Department of Family & Community Medicine

2020-2021

Guide for Family Medicine MSIII Clerkship

North Valley Center for Family & Community Health

3401 4th Street NW

505-994-5300

Contact Information:

Felisha Rohan-Minjares, MD

NVC Medical Student Education Coordinator

505-264-4196

Jeff Gibson

System Analyst 2

505-272-1571

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Clerkships during COVID All of us are adapting to week-to-week changes in clinic practice due to COVID. Much of our work is via telemedicine now and we continue to learn how to use this tool to provide the best patient care possible. We are excited to embark on this learning process with you! A few things:

• IF YOU HAVE SYMPTOMS, PLEASE STAY HOME. Notify Drs. Bissell and Rohan-Minjares. Continue to fill out the email attestation.

• Wear your own mask to clinic. Check in at the nurse’s station for temperature check and another symptom check.

• Bring your computer and power cord every day • Sign up for Tiger Connect ASAP. We will use this to communicate with you during clinic. • Sign up for you Telehealth Zoom account. You may use your own account or you may be asked

to sign in with your preceptors account. • Find a spot to eat lunch on your own. Our outdoor patio is nice!

PPE

Once you arrive at clinic, you should get a new procedural mask and use this for that day’s clinical work. If it gets soiled or damaged during the day, please replace it.

On your first day, you will receive TIDI shields (eye shields) which you will use throughout the

rotation. These can be cleaned every few days. If they get damaged, you’ll get a new pair.

Space – During normal times, you would be sitting side-by-side with your preceptor. During COVID, we need to do our best to distance from one another. We are going to try to designate a private space for you to work each day. When you need to present to your attending or resident, this can be done face-to-face, again doing our best to maintain distance. We may not always have a private space. When that is the case, do your best to distance and keep your mask on. Please wipe down your space when you are done in the area for the day. Seeing Patients:

We know that COVID transmission risk increases in when people are together for more than 15 minutes indoors. Please be mindful of this and try to limit your time in the room with patients

for 10 – 15 minutes. This is not our usual standard, but all of us are practicing this at this time.

Be mindful about your physical exam. If you need to do an HEENT exam and patient needs to take mask off for that, plan to do that exam with your preceptor to limit exposure time.

Think: What parts of the physical exam really need to be done? This is good clinical reasoning practice!

Sometimes patient’s masks slip down their nose. Practice what you’ll say when this happens.

Consider, “Just to keep both you and me safe, will you please pull your mask over your nose?

Thanks so much.”

Try to maintain 6 feet of distance from your patient during the interview. It feels awkward, but our exams rooms are big enough to do this!

Sometimes your patients who have difficulty with hearing are going to have a hard time hearing you with masks on. Do your best. You may have to speak louder than usual. Keep your mask on.

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Welcome to your North Valley Center for Family & Community Health

MSIII Rotation! Our goal in the 4 weeks is to introduce you to the core skills and knowledge of outpatient

Family Medicine.

If Preceptor is Absent:

Contact Dr. Rohan-Minjares and

Dr. Carrejo vcarrejo@salud.unm.edu

Clinics:

Total ½ days = 20 half days to obtain

credit for the clerkship

(approximately 5 half days per

week)

It is your responsibility to make up

the ½ day(s) that you miss and

meet the required total number of

clinics.

If you need to make schedule

changes, contact Drs. Rohan-

Minjares and Bissell FIRST to

obtain permission in advance

BEFORE requesting the change.

Then contact Jeff Gibson to make

the schedule adjustment.

ABSENCES MUST BE

On-site Clinics: Faculty, Resident and APP Clinics

Peds Clinic (Mon AM) – see Dr.Hsi

Procedures Clinic (Tues PM) – see

Dr. Jones

TEASC (Transdisciplinary Evaluation

& Support) – meet in 3rd Floor

Conference Room (302) in the Family

Medicine Building at 8am

FOCUS Clinic

Clinical Pharmacist Clinic

(Ray/Horne)

Adobe Clinic

FAQ Your schedules will be emailed to you

by Jeff Gibson.

Review your schedule; contact Jeff

Gibson to resolve conflicts.

Morning clinics generally start at 8am

and afternoon clinics start at 1pm.

Come 15 minutes before clinic starts

so that you can review the patient list

and arrange with the preceptor,

patients who you might see.

Most clinics are located in the North

Valley Clinic but some are off-site (see

pages 4 – 5)

Sick/Absence:

If sick or unable to make a scheduled

clinic, contact the clinic ASAP to notify.

Dr. Rohan-Minjares via phone –

264-4196

Dr. Bissell via email

ebissell@salud.unm.edu

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Learning Resources:

Learning Issues: Proper way to cite UpToDate

Marion, DW. Diaphragmatic pacing. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.

(Accessed on November 25, 2013.

H&P skills Physical exam General:

https://videos.med.wisc.edu/tags/1089

Physical Exams - specific systems:

http://www.fammed.wisc.edu/our-department/media

http://stanfordmedicine25.stanford.edu

Assessment Statements:

Create an initial problem representation (a one or two sentence summary of the pertinent

details you’ve obtained thus far)

Age + Gender + Risk Factors or Relevant Epidemiological Features + Semantic Qualifiers

Describing Acuity or Notable Qualities + Most Prominent Problem(s) (using medical

terminology).

EXAMPLE:

65 year old male smoker with history of uncontrolled DM and HTN, early FH of CAD

presents with constant squeezing chest pain, tachycardia, and EKG findings of ST

elevations in the inferior leads.

