Family Medicine Principles

from John W. Saultz, Textbook of Family Medicine (New York, McGraw-Hill, 2000)

• Access to care
  • under- and over-utilization of services
  • barriers
• Continuity of care
  • chronologic
  • geographic
  • generalism
  • continuity for families
• Comprehensive care
  • scope of practice
  • extent of services
• Coordiation of care
  • referral
  • in-office systems
• Contextual care
  • family
  • community
  • social
  • ethnic
  • belief system

One-Minute Preceptor Microskills

Call on Sunday Generates Rounds on Monday

• Get a Commitment
  • Ask, "What do you think is going on?" and "What do you want for it?"
• Probe for Supporting Evidence
  • Ask, "How did you arrive at that conclusion?"
• Teach General Rules
• Reinforce what was Right
• Correct Mistakes

Neher JO, Gordon KC, Meyer B, Stevens N. A five-step "microskills" model of clinical teaching. J Am Board Fam Pract 1992; 5:419-24.
Moser SE. "Mnemonic Helpful for Preceptors." Family Medicine, January 2001; 33(1):8.

Questions for Reflection:

• What would you do the same next time?
• What would you do differently?
• What insight did you gain about the patient? About yourself?
• What similarities do you see with your prior experience?
• What differences do you see?
• What surprised you? Why?

Evaluation Using the GRADE Strategy

from Langlois JP, Thach S. Family Medicine March 2001; 33(3):159-160

• Get Ready
  • review course goals and objectives, evaluation form, decide what you expect from the student
• Review Expectations with the Student
  • orient student to your practice, set learning goals
• Assess
  • 1-Minute Preceptor, observe student, frequent direct feedback
• Discuss Evaluation at the Midpoint
  • formal session, strengths, problems, new learning goals
• End with a Grade
  • complete form before formal 1-hour session, use specific examples

SOAP Approach to Problem Interactions

Lanolis JP, Thach S. Managing the difficult learning situation. Family Medicine 2000; 32(5):307-9.

• S: What do others say? Student self-assessment?
• O: What specific behaviors do you observe?
• A: Differential diagnoses to consider
  • Cognitive (information, learning problem)
  • Affective (anxiety, fear, anger)
  • Valuative (expectations, value of rotation)
  • Environment (orientation, available experiences)
  • Medical (illness, depression, substance abuse)
• P: Plan to get more information, intervene, or get help