Family Medicine Clerkship, Tracks, and Faculty Support for Family Medicine Education in Departments of Family Medicine: An Update

Departments of Family Medicine, while experiencing financial resource diminution, are simultaneously called upon to expand their primary care bases and teaching programs, while building and testing medical homes with a goal of advancing to fiscal independence. These rapid changes, while posing unique opportunities, have the potential to diminish and de-prioritize student education as practice transformation occurs.

The changing environment of academic and community clinical venues used for medical student education presents substantial challenges for family medicine educators. Evolving health care reform with greater emphasis on access, quality, outcomes, and appropriate reimbursement are some of the components forcing transformation of family medicine patient care environments to meet emerging primary care delivery challenges. These challenges are being addressed differently across diverse clinical venues potentially creating substantial inconsistency in the way concepts such as the Patient Centered Medical Home are implemented. These evolving primary care delivery settings will likely, create another level of resource inconsistency in clinical venues secured and used for family medicine clerkship teaching.

Adding to the challenges of ensuring consistent student teaching experiences in diverse clinical settings is the integration of the national Family Medicine Clerkship Curriculum. The Family Medicine Clerkship Curriculum provides the core portion of student clinical experiences and content that should be provided to students in all clerkship settings across the country, the “what” of family medicine student education. The Curriculum’s national task force’s decision to start with a small set of content expectations immersed in a patient-centered context may prove to be wise as a second project currently engaged by STFM seeks to determine the “how” as it relates to implementation of the Curriculum. The “how” will likely be complicated by the diversity of the clinical venues where medical students receive their core clinical family medicine training. These settings, which are usually distributed and/or decentralized, make it necessary for curriculum planners to create multiple paths to achieve similar curricular goals (tailoring clinical teaching to unique care delivery settings).

The ADFM’s 2010 Quick Hitter Survey of 93 departments (66% of all ADFM member departments) reveals the presence of a required family medicine Clerkship in 95% of responding departments with a wide range of resources available to support the clerkship experience. Eighty-four percent of these clerkships were in the 3rd year with 32% reporting a 4-week requirement, 45% a 6-week requirement, and 11% an 8-week requirement (9.5% not mentioning length of time), and 5% reporting clerkships with both 3rd- and 4th-year students. Multiple unique clerkship arrangements were reported such as 4th-year requirements, longitudinal experiences, special tracts such as rural locations, special subject interests such as geriatrics, and various levels of integration with other primary care clerkship experiences. These different settings will demand unique implementation strategies to ensure appropriate integration of the new curriculum guidelines.

Efforts to develop consistent curricular core content for the family medicine clerkships will almost certainly require additional departmental investment to support implementation, maintenance, and evolution of these teaching experiences. Many family medicine clerkships are already highly dependent on volunteer teaching and the management of resources beyond the medical school. The dynamic practice transformation occurring in these clinical education sites must be evaluated to determine the implications of these changes on student education. If, especially in academic settings, planned practice transformation could consistently occur simultaneously with efforts to support the core content requirements of the family medicine clerkship, exportable teaching models for use in dispersed clinical settings may emerge.

The differences in the number of FTE’s devoted to support medical student education varied greatly in the ADFM Quick Hitter Survey with the differences appearing not attributable to class size. The survey reveals responses concerning a variety of tracts for medical student learning to include rural, urban, and underserved, global/international health, research, and community/integrative health. Although these tracts may have unique importance for individual departments, the implication of these activities on the ability to deliver required family medicine teaching experiences consistent with national norms is unknown. Departments must carefully balance their practice transformational activities with the dynamic changes that come with evolving standardization of required family medicine teaching experiences occurring mostly in stand-alone family medicine clerkships as well as department-specific elective and selective activities.

• © 2010 Annals of Family Medicine, Inc.