Primary Care Ambulatory Clerkship

Syllabus - Clerkship Overview

I.) Program

A 24-week (consecutive) set of clinical experiences focusing on ambulatory primary and specialty care settings. The overall objectives of this academic experience are to provide the student with exposure to ambulatory care settings and a realization of its current and future importance in the health care delivery system. The ambulatory clerkship is also meant to serve as a bridging experience between the classroom and clinical setting, moving the student from a more passive learner to an active participant in the educational experience.

II.) Prerequisites

Successful completion of Units I & II

III.) Overall Objectives

Upon completion of the PCAC, the student will:

  1. Apply the clinical decision-making process to patient encounters that reflects knowledge of osteopathic principles
    • Systematically collect and organize data
    • Generate and interpret diagnoses for common primary care health problems
    • Prioritize presenting problems and provide rationale for this prioritization
    • Develop management plans that are individualized to the patient as well as his/her family
    • Develop management plans that reflect health promotion strategies, acute and chronic care principles, and osteopathic treatment methods.
    • Communicate the clinical decision-making process in charting
  1. Utilize principles of primary care in working with patients in ambulatory care settings
    • Initiate collaboration with other health care providers in decision-making and management of patients
    • Provide continuity of care over time for the patient
    • Involve patients actively in preventing illness, acquiring behaviors that promote health, and in coping with their illnesses
  1. Update his/her knowledge on an ongoing basis through active dialogue with colleagues and review of the literature
    • Critically review journal articles
    • Utilize the clinical decision-making process presenting cases
  1. Experience a variety of specialty ambulatory care clinics
  2. Develop an understanding of the relationship between the primary care provider, specialists and other members of the health care team
  3. Become knowledgeable of the economics/cost effectiveness of health care
  4. Be empowered with the knowledge and skills to deal with common presenting problems
  5. Be exposed to a comprehensive primary care experience with an attending physician in the ambulatory setting, on hospital rounds, and in the community
  6. Demonstrate knowledge of practice management principles

IV.) Absenteeism Policy

Students will be allowed a maximum of four days excused absences - two days classroom, two days clinical (illness and/or death in the immediate family) from the entire PCAC program. Absences which exceed the four days must be made up. Classroom experiences are considered an extension of the clinical experience and participation is required. Students must notify the office of the PCAC coordinator of any absences, whether from the classroom or clinic. In addition, students need to contact their clincial instructor of any absence from clinic. Lack of notification is considered an unexcused absence.

UNEXCUSED ABSENCE(S) WILL RESULT IN AN "N" GRADE.

Vacation may not be scheduled during this rotation, beyond that set by the Clinical Clerkship office.

V.) Ambulatory Clerkship Evaluation Procedures

The primary evaluation of the individual students in the Ambulatory Clerkship is the responsibility of the Clerkship Coordinator. The clinical evaluation and classroom evaluation (Current Case & Topical Formal) scores are reviewed and a promotion decision is based on these. Performance in both categories (clinical and classroom) must be satisfactory for a student to be given a passing grade. Satisfactory clinic performance does not compensate for failing classroom scores, nor does a high classroom score negate inadequate clinic performance. Failure in one or the other category of clinical or classroom, or failure to complete any other evaluation components required by your base hospital, will result in an unsatisfactory grade. The required evaluation components as listed are: clinical - "Clinician Completed" & "Student Completed" for each or your clinical rotations; didactic - "Current Case" & "Topical Formal Presentation" which will be completed by faculty and the overall "Didactic Evaluation" which needs to be completed online by students at the end of the PCAC.

To satisfy expectations in Pediatrics and become a candidate to graduate from the College of Osteopathic Medicine, all students must exhibit mastery of every goal listed for your pediatric rotation, receive a satisfactory evaluation from your clinical preceptors, and pass the NBOME Pediatric Shelf Examination with a score of 300 or above. The COM Department of Pediatrics reserves the right to add additional questions to that examination as part of the requirement. The exam will be administered four times a year on the last day of the student's six-month PCAC experience (in December/February or in June/August, dependent on when you started PCAC). Ms. Robin Borowski is the Pediatric Department contact person and Ms. Brandy Church will contact students via e-mail for registration of the exam. This exam is one of the requirements for passing PCAC and is offered only to students who have completed their PCAC general pediatric rotation. Students failing the examination will have to take a remediation examination prepared by the Department; you will not be permitted to merely retake the NBOME examination. That Departmental remediation examination will have a passing grade of 70%, a standard much higher than that currently in place for the NBOME examination. Those who fail the remediation examination will be required to repeat the entire pediatric rotation as well as designated didactic assignments. Since you must pass the pediatric portion of COMLEX 2 to graduate from medical school and since the inpatient rotations are no longer required, vital content related to the care of newborns and hospitalized children will be woven into your clerkship experience.

