WELCOME

The Department of Family & Community Medicine of the Sidney Kimmel Medical
College at Thomas Jefferson University welcomes you to the Family Medicine
Clerkship. The Family Medicine Clerkship is a six-week rotation with sites around
greater Philadelphia. Contact information for each of these sites is available on
Canvas.

The following pages are designed to prepare you for the clerkship, provide useful
information, and direct you to resources that will help you prepare for the NBME
exam and USMLE Step II.

For any questions about the Clerkship, please contact:

Clerkship Director
Marisyl D. de la Cruz, MD
mariasyl.delacruz@jefferson.edu
215-503-3461

Education Programs Administrator

Laura Monroe
laura.monroe@jefferson.edu
215-955-2362

Education Coordinator
Amy Levine
amy.levine@jefferson.edu
215-955-1372

The Family Medicine Liaisons for the 2022-2023 academic year are:

Will Cooley
william.cooley@students.jefferson.edu

Sebastiano Porcu
sebastiano.porcu@students.jefferson.edu

Family Medicine Clerkship Handbook

 TABLE OF CONTENTS

Policies and Guidelines...............................................4

SKMC Honor Code......................................................4
Attendance..................................................................4
Professionalism...........................................................4
Dress Code..................................................................4
Duty Hours...................................................................4
Learning Objectives.....................................................5
Clerkship Structure......................................................6
Expectations................................................................6
Assignment Summary.................................................7
PELS...........................................................................8
OSCE........................................................................10
Grading and Evaluation.............................................11
Clinical Grades..........................................................11
NBME Exam..............................................................12
Evaluation..................................................................13
Mid-rotation Feedback...............................................14
Student Feedback.....................................................16
Resources.................................................................16

Family Medicine Clerkship Handbook

POLICIES and GUIDELINES
Students on the Family Medicine Clerkship are expected to adhere to the Sidney Kimmel Medical
College Honor Code at all times (excerpted below):
The Honor Code assumes that all faculty, residents, fellows, and students conduct themselves in an
ethical and professional manner. Altruism, accountability, commitment to excellence, duty to serve,
honor, integrity and respect for others are essential characteristics of a physician. In addition, the
code is dependent on the collective desire of all members of the academic community to prevent and
deter violations, rather than on proceedings to impose penalties after violations have occurred. If
violations do occur within this system, each member of the community is expected to support and
uphold all aspects of the code.

Attendance
Attendance is mandatory at all clinical and educational activities and supplementary work or
additional clinic time may be assigned to make up for any absence.
Excused absences: If you have an unavoidable conflict (e.g., religious observance), you must
inform Laura Monroe prior to the start of the clerkship and submit a request through the
Student Absence Reporting System.
Unplanned absences: Unplanned absences will be dealt with on a case-by-case basis. You must
notify Laura Monroe immediately.

Professionalism
Conduct in keeping with the Shared Professional Values of Sidney Kimmel Medical College is
expected at all times. These values dictate that,
“As a physician or future physician, I recognize the implicit trust placed in me by patients and society.
Therefore, I commit to embodying the highest standards of civility, honesty, and integrity in all aspects
of my personal and professional life. These standards include my interpersonal relationships, my
academic pursuits, and my medical practice. I will strive to communicate sincerely and effectively with
my patients and their families. I will treat everyone compassionately, providing respect and protection
of privacy, dignity, and individuality. As part of the trust that society has placed in me, I will advocate
for outstanding patient care. I will endeavor to work effectively with other members of the health care
team to provide the safest and highest quality patient care.”

Dress Code
Students are expected to wear professional attire at all times. White coats and name tags must
always be worn. Jeans, athletic wear, and leggings are not acceptable.

Duty Hours
Each student must have no more than 80 hours per week of duty hours, averaged over a four
week period. Duty hours are considered all clinical and academic activities undertaken by
students. The full policy is posted on Canvas.

