Family medicine is an essential component of the primary care infrastructure of the US health care delivery system. This primary care specialty provides first contact, ongoing, and preventive care to all patients regardless of age, gender, culture, care setting, or type of problem. Family medicine clinical experiences allow students to understand how context influences the diagnostic process and management decisions. Students learn the fundamentals of an approach to the evaluation and management of frequently occurring, complex, concurrent, and ill-defined problems across a wide variety of acute and chronic presentations.
Every medical student should have a third-year family medicine clerkship in addition to any earlier primary care experiences. Experiential learning in primary care and the principles and methods of family medicine provides essential patient care knowledge and skills necessary for generic medical school development, regardless of ultimate career choice. By the third year of training, students should have developed the basic skills and cognitive structures required to understand the content of a family medicine clerkship and the role of family physicians in delivering this type of care. Family medicine clerkships across the country provide a wide variety of educational experiences, due to the breadth of care provided by family physicians. In a positive sense, this breadth gives clerkship directors the autonomy to address regional variation in prevalence of diseases, supplement areas of need in their medical schools' curriculum, and infuse content with their faculty's preferences. These curricular differences, however, also limit the ability to consistently describe the clerkship's unique contributions to the medical school's curriculum and to provide focus for national subject examinations and national curriculum resource materials.
To address these limitations, the Society of Teachers of Family Medicine 2008–2009 president, Scott Fields, MD, MHA, convened a task force to define the objectives and conditions for a core family medicine clerkship curriculum. Through an iterative process of meetings and feedback, the task force developed a list of common and important patient problems frequently encountered in the family medicine office. This document can serve as a guide for clerkship directors and describes a minimum standard training experience that could be linked to a national subject examination and supported by national resource materials. The task force includes members of the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the American Academy of Family Physicians, the Family Medicine Curriculum Resources project, and fmCASES—a set of virtual patient cases.
This document, the Family Medicine Clerkship Curriculum, is a set of learning objectives and common conditions tied to one of three types of office visits—patients presenting for acute, chronic, or preventive care. It is not a list of all possible patient presentations that family physicians competently manage. In addition, although we address complexity, including patients with multiple concerns, various psychosocial issues, and different, sometimes conflicting behaviors that influence their health and health care, the task force did not attempt to capture this complexity. Clerkship directors must weave some of this content into the curriculum as appropriate for their individual medical school curricula, students, and times of the year.
In addition to the acquisition of content knowledge, students should also build skills during the family medicine clerkship. In most family medicine clerkships, less than 50% of the student's grade is based on a knowledge assessment. The Family Medicine Clerkship Curriculum includes historical assessment, physical examination, communication, and critical thinking and decision-making skills.
Teaching these skills involves hands-on training, and assessing these skills requires observation. Students usually come to the clerkship with prior instruction in basic physical examination skills. Students learn advanced physical examination skills and how to interpret physical examination findings during the entirety of clinical training—not just in the family medicine clerkship. However, based on the prevalence of musculoskeletal conditions seen in the family physician's office, the task force believes that the family medicine clerkship should teach and assess the musculoskeletal examination specifically in addition to global physical examination skills. Several developmentally appropriate skills in communication and clinical reasoning are also included because of the key nature of these skills in family medicine.
This document is divided into clerkship goals and objectives; student learning objectives; principles of family medicine; overview of office visits; core presentations for acute, chronic, and preventive care; and the role of family medicine. Within many of these sections are key messages and student learning objectives. Additional topic-specific objectives can be found in the tables. Following many of the objectives, we include a designation for the corresponding ACGME competency. These appear as abbreviations in parentheses for the competencies of problem-based learning and improvement (PBLI), professionalism (PR), and systems-based practice (SBP). We did not highlight the remaining competences of medical knowledge, patient care, and interpersonal communication because we believe that all objectives incorporate these aspects.