Clerkship Objectives

By the end of the family medicine rotation, the student will be able to:

1. Recognize that the patient-physician relationship and continuity of care are central to the practice of Family Medicine.
   
2. Describe how illnesses present at an early undifferentiated stage in the Family Medicine environment when compared to the other clinical settings.
   
3. Demonstrate effective communication skills in carrying out a patient-centred interview, exploring the patient’s illness experience, personal history and social context.
   
4. Perform a physical examination, which is accurate and appropriate to the presenting problem and sensitive to patient comfort and interpret the findings.
   
5. Describe the indications for, risks of and methods used in the common investigations, diagnostic and interventional procedures used for the common problems and presentations in a Family Medicine setting and interpret the results.
   
6. Demonstrate clinical problem-solving skills, including the ability to diagnose and to initiate management (both non-pharmacological and pharmacological) with supervision, of the common problems and presentations in a Family Medicine setting.
   
7. Communicate effectively, both orally and in writing, including documenting in patient records, making case presentations, writing prescriptions, writing referrals and in negotiating and summarizing the management plan with patients in a patient-centred manner.
8. Demonstrate an understanding of common ethical issues in practice such as confidentiality, consent and patient autonomy.
   
9. Recognize the importance of personal health on one’s ability to care for others.
   
10. Introduce health promotion and disease prevention principles and activities appropriate to particular patient populations into the clinical encounter using evidence-based guidelines.
    
11. Demonstrate self-directed life-long learning and will use evidence-based resources to provide patient care.
12. Identify and use or liaise with appropriate resources to support the delivery of patient care including inter-professional teams and community resources.

THE FAMILY PHYSICIAN IS A SKILLED CLINICIAN

By the end of the rotation the student will be able to:

1. Describe how illnesses present at an early undifferentiated stage in the Family Medicine environment recognizing:
   
   • The ill-defined nature of early presentations
   • The greater uncertainty
   • The use of time as a diagnostic tool
2. Demonstrate effective communication skills in carrying out a patient-centred interview, exploring the patient’s illness experience, personal history and social context by:
   
   • Routinely exploring the patients’ experiences of illness—their feelings, ideas, effects of the illness on function and expectations for care.
   • Exploring the patients’ personal history and context (family, job, school, geography, environment, etc.)
   • Conducting shared decision making/finding common ground—supporting patients having as active a role in all decisions affecting their health care as they desire
   • Providing patient education
3. Demonstrate a patient-centered approach to history-taking, physician examination, diagnostic testing and clinical problem-solving skills, including the ability to diagnose and to initiate management (both non-pharmacological and pharmacological) with supervision, of the common problems and presentations in a Family Medicine setting.
   


4. Describe the indications and demonstrate the technique used for the following procedures:
   
   • Injections (Subcutaneous and Intramuscular)
   • Pelvic Exam/Pap Test
5. Demonstrate the technique for the following examinations:
   
   • Vital signs
   • Breast exam
   • Newborn exam (up to 4 weeks of age)
   • Rectal exam
   • Peripheral neuropathy testing    

THE PATIENT-PHYSICIAN RELATIONSHIP IS CENTRAL TO THE ROLE OF THE FAMILY PHYSICIAN

By the end of the rotation the student will be able to:

6. Recognize that the patient-physician relationship and continuity of care are central to the practice of family medicine by:
   
   • Respecting differences in beliefs and backgrounds and treating the patient as a whole person in a non-judgmental manner
   • Establishing professional relationships with patients, families, communities, and colleagues
7. Demonstrate how to obtain informed consent for an investigation, procedure or management from a patient

THE FAMILY PHYSICIAN IS A RESOURCE TO A DEFINED PRACTICE POPULATION

By the end of the rotation the student will be able to:

8. Introduce health promotion and disease prevention activities into the clinical encounter, demonstrating:
   
   • Awareness of stages of change theory
   • Awareness of systems for health promotion and prevention activities in the office
9. Utilize critical appraisal skills and evidence-based resources to prepare a 10-minute presentation for their colleagues.

FAMILY MEDICINE IS COMMUNITY-BASED

By the end of the rotation the student will be able to:

10. Describe the types of services provided by various community resources/services/agencies within the community in which the student has worked and the relationship between these organizations and family physicians in providing care to the patient population.
    

Abdominal Pain
Chest Pain
Cough
Diabetes Type II
Family Violence
Fatigue
Fever/Common Infections
Gynecological Care
Headache
Hypertension
Maternity Care
Metabolic Syndrome/Obesity/Dyslipidemia
Mood Disorders
Musculoskeletal Pain
Palliative Care
Preventative Health Care
Rash/Skin Disorders
Risk Factor Modification/Counselling
Vertigo/Dizziness

Seminar: Preventive Health

By the end of the seminar, the medical student will be able to:

• Demonstrate a general approach to incorporating periodic health examinations/preventive care within a practice.
  
• Determine patient risks for common gender/age specific conditions.

