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.If you Agree to participate in the study, please answer the following questions.Your gender
Your preceptor's gender (N/A if you worked with more than 1)
Rotation site
Rotation site characteristics (check all that apply)
Format: YYYY-MM-DD
Contact Information
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 ENT/RESPIRATORY
EYE
GASTROINTESTINAL
GU/REPRODUCTIVE
METABOLIC
MUSCULOSKELETAL
NEUROLOGICAL
PSYCHOSOCIAL
SKIN
MISCELLANEOUS DIAGNOSES
PHYSICAL EXAM/PROCEDURES/PATIENT EDUCATION
Specifics of Physical Exam
Geriatrics
GU/GI
GYN/OB/PEDS
Routine Health Maintenance
HEENT
ORTHO
PATIENT EDUCATION
Respiratory/Cardiac
Skin