FAMILY MEDICINE SKILLS CHECKLIST - University of Iowa We invite you to participate in a research study. The purpose of the study is to use the Clinical Skills Checklist developed in the Department of Family Medicine at the University of Iowa to collect information from students at a number of medical schools, (including the University of Iowa Carver College of Medicine) regarding their highest level of experience with 168 primary care skills and procedures during their required M3 Family Medicine (FM) rotation. This information will be used to: 1) identify factors that are associated with students gaining more experience on their FM rotations, 2) To begin to develop some benchmarks for FM clerkship directors about the skills their own students experience compared to students nationally. The information you provide on your clinical skills experience is required for course evalaution and will be used to evaluate and improve the course. In addition, we ask for your consent to use this information for educational research. You will complete the Clinical Skills Checklist and MEDEDIQ evaluation forms on-line at the end of your Family Medicine rotation. If you agree, we will use your responses on the checklist and evaluation form and the demographic data you supply in our study. We will keep the information you provide confidential, however federal regulatory agencies and the University of Iowa Institutional Review Board (a committee that reviews and approves research studies) may inspect and copy records pertaining to this research. Your personal identifying information will be removed from your responses. The list linking your study number and your name will be kept in a secure location that is accessible only to the investigator. At the completion of the study, the list will be destroyed so that the information you provide is totally anonymous. If we write a report about this study, we will do so in such a way that you cannot be identified. There are no risks to participating and you will not benefit personally. We hope that future medical students will benefit from what we learn from this study. Taking part in this research is completely voluntary and if you decide not to participate, you will not be penalized. We will not contact you again by e-mail, letter or phone. If you have questions about the research, contact Barcey Levy, M.D. 01292-E PFP, UIHC, 319-384-7622. If you have questions about the rights of research subjects, contact the Human Subject Office, 300 College of Medicine Administration Building, University of Iowa, Iowa City, IA 52242, 319-335-6564, or e-mail irb@uiowa.edu. Your selection of Agree or Disagree indicates your voluntary consent to participate in this research project.Agree - I wish to have my information included in the study. Disagree - I do not wish to have my information included in the study. If you Agree to participate in the study, please answer the following questions.Your genderM F Your preceptor's gender (N/A if you worked with more than 1)M F NA Total number of physicians you worked withLength of rotation (weeks)Rotation siteRural Suburban Urban Rotation site characteristics (check all that apply)Private Family Physician Office (single specialty) Private Family Physician office (multispecialty) FP Residency Program (not in academic health center) FP Residency Program (in academic health center) Community Health Center/AHEC Rotation state dateFormat: YYYY-MM-DDContact Information Student ID Last Name First Name We are interested in knowing about your level of involvement with the following primary care skills and procedures DURING your Family Medicine preceptorship. Please mark your HIGHEST LEVEL of involvement with the following diagnoses and procedures, and patient education skills. We assume all activities were done under supervision. This is an important part of our course evaluation and is helpful to the Dean's Office and Liaison Committee on Medical Education (LCME). This form should take about 10 minutes to complete. Thanks very much. DIAGNOSES CARDIOVASCULAR Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 1. Atrial fibrillation (new diagnosis) 2. Acute Angina/chest pain 3. Congestive heart failure 4. Hypertension (new diagnosis) 5. Hypertension (medication adjustment) ENT/RESPIRATORY Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 6. Allergic rhinitis 7. Asthma (not COPD) 8. Bronchitis 9. COPD (not asthma) 10. Influenza/viral syndrome 11. Laryngitis 12. Otitis externa 13. Otitis media 14. Pharyngitis 15. Pneumonia 16. Sinusitis 17. TMJ pain 18. Upper respiratory infection EYE Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 19. Conjunctivitis 20. Corneal abrasion/foreign body GASTROINTESTINAL Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 21. Acute abdominal pain 22. Chronic abdominal pain 23. Constipation 