@iu.edu is the only address that will work)
4. You will be sent an email with a link to complete registration. Upon receipt of the registration email, click on the link "Click Here." You will then be brought to the profile setup page.
5. You will be asked to fill in your profile information and set up a password (8 character minimum).Once you have completed your user profile and created a password, you will receive a welcome email with links to useful information and guides. You would also be logged into the Aqueduct learning management system.
6. Once your profile is completed successfully, you will be brought to Indiana University's course page.
7. Now that you have completed your user profile and created a password, your sign in will be quick and easy. Go to Aquifer.org and click "Sign In" at the top right corner. 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.

Social Medicine and Community Health: All third-year medical students are required to complete a curriculum on public health. There are four (4) individual modules in the Social Medicine and Community Health curriculum. You are required to complete two sub-modules of this learning unit. Each module should take about one (1) hour. You are required to complete Mod 1 and one of the remaining three modules (complete either Mod 2, Mod 3 or Mod 4). Total amount of work on this module should not exceed 3 hours. Each module has an assignment. You are required to complete the Mod 1 assignment and the assignment for whichever module (Mod 2, Mod 3 or Mod 4) you select. By the last day of the clerkship you are to have submitted a total of three assignments:

1. Module 1 assignment
2. Module 2, Module 3 or Module 4 assignment
3. Community Health Partnership Project

Motivational Interviewing Module: All third-year medical students are required to complete a curriculum on motivational interviewing. You are required to complete the entire module during Week 2 (see "Rotation Specific Checklist" for your specific due dates). The entire module will take approximately two (2) hours to complete.

Musculoskeletal Exam Resource (optional): While you are required to have logged MSK exams, this module is an optional resource. The MSK Exam resource is comprised of several video segments demonstrating the required MSK physical exams.

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) Community Health Partnership Project ; 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.

Evaluation Comments

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

Exam (100 points)

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.

Timely Completion of Assignments (20 points)

Description: Students are expected to complete all 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.

Suggestions for Preparation: The Family Medicine Clerkship has created a checklist specific to each rotation with due dates/times for each assignment. The checklists can be found in the module "Rotation Specific Checklist" for your specific due dates. It is your responsibility to make sure assignments are completed by the due dates.

Graded/Verified Components (80 points)

Description:

• Social Medicine and Community Health Module (40 points)
• Motivational Interviewing Module (20 points)
• Practice Based Learning and Improvement (12 points)
• 7 day History/Physical (6 points)
• Syllabus Attestation (2 points)

Suggestions for Preparation: The Motivational Interviewing module and Practice Based Learning and Improvement are rather straightforward. However, the Social Medicine and Community Health module is a longitudinal module that covers the span of this clerkship. It is strongly suggested you review the "Introduction" page in the Social Medicine and Community Health module at the beginning of the clerkship. While the module assignments and project are not due until the end of the clerkship, because this is a longitudinal module, it requires you work with a patient from this clerkship. The earlier you identify the patient, the more smoothly this module will go for you.

Late Submissions: Any of the above required assignments submitted after the due will have 1 point docked for each day the assignment is late. If you are having issues with any of the assignments, please contact fmclerk@iupui.edu prior to the due date.

Preceptor Evaluation of Student (200 points)

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”.

Final Grade Determination

The family medicine clerkship has a maximum of 400 points that can be earned. Your final grade is simply determined by your total points earned divided by 400 points. The cut-offs for grades are as follows:

• Honors 366-400 points (92%-100%)
• High Pass 334-365 points (84%-91%)
• Pass 238-333 points (60%-83%)
• Fail less than 238 points (below 60%)

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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.

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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. If a student submits two or more graded assignments or non-graded clerkship tasks late OR other types of professionalism concerns arise, a professionalism AOC will be submitted. (Phase 2 Grading Schema Policy)

Professionalism

Students must be professional in all communications and interactions. Students must comply with all HIPPA guidelines. Student’s behavior should be professional at all times.

Consult the IUSM Mission and Vision and Professional Conduct Policy 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.

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IU SCHOOL OF MEDICINE HONOR CODE & POLICIES

• Academic Misconduct
• Area of Concern Policy
• Disabilities Accommodations Policy
• Documenting Electronic Medical Record Policy
• Grade Appeal Policy
• Grade Policy for Courses, Clerkships, and Electives in the Clinical Years
• Phase 2 Grading Schema Policy
• Professional Conduct Policy
• Dress Code Policy
• Required Clinical Experiences Policy
• Schedule Conflicts, Absences, and Vacation Policy
• Student Clinical and Educational Work Hours
• Supervision and Scope of Practice Policy
• Teacher- Learner Conduct Policy (with mechanisms for reporting)
• Transportation Policy and Medical Student Travel Guidelines
• Universal Precautions
• Response to and Accommodation for Exposure to Infectious Agents Policy

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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
• Academic Advising
• Career Mentoring
• MSE Resources for 3^rd Year Students OR MSE Resources for 4^th Year Students
• Ruth Lilly Medical Library

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APPENDIX

All rubrics are located within each assignment, where appropriate.

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