Clerkships, Medical School, Uncategorized

Family Medicine Clerkship Tips: Family First

Emile here! Family Medicine happened to be my first rotation and being first had a lot of pros and cons. Family Medicine at our program is a 6-week clerkship that combines both inpatient (1 week) and outpatient (5 weeks) experiences. Family Medicine physicians treat everyone (children, adults, and the elderly); they can also manage prenatal care and do some minor surgeries (splints, punch biopsies, minor outpatient procedures, steroid injections). It’s a versatile field with many opportunities to develop continuity of care with patients and see a variety of medical conditions. Here are some general highlights of family medicine:

  1. You’re able to see a lot of patients both in an inpatient and outpatient setting. Ambulatory care and long term management of chronic illness are the cornerstones of family medicine.

  2. Over the course of this rotation you will get really good at interviewing patients, gathering a pertinent history and performing the necessary physical exams . This will lay a strong foundation for you in preparing for the Family Medicine OSCE and future rotations H & P’s.

  3. You will get a baseline knowledge of internal medicine, pediatrics, OB-GYN, surgery, psychiatry, MSK, and infectious diseases that will help you with the rest of your M3 rotations.

  4. Chronic illness and management is becoming the crux of medicine as we continue to improve the treatment of acute diseases. Being good at managing and counseling patients on lifestyle and diet changes is so important, especially in the U.S.

Ultimately, it was nice to get a little taste of everything and see patients in an ambulatory setting. I did a lot of well child visits, patient counseling and education, and chronic pain and disease management (blood pressure, diabetes, back pain, etc). Also, there are lots of opportunities to build rapport with patients and counsel them on healthy lifestyle changes. I also really enjoy the idea of being able to manage the care for children after they turn 18 and even help them with their prenatal care and the care of their future children (sort of like inception). Family Medicine is unique in its ability to develop this longevity with the patient as they build their future family.

Things to consider purchasing before you start:

1. Perfect H & P: This was a total lifesaver during family as it saved me a ton of time at the clinic. Everything is laid out and organized, the review of systems is all there, and when you precept to your resident/attending you’ll have more flow and structure in your presentations.

https://www.amazon.com/Perfect-Notebook-Medical-History-Physical/dp/B015UT66P8/ref=sr_1_1?ie=UTF8&qid=1503686323&sr=8-1&keywords=perfect+h+and+p

2. Maxwell’s Quick Medical Reference:

https://www.amazon.com/Maxwell-Quick-Medical-Reference-Robert/dp/0964519143/ref=sr_1_1?ie=UTF8&qid=1503686563&sr=8-1&keywords=maxwell+quick+medical+reference

General Tips:

Family medicine allows you to really work on gathering a thorough yet focused history. Take the time to develop good habits early on as it can become tempting to make short cuts to speed up the patient encounter. Here are some tips:

  1. Walk in with a smile and ask your patient what name they prefer. It only takes a couple of seconds and really shows the patient that you’re interested in who they are as a person and gives them control during the interview.

  2. Prepare the night before by reading up on whatever procedures you’re going to see the next day AND read up on each of the patients you’re going to see.  If you know someone is coming in with an ankle injury, read up on the AAFP on the Ottawa Rules. If you have a scheduled prenatal visit, make sure to review what labs/testing that needs to have completed around that week. If a child is coming in with a sore throat, read up on the CENTOR criteria.

  3. Know the USPSTF (US Preventative Services Task Force) recommendations and guidelines (especially A and B). Attendings and residents will love to pimp you on these and it looks great if you’re able to recall that your 67 yr old patient is due for their Zoster vaccine.  Here is the link: https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/#more

  4. Know everything you can about diabetes and hypertension. Diagnostic criteria, treatment, management, etc. They are the two most common chronic conditions that Family Medicine docs have to manage and it’s worth knowing the algorithms for treatment.

  5. Print out the prenatal care checklist (i.e. which labs, studies, vaccines need to be ordered at each visit) and print out the child vaccine schedule handout.

  6. When conducting a sports physical exam for a child, be sure to ask about heart conditions that run in the family, check for any signs of hypertrophic cardiomyopathy (HOCM), and check for any signs of an inguinal hernia. While it is important to run through everything that the form requires, those two findings are extremely important for children in sports.

Study Resources:

There is no “Family Medicine” section on UWORLD, so I utilized other resources instead for this rotation. Some people purchased UWORLD and began doing some Internal Medicine, Pediatrics, Dermatology, and OB-GYN questions so you can do that if you would like. Personally, I didn’t want to waste questions on Family that I wasn’t yet responsible for knowing.

1. Online Medical Education (OME) Videos (Family Medicine Clerkship 6 week schedule).

This is where I would start. There are roughly 40 videos for OME and they are free for medical students. Dr. Dustyn Williams does an incredible job of helping you recognize, manage, and treat diseases in a very systematic and well organized manner. I would also recommend reviewing these videos closer to your exam and writing out some of the algorithms and charts.

https://onlinemeded.org

2. CASE FILES Family Medicine Textbook ($27):

I thought this was an incredible resource that covered a lot of what we had to know for Family Medicine. They present 60 cases and discuss disease definitions, approaches, differentials, causes, treatment options, and comprehension questions. I read it near the end of the clerkship but I wish I read it over the course of the rotation instead because it really does help throughout the rotation. You can find it on amazon.com!

3. University of Virginia Family Medicine Questions (Free):

This website contains 125 well written family medicine clerkship questions written by the University of Virginia. The explanations are also really great in helping you navigate through diseases and management.

https://www.med-ed.virginia.edu/CourseSites/display.cfm?keyID=1154&click=7

4. AAFP Board Review Questions (Free):

Sign up for the AAFP early on in your rotation because it takes a few days to activate your account. There are over 1000 questions and they are really random. I would recommend doing some just to get an idea of what the AAFP finds important BUT I wouldn’t spend a ton of time trying to make sure you complete them. They come in 10 question sets and the learning comes from reading through the answer explanations. These questions help for understanding “next best step” types of questions that are common for STEP 2 CK.

5. Firecracker- Family Medicine Clerkship ($249)

I didn’t really use Firecracker for M1/M2 year but its been a great resource during clerkships. Purchasing and using Firecracker is a commitment (and why I placed it at the end of this discussion). What a lot of people don’t know is that there is a firecracker section for Family Medicine (outside of the USMLE STEP 2 CK section). Its a little hidden but it covers topics from other question banks. If you’re a firecracker person, these are great for helping you on the boards (Shelf) and the wards (i.e. getting pimped). There is also a 110 question practice shelf exam that I did the day before the exam that I felt helped a lot.

In a nutshell: 1. Online Medical Education2. Case Files, 3. Virginia Family Medicine Questions, 4. AAFP Questions, 5. Firecracker 

If you have any questions, don’t hesitate to shoot us a message on our Instagram page. Feel free to comment with any of your tips you learned on your family medicine rotation in the comments below!
Be aware that differences between hospitals and hospital systems make these tips applicable to some more than others. Use common sense and evaluate appropriate times to utilize these tips. These experiences and opinions are our own and do not represent the views of the hospital where we rotate.
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