Course Director: Lisa Dodson, M.D., Family Medicine Co-Director: Joseph Zenel, M.D., Pediatrics Contact: Becki Anderson, 503-494-1165 Duration: 5 Weeks Locations: Rural communities in Oregon
Selection Process: Each student will be given a list of communities that will be available during the 5 week rotation they have scheduled. The student will be asked to rank three choices. Selection can be based on location, discipline, living arrangement, interest in a special population, etc. Assignments will be coordinated by Vicki Fields.
Housing: Housing is provided at no cost to students. Students planning to bring family members should review housing accommodations prior to selecting a site. Most of the housing is shared with other learners. No pets are allowed at any of the sites.
Travel: Student is reimbursed for travel expenses (one round trip) except for community sites.
Unique Opportunities for Learning on this Clerkship: This five week rural community health care clerkship provides an opportunity for the third year medical students to experience primary care as practiced in rural areas or with under served populations in Oregon. Each student will be supervised by a skilled and experienced primary care physician currently practicing in the community.
Assume responsibility for first-encounter evaluation of patients with undifferentiated complaints.
Generate chronologically based history, including psycho-social information.
Perform appropriate, logical, physical examinations, based on the focus from historical information, including well-infant and well-child interview and examinations.
Assess the problem/problems based on the history and physical examination data in an organized and pathophysiologically sound manner.
Compile the historical, physical examination, and assessment data in complete but concise, written and oral presentations to the preceptor.
Prepare plans for further evaluation to establish a diagnosis and to begin management.
Establish management plans and provide appropriate on-going follow-up for the patient.
Become familiar with Quality Assurance procedures in the primary care practice setting.
Identify and acquire basic knowledge of the most common patient problems seen in a community practice through the life-span.
Identify and demonstrate understanding of the most common procedures done in a community practice.
Develop and utilize self-directed learning to the care of patients using the resources of the clinical practice site, the Communications Center and other University programs.
Students are required to investigate a health problem affecting a particular population within the community in which you are working (population-based medicine).
Location of Clerkship Activity Rural communities in Oregon or practices working with under served populations (e.g. homeless, migrants)
Student Responsibilities Students are expected to participate in patient care team as appropriate: become familiar with quality assurance in practice setting; research case, disease or health service delivery system; develop self-directed learning skills; complete population based primary care project; present clinical practice discussion question. Students will present community project clinical practice questions upon returning to OHSU.
Teaching Rounds Not Applicable
Operating Room Activity There will be minimal experience at most sites. However, operating room activities will depend on the type of practice you select. Several locations offer more scheduled OR time.
Meeting with Clerkship Director Weekly meetings with preceptor at the site to review activities and progress in the clerkship.
Conferences/Additional Activities Preceptors may assign additional educational activities.
Self-Educational Opportunities Population-based, primary care project; internet access, computer databases through the BICC, community based health resources (e.g. hospital, ambulances, schools, hospice, nursing home).
Time on Clerkship/Night Call Students are expected to be available daily throughout the clerkship; night and weekend call is negotiated with preceptors.
Sleeping Quarters Not Applicable.
Evaluation Methods 70% Overall clerkship assessment and student evaluation by preceptor. 20% Community project report. 10% Clinical practice discussion question
The assumption underlying all of the following goals and objectives is that the clerkship experience is occurring in the context of a rural and/or medically underserved population.
Goal The student will develop an understanding of the unique nature of primary care in a rural or underserved community or population.
Objectives The student will:
Identify and demonstrate basic knowledge of most common patient problems seen in the practice;
Identify and demonstrate understanding of the most common procedures performed in the practice;
Understand the purpose and operation of Quality Assurance procedures in the primary care practice setting and in the community hospital.
Goal The student will observe and participate in the examination, evaluation and management of patients representative of those seen in the practice, and will evaluate several clinical problems in depth.
Objectives The student will:
Assume responsibility for first-encounter evaluation of patients with undifferentiated complaints;
Demonstrate the following clinical skills:
generate chronologically-based history, including psycho-social information;
perform appropriate physical examinations, based on the focus from the historical information;
assess the problem(s) based on the historical and physical examination data in an organized and pathophysiologically sound manner;
compile these data in complete, but concise patient records and oral presentations to the preceptor;
prepare plans for further evaluation to establish diagnosis;
establish management plans and provide appropriate ongoing follow-up for the patient.
Goal The student will refine self-directed and lifelong learning skills, particularly the ability to access and use biomedical information systems.
Objective The student will:
Develop and use self-directed learning skills, using resources of the clinical practice site, the community and OHSU, to better understand the provision of health care to individual patients and to populations.
Goal During the clerkship the student will become familiar with local and regional consultative services.
Objectives The student will:
Demonstrate understanding of when and why consultations are sought, how consultants and consultative services are chosen and the relative cost/benefit of different kinds of services; Demonstrate understanding of how both medical and social factors influence the decision-making process of when, why and where patients are referred and of communication with the recipient providers/institution and follow-up with the patient;
Demonstrate understanding of appropriate communication among providers, consultants and patients.
Goal During the clerkship the student will become familiar with community resources and support services.
Objective The student will:
Demonstrate awareness and understanding of relevant community resources available to the primary care practice site. These services may include: public health (well-child care, immunizations, prenatal, nutrition, etc.); mental health; alcohol and drug services; child welfare; voluntary health agencies; home health; hospice; emergency services; public information and education programs and other resources supportive of the well-being of patients in the community.
Goal The student will understand and appreciate the importance of population-based health care in a primary care setting.
Objective The student will:
Design and complete a community oriented primary care project using the following structure:
define and characterize a population within the geographic locale of the rotation;
identify a health problem that affects a segment of the population identified;
collect, organize and analyze resources and information pertinent to the problem;
discuss the findings and their importance.
Goal During the clerkship the student should experience the culture of the community and understand the lifestyle of a primary care health care provider in such a community.
Objectives The student will:
Become involved in various non-medically related activities in the community;
Understand the non-medical roles of the preceptor in the community, how the community perceives the preceptor, and the practice and lifestyle choices made by the preceptor.
