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Residency Faculty Applaud Smiles for Life

Oral health is essential to overall health and well-being.¹The “silent epidemic” of dental and oral diseases continues to affect the country’s most vulnerable citizens often leading to other health problems such as heart disease, heart attacks, strokes, and respiratory disease.^2,3

Fred Miser, MD, program director at the Ohio State University FMR sees the importance oral health plays in relationship to overall health and has implemented Smiles for Life Oral Health Curriculum into his residency. “We didn’t have an oral health curriculum prior to implementing Smiles for Life. It provides a fairly comprehensive overview of teeth care from infants to elderly. It's very applicable to primary care, giving us what we need to know as family physicians to promote oral health to our patients," said Dr Miser.

Stephanie Gill, MD, a second-year faculty development fellow at UPMC St. Margaret Family Medicine Residency Program chose to implement Smiles for Life into her residency as a curriculum development project. "Because so many of our patients do not receive regular dental care and I noticed that residents didn’t feel comfortable with oral health problems, I thought it was important that we emphasize more oral health in our residency curriculum," said Gill.

This year, UPMC St Margaret Family Medicine Residency implemented the entire Smiles for Life lessons during a half-day oral health seminar. "I asked our local faculty each to take a different module based on their personal interests and present it. The Smiles for Life modules were so helpful because our faculty didn't have to spend extra time researching the topic and putting together a presentation. It was already done for them," said Gill. "We also did interactive sessions—practicing an oral exam, applying fluoride varnish, Q&A, discussions. It was a high-yield morning."

Gill stressed the curriculum's comprehensiveness and value to family medicine educators. "The curriculum is evidence-based and well-organized. The modules can be done on your own time or in PowerPoint format. The program also has all sorts of supplementary materials and resources—posters, pocket cards, videos, and more."

Gill sees Smiles for Life as a positive move for her residency. "While it is early in our residency program's emphasis on oral health, I am beginning to see more fluoride varnish being done in the clinics and slightly better recognition of oral health problems," Gill added. "Residents get excited to share with me what oral health problems they identified in clinic that day or when they applied fluoride varnish on a patient and how it went. I have been working with them to improve in-clinic preventive counseling and their documentation of oral health assessments and problems." With continued reinforcement, Gill is optimistic that these practices will continue to grow and the residents will take the knowledge they've learned through Smiles for Life with them into their future practice.

The National Interprofessional Initiative on Oral Health recognizes Smiles for Life as their core curriculum for integrating oral and general health. NIIOH is a consortium of funders and health professionals whose vision is that dental disease can be eradicated. The American Dental Association has commended Smiles for Life for providing a common resource and central website for health professional education on oral health.

A product of the Society of Teachers of Family Medicine, Smiles for Life Oral Health Curriculum is also officially endorsed by American Academy of Family Physicians, American Academy of Pediatrics, American Academy of Physician Assistants, Association of Faculties of Pediatric Nurse Practitioners, National Association of Pediatric Nurse Practitioners, and the Physician Assistant Education Association.

References:

1. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

2. Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 1988–1994 and 1999–2004. Vital and Health Statistics Series 11, Number 248. Hyattsville, Md.: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2007:67. DHHS publication PHS 2007-1698.  

3. Grogan, Martha, MD, “Heart disease prevention: A link to oral health?” MayoClinic.com Aug 26, 2010

You've All Decided — Top-rated Sessions from the 2011 Annual Spring Conference Revealed

All the evaluations have been tallied, and we've identified the three top-rated educational sessions presented at the 2011 Annual Spring Conference in New Orleans. Click on the session titles below to access the presentations' meeting PowerPoints and handouts.

Great Precepting: Three Essential Tools for Outstanding Teaching Moments
Belinda Fu, MD, Valley Medical Center FMR, Renton, WA, Nancy Gray Stevens, MD, MPH, University of Washington

Precepting, ie case-based teaching in a clinical setting, is the most frequent teaching scenario for a family medicine educator, yet we are infrequently taught how to precept. This seminar will familiarize educators with three core models about student learning and clinical teaching (PRIME, SOAP Bucket, and Teaching Microskills) and then immediately give participants the opportunity to transform them into applied skills, mastering them through live practice during the seminar. Participants will learn how to easily adapt these models to their individual teaching styles and to a variety of teaching settings. The seminar will set the stage for participants to continue developing these skills at their own residency, and will enable participants to model and teach these skills to their own learners and colleagues. By the end of this seminar, participants will be able to: 1) Quickly assess a learner's clinical skills level by applying the PRIME model 2) Structure a learner's presentation skills by applying the "SOAP bucket" model, using the technique of "backtranslation" 3) Provide efficient and effective clinical instruction by selectively applying "Teaching Microskills" 4) Develop a personal language to apply these tools in their practice.

S28: Practicing What We Preach: Using Motivational Interviewing Skills to Facilitate Challenging Teaching Encounters
Catalina Triana, MD, University of Texas Medical Branch at Galveston, Rory Bradt, DO, University of Texas Medical Branch at Galveston  

When faced with a roadblock while attending, do we give in, give up, push harder? It is easier to just tell our learners what to do, isn’t it? When we teach we are asking someone to see things from our point of view; this involves change. When learners are not ready, they resist and the interaction becomes challenging. Drawing from our clinical experience, we recognize the value of a relationship-centered style, such as Motivational Interviewing (MI), as an effective approach to minimize resistance and promote change. This seminar will demonstrate the use of MI principles and skills to facilitate a challenging teaching encounter and give the audience opportunity to practice.  

L32A: Using Neuropsychology for Effective Presentations
Aaron Michelfelder, MD, Loyola University

Have you ever wondered what colors or graphs help people learn best? This session will use PowerPoint as a model to apply adult learning theory and neuropsychology to the subtle presentation choices we make to enhance student learning. You will learn what colors, fonts, tables, art, graphs, and more will help students learn your intended lessons the best. You’ll learn about how the human retina works and how the learning centers of the brain respond to different stimuli during presentations. Bottom line: this talk will change how you construct your presentations to learners.

STFM Is Saddened by the Recent Deaths of Two Leaders in the Discipline

Barbara Starfield: A Primary Care Champion

Barbara Starfield, MD, MPH, an accomplished researcher and champion of the need for a strong primary care system in the United States and worldwide, died of an apparent heart attack on June 10. She was 78. Her research was instrumental in proving to the world, including the Administration, why primary care-based health care systems are the most effective.    

