I started Family Medicine right before winter break (which was almost 6 months ago, bear with me - I'm trying to catch up on all of these!). After finishing both medicine and peds, family med was a good summary of the two and gave me lots of exposure to a strictly outpatient setting. Interestingly, at our institution the family med attendings and residents have labor & delivery privileges in the hospital for their low-risk Ob patients, though I didn't get to experience that with them it was definitely something I could have participated in. Family med offers a broad range of patients, diseases, and opportunities for intervention. This rotation is where I most actively participated in promoting preventative care strategies which enlightened me to the fact that many patients know very little about the changes they can make to improve their health or that of their families and they genuinely appreciate learning how to do so. I also didn't have to give up my favorite patient population - kids! - because I saw lots of babies and well-child visits. My clerkship site took place in our university family medicine outpatient clinic. It was very academic setting that focused on teaching and featured 4-5 residents (and 1 med student - me!) supervised by 1 attending. There was also a huge integrative medicine influence in the clinic from multiple attending which was neat.
CLERKSHIP OUTLINE:
- 6 weeks of outpatient care + optional labor & delivery experience
- scheduled lectures for 3 days
- NBME shelf exam
CLERKSHIP WORK HOURS:
Because this clerkship was in a strictly outpatient setting, I worked Monday-Friday from about 7:50 to 5:30. I didn't have call or weekend shifts (something I definitely should have appreciated more lol). The days varied in terms of how late I would stay depending on what the last patient of the day needed and if my resident & I got really behind.
A day in the life:
On any given day in the clinic I would wake up at 6am and workout, walk Melo and get ready to leave the house by 7:30 in order to be at clinic by 7:50. Since our clinic is academic there's a 10-minute teaching session by an attending until 8:00am. Usually it was just my best friend and I (I got lucky to be at the same site as her!) since the residents didn't always make it in time lol. But after the presentation I would report to whichever pod my resident was working in and try to prep for patients. Depending on the resident, one of two things would happen 1) I'd see every other patient, or 2) I'd have 3-5 patients assigned to me. I really enjoyed the second option because if one of them didn't show up I had some time to write my notes. Otherwise it was back to back patients with note writing at the end of the day. Most days there was a 40 minute window where no patients were scheduled so that was my lunch time! If you've ever worked in a clinic you know that this window doesn't actually guarantee said amount of precious time so I'd keep checking to see if my patient's had arrived while I ate. After lunch, the flow would be pretty much the same until all the patients were seen. At the end of the day I would make sure all of my notes were thorough, complete, and had citations / links to current journal articles and research to support my assessment & plans - again, very academic.
In terms of patient care, I'll try to break down what I did for different kinds of patients. In general, I would briefly discuss each patient with the resident before going in. If it was a new patient, I knew I would have to cover your basic H&P details as well as determine whether preventative care screenings were due (colonoscopy, pap smears, AAA screenings, etc). If it was a follow-up, the visit was much simpler and we could address the status of ongoing issues and maybe discuss a couple new ones if time permitted. For prenatal visits, I would measure fundal heights, listen to fetal heart tones and see if the patients were experiencing contractions, loss of fluids, bleeding, fetal movement, and other pertinent symptoms. My favorite visits were the well-child checks. For these, I would discuss key developmental milestones for age and discuss things like nutrition, sleep, exercises when appropriate.
Memorable moments:
- One of my first patients, a young obese boy around age 13, asked us if we thought he was overweight once his parents left the room. When we showed him where his BMI fell along the curve he very maturely asked us to help him with strategies to get healthier. When we welcomed the parents back into the room, we all discussed barriers to health in their home - mainly their diet and lack of exercise. It was pretty cool to approach such a devastating disease like obesity at a young age and with family support.
- On residency interview days we got to meet residency candidates and have lunch with them, which usually featured a delicious tamale feast. It was nice to catch a glimpse at what residency interviews would be like since they're coming up soon!
- Our clinic worked with a very large African and Asian refugee population which helped me appreciate the obstacles that these patients have to get access to care and other life challenges they face.
- I listened to fetal heart tones on a patient for the first time during my family med rotation and it was so exciting - and who knew that J & I would get pregnant that same month. So crazy.
Study resources:
I personally found this clerkship hard to find good resources for. This makes sense because the testable material for this specialty is so broad and covers internal medicine, pediatrics, gynecology, obstetrics, geriatrics. preventative medicine, and psychiatry - to name a few. Because it covers so much, this shelf can be really challenging if it's taken at the beginning of third year. So taking it after 12 weeks of internal medicine and 6 weeks of peds was probably the best prep I did for it and I would highly recommend scheduling it at the middle or end of your third year if possible. To begin my studies, I went back into my pediatrics and medicine UWorld questions and brushed up on my previously incorrect answers. I also reviewed the medicine and peds shelf reviews by Emma Ramahi - can't say enough good things about these! I signed up for the AAFP question bank but found that there were too many questions and that the level of difficulty was more at a resident level and wouldn't be helpful for the shelf, so I didn't use them. I went through Pre-Test as well, but didn't feel like I learned anything new. Rather, it was a decent review - though I'd only suggest doing this if you have enough time. Otherwise, I made sure I knew the US Preventative Task Force Guidelines for as many things as possible, mainly hypertension, diabetes, women's health, children's health, smokers, etc. The good news is you will end up learning most of the guidelines and management of primary care diseases organically during your work in the family med rotation.
Advice:
During my family medicine rotation I met some of the genuinely nicest people to work with. The residents truly cared about their patients and their passion for primary care was really admirable. It's easy to be inspired when those around you make an effort to improve the health of their patients in such a sincere way. So one way to be successful on this clerkship is to be present and actively participate in the care of your patients - you learn so much by simply doing your part!
