USUHS Family Medicine Clerkship

Additional Written Assignments

A. Patient Centered Healthcare Planning Assignment

Overview:

Effective care often requires consideration of a patient’s context, to include social, cultural,
family, and personal value and preferences. Understanding this facilitates development of a
patient-centered plan. By creating a relationship of trust between you and your patient, the
chances of a patient adhering to an agreed upon plan is enhanced.

The two goals of this assignment are to: 1) expand your understanding of the role of the family
physician within the complex healthcare delivery system and 2) further develop your ability to
effectively use interpersonal skills in building doctor-patient relationships.

This assignment has been developed to meet the following objectives. By completion of this
process, you will be able to:

1. Create therapeutic and ethically sound relationships with patients and families using a
patient-centered approach.
2. Demonstrate the ability to listen with attention and precision to patients in order to elicit a
patient’s concerns and healthcare priorities as well as their contextual framework.
3. Discuss the relationship between a patient’s priorities, the context of a patient’s life, the
approach to care, and referral to relevant healthcare and community services.
4. Describe the importance of maintaining continuing professional responsibility of a family
physician, not only as coordinator of care, but also as a provider of continuing and
comprehensive care.
5. Recognize the social, community, economic and military factors and potentially barriers
that affect the patient the patient’s health, access to care and treatment options.
6. Explore the effects of family relationships on a patient’s healthcare (family may not be
traditional definition).

Instructions:

Part of your onsite clerkship experience in Family Medicine includes a longer visit with a patient
in any setting to discover some of the psychosocial aspects of patient care.

Step #1 Find a “patient”

Your clerkship coordinator, other faculty, residents and the social worker are all resources to
help you identify a good “patient” for this project. A “patient” may be a single patient, a married
couple, a traditional or nontraditional family where a health condition(s) have brought them in
contact with the health care system. A health condition may be an acute illness or chronic
disease. It might represent an adjustment reaction to an outside stressor—such as a deployment.
The ideal “family” is one in which learning about priorities, context, support, coordination and
resources will assist in optimizing their health and their health care. You may want to look
ahead to an entire week’s worth of clinic patients and speak with individual preceptors to
identify a patient in advance. You might also consider interviewing a patient during your
inpatient week. .

Step #2 Prepare for your visit:

Make sure you have a blank copy of the PASS-C to guide you in considering all aspects of the
interview. If possible, review the medical record briefly. Ask the primary physician if there are
concerns that you can “fill in” for the physician to facilitate care in the future.

Step #3 Complete your extended visit

Please use the PASS-C form to organize your observations and conversation with this patient and
family. The form is available on SAKAI, and was given in the folder the first week of the
clerkship. The goal is to build a relationship, understand the patient’s needs and perspective, and
attempt to formulate a plan. You may or may not be completing a physical exam. This may be a
patient with a routine appointment who agrees to extend the visit for your assignment after the
preceptor has left. It is important to understand the critical relationships in the patient’s life and
the effect on healthcare.

Step #4A Accomplish your comprehensive Patient Centered Healthcare Plan

Your paper should be no longer than one typed page single spaced. There will need to be 2
paragraphs.
First paragraph: (reporting)
 Introduce the patient
 Describe the patient’s and family’s goals and priorities.
 Describe any barriers to healthcare (financial, education, transport, etc.)
 Discuss any social or additional family factors to include pros and cons of formed
relationships (sometimes called family dynamics)
Second paragraph: (interpreting and managing)
 Discuss what resources have helped this family and if/how physicians have partnered
with them in managing their problems
 Summarize the impact of medical conditions on this patient and family. Suggest what
additional relevant healthcare and community services might benefit this family.
 Propose a plan of care. This may include treatments, consults, regular follow-up,
education services, etc.
 Discuss any difficult issues within the family that may interfere with healthcare

Step #4B Turn in the PASS-C

Complete a PASS-C form with the information about the patient or family you visited by writing
directly onto the form or completing it using Microsoft Word.

Your completed PASS-C and one page summary must be turned into your Site Coordinator or
Behaviorialist to be graded.
Grading Criteria:

Your performance in completing the entire process as described above will be assessed by your
site coordinator, graded according to the criteria listed below and included as part of your overall
site evaluation. The following criteria will guide the evaluation of your work:

2 points Emerging Manager This grade will be assigned when a student adeptly
synthesizes the patient’s and family’s priorities, context and needs and completes
all components of the assignment in a timely fashion. In their work, the student
describes patient and family needs in relation to both their health problems and
their context. The student integrates this information with plans for healthcare.
The student describes the family physician’s role in coordinating care and in
linking the patient and family with appropriate resources. The student identifies
gaps in care or services if applicable and suggests resources that would help care
be more effective. These suggested resources reflect an understanding of the
patient’s and family’s individual values, culture, and preferences. This student
demonstrates a good fund of knowledge about healthcare and community
resources and discusses advocating for patients and families in the complex
healthcare system as part of their responsibility as a student and physician. This
student articulates the impact of any relationships on the patient’s healthcare if
determined.

1 point Complete and reliable reporter, interpreter. This grade will be assigned if a
student thoughtfully completes all components of the assignment. The student
describes a patient’s and family’s priorities, context and needs accurately and
thoroughly, but may miss very few details. This student can identify the resources
a family needs but not where to get them. This student discusses healthcare and
community resources in broad categories but does not identify or only identifies
one or two specific resources. Interpretation of the relationships between the
health problems and the patient or family’s context or priorities is present in the
discussion but limited. This student demonstrates a superficial fund of knowledge
about healthcare and community resources. The student indicates an awareness of
the responsibility of a physician to advocate for patients and families and/or
effectively link them with resources.

0 points Incomplete reporter, very limited interpretation. This grade will be assigned if
a student completes all components of the assignment, but completes some in a
cursory fashion. The level of detail in the descriptions of a patient’s and family’s
priorities, context and needs is limited. The description of healthcare and
community resources is also limited and/or there is no indication of an awareness
of missing resources. This student demonstrates a limited fund of knowledge
about healthcare and community resources. There is limited discussion of the
responsibility of a physician to link patients and families with resources. No
discussion of any social relationships.
Incomplete Failure to complete any component of this required assignment.