Third Year Family Medicine Clerkship
The Clerkship in Family Medicine is a required four-week clinical rotation for third-year medical students designed and administered by the Department of Family Medicine at the Indiana University School of Medicine.
---Frequently Asked Questions
---Goals and Objectives
---Grading Policy and Evaluation
---Site Director and Student Coordinator Information
---AAFP Clerkship Topics
The Clerkship in Family Medicine is:
- A required four-week clinical rotation for third-year medical students;
- Designed and administered by the Department of Family Medicine at the Indiana University School of Medicine;
- The first extensive exposure to ambulatory community-based medicine for many students;
- An opportunity for students to begin to develop the knowledge, skills and attitudes required to approach a problem in the primary care setting;
- Often much different from the traditional in-patient model that currently characterizes the majority of medical education.
The clerkship will introduce students to the principles and practice of Family Medicine. Students will:
- Observe how family physicians provide for the ongoing medical needs of their patients within the context of the family and community setting;
- 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;
- Meet patients who present with acute medical problems, chronic illness, in need of preventive health education, and seeking the support of their physician to cope with the trials and stresses of everyday life;
- See patients interacting with their "personal" physician and witness firsthand the therapeutic power of the doctor-patient relationship.
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The Family Medicine Clerkship provides students with an opportunity to encounter the many
aspects of primary care. As part of the requirements for this Clerkship:
- Students must record minimum numbers of core diagnoses
- Minimums have been set based on past student encounters
- Examples are listed under each category
Students are not required to encounter only these diagnoses but instead to meet the minimum requirements for each system. Students are required to record a minimum of 110 patient encounters even if they have met all the diagnoses minimum requirements.
Q: Do I have to blue chip Family Medicine if I want Indianapolis?
A: Yes. Indianapolis is a very popular site and always fills up before all students are assigned. Blue-chipping Family Medicine DOES NOT GUARANTEE you will receive your 1st, 2nd, or even 3rd choice. When too many students request one specific site, the students are selected with a lottery system.
Q: I have small children and need to stay in Indianapolis for my Family Medicine rotation. What should I do?
A: First, you will need to use your blue chip. Second, you need to attach a letter to the clerkship director explaining why you need to stay in Indianapolis or any other selected site.
Q: I have a disability that requires me to stay in Indianapolis. What should I do?
A: This situation applies the same as having small children. You must use your blue chip to stay in Indianapolis. You must also attach a note to your request stating your reasoning for needing Indianapolis.
Q: My wife is pregnant and due during my rotation. Can you assign me to Indianapolis?
A: This situation applies the same as having small children. If you or your spouse is pregnant and due near the time of the Family Medicine clerkship, you should blue chip Family Medicine and write a letter to the clerkship director explaining the situation.
Q: I didn't fully complete my site preference form. What will happen with my assignment?
A: If you are not selected for the site you requested, your preference form will be placed at the bottom of the stack REGARDLESS of your blue chip. You will be assigned to the last spot available.
Q: Where do I report on the first day of the clerkship?
A: Most sites have an orientation on the first day of the clerkship. If you do not receive a letter explaining when and where to report on the first day, you should contact your student coordinator at your assigned site. Click here to review site contact list.
Q: My family physician has agreed to be my preceptor. What does he need to do to receive clerkship materials?
A: Students may not make their own assignments for the clerkship. However, if there is a physician you would like to rotate with during the Family Medicine Clerkship, you will be provided an opportunity to request that preceptor. The preceptor must be approved by the department and site. Preceptors MUST be board-certified (or board-eligible) family physicians.
Q: I have not been assigned to the site I requested. Can I be reassigned to the site requested?
A: All sites must have an equal amount of students. We will not move students unless a student is dropped or added to the rotation. Students are welcome to call and request to be added to the wait list for that rotation. Students must speak to the clerkship coordinator to make this request. Requests are honored on a first-come, first served basis.
Q: I have not been assigned to the site I requested. Can I be reassigned if I find my own preceptor?
A: No. Students should not seek their own preceptors or contact sites to be added. All site assignments are completed by the clerkship coordinator at the Department of Family Medicine.
Q: Whom do I call if I am having difficulties with my preceptor?
A: Your first step is to notify the site director. While preceptor conflicts do not happen often, there are times when students should be reassigned. Your site director will help facilitate this process. However, he/she can only do this if you let them know there is a problem. Sometimes the site director only needs to relay to the preceptor the problem and the situation is resolved. If you are not satisfied with the site director's attention to this problem, you should contact the clerkship director immediately. We want to make this experience positive for both you and the preceptor. The clerkship director will work with all parties to resolve the issue.