She was the director of the Johns Hopkins University Primary Care Policy Center, a member of the Institute of Medicine, and was the author of two landmark books regarding primary care: Primary Care: Concept, Evaluation, and Policy and Primary Care: Balancing Health Needs, Services, and Technology. 

However, Dr Starfield was not only a renowned researcher but a cherished mentor as well. Rebecca Malouin, PhD, MPH, director of the Primary Care Research and Evaluation Program at Michigan State University, was honored to have Dr Starfield as a mentor and a friend since 2006. “I was often asked how Barbara Starfield became my mentor. To which I simply replied that I sent her an e-mail and she responded,” said Dr Malouin.

“Through her mentoring, Barbara provided very critical feedback, not necessarily for the weak of heart, but challenged me to be a better researcher, reminding me to be grounded in established theory, yet to experiment with measurement and evaluation of new models of primary care,” said Dr Malouin. “Barbara cared deeply about equity in health care, equity that could be better achieved through provision of more and improved primary care.”

Dr Malouin stressed that Dr Starfield also cared deeply about her family. “She was not only a mentor in my professional life, but modeled the epitome of a seemingly perfect balance between professional and family life. She was fortunate to have a wonderful husband, four children, and eight grandchildren," explained Dr Malouin. “In late May, I had the opportunity to spend a few days with her and her family in their home in California. I witnessed her energy and love as she cared for two of her grandsons in the mornings and evenings before and after their preschool. She shared with me her pride in the accomplishments of her children and grandchildren.” “Barbara has mentored generations of primary care health services researchers. We all mourn her passing, but have committed to one another to carry on her work. We hope that this work will enable her spirit to live on and inspire others to continue in the path she pioneered,” said Dr Malouin.

We'd like to share a letter of tribute from Richard Roberts, MD, JD, president of World Organization of Family Doctors (Wonca). Also see the news release from Johns Hopkins regarding memorial arrangements. If you'd like to donate to the STFM Foundation, in memory of Dr Starfield, visit HERE.

Thomas Stern: a Family Medicine Founder

Thomas Stern, MD, a founding father to the specialty of family medicine, died May 28 at age 90. Dr Sterns shaped US family medicine residency training through his work as founder of the Residency Assistance Program (now Residency Program Solutions) at the American Academy of Family Physicians (AAFP).

"Tom Stern is largely responsible for the modern residency program as we know it. He was the first person I ever heard describe the “model family practice center” to be used for residency training, and he was a champion of preserving comprehensive care and continuity of care, even during residency training," said Joseph E. Scherger, MD, MPH, Vice President, Primary Care and DIO, Eisenhower Medical Center, as he recalled how Dr Stern introduced him to the new specialty of family practice when he was a 21-year-old first-year medical student at UCLA. "He nurtured my career by inviting me to give my first major presentation as a medical student—talking to practicing family physicians and urging them to become teachers for the many new residency programs emerging in the early 1970s."

Stern received his medical degree from the Oregon Health & Science University School of Medicine in 1950. After several years in private practice, he directed the Family Practice Residency Training Program at Santa Monica Hospital Medical Center from 1970-1974. It was during this time that he served as technical adviser for the Marcus Welby, MD, TV series.

From 1974 until his retirement in 1991, Dr Stern served the AAFP and the AAFP Foundation in many capacities including Division of Education director, director and founder of the Residency Assistance Program (now Residency Program Solutions), vice president of Education and Scientific affairs, deputy EVP, and founder of the AAFP Home Study Self-Assessment Program. He was named the first vice president of professional and corporate affairs for the Family Health Foundation of America, which subsequently became the AAFP Foundation.

Stern served as a consultant to the Surgeon Generals of the Army and Navy and as president of the California Academy of Family Physicians and the International Center for Family Medicine. His awards include the Society of Teachers of Family Medicine Foundation's  F. Marian Bishop Award, STFM Excellence in Education Award, the AAFP Award of Merit, the AAFP Thomas W. Johnson Award, and the AAFP John G. Walsh Award for Lifetime Contributions to Family Medicine.

The Center for the History of Family Medicine maintains a sizeable collection of Stern's papers and other artifacts, including his 2001 autobiography, House Calls: Recollections of a Family Physician.

See more here

If you'd like to donate to the STFM Foundation, in memory of Dr Stern, visit HERE.

STFM Annual Spring Conference Shatters Attendance Record in the Big Easy

by Stephen Wilson, MD, MPH, STFM Program Committee Chair

At the recent Annual Spring Conference in New Orleans, records were broken, people participated in fun activities, but most of all, attendees developed skills and networked with people that will help them advance their abilities to be the physicians and teachers they want to become.

This year's conference attendance of 1,297 broke the previous attendance record. There were 160 residents, 40 medical students, 220 first-timers, and 21 internationals.The international attendees hailed from Australia, Brazil, Canada, Dubai, Japan, Russia, Saudi Arabia, United Kingdom, and Vietnam. Conference attendees were of many types of family medicine teachers: family physicians, pediatricians, social workers, pharmacists, behavioral scientists, fellowship/medical school/residency faculty, community preceptors, geriatricians, physician assistants, and sports medicine providers: truly, a diverse cadre of family medicine educators.

Attendees partook of the New Orleans neighborhoods, food, and entertainment. They ran in the annual STFM Marathonaki Fun Run/Walk.They enjoyed the Welcome Reception, which featured both Cajun food and a talented jazz ensemble of locals and some STFM members, and an opening plenary session that had the music of the TBC Band and a Second Line of STFM members.  

Innovations and special happenings at STFM 2011 were:

1)     A service project to collect money and goods to support the local Bridge House.
2)     Evening With the Authors to meet authors of new family medicine-related books.
3)     A plenary consisting of young, rising leaders in our discipline
4)   A scholarship program to bring in and expose minority medical students interested in family medicine
5)     A special panel discussion dedicated to remembering  and learning from Katrina
6)    A lunch session on estate planning
7)   Poster sessions were reconfigured to enhance exposure and impact
8)   The STFM Group on Women celebrated their 30^th anniversary
9)   Informative preconference workshops on accountable care organizations, evidence-based behavioral practice, work/life balance for women in family medicine, and teaching alcohol screening, brief intervention, and referral to treatment.

The 2011 conference saw not only a record number of submissions, but an increase in the quality of presentations.Visit the STFM Resource Library to view uploaded presentations by some of the conference presenters. More being added daily.