Seminar: Well Baby/Child

By the end of the seminar, the medical student will be able to:

• Utilize an evidence-based standardized health maintenance guide to monitor development of newborn/infant such as Rourke Record.
  
• Educate parents about developmental parameters, child safety, behaviour issues, nutrition and health promotion which is age appropriate.
  
• Demonstrate an 18-month screening physical, as an example of a routine screening visit. 
• Evaluate an individual's child risk for harm.
• Know when to refer a child for developmental delay.

Seminar: Chronic Cough

By the end of the seminar, the medical student will be able to:

• Explain underlying pathophysiology of asthma to patients and/or family members.
  
• Assess asthma control at follow-up.
  
• Identify modifiable triggers for patients with asthma.
  
• Describe the different medication delivery methods (and relevant compliance/educational issues.)
  
• Describe major medication categories for asthma, including mechanism of drug action, particularly SABA and ICS, their benefits and risks.
  
• Explain underlying pathophysiology of COPD to patients and/or family members.
  
• Describe major medication categories for COPD, including mechanism of drug action, particularly SABA and LABA, their benefits and risks.

Seminar: Hypertension

By the end of the seminar, the medical student will be able to:

• Define how to diagnose hypertension in a family practice setting for different patient groups and identify the blood pressure targets for these groups. 
• Describe end-organ damage from hypertension and how to assess a patient for these.
• Propse an initial diagnostic workup for a patient with a new diagnosis of high blood pressure to determine if there is a secondary cause for hypertension (versus essencial hypertension).
• Define the diagnostic and treatment targets for various groups of patients with high blood pressure. 
• Propose a treatment plan (incorporating non-pharmacological and pharmacological options) for a patient with a new diagnosis of high blood pressure. 
• Recognize and act on a hypertensive crisis.
• Describe the various drug classes used to treat high blood pressure and their mechanisms of action, side effects, relative cost, and pharmacokinetics. 

Seminar: Musculoskeletal Pain

By the end of the seminar, the medical student will be able to:

• Describe a patient-centred interview that includes
  a. exploration of different causes of mechanical low back pain.
  b. probing for red flags of potentially serious causes.
  c. potential psychosocial risk factors for chronic disability (i.e. "yellow flags").
• Describe a focused physical exam that distinguishes different causes of mechanical low back pain and identifies signs of potentially serious secondary causes e.g. infection, pathological fracture, non-MSK referred pain. 
• Propose initial management plan for low back pain that includes
  a. appropriate and timely investigation of urgent potentially serious secondary causes.
  b. appropriate evidence-informed management of mechanical LBP, including pharmacological and non-pharmacological modalities, return to work, and secondary prevention. 
• Describe a history and physical exam so as to:
  a. identify an acute hot joint (and act upon this finding),
  b. differentiate arthritis bs. soft-tissue disorder, and/or
  c. differentiate inflammatory vs. non-inflammatory arthritis.
• Establish a differential diagnosis for patients presenting with the following joints specifically:
  a. shoulder (dislocated and separated shoulders, fractured clavicle,rotator cuff tendinitis, osteoarthritis, etc.)
  b. Elbow (lateral epicondylitis, medial epicondylitis, etc.)
  c. Knee (mmeniscal tear, MCL/ACL/PCL tears, dislocated patella, patella-femoral pain, osteoarthritis, etc.)
  d. Ankle/Foot (gout, fractures vs. ankle sprains, etc.)
  e. Hip (dislocation, fracture, osteoarthritis, etc.)
• Identify musculoskeletal clinical scenarios for which investigation is appropriate and describe their inherent limitations. 
• Propose an initial treatment plan of musculoskeletal pain, including pharmacological and non-pharmacological modalities. 

Seminar: Abdominal Pain

By the end of the seminar, the medical student will be able to:

• Given a patient presenting with abdominal pain:
  -Identify signs and symptoms of a surgical abdomen.
  -Identify red flags of potential serious causes including referred pain from chest.
  -Identify psychosocial factors associated with chronic and recurrent abdominal pain. 
• For patients with acute abdominal pain, propose an initial management plan that includes appropriate and timely referral/investigation for potentially serious causes. Example includes:
  -Gastroenteritis
  -Diverticulitis
  -Appendicitis
• For patients with chronic/recurrent abdominal pain, propose a management plan that highlights initial investigations and basic management. Examples include:
  -GERD, Dyspepsia, Peptic Ulcer Disease
  -IBS

Seminar: Diabetes Type II

By the end of the seminar, the medical student will be able to:

• Identify patients at risk for T2DM and select an appropriate screening strategy.
• Diagnose DM using current criteria.
• Discuss with patients the importance of lifestyle in the management of diabetes and the prevention of complications, especially the role of exercise, nutrition and avoidance of tobacco. 
• Propose an initial therapeutic plan for patients with T2DM and identify major drug side effects. 
• Describe recommended targets (glycemic control, lipids, blood pressure) for specific diabetic patients. 
• Propose a surveillance plan for patients with T2DM including the role of flowsheets and/or electronic records, and identification of end-organ damage. 