Family Medicine Clerkship Handbook

LEARNING OBJECTIVES of the Family Medicine Clerkship

1. Describe the basic pathophysiology and clinical presentations of common

problems in family medicine

2. Gather information, formulate differential diagnoses, and propose plans

for patients with common acute presentations and chronic illnesses
across the patients’ lifespan, including end-of-life care

3. Discuss the health of the patient in the context of biological, psychological,

social, cultural, and economic factors which may impact health

4. Describe barriers that patients commonly face in addressing their health

5. Demonstrate advanced elicitation of history, communication, physical

examination, documentation, counseling, and critical thinking skills

6. Develop evidence-based health promotion/disease prevention plans for

patients of any age or gender

7. Describe community resources and the appropriate use of

consultation/referral

8. Explain the role of the primary care physician in the delivery of care to the
patient, the family, and the community

9. Discuss the role of Family Medicine within the health care system

10. Incorporate skills needed for cost-effective delivery of care, including

quality improvement, population health, and use of the electronic medical
record

Family Medicine Clerkship Handbook

CLERKSHIP STRUCTURE
Caring for patients in an outpatient setting is a central component of Family
Medicine. At all clerkship sites, you will spend a significant portion of your time in
an outpatient practice. These sessions will be supplemented by didactics and
community-based experiences in order to expose you to other areas of Family
Medicine. These vary from site to site, but often include spending a day on home
visits or in a nursing home.

Students will be supervised by Family Medicine faculty and upper-year residents at

all sites. Specific clinical assignments will be provided during orientation at each of
your sites.

EXPECTATIONS
As a 3rd year medical student, you are now an integral part of the team providing
patient care. Your focus should be on gathering information through the history
and physical exam, accurately reporting that information, providing a differential
diagnosis, and prioritizing problems.

Every day, you should ask your preceptor about their expectations for
presentations and the overall structure of patient encounters. All attendings and
residents have unique styles and expectations for student performance and it is
your job to adapt accordingly.

As a general guide, patient encounters should always include the following steps:
 Wash your hands
 Introduce yourself to the patient
 Obtain pertinent medical history information
 Perform focused physical exam
 Organize and synthesize patient information
 Prioritize the problem list
 Develop an assessment
 Develop a plan
 Document the above in the EMR and/or on paper as instructed
 Present an organized summary to your preceptor

Family Medicine Clerkship Handbook

ASSIGNMENT SUMMARY
More details on all assignments can be found on the FAMED 350 Canvas site

Assignment Details
Aquifer 5 Aquifer Family Medicine cases must be completed. Choose cases that
Family address a self-identified learning gap. Each case will take 1½-2 hours.
(These cases do not include Internal Medicine or Pediatrics cases—they
Medicine
must be Family Medicine.) Besides being a valuable learning exercise, the
cases are a good way to prepare for the shelf exam and we urge you to do
as many as possible.
 When: 2-3 cases per week is suggested
 Due: Last day of the clerkship

JeffDOT Using JeffDOT on your mobile device, ask an attending, resident, or fellow
Bedside to observe you:
1) take a history
Observation
2) perform a physical exam
and 3) give an oral presentation
Feedback 4) counsel or discharge a patient
These are brief micro-assessments that don’t need to be done at the same
time or by the same physician. The observed encounter doesn’t have to be
a complete history and physical, but can be part of a focused problem and
exam.
Each student needs to do a minimum of eight observations during the
rotation, two in each category. You may ask for more assessments if you
would like additional feedback.
 Due: Last day of the clerkship

Patient By Friday of week 3, all students must have:

Encounter  Certified that they received mid-term feedback
 Certified that they have been observed during a patient encounter
Log System
(PELS) By the end of the clerkship, all students must have:
 A minimum of 40 patients recorded

Quality This project includes a pre- and post-test, online modules, creation of
Improvemen process map, and completion of reflection assignment. Students at
Jefferson will be expected to do a final group presentation. It is
t and Health
recommended that you work on this project during the course of the
Disparities clerkship and do not wait to do it all at the end.
Project
 Due: The last week of the clerkship
(Also need to submit on Canvas)

Family Medicine Clerkship Handbook

PATIENT ENCOUNTER LOG SYSTEM (PELS)
For all clerkships at SKMC, PELS is how you track the patients, procedures, and conditions you
witness.

By the middle of the clerkship, all students must have:

 Certified that they received mid-term feedback
 Certified that they have been observed during a patient encounter
By the end of the clerkship, all students must have:
 A minimum of 40 patients recorded
 Reported seeing each of the diagnoses/patients listed below

* Definitions
Observe: student is present for evaluation of patients with specified medical
diagnoses/problems or during specified procedures by another provider.
Perform: student directly performs specified items (physical exam maneuvers, demonstrates
clinical skills, performs counseling) under supervision as specified in the Medical
Student Supervision Policy

How to ensure completion of these requirements:

 Each clinical encounter must be documented in PELS in order to ensure that you are
seeing the numbers and kinds of patients expected.

Family Medicine Clerkship Handbook

  Any encounter with a patient (in-person, telehealth, or phone call) counts toward your
PELS requirements.
 Encounters should be entered daily in order to stay on target.