Special STFM chocolates were provided by Blue Frog, a chocolate store owned by the wife of one of our local family docs. Special thanks to Rick Streiffer, MD, and Tulane University for being tremendous local hosts. Thanks to our conference partners for their support.

Start planning and preparing your materials for 2012. STFM 2012 will be in Seattle. Plan to be there. Come to learn, share, and recharge your academic batteries. Submission details are now available.

 

STFM Member Helps Disaster Victims in One of Hardest Hit Areas of Japan

Daisuke Yamashita, MD, instructor and clinical leadership fellow at Oregon Health & Science University, is currently working with the Japan Primary Care Association and its disaster relief project called Primary Care for All.   

Through the association’s efforts, they’ve established base camps in two hospitals in the Iwate prefecture and the Fukushima prefecture. Currently, Dr Yamashita and other physicians are working in these areas with local government to (1) assess health conditions of evacuees, (2) visiting shelters, some of which house more than 1,000 people, and providing for health checks and urgent care, (3) providing information to communities for their concern regarding radiation exposure, and (3) working with police departments with the daunting task of postmortum examination of thousands of corpses.

“The situation is transitioning to sub-acute phase, and many health-related problems are around lack of regular medicine and worsening of chronic diseases and increasing stress among evacuees,” said Dr Yamashita, a past resident representative for the STFM Board of Directors. “Many international rescue agencies and Japanese Emergency Response Teams are finishing their work, and needs are shifting toward chronic care and support for these people.”

The Japanese Primary Care Association is planning to send physicians, nurses, and pharmacists for more than 6 months and up to several years to provide continuous care for these communities. These communities will have different needs depending on different phases. “We think it is very important to provide comprehensive care to these people since they are at risk for many health-related conditions such as depression, worsening of chronic diseases, and decrease in family function, not just during the acute or sub-acute phase but also during the chronic phase,” said Dr Yamashita. “Reflecting on past experiences from a devastating earthquake in Kobe, Japan in the 1990s, we know that people may suffer many long-term problems, and we are hoping to prevent some of them by being proactive.”

Dr Yamashita is currently working in Iwate, Japan, one of the hardest hit areas. He will be developing a training program for people who are going to participate in this project. It will be a 1-day course to provide knowledge and skill to work with evacuees. “The Japanese Primary Care Association has only three full-time staff, so many of the volunteers, mainly physicians, are here to move this project forward any way we can. This includes many phone calls, gathering data, food, supplies, and information,” said Dr Yamashita.  “Many agencies and professional organizations never experienced a disaster of this scale and were not prepared. We are proud that we are able to be part of the relief efforts.”

If you would like to help the victims of Japan, STFM encourages you donate to the AAFP Foundation and its Disaster Relief Fund that is accepting donations for Japan relief efforts and the Red Cross.

Winners of the Conference on Practice Improvement Awards

The following awards were recently presented at the Conference on Practice Improvement in San Antonio, Texas.

2010 Family Practice Management Award for Practice Improvement

Cosponsored by Family Practice Management

Robert Edsall, editor of Family Practice Management, (center) presents the FPM Award for Practice Improvement to Mary Minniti, BS. CHPQ, (left) and Ralph Fillingame, MD, (right) of PeaceHealth Medical Group, Eugene, Oregon.

The 2010 Family Practice Management Award for Practice Improvement was presented to the PeaceHealth Medical Group (PHMG), a large multi-specialty physician group located in Eugene, Oregon. This award is presented to a primary care practice or practice organization that has made significant improvement in one or more of the following in the past 3 calendar years: clinical outcomes, clinical process improvement, patient satisfaction, staff satisfaction, physician satisfaction, practice efficiency, and productivity.

In 2008, the PHMG Adult and Family Medicine Division’s aim was to re-invent a practice to improve patient, physician, and staff satisfaction as well as its clinical and operational outcomes.  Two basic principles guided the design in the Innovation Pilot:  “Make it easy to do the right thing for the patient” and “All should be working at the top of their license.” 

The redesigned practice is a team-based model. At the center of the team is the patient. Purposeful efforts were made to engage the patient as the ultimate manager of their conditions. To prepare the staff for their new roles, training in patient activation, health coaching, communication, and conflict resolution skills occurred for all staff. Attention was paid to team development and its measurement. This required substantial change in the relationship of the doctor to other members of the team.  

In less than 2 years, the team has made substantial progress on all of its goals. Some of the practice changes include daily huddles, use of behavioral health coordinator and RN Care Manager for high-risk patients, follow-up for patients presenting in ER or Urgent Care within 48 hours, and improved access to health coaching by phone. As a result, the team has seen improvement in controlled BP from a baseline of 56% to 77% of patients and increased access with 68% appointment availability, and substantial reductions in ER and UC visits.This is a model that can be implemented in many practices. The tools for activation, shared decision making and the techniques for health coaching provide support to this new model of care. The model returned the “joy” to medicine for all. Hope, enthusiasm, and team work are the inspiration that keeps this practice energized and open to continued innovation. 

2010 H. Winter Griffith Resident Scholarship for Excellence in Practice Improvement and Patient-centered Care

Herb Young, MD, AAFP Scientific Activities Division Director, (left) presented the H. Winter Griffith Resident Scholarship to Ravishankar Ranaswamy, MD, MS.

The 2010 H. Winter Griffith Resident Scholarship was presented to Ravishankar Ramaswamy, MD, MS, Underwood-Memorial Hospital FMR, Woodbury, NJ. This scholarship recognizes excellence in practice improvement involving patient-centered care by an outstanding family medicine resident. The award honors H. Winter Griffith, MD, who was the author of more than 27 books, including his first book, Instructions for Patients. Dr Griffith was a strong advocate for patient engagement through patient education. Thus, this award will recognize outstanding patient interaction, education, care, and outcome by a resident in the family medicine medical home setting.

During the course of his  training in family medicine, Dr Ramaswamy undertook several practice improvement and educational projects, including evaluating physician knowledge of abdominal aortic aneurysm screening guidelines and physician screening behavior, evaluating the impact of a sequential and comprehensive education program to improve identification of delirium in hospitalized elderly patients, and devising a EMR template and office protocol to ensure all Medicare recipients receive the benefits of their Initial Preventive Physical Examination.

His experience included organizing the GMV for diabetic patients at the Family Medicine Center. The aims were to improve patient self-care in diabetes, and improve patient awareness about the disease and its comorbidities in an education model that has been proven in several settings. The overall goal of this project was to decrease diabetes-associated mortality and morbidity through reiteration of self-care goals and a comprehensive, yet patient-friendly education model. Other goals included giving medical students and training physicians the opportunity to learn the art of facilitating group visits and to enhance communication skills, to increase the involvement of community teachers in health promotion, and to evaluate effects of this activity on patient care and health and patient and provider satisfaction.