Q: I received a card in my mailbox regarding the exam. What does it mean? Did I pass?
A: Sometimes it takes preceptors and site directors some time to return the evaluations on students. We like to inform students of the exam scores so you have some feedback. The score listed is your final score on the exam. We also provide you with the highest and lowest grades, as well as a mean score. The lowest passing score for the exam is 60. Students receiving a grade lower than 60 will be contacted by the student coordinator to schedule remedial work.
Q: When will I receive my final grade and comments?
A: While we make every effort to submit final evaluations within 30 days from the end of the clerkship, sometimes preceptors and site directors do not send forms in a timely manner. We continue to work on this situation and will submit all evaluations for any given rotation at the same time.
Q: What my preceptor told me was different than what was reflected in my evaluation. May I review his evaluation of my performance?
A: Yes. Students should call the student coordinator or the administrative secretary to copy the evaluation forms. Students must come to the office to pick up the evaluations. You may be asked to present picture ID. Keep in mind that preceptors do not determine the final grade. Your exam will count for 25% of your final grade.
Q: I have reviewed my evaluation and disagree with my grade. Who do I call?
A: Your first step is to call the clerkship coordinator. The coordinator will review your score and give you the cut off for specific grades. If you still disagree with your grade, the coordinator can set up an appointment with the clerkship director. The clerkship director will review the file prior to the appointment. If necessary, she will contact the preceptor and/or site director to request further feedback.
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Goal 1: The student will develop a primary care evidence-based approach to the diagnosis and management of problems commonly seen in community-based Family Medicine.
- Demonstrate increasing knowledge of the 40 problems commonly seen in family medicine with emphasis on the Core Topics.
- Demonstrate consistent application of relevant current, evidence-based when possible, literature at the "point of care" to determine patient management.
- Consistently develop reasonable diagnoses and management plans for both undifferentiated and common medical problems.
- Consistently demonstrate intuitive reasoning which supports diagnoses and management decisions.
- Recognize serious and life-threatening patient presentations which require immediate intervention and demonstrate an appropriate clinical response.
Goal 2: The student will develop and refine clinical skills which are essential to the practice of competent Family Medicine as well as medicine in general.
- Demonstrate increasing skill in the appropriate performance of focused versus comprehensive histories and physical exams.
- Demonstrate increasing interpersonal and communication skills which facilitate accurate, pertinent and appropriately comprehensive information gathering.
- Consistently demonstrate increasingly correct physical exam techniques and reproducible physical exam findings.
- Document patient visits in the SOAP format with increasing organization and attention to pertinent information.
- Observe common office procedures and whenever possible demonstrate increasing skill in procedure performance.
Goal 3: The student will understand the specialty of Family Medicine and its role within the healthcare delivery system.
- Consistently demonstrate increasing integration of clinical and biopsychosocial information to achieve patient centered care.
- Identify, discuss and when possible demonstrate the benefits and barriers to providing continuity of care.
- Discuss and when possible demonstrate the impact of whole patient and whole family care on patient health outcomes.
- Consistently demonstrate effective coordination of care with medical consultants, health professional services and community resources.
Goal 4: The student will develop knowledge and skills regarding the principles and clinical application of health promotion, disease prevention and patient education.
- Demonstrate progressive integration of health promotion and disease prevention strategies into all patient visits.
- Consistently identify health risk factors and demonstrate use of motivational interviewing techniques to identify and develop strategies for change.
- Consistently identify appropriate patient education materials and activities, and demonstrate integration of these into patient care.
Goal 5: The student will understand the relevance of biopsychosocial, familial, socioeconomic and community factors to providing patient-centered whole person and whole family care.
- Accurately identify and discuss the family, support system, community, cultural, ethnic, religious, occupational and economic factors influencing patient management and outcomes.
- Demonstrate increasing integration of this above biopsychosocial information into patient care in a manner which will improve patient outcomes.
- Demonstrate correct use of an interpreter in practices where this is possible.
Goal 6: The student will gain understanding of medical practice as both a profession and a business.
- Demonstrate consistent responsibility for one's own learning through timeliness, preparation, initiative in patient care, initiative in information gathering and response to feedback.
- Consistently demonstrate compassion and understanding toward patients and their families, especially those who are disenfranchised or disadvantaged.
- Consistently demonstrate increasing interpersonal and communication skills which facilitate peer, faculty and ancillary staff relationships.
- Identify and discuss practice factors which affect efficiency, patient outcomes and office team functioning in both positive and negative ways.
- Identify and discuss external factors which impact practice operations.
