Family Medicine Clerkship

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CLERKSHIP SETTING

Skilled clinical educators (i.e., preceptors) are needed to teach adequately the competencies contained within this resource. Additionally, clinical settings (i.e., clerkship sites) where learning can optimally occur need to be identified, developed, and maintained. In 2004, the Future of Family Medicine project defined the ideal setting for teaching family medicine clerkship students as a New Model Practice, which serves as a "personal medical home" where patients are involved in a continuous, healing relationship with their family physician. (1) Characteristics of skilled teachers (sometimes referred to as "master teachers") and the ideal clinical settings in which faculty and students teach and acquire the family medicine clerkship competencies were first described in 1991. (2) What was described at that time still applies in large measure today, even within the "New Model" of family medicine. In 1991, the characteristics of the ideal clinical teaching setting were described as follows:

• The care of patients should be continuous and not limited by the duration, severity, or type of illness, or by the patient's age or gender.
• The patient population should reflect the ethnic and socioeconomic mix of the community at large as closely as possible and should be sufficient in volume to provide diversity in patient encounters.
• The care provided should be community-based (that is, where care follows the need and the setting most suited to the patient, not just the practice) and should occur wherever most appropriate for the patient, including the home, office, nursing home, hospital, or extended care facility.
• The care of patients should include consideration of family, occupation, social support, resources, and ethnicity, and be customized according to the patient's needs and values.
• The faculty should be trained for, educated for, and involved in the practice of family medicine.

There is a pressing need to preserve these sites for clinical instruction and learning for our medical students; otherwise, we cannot properly deliver the content and process of family medicine proposed by the FMCR. (3) What so clearly characterizes the family medicine clerkship is the interaction between the community preceptor and student that occurs in these sites. All of the characteristics above that were defined in 1991 still hold true today for defining the optimal setting and faculty involved in a family medicine clerkship. Today, however, there are other considerations and opportunities emerging as the Future of Family Medicine (FFM) project redefines the specialty of family medicine. According to the New Model as described by the FFM project, family medicine care (and teaching) will occur in a dramatically changed environment. Characteristics of the New Model of family medicine include:

• a patient-centered team approach;
• elimination of barriers to access;
• advanced information systems, including an electronic health record;
• redesigned, more functional offices;
• a focus on quality and outcomes;
• and enhanced practice finance.

Characteristics of faculty needed to train students in this new environment have also been defined by the FFM report:

• The faculty should be trained and current in use of technology at the point of care with patients. The setting should provide access to Web-based learning resources with access to the Internet for all students.
• The faculty should be self-aware individuals who can demonstrate and role model lifelong learning principles in their routine, everyday care of patients.
• Faculty diversity will reflect the diversity in the patient population served at the setting where student clinical training occurs.

Community clinical teaching sites in the family medicine clerkship provide a unique learning experience for all medical students. Preserving and nurturing these teaching settings is the key to teaching a new generation of student physicians the "New Model" for family medicine.

REFERENCES

1. Future of Family Medicine Recommendations; Annals of Family Medicine ; 2: Supplement; March 2004.
2. Sheets K (Chair of STFM Working Committee to Develop Curricular Guidelines for a Third-Year Family Medicine Clerkship) et al: National curricular guidelines for third-year family medicine clerkships . Acad Med. 66(9): 534-39; September 1991.
   [purchase the guidelines at the STFM on-line bookstore ]
3. Hobbs J. The invisible faculty. Fam Med. 29(10): 689-691, November-December, 1997.
   Article posted with permission.

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This page last updated November 6, 2004