What counts for PELS?

What you saw How to record it
RJ is a 55 yo M who presents for a blood pressure check. He was  Medications
started on HCTZ 25 mg at his last visit 2 weeks ago (last BP 150/85).
He denies any side effects from the medication. Repeat BP today is  Hypertension
135/70. He also requests a refill on omeprazole, which is working  Nutrition/diet/exercise
well for his acid reflux. He has been working on healthy lifestyle
changes, current BMI is 35.
MC is an 60 yo healthy F who presents for a health maintenance  Nutrition/diet/exercise
exam. She has been working on a healthy diet and exercises 3 times
a week. Her last mammogram was one year ago, her last pap smear  Women’s health
was 5 years ago (normal, HPV negative), and her last cholesterol  STIs
panel and glucose a year ago were normal. Her last colonoscopy
was 10 years ago. Her immunizations are UTD. You order a  Preventive medicine
mammogram, colonoscopy, lipid panel and A1c, and perform a pap
smear today. 

PELS Review:
The Clerkship Coordinator will regularly review your PELS progress. Email notifications will be sent
if you have fewer entries recorded than would be expected by that point during the Clerkship. If
you are concerned that you may not meet the requirement of 40 entries or meet all required
targets, please contact the Clerkship Director and Coordinator immediately.

At the midterm of the Clerkship, PELS entries to date should be reviewed with a faculty member
who you have worked with several times. They will need to electronically sign off on your entries,
either with a campus key or their initials. At this point, you should look to see if there are certain
patient populations or types of diagnoses that you need to see before the end of the rotation.

Family Medicine Clerkship Handbook

OBSERVED STRUCTURED CLINICAL EXAM (OSCE)
Reporting Instructions
The OSCE will take place on the final Wednesday of the clerkship virtually. All students will be
assigned to a specific time and the schedule will be posted on Canvas. Please follow the
instructions you will receive from the Clinical Skills Center a few days before the exam.

Structure
All students will have three encounters each with standardized patients.

What’s Evaluated?
The Family Medicine OSCE is different from other OSCEs you will take in the 3 rd year, as there is no
physical exam. Instead, this OSCE focuses on communication and counseling skills. Skills
evaluated:

Information Sharing Skills History Taking and Interpersonal Skills

Information Giving: History Taking:
Avoids using jargon Starts with open-ended questions
Explains medical terms used Progresses to specific questions
Solicits questions Does not ask multiple questions
Explains reasons for recommendations Does not ask presumptive/leading questions
Checks understanding of patient/family Does not interrupt patient
Assesses patient’s willingness to follow recommendations Asks for clarification, if necessary
Assesses patient’s ability to follow recommendations Appropriately includes patient in interview
Uses logical sequencing of questions
Has clear transitions
Segment summary
Management: Interpersonal Skills:
Explains diagnosis Introduces self
Explains management plan Shakes hands with patient upon entering/leaving
Uses visual reinforcement Calls patient by preferred name
Uses written reinforcement Uses good eye contact
Arranges for follow-up Appropriate open body language, sits down
Outlines reasons for follow-up Appropriate facial expression and tone of voice
Appropriately includes parent/child in explanation Uses silence appropriately
Listens carefully
Reflects/ legitimizes patient’s feelings or concerns
Offers partnership, support, encouragement/praise

Feedback
Following each encounter, the standardized patient will give you verbal feedback. This feedback is
designed to help you improve your communication skills for future patient encounters.

Grading
The OSCE counts for 10% of your final grade. Students who score poorly will have their recordings
reviewed by the Clerkship Director and may be asked to re-take the OSCE and/or undergo
remediation.

Family Medicine Clerkship Handbook

GRADING AND EVALUATION

Grading
Your final grade will be based on the following components:

Clinical grade 60%

NBME score 20%
OSCE score 10%
QI project 5%
Professionalism 5%

Clinical grades are based on feedback from attendings and residents who supervised each student’s
work. Each student’s advisor is responsible for compiling feedback received from attendings,
residents, and other providers who worked with the student and, after reviewing all of this
information, the advisor assigns a clinical grade. Therefore, only one final evaluation will be completed
for each student. The student does not have to request an evaluation from anyone.

For the NBME exam, students who fail the exam will receive a “Conditional Pass” for the clerkship.
The exam must be repeated and a passing score received before beginning the fourth year. The
Conditional Pass will then be changed to a grade of Pass, High Pass, or Honors.