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Final grades are determined by several indicators of student performance on the Family Medicine Clerkship: 1) the Preceptor Evaluation; 2) the Didactic and Project Evaluation; 3) the Written Examination; and 4) appropriate and full completion of all assignments/requirements. The preceptor does not assign the student's final grade. Specific criteria for Honors, High Pass, Pass and Fail in Family Medicine are described below (Mechanics of Student Evaluation).
Preceptor Evaluation: The preceptor completes an objective, competency-based evaluation designed to measure specific knowledge, skills and attitudes (sample: https://fammdata.iusm.iu.edu/presentation/lfserver/PrecEvalT_EXAMPLE). Written comments offered by the preceptor will be paraphrased on the final IU SM Clinical Performance Evaluation form. If a student is evaluated poorly on any area of the preceptor evaluation form, 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".
Didactic Project Evaluation: The faculty at the residency program complete an objective evaluation (sample: https://fammdata.iusm.iu.edu/presentation/lfserver/DidacSiteEval_EXAMPLE) of the student's overall performance and participation in didactic day activities, the Family and Community Project and procedure sessions. If a student is evaluated poorly on any area of the didactic project evaluation form, 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".
Written Examination: All students will take a comprehensive multiple-choice examination designed to measure knowledge of medical diagnoses and complaints seen in the family physician's office. All clerkship students will take the FMCases exam as the written examination for the course. The questions on the exam come from the case material. The examination will be administered in Indianapolis on the final day of the clerkship.
Students scoring less than Pass on the written exam must re-take the exam. The exam failure will be recorded with the School evaluation system as an ID-3. The recommendation of a re-take will be requested. A student may not re-take the exam during any other clerkship rotation. The School reserves the right to require the student takes a 30-day leave of absence to study for a re-take exam. This decision will be made by the Student Promotions Committee. If the student passes the re-take exam, a grade of ID-3/P will be granted (pending he/she passes the preceptor and site director components of the evaluation).
In the event that a student fails the re-take, the student will fail the Family Medicine Clerkship. This will necessitate repeating the Clerkship.
Evaluation and Competency Comments: Late or unsatisfactory completion of assignments/requirements may be noted in the Comments section of the student's final evaluation and on the Competency Evaluation. Omission of or unsatisfactory participation in Intersession activities may be noted in the student's Competency Evaluation.
ID-9, Professionalism and Role Recognition: Students are expected to complete assignments on time. Students exhibiting consistently late or unsatisfactory completion of assignments/requirements may receive an ID-9.
The Department of Family Medicine is following the Clerkship Exam Policy approved by the Indiana University School of Medicine Curriculum Council. The following excerpts have been included for the students' information.
- Student should be informed at the time of the exam and in writing that they are suspected of an irregularity/cheating and will be investigated.
- Student allowed to complete exam with grade pending outcome of investigation.
- Student will receive written notification of investigation; copy will be sent to appropriate Competency Director; copy will be placed into student's file.
- If less than 30 minutes late, student may be admitted to exam but will have only the time remaining.
- If greater than 30 minutes late, student will need to reschedule examination
- If valid excuse, no penalty assigned
- If non-valid excuse, student penalized by having maximum grade on final exam portion of grade be a PASS
- Determination of valid or non-valid is at the discretion of the Clerkship Director
- Student with "valid excuse" will be permitted to take exam without penalty to grade
- Student with "non-valid" excuse will be penalized by having maximum grade on final exam portion of grade be a PASS."
Mechanics of Student Evaluation Calculation
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. Three components are utilized to calculate an overall clerkship grade:
- Preceptor evaluation (50% of overall score)
- Didactic/Project evaluation (20% of overall score)
- Written Exam (30% of overall score)
Each component is scored by the appropriate faculty and points are assigned based on the contents of each evaluation form.
Grade of Honors requires:
- Overall score percentage in the highest 20% of the rotation
- Honors scoring on two of three components
- Completion/Passing all clerkship requirements
Grade of High Pass requires:
- Overall score percentage in the highest 55% of the rotation
- High Pass on two of three components
- Completion/Passing all clerkship requirements
Grade of Pass requires:
- Completion/Passing all clerkship requirements
Fail – Repeat Family Medicine Clerkship: A grade of Fail will be reported for students who score less than Pass on either of the Preceptor Evaluation or Didactic Project Evaluation, or score less than Pass on the written exam twice. The first time a student fails the written exam, the student will receive an ID-3 (Using Science to Guide Diagnosis, Management, Therapeutics and Prevention) and be required to retake the written exam. The maximum final grade for the Family Medicine Clerkship after one failure of the written exam is a 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 preceptor, one of his/her patients or the site director.
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