To satisfy expectations in Family and Community Medicine and become a candidate to graduate from the College of Osteopathic Medicine, all students must pass a Family Medicine Examination with a 70% or above. The exam will be administered four times a year on the last day of the student's six-month PCAC experience (in December/February or in June/August, dependent on when you started PCAC). Additional information regarding remediation is available from the Dept. of FCM.

VI.) Exposure Incidents

A new form has been developed by the University to report exposure incidents (to be distributed at orientation). These forms will be on file in your DME's office and available on this site. Please make yourself familiar with the procedure and the form.

VII.) Recommended Texts

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders: DSM-IV-TR, 4th ed. Washington, DC: American Psychiatric Association. McMillan, JA, DeAngelis CD, Feigin RD, & Warshaw JB (Eds.) (2006). Oski's pediatrics: principles and practice, 4th ed. Philadelphia: JB Lippincott.
Andreoli TE, Carpenter CCJ, Plum F, & Smith, LH (2007). Cecil essentials of medicine, 7th ed. Philadelphia: WB Saunders Company. Reilly BM (1991). Practical strategies in outpatient medicine, 2nd ed. Philadelphia: WB Saunders.
Barker LR, Fiebach NH, & Zieve PD (Eds.) (2006). Principles of ambulatory medicine, 7th ed. Baltimore: Lippincott Williams & Wilkins. Schwartz SI, et al (Eds.) (2005). Principles of surgery, 8th ed. New York: McGraw-Hill.
Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, & Loscalzo J (Eds.) (2008). Harrison's principles of internal medicine, 17th ed. New York: McGraw-Hill, Health Professions Division. Sloane PD, Slatt LM, Ebell MH, Jacques LB, & Smith MA (2007). Essentials of family medicine, 5th ed. Baltimore: Lippincott, Williams & Wilkins.
Gehlbach SH (2006). Interpreting the medical literature: Practical epidemiology for clinicians, 5th ed. New York: McGraw-Hill, Health Professions Division. Swartz MH (Ed.) (2005). Textbook of physical diagnosis: history and examination, 5th ed. Philadelphia: WB Saunders.
Gibbs RS, Karlan BY, Haney AF, & Nygaard IE (2008). Danforth's obstetrics and gynecology, 10th ed. Philadelphia: Lippincott, Williams & Wilkins. Taylor RB & David AK (2003). Family medicine: principles and practice, 6th ed. New York: Springer.
Goldschlager N (1999). 1999 principles of clinical electrocardiography, 13th ed. Norwalk, CT: Appleton & Lange. U.S. Preventive Services Task Force (April 2002). Guide to clinical preventive services: An assessment of the effectiveness of 169 interventions. Report of the U.S. Preventive Services Task Force. Baltimore: Williams & Wilkins.
Goroll AH, May LA, & Mulley, AG (2009). Primary care medicine: Office evaluation and management of the adult patient, 6th ed. Philadelphia: Lippincott, Williams & Wilkins. Waldinger RJ (1997). Psychiatry for medical students, 3rd ed. Washington DC: American Psychiatric Press, Inc
Greenman PE (2003). Principles of manual medicine, 3rd ed. Baltimore: Williams & Wilkins. Ward, RC (Ed.) (2003). Foundations for osteopathic medicine, 2nd ed. Baltimore: Williams & Wilkins.
Kliegman RM, Behrman RE, Jenson HB, & Stanton BF (Eds.) (2007). Nelson textbook of pediatrics, 18th ed. Philadelphia: WB Saunders Company. Way, LW (2006). Current surgical diagnosis & treatment, 12th ed. Stamford, CT: Appleton & Lange.