Professionalism is expected of all students on the clerkship. Professionalism includes but is not limited
to punctual attendance, notice for requests for time off, completion of all clerkship assignments
(JeffDOT, PELS, Quality Improvement Project, Aquifer cases), interpersonal communication, behavior,
and teamwork.

Examples of unprofessional behavior include texting during lectures, repeated lateness, and
inappropriate communication with patients, preceptors, and staff.
 Absences, late assignment submissions, and failure to complete faculty evaluations are
also aspects of professionalism that may negatively impact your grade.

An undergraduate medical committee composed of faculty and staff reviews all clinical grades and
calculates the final grade according to the grading rubric above.

Grades will be posted within six weeks of the end of the clerkship.

Grades are based on the following scale, excerpted from the SKMC clinical evaluation:

Failure Conditional Pass Pass High Pass Honors

Please familiarize yourself with the clinical evaluation (a full copy is on Canvas) and use it during
the clerkship to ask for feedback on the areas listed.

Concerns about the clinical grade can be addressed with the Clerkship Director. Appointments
may be scheduled starting one week after grades have been posted on Banner. Please consult the
Clinical Rotation Grade Grievance Policy for more details.

Family Medicine Clerkship Handbook

Grievance process timing:
 Once the grade is published, a one-week reflection period will be enforced during which
students cannot appeal their grade.
 After the reflection period, students have up to 20 business days to appeal their grade. No
grade appeal will be considered if received more than 25 business days after the grade is
published.
 If a student’s concerns are not resolved at this meeting, the student should contact
his/her assigned Student Affairs Dean.

The NBME exam covers all material relevant to family medicine.

 When: the final Friday of the Clerkship
 Length: 110 questions, with 2 hours 45 minutes to complete it
 Where: JAH Learning Resource Center or other campus computer lab
 Passing score: Students must receive a 64 on the exam in order to pass
How to Prepare
It is important to begin studying immediately as family medicine is a broad field. Be familiar with
all the pediatric and gynecology problems frequently seen in family medicine. Particular clerkship
locations may not have as many patients suffering from a wide variety of medical problems,
making it important to thoroughly review all of the common diseases. Utilize the Aquifer cases to
supplement patient topics that you may not have seen. Some of the topics covered are health
maintenance, chronic care, continuity of care, and diagnosis and management of common
musculoskeletal problems.

Students have suggested the following NBME resources:

UWorld Family Medicine Question Bank

AAFP Board Question Bank (these are typically more difficult as they are designed for Family
Medicine residents but can offer good educational topics).
Free Student Membership Application:
https://www.aafp.org/membership/join/student.html

PreTest Family Medicine

Case Files Family Medicine

Make-up Exams
Make-up exams and retakes are only offered at pre-determined times. If you anticipate needing a
make-up exam, you must contact Dr. de la Cruz immediately.

Family Medicine Clerkship Handbook

Evaluation

The R.I.M.E Student Evaluation Framework

The R.I.M.E method of evaluation is frequently adopted as it improves inter-rater reliability. It also
assists with providing useable feedback to medical students and residents. There are four cognitive
levels that mark the natural progression in a medical skills development. Based on your progression
from third to fourth year, this can be an objective scale to help assess your stage of training compared to
your peers. Adapted from Emory University School of Medicine & Pangaro LN. Academic Medicine 1999;
74:1203-7

Reporter
 Obtains and reports basic information accurately: answers the "What" questions about patients
 Clearly communicates clinical facts about patients, and follows data daily
 Uses proper terminology
 Is beginning to interpret data: has basic knowledge to know what to look for in a history and
physical
 Has the ability to recognize normal from abnormal and confidence to label a new problem
 Reliable, honest, hard-working
 Works well with patients, staff, and colleagues: solid professional qualities.

Interpreter
 Good working fund of knowledge
 Active participant in patient care: consistently prepared for rounds, the OR, clinic, etc.
 Consistently able to interpret data: can identify and prioritize new problems
 Can offer a differential diagnosis: can present 2-3 reasonable possibilities for new problems and
cite reasons they may apply to this patient
 Not always correct, but has a higher level of knowledge, more skill in selecting clinical findings
which support possible diagnoses and applying these to specific patients
 Answers the "Why" questions about his/her patients

Manager
 Excellent general fund of knowledge
 Broad/deep knowledge of his/her own patients
 Excellent level of patient care: actively suggests management options, answers the "What's
next" questions about his/her patients
 Has the skill to select among options for his/her patients: is proactive rather than reactive,
actively suggests management options
 Confidence/willingness to state own preferences
 Diagnostic plans include more than one appropriate treatment option, and therapeutic plan
considers the merits of all reasonable therapies
 More judgment in deciding which action needs to be taken: can tailor plan to patient's
circumstances and preferences (finds common ground)