This initiative was successful in utilizing the expertise of several community and academic providers and novel teaching methods to facilitate discussion. We maintained patient-centric focus in selection and discussion of topics. Most patients felt that the GMVs were qualitatively better than individual visits, in reinforcing key principles of diabetes self-care and addressing common health concerns. Additionally, these visits ensured continuity of diabetic care, medication, and testing compliance among patients. In summary, the diabetes GMV initiative resulted in subjective improvement in patient and provider satisfaction, diabetic medication and aspirin use, blood sugar testing, and other qualitative diabetic goals.

Dr Ramaswamy said the initiative would not have been possible without the contributions of John Armando, LCSW and Suzanne VanDerwerken, MD and the residents and office staff. He would also like to acknowledge Gregory Herman, MD and his mentor Barbara Roehl, MD for providing support and inspiration in his endeavors.

Family Medicine Clerkship Curriculum – Next Steps

Family medicine is an essential component of the United States health care delivery system. A required family medicine experience is part of the curriculum of most medical schools. However, the content of the family medicine clerkship varies widely among medical schools. To develop consistency across family medicine clerkships, the Society of Teachers of Family Medicine convened a task force to define the core objectives and content for the family medicine clerkship. The task force included representatives from the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the American Academy of Family Physicians, the Society of Teachers of Family Medicine Group on Medical Student Education, the Family Medicine Curriculum Resources Project, and fmCASES, a set of virtual patient cases. This task force defined the Family Medicine Clerkship Core Content as a list of common and important presentations that students should experience during their clerkship experiences. The curriculum has five sections: principles of family medicine, acute presentations, chronic diseases, health maintenance and disease prevention, and the role of family medicine. Each section has general objectives and specific objectives for each core content condition, which are available in the curriculum document. This document was approved by the Council of Academic Family Medicine (CAFM). This initiative was funded by the STFM Foundation
.
The Family Medicine Clerkship Core Content document serves as the foundation for a national clerkship curriculum; however, it did not address many issues critical to curriculum design. In addition to content, a curriculum includes educational methods for students and faculty members; learner, faculty, and program assessment; and considers context such as the length of the rotation, types of experiences, and strengths of students and faculty members. There is a need to develop more detailed information that outlines how to deliver the Family Medicine Core Curriculum and how to assess effectiveness. In August, 2010, a second task force was formed to develop a document that outlines best practices for delivering and evaluating the core curriculum for third-year family medicine clerkships. This task force also includes broad stakeholder representation.
 
The task force met on October 7 and 8 in Kansas City with the purpose of creating a shared vision among task force members of what this type of document would be and the process by which it would be developed. The task force envisioned the first iteration to be a Web-based resource that would contain curricular content, resources for faculty members, information about educational methods, and assistance with assessment strategies.
 
The curriculum content developed by the first task force forms the first section of the clerkship curriculum. The content currently housed in a document will be moved into a Web format and will allow easy navigation among the five sections. Section pages will include topic links dedicated to core principles, acute presentation, chronic disease, and health promotion and disease prevention, and the role of family medicine. These topic links will contain the objectives for that condition along with examples of educational and assessment strategies that can be used to address those objectives. We anticipate also creating links to search The STFM Resource Library (FMDRL), multiple resources, and to query the medical student educators’ listserve (FM-PDN@FPEN.Org).
 
The resources for the faculty development page will serve to help clerkship directors and others find the resources they need to implement and evaluate curricula. We are considering a type of self-assessment that would help clerkship directors target their personal development towards the highest yield activities. We plan to provide links to several resources with quick descriptions of what those resources are, how to find them, and when they may be useful.
 
The educational methods section will provide a brief introduction to learning theory and links to various types of educational methods such as: small group discussions, experiential (participation in supervised clinical care), self-study, and others. Specific educational methods pages provide information about that method including key articles and best practices when available. We anticipate creating links to assessment tools commonly used with each specific method. As we believe that best practices may be lacking for many types of educational methods, we are considering how to harness the expertise of our discipline into blogs or wikis that can inform the development of those best practices over time.
 
The assessment strategies section will have a brief introduction to assessment and links to various types of assessment methods such as: multiple choice questions, subjective clinical evaluations, OSCEs, and others. Specific assessment strategy pages provide background information, key principles, and basics of design and grading. We hope to house some national assessment tools, thereby providing a mechanism to facilitate use of a common assessment tool across multiple sites to enhance educational research. We anticipate creating links to send questions to the medical student educators’ listserve and some type of blog or wiki for these pages as well.
 
The task force has held monthly phone conferences to flesh out the sections of the Family Medicine Clerkship Curriculum prior to the STFM Conference on Medical Student Education. This conference will provide opportunities for input from a large group of medical student educators. CAFM members will also be asked to provide their input and we plan to solicit feedback at the STFM Annual Spring Conference in April as well. We will incorporate this feedback as we continue to build the Family Medicine Core Curriculum over the next year. Our current timeline was designed to have a working Web site, approved by CAFM members in late fall of 2011 to allow medical student educators an opportunity to work with the Web site prior to the 2012 Conference on Medical Student Education. We will present an online model at the 2011 Conference on Medical Student Education to get early feedback in this process. An official launch at the 2012 meeting will give clerkship directors ample time to work with the Curriculum Web site in planning revisions for the coming academic year. 

The Family Medicine Clerkship Curriculum Implement Task Force includes Heidi Chumley, MD, chair, Patricia Carney, PhD, Susan Cochella, MD, Elizabeth Garrett, MD, MSPH, Gary LeRoy, MD, Katie Margo, MD, Christine Matson, MD, David Steele, PhD, and Beat Steiner, MD.
 
Members of the task force are looking forward to the critical input of family medicine educators to make this Curriculum Web site an outstanding resource. This initiative is being funded by the STFM Foundation and the Society of Teachers of Family Medicine.

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As a result of these initiatives, a new examination has been developed over the past 3 years in collaboration with a number of family medicine faculty members. The first step in the process included meetings with family medicine clerkship directors and faculty to gain consensus about expectations for students in family medicine clerkships, including defining the core curriculum and defining clinical tasks and responsibilities likely to be required across schools. Next, in 2005, NBME convened a Family Medicine Task Force meeting, which included members recommended by STFM and the Association of Departments of Family Medicine. At that meeting, the content specifications were changed to introduce more health and health maintenance and disease management to the exam.  