24. Chronic diarrhea/loose stools 25. Dyspepsia/GE reflux symptoms 26. Hepatitis/jaundice 27. Nausea/vomiting/diarrhea in an adult 28. Nausea/vomiting/diarrhea in a child 29. Rectal fissure/hemorrhoid GU/REPRODUCTIVE Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 30. Benign prostatic hypertrophy 31. Breast mass/cyst 32. Genital warts 33. Hematuria 34. Incontinence 35. Menopausal symptoms 36. Menstrual disorder/vaginal bleeding 37. Miscarriage 38. Ovarian enlargement/cyst 39. Pelvic pain 40. Prostatis/epididymitis 41. Renal stone 42. Sexual dysfunction 43. Sexually transmitted disease 44. Testicular pain/mass 45. Urinary tract infection 46. Vaginal discharge (abnormal) METABOLIC Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 47. Anemia 48. Type I Diabetes 49. Type II Diabetes 50. Hypercholesterolemia 51. Hyperthyroidism 52. Hypothyroidism 53. Elevated liver enzymes 54. Obesity/unwanted weight gain MUSCULOSKELETAL Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 55.Ankle pain/sprain 56. Carpal Tunnel Syndrome 57. Costochondritis/rib pain 58. Fibromyalgia/chronic fatigue 59. Acute gouty joint 60. Knee pain 61. Low back pain (without sciatica) 62. Multiple joint aches 63. Neck pain 64. Osteoarthritis 65. Osteoporosis 66. Rheumatoid arthritis 67. Sciatica 68. Shoulder pain NEUROLOGICAL Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 69. Alzheimer's or other dementia 70. CVA/TIA 71. Dizziness/vertigo 72. Headache 73. Mental status change 74. Parkinson's 75. Syncope 76. Tremor (not Parkinson's) PSYCHOSOCIAL Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 77. ADD/hyper activity 78. Alcohol abuse/dependence 79. Anorexia nervosa 80. Anxiety 81. Depression 82. Domestic abuse 83. Insomnia 84. Life stressors 85. Multiple somatic complaints 86. Tobacco abuse/dependence SKIN Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 87. Abscess/boil/cellulites 88. Acne 89. Actinic keratosis 90. Animal/Human Bite 91. Bee sting/insect bite 92. Burn 93. Decubitus ulcer 94. Eczema/rash 95. Herpes simplex (oral) 96. Herpes simplex (genital) 97. Herpes zoster 98. Ingrown toenail 99. Leg ulcers 100. Pruritis/Urticaria 101. Psoriasis 102. Scabies 103. Tionea corpora 104. Tinea versicolor MISCELLANEOUS DIAGNOSES Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 105. Deep vein thrombosis 106. Fatigue 107. Motor vehicle accident 108. Unintentional weight loss PHYSICAL EXAM/PROCEDURES/PATIENT EDUCATION Specifics of Physical Exam Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 109. Breast 110. Pelvic 111. Prostate/rectal exam (male) 112. Testicular exam 113. Tympanic membrane Geriatrics Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 114. Activities of daily living assessment 115. Mini mental status exam (MMSE) GU/GI Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 116. Anoscopy 117. Flexible sigmoidoscopy 118. Vasectomy GYN/OB/PEDS Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 119. Circumcision 120. Colposcopy 121. Endometrial biopsy 122. Episiotomy repair 123. Pap smear 124. Vaginal delivery 125. Lumbar puncture 126. Cervix check (laboring patient) Routine Health Maintenance Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 127. Well child check, 0-2 years 128. Well child check, 2-12 years 129. Adolescent PE, 13-17 years 130. Adult, 18-39 years 131. Adult, 40-64 years 132. Adult, 65 and over 133. Prenatal exam HEENT Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 134. Cerumen removal 135. Fluorescein staining of eye 136. Tympanometry interpretation ORTHO Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 137. Cast application 138. Splint application 139. Extremity film interpretation 140. Tapped joint effusion PATIENT EDUCATION Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 141. Anticipatory guidance for children 142. Taught breast self-exam 143. Contraception education 144. Diet/Nutrition counseling 145. Exercise counseling 146. HIV counseling 147. Hospice/terminally ill patient 148. Inhaler use 149. Life stressors 150. Medication use and side effects 151. Prenatal education 152. Safe sex 153. Smoking cessation counseling 154. Taught testicular self-exam 155. Weight loss counseling 156. Discussed hormone replacement therapy (risks/benefits) 157. Discussed osteoporosis prevention and treatment Respiratory/Cardiac Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 158. EKG interpretation 159. Peak flow assessment 160. Pulmonary function test/spirometry interpretation 161. CXR interpretation Skin Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 162. Abscess I&D 163. Cryotherapy 164. Excisional biopsy 165. Laceration repair 166. Punch biopsy 167. Subungual hematoma drainage 168. Toenail removal
Agree - I wish to have my information included in the study. Disagree - I do not wish to have my information included in the study.
