Family Medicine (FMED)

Family Medicine is a 6-week clerkship during which students will focus on the diagnosis and management of acute and chronic problems in the outpatient setting; health maintenance, preventive medicine, psychosocial and life stage contexts, time management, and cost-effective delivery of care. Offered at Thomas Jefferson University Hospital and affiliate locations. (6 week clerkship)

Students are given progressive responsibility, with supervision, for outpatient care. For the senior taking the rotation early in the academic year, emphasis is on developing skill in formulating an assessment and plan. For the advanced senior student, further teaching emphasis is on patient management and acute care. Students will enhance interpersonal skills in interview technique, understanding of the dynamics of the physician-patient relationship; and the reaction towards illness of physicians, patients, and the family. Students will develop primary care diagnostic, and psychosocial skills, promoting a positive transition to the intern year. Students will self-identify specific educational objectives for the rotation. Examples include honing physical exam skills, improving interview skills, improving time management skills, learning about practice planning and financial management.

Students encounter the diverse range of medical conditions and complex multiple diagnoses typical of hospitalized patients and learn comprehensive patient management for hospitalized patients. The inpatient subinternship student in Family Medicine assumes a high level of responsibility for patient management. The student pre-rounds on his or her patients in the morning, checks labs, and writes orders. The student presents succinctly to the attending and resident team the diagnosis, assessment, and treatment plan; and is the primary point of care for the patient throughout their hospitalization. Medical, social, economic and psychological factors are addressed. Students participate in family meetings, including end-of-life and other complex decisionmaking processes. The student communicates with the patients’ ambulatory physician, interacts with consultants, and arranges all necessary follow-up and aftercare.

Students may go to any of the Indian Health Service sites (a division of the US Department of Health and Human Services). IHS sites provide care exclusively for Native Americans. At IHS sites students take on considerable responsibility for patient care, and challenge themselves both medically and personally.

Students may choose to take a four-week elective at another residency program, or go abroad. Students are expected to generate their own educational goals and objectives in advance.

The student functions as a full-member of the Palliative Care team and rounds with the team on a daily basis. Responsibilities include seeing and evaluating patients, writing consultative notes, presenting to the Palliative Care team and communicating with the primary team about palliative care recommendations. Students also: 1. Attend daily morning rounds with Palliative Care Team 2. Participate and attend weekly didactic and Inter-disciplinary team (IDT)meetings with faculty, staff, palliative care fellows and residents. 3. Present a difficult case during weekly conference 4. Have an opportunity to participate in ongoing research projects or start their own research project.

Students spend time attending and participating in community- based health education programs (including Diabetes Self-Management, Weight Management, Asthma, Nutrition, and Breast Health), screenings (including stroke, diabetes, blood pressure, and cholesterol) and meetings with the Center for Urban Health staff. Programs include the Healthy Corner Store Initiative, the STARS Advocacy Café at Nemours Pediatrics, diabetes group visit classes, diabetes prevention telehealth visits, Jeff Hope clinic, school health fairs and sports physicals. The student functions as a full member of the Center for Urban Health Staff. By the end of the block, students are expected to write a paper on a topic of their choice. This is an opportunity to explore an issue that you would like to learn more about, or follow-up on an experience you have in the clinic or in the community.

Departmental research is scheduled after consultation with the department and approval of a research project. Students may complete up to 12 credits (or 8 weeks) of research in Phase 3. Students wishing to count their research project towards the SI requirement in Phase 3, must receive permission from the SI Director and complete a capstone project.

Students work with an experienced family physician in a community setting and participate in the daily life of the practice. The community practice experience will provide opportunities to appreciate population health in the contexts of prevention, treatment, family & community. Students are encouraged to engage the doctor and members of the practice team as they use individual, team, and systems-based approaches to patient care. Students may see patients in a variety of care settings and are encouraged to work on assessment and treatment planning skills. In addition, students should focus on the following aspects of the clinicians’ practice: scope of practice, relationships with colleagues in procedural specialties, hospitalists, home care, long-term care, and school-based settings.

This is a 2-week elective, graded pass/fail. The four week version of this course is FMED 406: Geriatrics Subinternship.