The NBME convened another Family Medicine Task Force meeting in October 2009. The purpose of the meeting was to continue the ongoing dialogue the NBME has had with family medicine clerkship directors regarding the content of the family medicine exam and how it can best reflect the clerkship experience. New items were developed and reviewed by family medicine faculty. New item development primarily focused on sequential item sets that unfold and challenge examinees to manage patients over time.

During the meeting discussion about further changes to the exam, the task force members reviewed the current content outline and specifications alongside the newly developed Family Medicine Clerkship Curriculum from STFM and the Council of Academic Family Medicine. The information obtained was used to develop draft specifications for building the new examination. The task force recommended that the new Web-based exam include a core component of 80 items plus additional modules that could be selected by each school. In addition to the core component, schools will have the option of including the following modules.

• Chronic Care (20 items)
• Musculoskeletal/sports medicine (10 items)
• Obstetrics (10 items)

The NBME staff will be facilitating a team of 10 family medicine educators who will map the Family Medicine Clerkship Curriculum to the new online exam and identify gaps where our curriculum topics are not covered by the exam. On the day following this mapping exercise, there will be a special session on Friday, January 21, from 1:30-3 pm. This session will cover the new and innovative products being developed by the NBME to assess clinical reasoning and professionalism. In this session, Aggie Butler, NBME staff, will give a 30,000 ft overview of what occurred in the mapping session.

The new examination will be available for the 2011-2012 academic year. NBME will notify schools when the exam is available. For more information, please contact NBME staff at medicalschoolservices@nbme.org.

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You've All Decided — Top-rated Sessions from the 2010 Annual Spring Conference Revealed

All the evaluations have been tallied, and we've identified the top-rated educational sessions presented at the 2010 Annual Spring Conference in Vancouver. Click on the session titles below to access the presentations' meeting PowerPoints and handouts.

Learn Experiential Methods for Teaching Interviewing, Interpersonal, and Clinical Communication Skills to Residents and Students

Laurel Milberg, PhD; Demetria Marsh, BA

Communicating skillfully with patients is a major aspect of physician practice. This is how physicians gather information, educate patients, help them change unhealthy behaviors, obtain informed consent. Often, communication, itself, is the treatment. The ACGME includes interpersonal and communication skills as required competencies faculty must teach in courses and clinical encounters. While there has been increasing data regarding the efficacy of certain educational methods to improve physician communication skills, few opportunities exist to identify and practice the skills needed to teach this core clinical skill. This seminar will arm attendees with the evidence regarding effective teaching of communication skills and help participants gain practical skills needed to teach them through a lively session of coached practice, modeling, experiential learning and feedback. (Session Code:SS6)

Everything That You Wanted to Know About Developing a Teaching Community Health Center

Warren Ferguson, MD; Scott Early MD; Beth Mazyck, MD; James Ledwith, MD; George Maxted, MD

Community health centers (CHCs) serve approximately 18 million individuals in the United States. Massachusetts has a long history as a leader in the community health center movement. Fully 60% of Massachusetts family medicine residents complete their longitudinal training at CHCs. Recent workforce research demonstrates that training in CHCs is associated with a greater likelihood of practice in underserved settings. Health reform has generated substantial policy discussion about funding for workforce training in CHCs. Yet, few understand the complexities of training in CHCs. Participants in this session will understand the core competencies of learning in CHCs and will be provided specific information about models, medical school affiliations, costs, and funding. Presenters have a combined 65 years of experience of practice and teaching in CHCs. (Session Code: L54B)

Cool Web Sites for Family Docs: Come See What You’ve Been Missing!

Sandra Harley Counts, PharmD; Stoney Abercrombie, MD

The Internet has become an integral part of the practice of medicine. In this presentation, we'll review many useful websites for family physicians. This fun, fast-paced presentation will give you tools to enhance or streamline patient care, and provide you with ideas to become a better teacher. We'll showcase Web sites that help you obtain quick, evidence-based answers to clinical questions. We’ll share a Web site for ‘one-stop-shopping’ for the various $4 drug formularies. We've got great websites for herbals and newly marketed drugs. For the faculty, we’ll show a Web site that shares lecture materials. Lastly, we’ll introduce you to the latest popular social networking sites such as Facebook and Twitter. Bring a list of your own favorites to share during the question and answer period. (Session Code: L9B)

Sometimes It IS All Fun and Games

Gretchen Shelesky, MD; Rachelle Busby, PharmD; Ruta Marfatia, MD; David Yuan, MD; Nicholas Owens, PharmD; Vincent Vargas, MD

With the new resident work rules, today’s residency education is increasingly formal. Many programs have implemented half-day didactic sessions to teach the clinical knowledge residents used to get through practical experience. Playing a game is an interactive process that fosters active learning and teamwork, and increases motivation. Teaching key points without information overload can be done by incorporating games into presentations. Satisfaction surveys show that students taught by games find it more enjoyable, stimulating and interactive. In this session, we will use a hands-on approach to walk our audience through the process of preparing PowerPoint games. Participants will leave with links to templates. Although computers are not necessary, your laptop can help maximize your hands-on experience in this session. We are Mac and PC friendly. (Session Code:S36)

Where Is the Family in Family Medicine Teaching? Identifying Best Practices Among Family Medicine Residency Programs

Eliana Korin, DiplPsic; Victoria Gorski MD; Nancy Newman MD; Amy Odom, DO

Family, as a concept, has been defined as a central value in family medicine practice and training as a way to promote contextual and relationship-centered care. This model has not evolved without challenges, particularly in the last decade, due to many changes in the training and practice environments. Yet, many family “believers” have continued to promote a family orientation in their curricular and practice endeavors. In this interactive seminar, a group of family “believers” from different programs will discuss the impact of these challenges and present specific strategies used for curriculum development and competencies evaluation to maintain a family orientation in residency training. Participants will play a key role in examining these challenges and identifying best practices in family teaching. (Session Code:SS8)

The Cultural Medicine Passport: A Portfolio Documentation of the Learner's Journey Toward Culturally Responsive Care

