Welcome to the ECMH Phase 2. The next year of your medical school career will be both challenging and immensely rewarding. By continuing to immerse yourself in the longitudinal care of patients with the continued guidance of expert faculty and resident educators, you will emerge with the core skills that will make you a successful resident and future physician. And, we hope that you will continue to experience the challenges and rewards of a life as a primary care physician.
Phase 2 ECMH has two major components, the continuation of your 4-year longitudinal experience in a primary care office as well as the Integrated Primary Care block. You will continue your bi monthly attendance at your ECMH. The focus in Phase 2 ECMH is the continued care of patients longitudinally, focusing more on patients with complex chronic medical and psychosocial issues. You will move your focus from gathering data via the history, physical and EHR, but also independently developing the assessment and care plans, with feedback from your preceptor. You will be the manager of ‘your’ patients EHR, managing their problem list, keeping them up to date on health maintenance issues and coaching them to improved health. To supplement this year you will take the 2 week IPC block. This block will be compromised of attendance at your ECMH as well as an alternate primary care clinic to be exposed to the breadth of primary care. Other clinical experiences will be in geriatrics, lifestyle medicine and chronic specialty care clinics e.g. heart failure, copd, diabetes. There will also be case based conferences on important topics in the ambulatory care of patients. Patient care conferences focusing on the issues of High Value care, Equity and Advocacy and MDM will round out the experience.
In addition to the above activities, students will be responsible for completing and actively maintain their online clerkship log to ensure they are completing the clinical requirements of the clerkship; they will also take the end of rotation Objective Structured Clinical Examination (OSCE) and the NBME Subject Examination at the end of the year.
FSM Program Objectives (Competencies)
Clerkship Goals & Objectives
Detailed Goals and Objectives
Find comprehensive ECMH Phase 2 Clerkship Goals and Objectives.
Assessment and EPAs
ECMH includes the Longitudinal portion as well as the two week IPC (Integrated Primary and Specialty Care Block). There will be one final grade at the end of Phase 2
Students are responsible for being aware of the following assessment policies:
- Assessment policy for Phases 2 & 3 (per AWOME)
- Examination policy per AWOME
Section I: Components of the grade
Your clerkship grade will be derived from the following components:
% towards final grade
Faculty clinical performance assessment
Patient care conference (HVC)
Patient care conference (Advocacy)
Ambulatory Medicine Shelf (NBME)
OSCE (Motivational Interviewing and Chronic Care)
Professionalism (see below)
*presentation during IPC 5%; presentations at ECMH 2.5 %
**Pass is above the 10th percentile nationally
*** required to pass the clerkship
A. Clinical Score: from the CPA form.
Your numerical grade will be derived from the following components of the CPA
- History taking and physical examination (H&P)
- Clinical reasoning (CR)
- Written notes
- Oral presentations (OP)
- MDM and incorporation of the literature
- Contributions as a team member
The numerical grade will be compiled with the following formula, scaled to 50 points:
Communication + (AdvocacyX2) + H&P + (CRX1.5) + Written notes + Oral presentation+ MDM+(TeamX1.5) = Total * 1.28 = Points towards grade
Example formula with maximum score earned:
Communication(3)+Advocacy(6)+H&P(4)+CR(6)+Notes(4)+OP(6)+MDM(4)+Team(6)=Total (39)*1.28 = 50
The written comments on the CPA will be available for you as well.
Based on the clerkship director’s assessment of rating patterns of faculty and residents, as well as other extenuating factors (e.g. professionalism issues) the clerkship director may modify the final clinical grade.
The OSCE will have one motivational interviewing case and one chronic care case. These will be assessed. It will also include several cases that are practice for the Clinical Skills exam.
The Ambulatory Medicine Shelf Examination covers a broad range of topics from the outpatient perspective, focusing more on preventive issues, guideline based care than the Medicine Shelf, though it encompasses the same topics. The final examination will be offered between January and April 2020. It is a web-based shelf exam. A score above the 10th percentile of nationally is required to pass. Students are required to pass the shelf to pass the clerkship but exam scores are not calculated into the grade.
D. Patient care cases
- Patient care conference (HVC): students will present cases morning report style and then present a teaching point related to principles of high value care/cost of care.
- Patient care conference (Advocacy): students will present cases morning report style and then reflect on the principles of advocacy and equity and the relationship to their case.
- MDM: students will create a well focused question, explore and critique the literature in an oral presentation to their peers.
E. Quality Improvement project
- Active participation in the planning and execution of the project with your peers. Completion of a poster.
Section II: Calculation of final grades
The pass/fail cutpoint will be determined by a standard setting meeting at the end of the year.
Requires extra time**
* When a numerical score falls closely between two grades, the clerkship director will evaluate all components of the student’s performance to determine the final grade.
** A clerkship director may decide a student needs additional time on the clerkship to meet the objectives. The amount of time needed will vary. In this case, the grade will be “Pass” and the number of additional weeks needed will be noted on the transcript.
*** A grade of fail will be given in the following circumstances.
- Failing the NBME shelf exam three times.
- Being unable to meet the clinical requirements of the clerkship after completing additional time twice.
- An egregious professionalism issue.
High Performing Student Behaviors
- Accountable, professional and motivated.
- Generally are able to consistently perform a complete history and physical even on complicated cases. They are able to present this patient in a well-organized fashion including retrieving pertinent information from the medical record. They are easily able to determine important issues in primary care visits and be able to focus their history, physical and plan accordingly.