Educator
 Can cite evidence that new therapies, tests, and procedures are worthwhile
 Takes an active role in educating themselves, colleagues, and patients
 Open to new knowledge
 Skilled in identifying questions that can't be answered from textbooks
Family Medicine Clerkship Handbook
  Superior fund of knowledge
 Provides superior patient care and consistently possesses superior knowledge of his/her
patients

The following attributes will be evaluated of students at every site:

 Clinical skills: history, physical exam, interviewing skills, rapport with patients and families
 Knowledge and understanding of medicine
 Interpersonal skills: relations with co-workers, peers, supervisors, etc.
 Personal attributes conscientiousness, motivation, initiative, responsibility, respect for
others, responsiveness to constructive criticism, self-directed learning
 Problem-solving skills and clinical judgment
 Technical skills
 Chart documentation skills
 Verbal presentation of clinical data
 Organization, efficiency, and time-management
 Management skills: patient education, execution of treatment plans, managing adherence
issues
 Life-long learning skills and use of appropriate resources (including evidence-based
medicine)
 Professionalism: interactions with faculty and staff; completion of all assignments

Mid-rotation feedback
 You are expected to ask your preceptors for mid-rotation feedback.
 Ask specific questions such as, “How can I improve my presentations?” and assess your
own performance first.
- If you do not receive mid-rotation feedback after requesting it, contact Dr. de la Cruz.
- Certifying that you received this feedback is a requirement for PELS.
 Students are expected to be active participants in receiving and responding to provided
feedback. Midterm feedback is designed to give you a sense of your progress and to
identify areas of your performance that could be improved. Use the below prompts as a
guide.

Topics to Address Notes

Student’s self-assessment

Feedback on areas of
strength

Feedback on areas for

improvement

Family Medicine Clerkship Handbook

Feedback on areas not at
an acceptable level

Family Medicine Clerkship Handbook

Midterm Feedback Components

Professional Behavior
Integrity, Compassion, Altruism:

Interprofessional Relationships, Initiative, Reliability, Commitment to Learning:

Cognitive Skills
Fund of Information, Synthesis and Application of Knowledge:

Data Gathering, Physical Exam:

Communication Skills, Patient Education:

Use and Interpretation of Diagnostic Tests, Oral Presentations, Documentation:

Family Medicine Clerkship Handbook

STUDENT FEEDBACK
During week four, you will be able to write evaluations of the faculty and residents with whom
you’ve worked via New Innovations. Completion of three evaluations is mandatory and your
responses are confidential. All evaluations will be compiled by the Clerkship Coordinator and will
not be shared with any of the people you evaluate until after clinical grades have been posted.

During week five, you will receive an email from the Family Medicine Student Liaisons with a link
to a survey. These responses are anonymous and are used to improve the clerkship for future
students. The survey will take less than 10 minutes to complete.

RESOURCES

1) The American Family Physician has great review articles on many core Family Medicine topics,
which can be found here:
http://www.aafp.org/afp/topicModules/viewAll.htm

2) The University of Michigan Department of Family Medicine presents high-quality modules on

a broad range of clinical topics such as women's health, integrative medicine, clinic
procedures, but we highly recommend the musculoskeletal exam modules:
https://sites.google.com/a/umich.edu/fammed-modules/

3) The ePSS is an application designed to help primary care clinicians identify clinical preventive
services based on the U.S. Preventive Services Task Force (USPSTF) recommendations. We
recommend downloading to your mobile device/smart phone:
http://epss.ahrq.gov/PDA/index.jsp

Most Common Visits in the Family Medicine Outpatient Setting

1. Hypertension 11. Hypercholesterolemia

2. URI 12. Rhinitis
3. Physical examination (wellness visit) 13. Back pain
4. Diabetes 14. Obesity
5. Sinusitis 15. Urinary tract infection
6. Bronchitis 16. Pregnancy
7. Degenerative joint disease 17. Headache (includes migraine)
8. Asthma 18. Coronary artery disease
9. Otitis 19. COPD
10. Depression 20. Neck pain

Under “General Clerkship Resources” on Canvas, you will find: AAFP common diagnoses in family
medicine, abbreviations/dose designations that should never be used in the medical record, a
diabetes algorithm, information on hand washing, a “How to” guide on presenting patients,
hypertension management and care guides, and SOAP note guidelines.

4/5/22
Family Medicine Clerkship Handbook