Jeffrey Ring, PhD; Julie Nyquist, PhD

The AAMC and the ACGME now insist that graduates of medical school and residency training must acquire competencies in the area of culturally responsive care. These new requirements make perfect sense, given the devastating health disparity morbidity and mortality statistics in the United States. This experiential workshop will provide participants with a strong rationale for the development and/or enhancement of a cultural medicine curriculum. Through experiential exercises, they will begin to acquire additional teaching strategies for the delivery of such curricula. Moreover, they will be introduced to a portfolio strategy that encourages longitudinal learner self-reflection on their progress through the curriculum which serves both as a source of evaluation as well as a stimulus for further learner-centered teaching. (Session Code:SS9)

Teaching Information Gathering Skills to the Google Generation: Emphasizing the Intellectual Rigor of Family Medicine 

Molly Cohen-Osher, MD; Kristen Goodell, MD

Students weaned on Google, Wikipedia, and Twitter are adept at using computer-based resources to obtain information rapidly. What they may need help with, however, is distinguishing useful from useless information and determining the validity of their medical information sources. The traditional information sources of medicine, PubMed and Ovid, are designed for researchers who must access primary research literature. However, there is a whole crop of new resources that aim to provide relevant and valid information in less than 60 seconds to physicians. We have developed an exercise for the family medicine clerkship to develop the skills to use these point-of-care resources while demonstrating the intellectual rigor of family medicine. (Session Code: L34A)

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Why Family Medicine? A Couple Chooses to Work With Those in Need and to Treat Patients From "Mind to Toe"

Rebecca Ryan and Jason Kurland met as students at the University of Rochester School of Medicine and Dentistry. They married in November of 2009. Rebecca and Jason, members of the Class of 2010, chose family medicine for a career and have begun residency at the University of New Mexico School of Medicine in Albuquerque. They each explain their choice.

Rebecca Ryan

At the start of medical school I had a specific, though somewhat idealized, vision of my future medical career: I was going to study infectious disease, discover new treatments for old diseases that plague the developing world, and be on the frontlines of disease outbreaks. My progression through medical school quickly began to alter my vision as I learned about the realities of actual patient needs, psychosocial determinants of health, and the preponderance of morbidity and mortality secondary to chronic diseases. 

Prior to my journey into medicine, I was a Peace Corps volunteer doing community health and HIV prevention in rural West Africa. I worked in a clinic where I saw patients with malaria, diarrhea, tuberculosis, and other infectious diseases. I began to note a close association between limited availability of health care, poor nutrition, and disease among these patients, as well as among my friends and neighbors. It wasn't until I started my medical training that I truly internalized the idea that though infectious diseases do ravage poverty stricken areas, the underlying causes of morbidity in these vulnerable populations are social determinants of health, limited education, and health care provider shortages.
"At the start of medical school I had a specific, though somewhat idealized, vision of my future medical career: I was going to study infectious disease, discover new treatments for old diseases that plague the developing world, and be on the frontlines of disease outbreaks."

More profound for me was the epiphany that resource limitations, poverty and poor health outcomes are not phenomena unique to the developing world. I was naively surprised to see these same disparities in my own neighborhood in Rochester and in pockets throughout the United States.

I had the opportunity to volunteer at URWell, the student-run clinic for people with no health insurance in Rochester. I was surprised to meet patients with serious medical problems who were denied care at other institutions and who had no access to a primary care physician on a regular basis. I heard the stories of our patients-of everyday people struggling with chronic diseases. I listened and learned from my patients and truly saw that health is related to employment, home life, family history, stresses and other psychosocial elements far more complicated than a simple disease diagnosis. Every patient has a rich story that informs who they are and how they approach their health. In order to help them be well, we need to know their stories and tap into our patients' strengths and world view.

After third year, I took a year out from medical school to work with underserved communities to study the relationship between primary care and public health and to learn about medical practice in resource poor settings. My mentors during this year-at Planned Parenthood in inner-city Rochester, in rural Alaska, in colonias along the Mexican-American border, and on the Navajo Reservation in New Mexico-were primary health care professionals and community health workers who are dedicated to decreasing barriers to health care and improving individual and community health. They taught me valuable lessons about patient care, cultural sensitivity, decision making in resource-poor settings and the true nature of integrative family medicine. I was exhilarated by these models of care based on a knowledge and interest in the patient's story and using that knowledge to improve the delivery of complete patient care.

In the end, family medicine was the most logical choice for me. I came away from Africa with a sense of solidarity with and personal responsibility towards the underserved. In medical school, I developed a more practical and focused outlet for this sense of purpose through a passion for rural primary care and developing personal relationships with patients. I studied with primary care providers who inspired me to embrace the family medicine model of providing patient-centered, prevention-focused care that empowers patients to achieve wellness for themselves and their families. I think I can best meet my goals of working and empowering underserved populations and approaching care in an integrated fashion through family medicine.

My husband and I are interested in developing our careers in such a way that will allow us to work with underserved populations and to provide support, services, and empowerment to those in need. As rural family medicine doctors, we will work to reshape the traditional structure of medical practice to empower those who are frequently overlooked and to realize the basic human right to accessible and affordable medical care. We both chose family medicine because it offered the best way to truly meet patient needs through integrative biopsychosocial care, while also being a resource, an anchor, and a teacher.
 

Jason Kurland

When I tell fellow medical students that I'm going into family medicine, their reactions vary. Yet almost inevitably, their response contains elements of two themes: "Why would you do that?" and "How noble!" 

No one in medicine is unaware of the trifecta of long-hours, lower-pay and limited-prestige that characterizes the primary care specialties. Medical students love mnemonics such that even advice on choice of specialty has been distilled into a memorable phrase: "Stay on the ROAD." The best specialties, or so the conventional wisdom goes, are Radiology, Ophthalmology Anesthesiology and Dermatology. These and related fields are held to offer the best "lifestyle," itself a kind of shorthand for an optimal combination of income, work hours, and status. In this view, family medicine isn't merely off the road, it's off the map. 

Although I'd like to claim a noble madness led me astray, I chose family medicine for the same reasons most of us choose a specialty: the opportunity to help people coupled with the potential for professional satisfaction.

The critical need for more primary care providers, particularly in rural and poor urban areas, is well established. On the macro level, I am pleased that my choice of specialty can contribute to meeting this need. On the level of the individual patient, I am convinced that high-quality primary care has the potential to do incredible good for people. The benefits of good primary care can be substantial, at the individual and population levels, but tend to be more difficult to recognize, quantify and reward than the benefits of acute dramatic interventions, such as placement of a coronary artery stent. The value of a stent seems obvious, direct and immediate; the value of preventive care and early intervention may show up only as an absence, as the need for one less stent. 

