Preventive Health Competencies

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Preventive Health Plan- Adult

Most of a students' clinical experience is focused on acute problems and they often feel overwhelmed when faced with a patient coming in for a preventive health visit.

Preventive health visits provide unique opportunity for students:

  • to think about their patients with a view towards health prevention.
  • to get to know patients on a deeper level.
  • to understand patients' social situations.
  • to understand patient's social and medical risks.

As you, as the preceptor, get ready to see a 63 year old woman for a preventive health visit, you may be thinking about questions to ask such as:

Chances are that your student is thinking:

  • What parts of the physical exam are necessary?
  • How do I manage the genital and breast exam?
  • What does a thyroid gland even feel like?

Take this opportunity to review, teach and model your approach to preventive health exams in an organized, structured, time-effective manner. If your office uses a preventive health checklist, share this with the student.

What the Family Medicine clerkship expects of the student:

  • Know about the screening guidelines published by the United States Preventive Services Task Force and be able to access and use these guidelines on their handheld computers.
  • Take a history, including:
    • Medication allergies
    • Immunizations
    • Current medications, including OTC and herbal or "natural" supplements
    • Past medical history, including previous health screening
    • Social history, including household members, education and work history with occupational risks and exposures
    • Sexual history
    • Substance use history, including alcohol, tobacco and illicit drug use
    • Diet and exercise history
    • Family history
  • Perform a physical exam that is age and risk appropriate, with attention to preventive issues and current complaints.
  • Recommend appropriate screening tests
  • Recommend appropriate immunizations
  • Identify and provide appropriate counseling regarding a healthy lifestyle

Preventive Medicine Tools and Links:

USPSTF guidelines on screening and counselinghttp://www.ahrq.gov/clinic/uspstfix.htm

Gail risk calculator for breast cancer: http://bcra.nci.nih.gov/brc/q1.htm

The osteoporosis risk assessment instrument (ORAI): http://www.osteoed.org/tools/orai_tool.html

The National Cholesterol Education Program (NCEP-III) cardiovascular disease risk calculator: http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof%09

The Framingham cardiovascular disease risk calculator:

http://www.americanheart.org/presenter.jhtml?identifier=3003500

 

Preventive Health Plan- Child

Students come to their Family Medicine clerkships with a broad range of experience with pediatric patients. At UVA, students on their Family Medicine rotation have either had one or two months of Pediatrics, largely inpatient or subspecialty outpatient, or they have not yet had any clinical Pediatric experience. Some students have their own children and are more comfortable with childhood growth and development, and some are child na´ve and scared to death of how to approach a pediatric patient, much less questions from a parent.

As with the adult preventive health visit, think about what questions and concerns you have before you go into the room with a child to perform a well-child visit.

  • What age-specific concerns do you have?
  • What questions will you ask the child and the parent or guardian?
  • What is most important to check on physical exam?
  • Any necessary lab tests?
  • What immunizations are recommended?
  • What are common parental concerns at this age?
  • What anticipatory guidance issues will you cover and how will you present them?

Students are usually somewhat familiar with pediatric developmental checklists. If your office uses checklists for well-child visits, share these with your student. They may have experience with the physical exam, but often feel at a loss with issues of anticipatory guidance.

Teaching Hints

Remember that the students are hungry to learn how to give practical advice to parents and how to address parental concerns. Please share this kind of information with your student - this is what is hard to learn from a book.

The student's history should include:

  • Interval health issues
  • Diet
  • Sleep
  • Elimination
  • Developmental milestones
  • Social historyhousehold members, smokers in house
  • Safety issues (risk of violence)
  • Parental concerns

The physical exam should be performed with special attention to certain age-related maneuvers hip exam in infants, eye exam in infants and toddlers, Tanner staging, etc.

Useful Links:

Childhood vaccination schedules

http://www.cdc.gov/nip/recs/child-schedule-jul-dec-rev.pdf

Evidence based-screening guidelines: http://www.ahrq.gov/clinic/cps3dix.htm#pediatric

Anticipatory guidance guidelines:

http://www.keepkidshealthy.com/index.html

 

Module 6 : Teaching the "Family Medicine Clinical Competencies"