Tips for Getting the Most From Your Family Medicine Clerkship
Supervised patient care contact will be the basis of your experience. You will be assigned patients who attend the clinic, or the hospital, and you will be the first contact, in each case. After taking a history and completing an appropriate physical examination, you will discuss your findings, identify a patient's problem list, construct a differential diagnosis and propose possible management options with your Preceptor. The Preceptor, after reviewing your findings and exploring your proposed differential and management, will then usually see the patient with you, and modify or support your suggestions for managing the patient.
The Preceptor will ensure that you are given the appropriate level of supervision and responsibility throughout the rotation. This will be based on ongoing observation of your performance, discussion with you about the patients you have seen and regular, objective feedback on your progress. If, at any time, you feel that you are inappropriately "exposed" without what you feel would be adequate supervision or if you feel you are not being given enough responsibility for patient care, you should discuss this with your Preceptor at the earliest opportunity.
The Preceptor should orientate you to the Practice in the community. You should be introduced to the appropriate hospital and clinic staff. Each Practice or Preceptor should consider having a handout/binder that would contain much of the orientation information. During the orientation, the Preceptor should familiarize you as to how he/she will be supervised in the office, on call, etc. You should be given the call duties and call schedules (see Expectations page).
The patients should be introduced to you by the Physician or reception staff and appropriate safeguards made to ensure that the patient is willing and not coerced into seeing you.
You should work with your Lead Preceptor, for the majority of the rotation, and see the same group of patients, as often as possible. Please encourage patients you have seen to come back and see you for follow up, wherever possible. This will help you follow the course of a patient's illness, see the value of their investigations in making diagnoses and assessing the progress of the condition and the value of the various therapies.
Emphasis should be on the quality of your experience rather than numbers of patients seen. On a typical afternoon clinic, consisting of 4 or 5 hours, you should see approximately 5 to 8 patients. Since some of these patients will require more complete, comprehensive assessments, numbers should be limited and emphasis should be on developing excellent skills rather than seeing large numbers of patients.
Wherever possible, you should be taught procedural skills. In the hospital, the O.R., Emergency or Case Room. When the opportunity arises, the Preceptor should teach you on procedural skills. You should, as a general rule, first observe a procedure being done, and then perform it only under the direct supervision of the Preceptor.
You should be given the opportunity to encounter patients in all sites of care: acute care hospital, auxiliary hospital, nursing home, clinic and, occasionally, in the patient's own home.
You will learn about the relationship between Family Physicians and community agencies. In some circumstances it may be possible for you to accompany the patient to the agency, thereby getting firsthand knowledge about the function of this particular agency within the health care system. Other agencies could simply be visited; try to interact with as many agencies as possible, to get the total picture of the health care system in any community.
You should be invited to and involved in team meetings about patients so that you can develop your skills in becoming a productive team member.
You should be involved in the consultation process by being supervised in writing referral letters on a number of patients. If possible the consultant's response should be reviewed with you, indicating how the consultation contributed to better patient care.