Yet a good primary care physician can provide much more than screening and preventive services. Unfortunately, our clinical training, weighted as it is toward the inpatient setting with only sporadic outpatient exposures, tends to dramatically downplay the potential benefits and satisfactions to be found in primary care.

When we do see outpatients, it is exceedingly rare to see the same patient twice. What I caught only glimpses of in medical school-but was lucky to experience prior to matriculation-is the power of continuity in the doctor-patient relationship. As a medical assistant working with one doctor over extended periods, I observed patients' almost universal need to feel known and understood as people, above and beyond any particular diagnosis or subset of problems. Specialists can and should offer the very latest thinking on diseases of the skin, kidney or lung. The primary care physician is uniquely situated, both within the health care system and within the patient-physician relationship, to integrate all aspects of a person's health into a coherent picture, taking into account not just the patient's current problem list but their personhood before and beyond illness.

While I expect that much of my satisfaction as a family physician will derive from relationships, the specialty's audacious, even intimidating, breadth of scope suits my personality. While I have great respect for the intellectual and practical rewards of detail work, it is the big picture patterns that truly excite me-and I like continuities more than I do boundaries. 

During third-year clinical clerkships, I was frequently frustrated by the distinct, sometimes counter-intuitive, boundaries between specialties. For instance, on obstetrics clerkship, I spent hours monitoring the minute-to-minute status of a laboring woman's fetus only to immediately turn the newborn girl over to another specialty once she had traversed the birth canal. Passing into this world, she passed out of our scope of practice with no hope of returning to it until she herself needed obstetric or gynecological care years from now.  

No doubt the ability to recognize and the humility to acknowledge the limits of one's own expertise are crucial to providing good care, primary or otherwise. Mindful of this fact, I am nonetheless excited at the prospect of following a heterogeneous panel of patients, assessing and addressing their health issues from mind to toe, ever balancing the care I can provide myself with that I can obtain for them from my colleagues, both those on the ROAD and those drawn away from it. 

Reprinted with permission. This article first ran in the Rochester Medicine Magazine.

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Advance Your Career in Medical Student Education With Nuts & Bolts Knowledge

“Extremely helpful overall. There was a great deal of knowledge shared in the lectures. The collaborative group discussions interspersed with the lectures allowed for processing and building on information provided. Small-group discussions were very valuable mentoring opportunities.”

“This was an extremely valuable experience. It was targeted toward my needs & interests. The faculty was dedicated, knowledgeable, and excellent facilitators."

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Family Medicine Journal Moves to an Online Manuscript Submission System

 

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Does the P4 Project Influence Match Results?—Q & A With Patricia Carney, PhD, Principal Investigator for P4

Patricia Carney, PhD will speak on Saturday, January 30, at the Predoctoral Education Conference in Jacksonville, Florida. She will highlight trends in health care reform that are likely to affect our educational programs and will address how partnerships must be formed to allow flexibility in program credentialing that will rapidly advance educational quality and improved health outcomes.

Q: Tell us about the impact of health care reform on your research. With the constant changes and unknowns, how in the world do you manage this study (any study)? It would seem challenging to measure the effects of residency redesign when nothing seems constant.

A: Yes, health care reforms are a dynamic process. We are using a case series design in P4, where each program is its own control group, and we are collecting historical cohort data, which will help us understand how features of all programs change over time. In addition, sites collect specific measures for the hypotheses they are testing that are unique to their programs. We conducted site visits to all 14 programs and reviewed/revised their hypotheses, identified data collection instruments and time periods, and we assisted them in connecting with other programs that are conducting similar studies. I like to think of our approach as health care and educational epidemiology—where we collect as much relevant data as is feasible and then conduct complex multivariate analyses designed to take into account the covariates that could be influencing outcomes.

Q: What do you believe is the most valuable lesson to date that family medicine educators can take from the P4 project?

A: Family medicine residents are very excited about the possibility of “intentional diversification;” that is, they want more flexibility in designing a residency program that will best prepare them for the type of medical practice they want to work in. Several programs are testing this innovation, and Match results (which we are analyzing now) appear to have improved for P4 sites.

Q: What, if anything, do your findings tell us about the future of family medicine education and our learners?

A: Preliminary data from the P4 project recently examined whether the innovations being tested at sites were influencing the residency Match. More specifically, we examined how programs fared in the Match, according to whether their innovations included a customized curriculum at the level of the resident. Our results show a 20% increase in LCME US graduates matching to these programs after implementation of this innovation compared to before.

Patricia Carney, PhD, is professor of family medicine and of public health and preventive medicine and associate director for Population Studies at the Oregon Health and Science University. She has contributed to the development of several clinical research grants in breast, cervical, and colorectal cancer screening, detection, and diagnosis.

Plan to attend the STFM Predoctoral Education Conference and hear more about the P4 Initiative, the initial findings, and the lessons Dr Carney believes family medicine can learn (and benefit) from.

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"Guided Care" Wins Award for Innovation at the Conference on Practice Improvement

Guided Care, a new model of health care for people with multiple chronic conditions, improves patients’ quality of life and care, while improving the efficiency of treating the sickest and most complex patients. Guided Care uses patient-centered teams that include a registered nurse, two to five physicians, and other members of the office staff who work closely together for the benefit of each patient. The team monitors each patient’s health and offers comprehensive, coordinated, patient-centered health care.

Early results suggest that Guided Care improves the quality of care and reduces costs for older adults suffering from multiple chronic health conditions. A recently published study in the American Journal of Managed Care showed that in the first 8 months of a randomized controlled trial, Guided Care patients spent less time in hospitals and skilled nursing facilities and had fewer emergency room visits and home health episodes, resulting in an annual net savings of $75,000 per Guided Care nurse. Other analyses have shown that Guided Care improves the quality of patients’ care, reduces family caregiver strain, and improves physicians’ satisfaction with chronic care.

“Guided Care has increased the efficiency of our team and of patients’ office visits, as well as improved our access to evidence-based guidelines for managing chronic conditions,” said Gary Noronha, MD, FACP, Medical Director of Wyman Park Internal Medicine, part of Johns Hopkins Community Physicians. “Our physicians agree that we now have the right mix of professionals to meet the needs of these vulnerable patients.”

