Family Medicine

Student Competencies

Although the Family Medicine Clerkship will be conducted at a variety of clinical sites in different settings, all students are expected to accomplish a core group of competencies. These competencies are based in three major domains: Patient Care, Health Promotion and Disease Prevention, and Professionalism.

DOMAIN A: PATIENT CARE

Competency 1:
Provide personal care for individuals and families as the physician of first contact and continuing care in health as well as illness.

Example: You will be expected to assist your preceptor in performing an initial history and physical on each patient. You will provide an assessment and plan for each problem encountered, whether they be biomedical or psychosocial in nature. In family practice, this process might involve working directly with the patient's family to obtain additional information. At times, you might have to make additional phone calls, or even a home visit with your preceptor to best serve your patient.

Competency 2:
Consider, understand and incorporate principles of family medicine into patient care.

Example: You might encounter patients in which biomedical and psychosocial problems are overlapping. In such a case, you could consider setting up a family conference between your patient and his/her family, and you and your preceptor. You might also want to help patients find resources outside of the medical community that might significantly impact their medical care, e.g., social, legal, or financial services.

Competency 3:
Assess and manage acute and chronic medical problems frequently encountered in the family practice setting.

Example: You will be expected to utilize a problem solving approach for each patient you see and construct not only a problem list, but also a plan for each problem. Once you have reviewed your plan with your preceptor, you will then write your SOAP note. Over time, you should begin to feel like you are developing your own “style” of problem solving.

Competency 4:
Provide continuous as well as episodic health care not limited by a specific disease, patient characteristics or setting.

Example: Unlike other clerkships, you may see certain outpatients on multiple occasions. Patients you see may be entirely healthy, but simply require anticipatory counseling or other health advice. Your visit may even occur outside of the office, i.e., in their home, school, skilled nursing facility, or other location. One of the advantages of continuity is that you not only get to know your patient better, but you can “work up” your patient in a more stepwise and cost-effective fashion.

Competency 5:
Describe the impact on economic and health insurance issues on patient care.

Example: You will need to consider the cost of each medication you prescribe. Is there a less expensive alternative? Often this will have an effect on compliance. Likewise, consider the cost of each test you order. Is the test outcome going to change how you treat the patient?

DOMAIN B: HEALTH PROMOTION AND DISEASE PREVENTION

Competency 1:
Provide anticipatory guidance using education, risk reduction and health enhancement strategies.

Example: Given the breadth of family medicine, you will need to learn about issues of prevention and health promotion at each age across the lifespan. For instance, you will have to decide which area of prevention you want to focus on in an office visit. For an elderly patient fall prevention may be more important than dietary counseling or smoking cessation.

Competency 2:
Incorporate nonpharmacologic, behavioral approaches in the management plans of common chronic illnesses.

Example: You will need to learn about providing “prescriptions” for exercise, dietary changes, or smoking cessation. You might want to talk with patients about any “alternative” care they might be receiving, e.g., acupuncture, herbal medicine, or chiropractic treatment. Patients may wish to talk with you about whether you recommend alternative treatments.

DOMAIN C: PROFESSIONALISM

Competency:
Establish effective physician-patient relationships to provide quality health care and understand the therapeutic role these relationships confer.

Example: You should spend time learning about your patient's cultural background and reflect how cultural practices might affect your interaction with different patients. As you learn more about your patient's background, you may find that it strengthens your bond with the patient and enhances your ability to communicate.

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