FAMILY MEDICINE

Course name and number: Acting Internship in Family Medicine

LSU Residencies:
Family Practice Residency, Ochsner Medical Center, Kenner FMMD 420a
Family Practice Residency, Bogalusa Medical Center FMMD 420b
Family Practice Residency, UMC, Lafayette FMMD 421h
Family Practice Residency, Lake Charles Memorial FMMD 422k

Pre-requisite:

Successful completion of the junior clerkship year

Note:

Request for availability with each Residency Coordinator required prior to registering for this course.

Information and Registration:

Note: Contact the Clerkship Coordinator in the Department of Family Medicine for assistance in placement.

Duration: 4 weeks

Availability: All senior blocks except block 7

Number of students: 1 student at each site per block

Goals and objectives:

The goal of this rotation for senior students is to develop knowledge, skills and attitudes commensurate with those of a first year house officer in Family Medicine. The students will develop an understanding of Family Medicine through the consistent application of the principles of Family Medicine and the development of sound clinical judgment and skills by accepting the primary responsibility for the care of patients admitted to the Family Medicine inpatient team. This is done under the close supervision and direction of a senior resident and faculty.

Objectives:

By the end of the course the student will:

• Understand the meaning of comprehensive care, the importance of continuity of care as applied in the inpatient setting, the importance of family and community in the delivery of health care, the importance of timely and effective consultation, and the value of cost conscious management of patient problems.
• Understand the use of laboratory testing and technical procedures for efficiently establishing comprehensive assessment, diagnosis and management of patient problems.
• Use a systematic approach to clinical reasoning by developing a comprehensive approach to problem solving, determining which factors need critical attention and stratifying management strategies to arrive at a favorable outcome and satisfied patient
• Understand the basic elements of effective diagnosis and management.
• Appreciate the importance of the psychosocial aspects of inpatient care on favorable outcomes of care.
• Appreciate the need for displaying professional behavior in dealing with others.
• Demonstrate ability to effectively use the problem oriented record system for charting in the medical record.
• Demonstrate competence in developing discharge plans and understand the importance of ancillary personnel and the role they play in providing excellence in patient care.
• Describe the importance of continuity and follow-up in the delivery of quality health care.

Means of Implementation:

At Ochsner Medical Center, Kenner, LA, Lake Charles Memorial, Lake Charles, LA and Bogalusa Medical Center, Bogalusa, LA:The student will function as part of the family practice residency inpatient team. On this rotation, the Acting Intern (AI) will generally be assigned 3-5 medicine patients under the direct supervision of the senior resident and faculty attending on service. The AI will be expected to see his/her patients every morning and enter daily progress notes in the patient chart before the start of attending teaching rounds (generally held at 9:00 a.m. each weekday). During teaching rounds, each patient on the service will be discussed with the attending, who will be updated as to patient status, including interim exam findings, lab/ancillary test results, consultant’s recommendations, and overall plan. After each patient has been discussed, the AI will join the faculty attending for daily walking rounds in the hospital, where the AI will have the opportunity to participate in medical-decision making and enter orders for patient care in the chart. During the month, the AI will take in-hospital call with the junior residents for one weekend and four weeknights total. All AI activities will be performed with direct resident and faculty oversight, and all AI orders will be co-signed by the faculty member of the team or senior resident, but the AI will have primary responsibility for each of his/her assigned hospital patients.

At University Medical Center, Lafayette: During that four-week block, the student Acting Intern (AI) will have primarily an inpatient experience, spending six half days weekly caring for inpatients assigned to family physician faculty members of UMC’s Family Practice Residency Program. The student will round daily with faculty member(s) and will be responsible for performing a comprehensive admission history and physical, daily charting of the patient’s progress, orders and discharge summary. Two half-days weekly will be in the Family Practice Center seeing assigned patients directly under the supervision of the faculty FPC preceptor. The remaining two-half days weekly will be assigned by the designated FPRP faculty member. No more than six inpatients will be assigned to the student at any time. Insufficient FP inpatient activities will prompt alternative educational activities as directed by the student’s preceptor. No more than one student at a time would be an acting FM intern at UMC.

Method of Evaluation:

Orientation:

The Senior Resident and Faculty advisor will undertake an informal needs assessment at the beginning of the rotation.

Observation and Feedback:

All student activities will be reviewed on a daily basis and formative feedback will be on an ongoing basis.

Formal evaluation:

Evaluation is based on general attendance, fund of knowledge, professional attitude and demonstrated adult learning mode. Subjective and objective assessment of the student’s clinical performance is done on one form submitted by the Faculty advisor in consultation with the senior resident.

Course name and number: Advanced Family Medicine Preceptorship FM MD FMMD 427m

Faculty:

Private Family Physician Preceptors

Information and Registration:

Note: Contact the Clerkship Coordinator in the Department of Family Medicine for assistance in placement.

Duration: 4 weeks

Availability: All blocks and summer

Number of Students: 4 in each block

General Objective:

The purpose of this course is to provide students with an opportunity to enhance their clinical skills in the ambulatory setting and to practice the delivery of health care in the office of community family physicians. A variety of practices and community sites are available to students, rural and urban.

Learning Objectives:

By the end of the course students will understand the meaning of comprehensive care, continuity relationships with patients, the importance of family and community factors in the delivery of health care, the place of consultation and referral in primary care, as well as the need to consider economic issues in medical decisions. They will, therefore, be able to:

• Assess and manage the common problems that present in the ambulatory setting at a level appropriate for a fourth-year medical student.
• Demonstrate competence in interviewing patients presenting with multiple problems.
• Use methods of interviewing that focus on facilitating clear communication, including the recognition of non-verbal as well as verbal clues.
• Demonstrate competence in performing diagnostic and/or therapeutic office procedures and tests.
• Demonstrate competence in physical examination skills with patients of all ages.
• Describe the importance of continuity and follow-up in the delivery of quality health care.
• Describe the economic considerations given in the delivery of patient care, both in assessment and in the development of a management plan.
• Describe some basic business aspects of practice, including cost containment, insurance concerns, operating expenses, and personnel matters.
• When appropriate, address family dynamics in both assessment and management.
• Appropriately engage in consultation and referral in the delivery of patient care.

Means of Implementation:

The student will be assigned to a family practitioner in private practice and will participate in the management of his/her patients in the office, hospital, emergency room, and on night and weekend calls. Possible sites include the Greater New Orleans area, Franklin, Ville Platte, Gonzales, Baton Rouge and others. The student is encouraged to attend hospital staff and committee meetings, medical society meetings, educational programs, and civic meetings that are a part of the preceptor's regular responsibilities.

Method of Evaluation:

The student will be evaluated by the preceptors on knowledge, clinical performance, and personal traits using the LSU grading scale of Honors, High Pass, Pass, and Fail.