Seminar: Maternity Care

By the end of the seminar, the medical student will be able to:

• Discuss key pre-conception considerations in healthy women of childbearing age (e.g. folic acid supplementation, smoking, rubella immunity, etc.). 
• Date a pregnancy accurately. 
• Explore the patient's feelings and concerns about her pregnancy (e.g. supports, stressors, etc.)
• Describe an adequate first prenatal visit including taking a history and performing an appropriate focused physical exam with the assistance of available antenatal tracking tools. 
• Screen for and identify pregancies at risk (e.g. domestic violence, multiple gestation, maternal age, substance use, etc.)
• Describe a basic prenatal follow up visit, including BP measurement, weight, fetal heart rate (starting at 12 weeks), symphysis-fundal height (20 weeks and beyond), screening for concerns and complications. 
• Describe basic education and counseling regarding delivery.
• Describe a six-week-post-partum visit that includes
  a. Pap test and breast examination
  b. family planning/contraception options appropriate for the patient (i.e. no estrogen if patient is breastfeeding). 
  c. screening for post partum depression. 
• Differentiate betwee  post-partum blues and post-partum depression. 

Seminar: Breastfeeding

By the end of the seminar, the medical student will be able to:

• Educate patient on the benefits of breastfeeding.
  
• Counsel a patient on how to breastfeeding.
  
• Describe common complications such as engorgement and mastitis and their management.

Seminar: Gynecological Care

By the end of the seminar, the medical student will be able to:

• Develop an evidence-based treatment plan for menstrual irregularities, including amenorrhea, menorrhagia, dysmenorrhea, which includes lifestyle counselling, non-pharmacological and pharmacological modalities.
  
• In considering the initiation of a contraception method, obtain an appropriate medical and sexual history (e.g. migraines, unprotected intercourse, smoking, depression, contraindications for common contraceptive methodologies).
  
• Be able to list and explain the absolute contraindications for hormonal contraception.
  
• Counsel patients on contraceptive options including:
  • consideration of patient preferences and values
  • risks and side effects
  • contraceptive methods and devices, both permanent and non-permanent
  • benefits & relative efficacy
  • barriers to access (e.g. cost)
  • proper use including initiation
  • potential drug interactions
  • emergency contraception
• Counsel patients on STI prevention and screen when appropriate.
• Diagnose and propose empiric therapy for vaginal/urethral discharge.
• Assess for signs and symptoms of menopause.
• Elicit possible menopausal associated conditions such as mood disorder, sleep disturbance, etc.
  
• Develop a management plan for a patient with menopause with investigations, if needed, and treatment modalities ensuring no contraindications exist.
• Counsel menopausal women about preventative health measures (osteoporosis, mammography)

Seminar: Family Violence

By the end of the seminar, the medical student will be able to:

• Describe factors contributing to violence.
  
• Describe the cycle of abuse.
  
• Assess risk and negotiate a safety plan.
  
• Recognize signs of imminent violence.

Seminar: Rashes

By the end of the seminar, the medical student will be able to:

• Conduct a focused history for a patient presenting with a skin concern including:
  -areas of involvement
  -timeline
  -associated features (e.g. pruritis, pain, fever)
  -travel, medications, exposures
  -recent/concurrent illnesses
• Describe skin lesion(s) using appropriate terminology (e.g. macule/patch, papule/plaque, vesicle, bulla, erythematous, ulcer, etc.)
• Apply the ABCDE’s (Asymmetry, Borders, Colour, Diameter, Evolving over time) to identify malignant melanoma.
• Recognize and propose initial management for the following conditions:
  • Atopic dermatitis/contact dermatitis
  • Psoriasis
  • Acne
  • Infectious causes
  • Viral (exanthems, herpes, shingles, molluscum contagiosum, warts)
  • Bacterial (impetigo, cellulitis)
  • Fungal (tinea, candidal dermatitis)
  • Drug-induced reactions
  • Drug eruptions
  • Anaphylaxis/Hives
• List the indications for biopsy and/or referral (e.g. treatment failure, uncertain diagnosis, possible malignancy).
• Counsel patients on sun safety.
• Identify risks of long-term topical steroid use.

Seminar: Family Medicine Integration Cases

By the end of the seminar, the medical student will be able to:

• Identify patients who would benefit from risk factor modication.
• Identify patients who require further investigation to confirm their diagnosis.
• Assess patient in lifestyle modification, pharmacological and surgical options, as appropriate for their stage in change cycle, social context, and their identified risk.
• Propose a surveillance and management plan for primary, secondary, and tertiary prevention. 

Seminar: Emerging Issues in Family Medicine

By the end of the seminar, the medical student will be able to:

• Discuss how a family physician responds to the changing needs of both patients and communities.
• Review how the patient-physician relationship and continuity of care are central to the practice of Family Medicine.