If you Agree to participate in the study, please answer the following questions.Your gender
M F
Your preceptor's gender (N/A if you worked with more than 1)
M F NA
Total number of physicians you worked with
Length of rotation (weeks)
Rotation site
Rural Suburban Urban
Rotation site characteristics (check all that apply)
Private Family Physician Office (single specialty) Private Family Physician office (multispecialty) FP Residency Program (not in academic health center) FP Residency Program (in academic health center) Community Health Center/AHEC
Rotation state date
Format: YYYY-MM-DD
Contact Information
Student ID Last Name First Name
We are interested in knowing about your level of involvement with the following primary care skills and procedures DURING your Family Medicine preceptorship. Please mark your HIGHEST LEVEL of involvement with the following diagnoses and procedures, and patient education skills. We assume all activities were done under supervision. This is an important part of our course evaluation and is helpful to the Dean's Office and Liaison Committee on Medical Education (LCME). This form should take about 10 minutes to complete. Thanks very much.
Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 1. Atrial fibrillation (new diagnosis) 2. Acute Angina/chest pain 3. Congestive heart failure 4. Hypertension (new diagnosis) 5. Hypertension (medication adjustment)
ENT/RESPIRATORY
Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 6. Allergic rhinitis 7. Asthma (not COPD) 8. Bronchitis 9. COPD (not asthma) 10. Influenza/viral syndrome 11. Laryngitis 12. Otitis externa 13. Otitis media 14. Pharyngitis 15. Pneumonia 16. Sinusitis 17. TMJ pain 18. Upper respiratory infection
EYE
Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 19. Conjunctivitis 20. Corneal abrasion/foreign body
GASTROINTESTINAL
Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 21. Acute abdominal pain 22. Chronic abdominal pain 23. Constipation 24. Chronic diarrhea/loose stools 25. Dyspepsia/GE reflux symptoms 26. Hepatitis/jaundice 27. Nausea/vomiting/diarrhea in an adult 28. Nausea/vomiting/diarrhea in a child 29. Rectal fissure/hemorrhoid
GU/REPRODUCTIVE
Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 30. Benign prostatic hypertrophy 31. Breast mass/cyst 32. Genital warts 33. Hematuria 34. Incontinence 35. Menopausal symptoms 36. Menstrual disorder/vaginal bleeding 37. Miscarriage 38. Ovarian enlargement/cyst 39. Pelvic pain 40. Prostatis/epididymitis 41. Renal stone 42. Sexual dysfunction 43. Sexually transmitted disease 44. Testicular pain/mass 45. Urinary tract infection 46. Vaginal discharge (abnormal)
METABOLIC
Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 47. Anemia 48. Type I Diabetes 49. Type II Diabetes 50. Hypercholesterolemia 51. Hyperthyroidism 52. Hypothyroidism 53. Elevated liver enzymes 54. Obesity/unwanted weight gain
MUSCULOSKELETAL
Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 55.Ankle pain/sprain 56. Carpal Tunnel Syndrome 57. Costochondritis/rib pain 58. Fibromyalgia/chronic fatigue 59. Acute gouty joint 60. Knee pain 61. Low back pain (without sciatica) 62. Multiple joint aches 63. Neck pain 64. Osteoarthritis 65. Osteoporosis 66. Rheumatoid arthritis 67. Sciatica 68. Shoulder pain
NEUROLOGICAL
Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 69. Alzheimer's or other dementia 70. CVA/TIA 71. Dizziness/vertigo 72. Headache 73. Mental status change 74. Parkinson's 75. Syncope 76. Tremor (not Parkinson's)
PSYCHOSOCIAL
Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 77. ADD/hyper activity 78. Alcohol abuse/dependence 79. Anorexia nervosa 80. Anxiety 81. Depression 82. Domestic abuse 83. Insomnia 84. Life stressors 85. Multiple somatic complaints 86. Tobacco abuse/dependence
SKIN
Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 87. Abscess/boil/cellulites 88. Acne 89. Actinic keratosis 90. Animal/Human Bite 91. Bee sting/insect bite 92. Burn 93. Decubitus ulcer 94. Eczema/rash 95. Herpes simplex (oral) 96. Herpes simplex (genital) 97. Herpes zoster 98. Ingrown toenail 99. Leg ulcers 100. Pruritis/Urticaria 101. Psoriasis 102. Scabies 103. Tionea corpora 104. Tinea versicolor
MISCELLANEOUS DIAGNOSES
Not Encountered Observed/Assisted Managed 1-2 times Managed 3-4 times Managed 5 or more times 105. Deep vein thrombosis 106. Fatigue 107. Motor vehicle accident 108. Unintentional weight loss
PHYSICAL EXAM/PROCEDURES/PATIENT EDUCATION Specifics of Physical Exam
Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 109. Breast 110. Pelvic 111. Prostate/rectal exam (male) 112. Testicular exam 113. Tympanic membrane
Geriatrics
Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 114. Activities of daily living assessment 115. Mini mental status exam (MMSE)
GU/GI
Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 116. Anoscopy 117. Flexible sigmoidoscopy 118. Vasectomy
GYN/OB/PEDS
Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 119. Circumcision 120. Colposcopy 121. Endometrial biopsy 122. Episiotomy repair 123. Pap smear 124. Vaginal delivery 125. Lumbar puncture 126. Cervix check (laboring patient)
Routine Health Maintenance
Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 127. Well child check, 0-2 years 128. Well child check, 2-12 years 129. Adolescent PE, 13-17 years 130. Adult, 18-39 years 131. Adult, 40-64 years 132. Adult, 65 and over 133. Prenatal exam
HEENT
Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 134. Cerumen removal 135. Fluorescein staining of eye 136. Tympanometry interpretation
ORTHO
Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 137. Cast application 138. Splint application 139. Extremity film interpretation 140. Tapped joint effusion
PATIENT EDUCATION
Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 141. Anticipatory guidance for children 142. Taught breast self-exam 143. Contraception education 144. Diet/Nutrition counseling 145. Exercise counseling 146. HIV counseling 147. Hospice/terminally ill patient 148. Inhaler use 149. Life stressors 150. Medication use and side effects 151. Prenatal education 152. Safe sex 153. Smoking cessation counseling 154. Taught testicular self-exam 155. Weight loss counseling 156. Discussed hormone replacement therapy (risks/benefits) 157. Discussed osteoporosis prevention and treatment
Respiratory/Cardiac
Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 158. EKG interpretation 159. Peak flow assessment 160. Pulmonary function test/spirometry interpretation 161. CXR interpretation
Skin
Not Encountered Observed/Assisted Done 1-2 times Done 3-4 times Done 5 or more times 162. Abscess I&D 163. Cryotherapy 164. Excisional biopsy 165. Laceration repair 166. Punch biopsy 167. Subungual hematoma drainage 168. Toenail removal