- Have a strong knowledge base and are able to formulate differential diagnosis, diagnostic and often therapeutic plans.
- They are independent learners continuing to read extensively and use the literature to advance their knowledge base and teach their peers.
- In Patient care conferences they are active participants adding to the differential diagnoses of other students’ patients, using excellent knowledge base to offer sound diagnostic, therapeutic options. On their own patients they can review the differential clearly for their peers, they bring in appropriate teaching points related to the designated topic.
- Their MDM project reveal extra effort with good-evidenced based references, thoughtful insights or conclusions. Their handouts and presentations are well organized and succinct.
- They elicit and respond to feedback by incorporating it into their performance.
- They mentor and teach junior students at their longitudinal site
- They have a few patients that they follow longitudinally between routine office visits
- They attend ECMH regularly spreading their sessions out during the year, without missing large blocks of time.
Low Performing Student Behaviors which may result in a failure
- Accountability may be low. They may not respond timely to emails. They attend ECMH sporadically often missing extended periods of time.
- These students often have clinical skills that are reported to be below expectations i.e. they often cannot do complete histories and physicals even on routine cases. They have difficulty differentiating pertinent issues in the primary care setting. Their presentations and write-ups may be disorganized and incomplete.
- They may have poor participation in Patient care conferences, less frequently adding to the differential diagnosis or being inaccurate.
- They may fail the examination (score <10th percentile of National mean.)
- They often fail to change behavior after feedback and/or are defensive.
- These students cumulative point score falls below the passing mark.
A student who requires extra time is one who:
- Accountability may be low. They may not respond timely to emails. They attend ECMH sporadically often missing extended periods of time, and below the minimum required sessions.
- Are unable to complete work-ups or elicit pertinent information on routine ambulatory primary care cases.
- Is unable to formulate a relevant differential diagnosis and treatment plan on routine cases, even with prompting and guidance.
- Is unable to perform a physical examination and is unfamiliar with the proper examination techniques.
- Demonstrates an extremely poor knowledge base.
- Is unable to perform daily clinical care duties, despite regular prompting and guidance.
- Demonstrates unethical or unprofessional behavior. Other professional grounds for failing include dishonesty, unexcused absences or poor work ethics including willful negligence in patient care duties.
Required Clerkship Clinical Experiences (Clerklog)
Students will be provided with a list of articles and textbook which cover common general medicine topics. They will also have case based conferences on outpatient management of key disease processes and care of the patient with chronic diseases The Aquifer IM casesare also available for students to use throughout the year, and cover core knowledge issues. The Aquifer HVC and the Dell High Value Care modules are available as well.
Frequently Asked Questions
What are the daily expectations for a M3 on this clerkship?
Students will be seeing patients almost exclusively in an outpatient setting. They will need to be efficient as often the entire visit is 20-30 minutes and patients may often more than one concern. They will be doing multiple succinct bedside presentations daily. They should move beyond reporting the history and physical during their oral presentations and focus on creating a detailed assessment and plan.
What is the typical schedule (number of days worked/hours per day) for this clerkship?
Each ECMH is on a Monday through Friday, generally 1 pm to 5:30 pm however a few clinics start later in the day. Each student attends approximately every other week from August – May and intermittently in June or July.
What is pre-rounding? Rounding? Note writing expectations for this particular clerkship?
For many ECMH there is a POW or scheduler who assigns students to each patient. Each student should remotely review the patient’s charts they will be seeing in ECMH the night prior. The day or two after clinic they also should review labs/tests they ordered on patients they saw in the previous session, discuss the plan with their attending and follow up with the patient. Students are also expected to write a note on every patient they see in ECMH.
What does “Call” mean on this particular clerkship?
What do I do if I have a question about my clerkship grade?
If you have a question about your clerkships grade you should discuss this directly with the clerkship director.
What do I do if I have experienced or witnessed Student Mistreatment during this clerkship?
If you have experienced or witnessed student mistreatment, there are many avenues to report this. You can discuss this with the clerkships director, mentor, any of the deans or Lisa Rone, MD, the ombudsperson.
What do I do if I feel burnt out or overwhelmed during this clerkship?
If you feel burnt out or overwhelmed during a clerkship there are a number of people you can speak with. The clerkship director, your mentor or anyone in the dean’s office are available to talk. CAPS can also be extremely helpful in this situation. You can contact CAPS at 847-491-2151.
Who do I contact if I am sick or have a personal appointment?
Contact the Clerkship Director, clerkship coordinator and preceptor. The student needs to let all three know. Each missed session needs to be made up on an alternate week or a different day at the preceptors discretion.
Any required equipment?
Policies and Procedures
For faculty and residents
- Safe and Healthy Learning Environment
- Medical Student Supervision and Level of Responsibility Policy
- Duty Hours Policy
- Assessment and Health Providers Policy
- Non-Discrimination Statement
- Non-Retaliation Policy
- Assessment Policy for Clerkships & Electives (Phases 2 and 3)
- Visiting Resident Policy
- Phases 2 and 3 Attendance Policy and Procedure
- Patient Caregiver Preferences and Refusal of Care by Caregivers Policy
- Performing Sensitive Physical Exams Policy
- Needle Stick and Other Blood-Borne, Body Fluid, and or Respiratory Pathogen Exposure Policy
Jennifer Bierman, MD