Family Medicine 350

Family medicine is a six-week outpatient clerkship. It is one of the few outpatient experiences you will have during medical school. As one wise family medicine attending shared, "you take care of patients from the womb to the tomb." On this rotation, you will manage many of the common outpatient health concerns, as well as learn health maintenance and preventative medicine.  Different supplemental reading materials are provided at different locations.  It may be worthwhile to share with friends who are doing rotations elsewhere.

Family medicine truly puts your ability to apply the biopsychosocial model to the test. The rotation is a good opportunity to hone your physical exam skills. Remember that you are one the patient's primary sources of care. Therefore you need to address all of their medical problems. A detailed history and careful physical exam is as important as the lab tests you will order in establishing the correct diagnosis. Your progress notes should be concise and focused in SOAP note format.
Visits are of three kinds: acute sick visit, management of a chronic illness, or health maintenance.  For a sick visit, restrict your history and exam to the immediate problem. The assessment and plan should include a differential diagnosis with support from history and physical exam.

Management of chronic illness visits may include blood pressure checks for hypertensive patients, check-ups for patients with diabetes, etc.  This type of visit requires a physical exam targeting all of the end organs that can be damaged in these diseases.  Some find it easiest to approach the assessment and plan by organ system.

Health maintenance issues should be listed in every assessment and plan, even if they are not addressed at that visit. A health maintenance visit usually includes performing a complete physical exam and addressing important preventative issues for the individual's age.  Screening tests should be stressed, including colonoscopy beginning at age 50 and annual mammography for women over 40.

Family physicians address a number of psychiatric problems. The time spent with the patient should be considered a "psychosocial" exam. You will glean essential information about the patient during this time by observing their affect, their interaction with you, and any stressors in their lives. You may hear the most telling comments as your hand touches the doorknob to leave the room. It is worthwhile to take the time to discuss issues of concern with your patients. These understated concerns may be the true reason they are seeking medical help.

Online Journals and Texts

• American Family Physician is an online journal with excellent review articles on many subjects relevant for medical students. The direct URL is http://www.aafp.org/afp/. It is also available via the JEFFLINE E-Journals page.
• Hospital Practice is another excellent online journal, much in the same vein: http://www.hosppract.com/
• The Family Practice Handbook is very useful: http://www.vh.org/Providers/ClinRef/FPHandbook/FPContents.html

Textbook

• Essentials of Family Medicine (Sloane) is the recommended text; however, it may be wise to preview it in the bookstore before buying it. Some people enjoy the problem-oriented layout of the text while others do not. The text is very useful for exam preparation, but is too dense to expect to read the whole text during the 6-week rotation.
• Blueprints in Family Medicine is probably the most popular text for third year students.  Definitely readable in the six weeks.
• Your Pediatric and Internal Medicine texts may be useful for this rotation.

Exam

Family Medicine is the last clerkship to hold out with a Jefferson examination.  There are 100 questions administered on a computer.  All questions are open-ended; that is, there is a sentence stem, and you have to complete the sentence from the extensive list of possibilities. The topics are reportedly limited to the common topics in family medicine. Please review your objectives per Carolyn Little (handed out on the first day). A few hours after the exam, Dr. Markham will host a review session to go over the questions with everyone. This is your only chance to protest a question, and he listens to all requests. If < 50% of the people taking the exam got a question right, it is not counted.

Call

Expectations can vary depending on location, but there is no formal call at most locations. Latrobe asks students to take an informal call on a few occasions.

Sites Offered

Before ranking your site locations, think about whether you would prefer a rural, suburban/small town, or urban family medicine experience. They all offer great teaching and different perspectives on medicine. This may be your only opportunity to practice medicine like Norman Rockwell would have painted......


Last revised: 6/08