1. Kathryn Chappelle, MA Anita Taylor, MA Ed Shawn Blanchard, MD William Toffler, MD Teaching Family Medicine in a Family Medicine Clerkship Oregon Health & Sciences University

2. Common Methods of Teaching “Family Medicine” Preceptorships Didactics on common clinical problems Problem or case-based learning Community projects OSCE’s Learning Activities with Simulated Families Sessions on Communication and Psychosocial Skills Shelf or Clerkship-specific exams Etc.

3. Problems with Preceptorships as “Family Medicine” Variable clinical experiences don’t reflect depth and breadth of specialty --urban vs. rural practices --OB vs. primarily adult or senior practices --preceptors with special interests --hospital vs. only outpatient care Variable enthusiasm/attitudes of preceptors

4. Family Medicine Myths Students form beliefs about Family Medicine based on very limited exposures. (Blind men and elephant phenomenon) They believe family physicians --don’t do hospital care (or can’t get privileges) --don’t do maternity care (or can’t do C-sections) --get paid much less than other specialties --don’t manage complicated medical problems --aren’t respected by other physician specialists

5. SO HOW DO WE TEACH THE PHILOSOPHY AND CENTRAL VALUES OF FAMILY MEDICINE?

6. OHSU Chairman’s Sessions Currently in seventh year 4 1-hr sessions per Clerkship Each student assigned one principle and gives brief presentation based on learning activity Presentations engender discussions Discussions of various preceptor practices illustrate core FM principles Focus is on teaching ALL students about FM, not on “recruitment”

7. The Fundamental Principles of Family Medicine Access to care Continuity of care Comprehensive care Coordination of care Contextual care

8. Chairman’s Sessions in a Five-Week Clerkship Preceptorship: 28 hours per week (minimum) Thursday Curriculum:27 hrs per rotation  4 PMR sessions 12 hrs  1 OSCE 4 hrs  4 Clinical Problem sessions 6 hrs  4 Chairman’s sessions 4 hrs  Videotape Self-review1 hr

9. Evaluation = A Necessary Ingredient 100% attendance/participation Chair’s sessions 10% of final grade Combination presentation, participation, and essay grade Provides look at students’ reasoning/ writing skills, willingness to learn, and professionalism

10. What do students think?

11. Positive Feedback from Students Appreciate personal interest of the chair Chair speaks to many issues relevant to their future practice of medicine Chair is charismatic speaker and great storyteller Chair generally well liked and respected

12. Negative Feedback from Students Sessions are “just like PCM”: nothing new Chair talks either too much or not enough Essay and assignments seen as “busywork” Time spent in these sessions “excessive” Discussions are too short Clinical didactics or patient care more valuable: what they “really need” right now

13. Revisions Over 6 Years Access to care session moved to 2 nd Year Students only required to do one activity Required, formal brief presentations Participation changed to group grade Essay now write-up of presentation activity Chairman as expert resource, not discussion facilitator

14. Student Ratings of Chairman’s Sessions 1999-002000-012001-022002-032003-042004-05 Quality of student discussions 3.64.13.94.33.9 Effectiveness of didactic presentations 3.74.03.94.33.93.7 Overall quality of learning experience 3.53.9 4.333.83.7 For Comparison: Clinical Session Scores Average 4.5 overall Non-Clinical Session Scores Average 3.6 overall (Rating Scale:1=Poor, 3=Satisfactory, 5=Outstanding)

15. Where do we go from here? Are we REALLY teaching Family Medicine better as a result of these sessions? Any evidence myths have been dispelled? Could these be replicated in other clerkships? Are these “chairman-dependent,” or could any faculty member lead these sessions? Other ideas on providing a context for teaching the specialty--not just the practice?