Guided Care recently received the Award for Innovation in Practice Improvement at the 2009 Conference on Practice Improvement in Kansas City. The annual award recognizes innovative practice improvement programs and strategies that transform medical office processes, promote patient participation, and contribute to an office practice’s overall success. “I was honored to accept the award on behalf of the many researchers, doctors, nurses, patients, and family caregivers who have made Guided Care an option for helping the 133 million Americans with chronic conditions to lead healthier lives,” said Chad Boult, MD, MPH, MBA, principal investigator of the Guided Care study and director of the Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health. STFM President-Elect Perry Dickinson, MD, (left) presented the award to Dr Boult (right). The award was sponsored by STFM, along with the American Academy of Family Physicians (AAFP), and Medical Economics magazine.

For more information about the Guided Care program, please go to: www.GuidedCare.org.

For information on the Conference on Practice Improvement, visit www.stfm.org/pic.

 

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Medical Students Hone Altruistic Skills Through Service to the Underserved

Many family medicine departments have developed medical student-run free clinics that provide services to underserved and indigent populations. These clinics are giving students the opportunity to work within a clinical setting with physicians to experience the patient behind the science. Below, we highlight three student-run free clinic programs providing valuable services to patients across the United States.

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The Free Outreach Clinics for the Underserved in San Antonio (FOCUS) project began in 2005 in the Center for Medical Humanities & Ethics at the University of Texas Health Science Center at San Antonio (UTHSCSA). The Clinics provide critical health care services, train students to care for underserved populations, and provide first-hand experience with the social justice issues and human suffering of medically under- and un-served populations. The FOCUS project provides free health care and enhanced quality of life for approximately 3,000 residents of Bexar County in south Texas, an area of the nation characterized by disproportionately high rates of chronic illness, and disproportionately low rates of access to health care.

Richard Usatine, MD, professor of Family and Community Medicine at University of Texas Health Science Center at San Antonio, was the founder of the FOCUS Free Clinics Project. The student-run free clinics accomplish two goals: providing medical care to underserved populations while enabling medical students to hone their altruistic sides. “The first 2 years of medical school are so focused on learning basic science, and students spend most of their time in class or labs. Involvement in the FOCUS clinics enables them to get out and see real people with real needs, and it reinforces why they're studying so many hours.” said Dr Usatine.

The FOCUS Free Clinics project currently operates at three residential facilities: Two for individuals and families recovering from homelessness and addiction. These FOCUS clinics have reduced the number of emergency room visits among the service populations, prevented common chronic diseases such as diabetes, and increased thousands of clients’ ability to recover from addiction and homelessness. Within one of the FOCUS Clinics housed in a residential facility for homeless pregnant/parenting adolescents, the FOCUS project will greatly reduce emergency room visits for the 2,200+ moms and their children served by this facility. In addition, providing on-site health care will help keep the young mothers enrolled in programs such as school completion and tutoring, vocational training and job readiness, counseling and therapy, and parenting skills.

You can more information about the UTHSCSA Student-run Free Clinic programs at www.studentrunclinics.org.

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The University of California, San Diego, Student-Run Free Clinic Project began one night a week in the basement of a church after a meal program for the homeless. Now, 12 years later, the clinic provides services each day of the week, based in two churches and two inner city elementary schools. “We practice a humanistic, empowerment model creating environments where patients and their families achieve well being,” said Ellen Beck, MD. Dr Beck founded the clinic, along with a group of committed medical students and dedicated community partners. It provides primary care services and outpatient specialty services to more than 1,000 San Diegans who do not qualify for access to care. Another 1,000 receive ancillary services including dentistry and acupuncture. 85% of the clinic’s patients have chronic illnesses, including diabetes, hypertension, hyperlipidemia, depression and asthma. All aspects of the project are administered and managed by students with the supervision of faculty. The clinic is transdisciplinary in nature and sees the community as the teacher.

Dr Beck said the UCSD program is unique in the range and depth of services that it is able to offer and in the extent of involvement of the medical students. First- and second-year students must take an elective class with a defined curriculum to work at the free clinic project. The UCSD’s popular fourth-year clerkship, Underserved Medicine, involves the fourth-year students acting as clinical coaches, and learning to be teachers. “Students immerse themselves in primary care, and learn about working with underserved communities,” said Dr Beck. UCSD also offers a 1- to 2-year Fellowship in Underserved Healthcare that brings former student leaders back after residency to be fellows and help run the clinic.

Dr Beck has also developed a national faculty development program, “Addressing the Health Needs of the Underserved,” where faculty build community among themselves, and learn to create and sponsor these types of programs. As a result, student-run free clinic projects have been started in over 10 communities in the United States, including clinics in Hawaii, Houston, Missouri, and Mississippi.

Learn more about the student-run free clinics at the University of California, San Diego at http://meded.ucsd.edu/freeclinic/.

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CARES (Community Aid Relief Education and Support) was established by Dr Wanda Gonsalves and medical students from the Medical University of South Carolina in August 2005. It is modeled after the UCSD student clinic and has evolved into an interprofessional service learning experience for medical, pharmacy, physical therapy, physician assistant, and masters of hospital administration students. Psychiatry residents are involved and see patients two times a month.

The clinic offers primary cares services, gyn (pap smears), diabetes group visits, psychiatry, and labs. Everything is free to the patients, and the clinic only sees those who are uninsured. The clinic sees patients, on a first-come basis, three nights a week in the evenings. Two volunteer MUSC faculty per night from the emergency medicine, family medicine, internal medicine, and psychiatry departments, as well community physician volunteers and practicing physician assistants.

The learning piece of the service is an elective called “Caring for the Community.” Students who take the elective are required to spend 5 nights per semester at the clinic. The CARES clinic is located in Dr Gonsalves' faculty practice, University Family Medicine, in Mt. Pleasant, SC. "Unlike many student clinics, which at times have very meager facilities, our patients are served in my office where students have access to wonderful exam rooms, equipment, and office lab procedures," said Dr Gonsalves.

“We are blessed to have a wonderful community partner, East Cooper Community Outreach (ECCO), a faith-based organization,” added Dr Gonsalves. CARES is also funded by the AAMC Caring for the community grant, the Medical Society of South Carolina, and numerous small grants given by the community. “It is a wonderful experience for our students who desperately need preclinical experience,” said Dr Gonsalves. To learn more about this program, visit www.thecaresclinic.org.

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All three of the faculty members mentioned above, Drs Usatine, Beck, and Gonsalves will be participating as faculty at the Student-Run Free Clinic Conference 2010: Creating High Quality Clinics in Our Communities, being held in conjunction with the STFM Predoctoral Education Conference, in Jacksonville, Florida.