Course Description

The motivation behind the creation of the new Primary Care Clerkship is largely twofold. First, public debates and attempts at health care reform have shed new light on the importance of the primary care physician. In addition, it has been difficult for third year medical students assigned to traditional inpatient oriented clerkships to obtain a good understanding of ambulatory medicine in their field of choice. We anticipate that a dedicated eight-week rotation through the various ambulatory arenas will facilitate career choices

The Primary Care Clerkship is a 6 week series of outpatient clinic experiences that will emphasize Medicine, Family Medicine, ER/Urgent Care, Geriatrics, Pediatrics and OB/Gyn.

Students will be paired off for most of these clinical activities. Because of space constraints at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, network hospitals will need to be utilized in certain instances. For example, New York Hospital Queens will be used for Medicine and Pediatric rotations. New York Methodist Hospital and Lincoln Hospital will be used for OB/GYN. Brooklyn Hospital clinics will be used for all Family Medicine rotations. Emergency Room rotations will generally end at 7:30pm, but students will have occasional half day free slots. During one of these free slots many students will be assigned to a blood pressure screening at the Stanley Issacs Senior Center.

The learning objectives of the clerkship are as follows:

Objective #1:
Students will learn to diagnose, generate differentials and initiate cost-effective management strategies for a broad array of common medical conditions and chief complaints that present in the ambulatory setting.

Plan:
Students will participate, with preceptor supervision, in the care of acutely symptomatic out-patients. Examples of appropriate and important chief complaints to focus on include: cough, dizziness, palpitations, chest pain, dyspnea, upper respiratory symptoms, fever, chronic fatigue, abdominal pain, diarrhea, GI bleeding/anemia, dysuria, vaginitis, sexual dysfunction, joint/neck/lower back pains, headache, leg edema, red eye, common dermatologic issues such as acne, fungal infections and dermatitis. Students are expected to have at least five such urgent visit/chief complaint-oriented encounter.

Objective #2:
Students will be able to manage multiple chronic medical diseases and risk factors in an ambulatory setting.

Plan:
Students will be exposed to patients who are being sequentially followed for chronic diseases such as hypertension, diabetes, lipid disorders, congestive heart failure, asthma/copd, thyroid disease, osteoporosis, renal insufficiency. Students should have exposure to five (5) such patient encounters where chronic disease and medical comorbidity management is emphasized.

Objective #3:
Students will foster health promotion by applying appropriate well care guidelines for specific patient populations and counseling about specific patient behaviors.

Plan:
Students may participate in the application of immunization guidelines for pediatric and adult patients and may participate in discussions regarding cancer screening protocols for breast, colon, cervical and prostate cancers. Students may participate in counseling patients regarding diet, obesity, exercise, smoking cessation, drug and alcohol abuse and safe sex. A minimum of five (5) such encounters, where well care and counseling is emphasized, is expected.

Objective #4:
Students will elicit psychosocial histories and functional assessments from patients with preceptor supervision and recognize psychiatric illness in a medical practice.

Plan:
Students will perform functional assessments on elderly patients during the scheduled geriatric activities. Students will be exposed in the various clinics to patients who suffer from depression, anxiety and somatization. Five (5) such patient encounters is expected.

One of the fundamental goals in the design of this clerkship has been to ensure an active learning experience for each student. In most instances, the student will be the first person to see the patient. Often patients have been specifically scheduled to see you, therefore ATTENDENCE IS MANDATORY!! In most clinics, you will not be merely shadowing a resident or attending physician. This would allow you only to passively observe the care they are giving their own patients. Instead, you will function very much as an intern. You will be asked to complete a history and physical examination on a patient, after which, you will be supervised by an attending or resident physician in the clinic.

A seminar series will complement the clerkship clinical experience. Two half-day sessions per week have been set aside for all the students to meet with the faculty. This session will be held on Tuesday mornings and Friday afternoons. These didactic sessions will draw heavily from readings from the required textbooks. Assessment of students will be based upon evaluations by attendings that have supervised the students in various clinics, as well a final written examination and an essay based take-home examination.