The motivation behind the creation of the 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. A dedicated rotation through various ambulatory arenas helps facilitate career choices
The Primary Care Clerkship is a six-week series of outpatient clinic experiences that emphasize Medicine, Family Medicine, ER/Urgent Care, Geriatrics, Pediatrics and OB/Gyn.
Students see patients at a variety of New York-Presbyterian Hospital/Weill Cornell Medical Center, as well as network hospitals and clinics. Students spend one-half day accompanying a geriatrician and geriatric nurse practitioners on home visits to older adults; they also conduct blood pressure screenings at the Stanley M. Isaacs Senior Center.
Students 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. They participate, with preceptor supervision, in the care of acutely symptomatic out-patients. Examples of appropriate and important chief complaints they focus on include the following: cough, dizziness, palpitations, chest pain, dyspnea, upper respiratory symptoms, fever, chronic fatigue, abdominal pain, diarrhea, GI bleeding/anemia, dysuria, vaginitis, musculo-skeletal pains, headache, leg edema, red eye, common dermatologic issues such as acne, fungal infections and dermatitis.
Students also learn to manage multiple chronic medical diseases and risk factors in an ambulatory setting. They are 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 learn to foster health promotion by applying appropriate well-care guidelines for specific patient populations and counseling about specific patient behaviors. For example, they may participate in the application of immunization guidelines for pediatric and adult patients; in discussions regarding cancer screening protocols for breast, colon, cervical and prostate cancers; in counseling patients regarding diet, obesity, exercise, smoking cessation, drug and alcohol abuse or safe sex.
Students also learn to elicit psychosocial histories and functional assessments from patients with preceptor supervision and recognize psychiatric illness in a medical practice. They will perform functional assessments on elderly patients during the scheduled geriatric activities and, in the various clinics, will also be exposed to patients who suffer from depression, anxiety, and somatization. Five 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. Usually students are not merely shadowing a resident or attending physician; often, the student will be the first person to see the patient. They will complete a history and physical examination on a patient and then be supervised by the attending or resident physician. Often patients have been specifically scheduled to see the student; therefore, ATTENDENCE IS MANDATORY!!
A seminar series complements the clerkship clinical experience. Two half-day sessions per week are set aside for all students to meet with the faculty - Tuesday mornings and Friday afternoons. These didactic sessions draw heavily from readings from the required textbook- Goroll's Primary Care Medicine, 6th Edition. Themes encompassing cost-economy and value in medical care, preventive medicine and well-care/guideline reviews and evidence-based medicine are developed during these seminars.
Students are assessed based upon evaluations by faculty and residents that have supervised them in various clinics, an essay-based take-home examination, and the National Board Subject Review Exam.