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Electives - Family Medicine

Outpatient Family Medicine at Stony Creek Family Medicine, Nellysford, VA

Elective Number: 1404 (arranged)

Rotation Supervisor: Dr. Sean Reed

Coordinator: Wanda Hudson, McKim 3161 - (will arrange with rotation preceptor)

Duration: Maximum: 4 weeks; Minimum 2 weeks

Available: Rotations 3, 7, 8 & 9

Place to Report: Stoney Creek Family Medicine, Nellysford VA

Time to Report: 8:45 am

Typical Day: 9:00 am - 5:00 pm M-F. Involvement with inpatient service or deliveries on weekends.

Attendance: Attendance at elective activities is mandatory.

  • Anyone who is ill or has a personal or family emergency must contact Student Affairs and the Attending on Service.
  • Students are allowed to take off up to 1 day per week to interview between November 1 and February 1.
    • Specific days missed must be approved by the Attending on Service.

Number of students per rotation: 1

Course Description: This rotation provides students with a supervised outpatient experience caring for patients in an academic family medicine clinic that delivers team-based care in the model of a patient centered medical home. Emphasis will be placed on caring for patients presenting with urgent medical problems, including acute illnesses, or exacerbations of chronic disease. Students will also have the opportunity to participate in educational conferences, ground rounds, and be expected to learn about the role of Information Mastery in medical care. The pace of learning and scope of patient care responsibilities expected of students are geared toward preparing students to assume the level of responsibility required of residents and as future practitioners.

Stoney Creek Family Medicine is located in Nelson County and serves a diverse patient population. Previously designated a Health Professions Shortage Area, Nelson County is a rural area with high rates of poverty and chronic disease. The office provides treatment of acute and chronic illness, acute injuries, preventative health, pre-natal/post partum care, pediatrics, and gynecological care.

Learning Objectives: Students completing the elective will be expected to:

  1. Play an integral role in caring for 20 patients per week by taking a history, performing a focused physical exam, developing a differential diagnosis, and communicating a plan to both the supervising preceptor and the patient.
    1. Explain why elements of the history are important
    2. Describe how the focused-physical exam changes the diagnosis or management of the patient
    3. Verbally present a differential diagnosis
    4. Verbally describe a management plan for the patient
    5. Provide patients with relevant after-visit resources so the patient may understand their role in any next steps.
    6. Write a note that documents an accurate history and physical exam
    7. Write a note that conveys why the student chose a leading diagnosis, kept multiple diagnoses in consideration, and excluded other diagnoses.
    8. Write a note that conveys why the student thinks the management plan will help the patient.
  2. Practice and become proficient at advanced physical exam skills
  3. Achieve a ‘competent, average, above competent, or highly competent’ rating from the supervising faculty for history taking, physical exam, development of management plans, and written notes.
  4. Achieve an ‘average competence for 4th year student’ or above rating from the supervising faculty for incorporating psychosocial issues into care of patients; or, for lower scores develop a strategy to practice and improve this skill during the 4th year.
  5. Obtain and EKG on a patient with assistance from a nurse, NP or physician, and interpret the EKG correctly as judged by the supervising faculty.
  6. Interpret a chest x-ray correctly as judged by the supervising faculty.
  7. Perform the following tests and interpret the results correctly: (this may be done either in direct patient care or by images provided by the course director or supervising physician, NP, or nurse)
    1. Urinalysis
    2. Urine sediment microscopy
    3. Urine pregnancy test
    4. Vaginal wet prep (KOH and Normal saline).
  8. Immunize a patient with a vaccine (subQ or IM) under the supervision of a nurse, NP or physician.
  9. Interpret a protime/INR result and write an order for Coumadin/warfarin dosing adjustment.
  10. Call a patient with lab results and explain the significance or abnormal and normal results.
  11. Communicate with a consulting physician (verbal, written, or electronic) (E.g., write a consultation note, compose an order, inquire where the patient should be referred and how urgently, or follow up with a question.)
  12. Achieve an average or above level of professionalism when working with patients as judged by the supervising physician.
  13. Achieve an average or above level of professionalism when working with office staff as judged by the supervising physician.
  14. The student will learn about basic principles of Information Mastery. The student will:
    1. Participate in all departmental educational conferences, including the weekly Information Mastery conference;
    2. Read about basic principles of Information Mastery with attention to the concept of the number needed to treat (NNT);
    3. Gain a working understanding of using filtered evidence-based medicine point of care tools during patient care.
    4. Under the supervision of a faculty member or fellow, develop a clinical question, and utilize a point-of-care evidence-based clinical tool to find an answer
    5. Research the NNT for a specific treatment modality (of their choosing) and develop a patient education “spiel” to use with a patient during the rotation (under the supervision of the preceptor)
    6. Read independently about patient problems seen in the office;
    7. Become more proficient in the selection of appropriate diagnostic studies, data gathering, data assimilation and patient management through the use of point of care evidence based decision support tools.
  15. Demonstrate the qualities of commitment, trustworthiness, integrity, compassion and respect of the patient's autonomy, confidentiality and need for information.
  16. Model professional attributes with regard to professional responsibility
  17. Show the ability to communicate effectively with office staff.
  18. Participate in clinical team meetings and be able to distinguish key aspects of team-based care
  19. Describe the core features and values of a patient centered medical home.
  20. Identify the core components of pre-natal care and the development of a labor plan.