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Clinic Responsibilities

1. Meet with your preceptor for 5 minutes before clinic starts and review the patient cases of the

day.

2. Interview and examine patients (watch your time) in person or via telephone or video!

Collect and gather data (a useful tool is the H & P Data Collection Form)

Examination may be focused or expanded (to be determined with the preceptor)

3. Create an active problem list.

4. Create an assessment statement. Look back at your materials from Foundations of clinical

practice. This is a big deal now and OSCEs pay attention to this.

5. Develop a differential diagnosis with justification.

6. Develop a treatment plan.

7. Efficiently present the case in oral format.

8. Get help from your supervising physician with:

Procedures and “sensitive” exams, (PAP, rectal and painful joint) – done with your

preceptor in the room.

Physical findings that you do not understand.

9. Obtaining the delicate social history and counseling the patient on these related topics

(diet/exercise/ETOH/tobacco/Hep C/IV drug use/safe sex, etc.) are important skills you will

work on.

10. Use guidelines & templates for information. AAFP is a great place to find these!

11. See if there is a case to practice A mock OSCE on, i.e. a patient who has a c/o “knee pain”.

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Professionalism This is a significant component of your performance in the Family Medicine Clinic. Aspects of

professionalism include:

Arriving on time

Completing assignments

Taking an active role in patient care

Seeking and acting upon feedback

You do not have to wear a white coat but appropriate attire is a must! Business casual.

Common Cases: Bread & Butter Family Medicine Issues

Try to see them all!!

Acute upper

Depression/anxiety hypertension

respiratory tract Diabetes, type 2 Menopause and

infection Dyslipidemia menstrual

Addiction/ Dyspepsia/ disorders

substance use abdominal pain Obesity

Arthritis/joint pain

Elder care Skin problems/rash

Asthma/COPD Fatigue Well adult care

Back pain, acute & Genitourinary Well child care

chronic symptoms

CAD/chest pain Headache/

Every ½ day session:

Clinic Assignments

Your faculty preceptor is expecting write a note on at least one patient you saw during

each half day session. In addition, your preceptor is expecting you to have completed

one learning issue and reported back on it, in whatever manner you have previously

agreed upon.

NOT GETTING ENOUGH FEEDBACK??? EVERY FRIDAY – SEND TO Dr.

Rohan-Minjares:

o One (1) example of an H & P write-up

o One (1) example of a learning issue

**Submitting the requested H & P write-up and learning issue will assure that you

are getting feedback and guide you during the clerkship.

One (1) write-up in Powerchart (as you gain experience, you may chart on more of your

patients – negotiate this with your preceptors)

o H & P or a focused note: decide with your preceptor

o Data – labs, radiology

o Problem list

o Differential diagnosis with justification

o Assessment statement

o Plan of treatment or further evaluation

One (1) learning issue:

o May be written or oral – be creative

o BRIEF and high-yield

o Make sure you site references EVEN IF IT IS UP-TO-DATE (see how)

o Share with your preceptors either in batches or individually

o One helpful hint is to ask a good concise question

What is DM? This question is too broad (poor question)

What is the evidence that supports an A1C goal of 7% in this patient and

how does it protect them?

o Resources:

Review articles – AAFP Journal site/Up-to-Date

Original research – PubMed, etc.

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Personal Wellness Taking care of ourselves, in particular because we are caring for others so much of the time, is

very important! We want to encourage you to choose two things over the next 8 weeks that you

will do to take better care of yourself. Some examples are:

Try a new recipe

Try a new restaurant

Meditate – check out this link for some free guided meditations

Take a walk in nature/Go for a hike

Drink more water

Go skiing/snowboarding/snowmobiling

Visit the zoo

Visit a cultural site in New Mexico that you haven’t seen before

Additionally, reflection can be a useful tool for personal and professional growth. You may, if

you choose, write one reflection, about a patient encounter or an encounter with one of your

preceptors, that really touched you, made you angry, confused you or just that you feel you

want to share with another person. You will not be graded on your reflective piece but you may

replace and get credit for one of your required patient write-ups if you choose to turn in a

reflective writing piece.

Apps for General Wellbeing (apps are iOS or Android unless otherwise noted and core app is FREE)

2. Relaxation

a. Headspace – meditation for health and happiness, refreshingly plain

b. Saagara (free) – Pranayama breathing teaching

c. Calm.com - guided meditations for sleep, focus, calm, no mystic talk!

d. Relax melodies: sleep – fall into a deep restful sleep

e. Digipill – the road to inner calm…

1. Fitness

a. Fitstar – gives you focus on specific routines

b. Myfitnesspal- you will be shocked by the calorie counts

c. Sworkit – a plethora of guided workouts to fit the time you have

d. Scientific 7-min workout -

i. on phone access: well.blogsnytimes.com/projects/workouts/

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3. Mindfulness

a. Re-mindful - random reminders to smile, breath or just be

b. Breathe (tools for peace) – self-reflection, check emotions, and meditation matched to

your current mood

c. Happier – community blog, gratitude journal, focus on the positive!

5. Lifebalance – visual calendars that help you be cognizant of how you spend your time to achieve a healthier lifestyle

a. Candooit -

b. Life-Clock

c. Owaves - ipad only

4. Yoga

a. FitstarBasic – yoga – “yoga meets you where you are”

b. Pocket Yoga by Rainfrog – variety of workouts for a variety of levels

c. Yoga.com: 300 Poses &Video by Plus Sports - you will never have to miss a yoga

class again

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H&P Template