1st Session - week 1 - orientation
The first session, an IP-based conference call, generally occurs the first week of the clerkship and is focused on clerkship expectations and the future small group meetings. If IP-based conferencing is unavailable in your area, you will need to call 1-888-809-4012, access code 7770000#. Objectives of the first conference call are to identify problems, concerns, surprises, review course requirements, review faculty site visit, discuss examinations, and discuss group topics presentations for future conference calls.

For subsequent sessions (Group Topics) each student will have five to eight (5 - 8) minutes, including discussion time, to present a topic. Provide only pertinent details, but be prepared to expand the discussion depending on questions.

2nd Session - week 3 of clerkship
In the past decade we have seen an increased focus on health promotion and disease prevention (HP/DP), with the principal objective of reducing the burdern of suffering for the major preventable illness. As you interact with patients on a daily basis, consider some questions that emerge in context of your preceptor's patients and practice to help you select your topic for presentation.  Review of chapters 4-7 (four through seven) of the required Family Medicine textbooks, Essentials of Family Medicine, 5th Edition, by Sloane et al (eds), as well as some of the other resources on the reference list.  Chapter 3 of the "Essentials" text will also be helpful in addressing issues regarding best available evidence for these presentations.  The introducation portion of you r presentation might well begin with comments about:

1. What are the health priorities in the practice or community in which you are completing your clerkship? (Many prevention activities are age, gender, and environment specific and must be individualized to the patient and community.)

2. What are the barriers or challenges to implementing the HP/DP in that community?

The topic must address either a primary or secondary prevention intervention.  Primary interventions refer to Prevention. Secondary interventions refer to Screening. Tertiary interventions address Treatment of symptomatic disease to minimize morbidity and mortality, and should not be the focus of this discussion. For your presentation about a Primary or Secondary intervention, attempt to respond to some or all of the following questions:

1. Does the problem/disease significantly affect the length or quality of life?
2. Is available treatment effective/acceptable?
3. Does the condition have an asymptomatic period during which detection

    and treatment significantly reduces morbidity and/or mortality?
4. Is the prevention or screening procedure effective, acceptable, and cost

    effective?
5. Does the problem/disease occur with enough frequency to justify

    screening or focus on prevention for that community?
6. Does the screening introduce a lead time bias?
7. Does the screening/intervention create a length bias?
8. What is the evidence to support a position on this question?

9. How does this intervention impact Potentially Productive Years of Life

    Lost (PPYLL)?
9. What resources/partnerships are available to aid implementation?

3rd Session - week 5 of clerkship
For this session each of you will discuss, in 5-8 minutes,  an aspect of health care important in the community in which you are completing your Family Medicine Clerkship, or a health care issue affecting underserved populations or high risk groups in North Dakota.  The general focus of your presentation should be on the community resources (present, or needed, but absent), but the introduction could well be in context of the patient(s) you see in the clinic or hospital.  The issue may have caught your attention because of a single patient encounter, or a general observation or discussion with your preceptor(s).  Your presentation should be framed in terms of general learning for yourself and your colleagues, and  not as an assessment of the community, the practice, or individual patients.  Because we will know your community of interest, attempt to avoid specific identification of patients (HIPAA rules)  durring your presentation.  Issues or questions you might address include. 

What segment of the population is underserved or otherwise high risk?

What social and/or cultural issues in your community affect and effect health care?
What community resources are available for specific patient problems or illnesses?
What occupational or environmental health risks are prevalent in the community?

4th Session - week 7 of clerkship
The focus of this session will be the "Family Connection". To help direct your thinking about what kind of problem or patient issue to discuss, read Chapter 2 of the "Essentials" text, "The Challenging Patient Encounter".  Thinking about the "Family Connection" provides an opportunity to explore, with the patient, the meaning of their illness for themselves and their family, rather thatn limiting the discussion to the allopathic medicine understanding of the disease. Thinking about and understanding the family connection may help health care providers:

1. Understand how differences in culture can be a barrier or an asset to

    providing primary care, (ie, the impact of cultural/family health care

    beliefs on health care seeking and adherence behavior, as well as the 

    impact of different beliefs of the health care provider).
2. Identify alternative techniques for data collection and processing when

    the patient's culture differs from yours.
3. Understand when and how to perform a family assessment.
4. Match community resources with patient and family needs.
5. Integrate findings from assessment of the family into patient

    management.
6. Incorporate family issues into patient education.
7. Appreciate the influence of personal upbringing and lifestyle on how the

    medical student or physician views disease, patients, and patient

    families.

Please review the definitions, terms, "rules", and descriptions of possible family dynamics.  You likely will find one or more of the "rules", terms, or definitions helps to define the family/patient dynamics.  That material, plus some discussion on how to construct and use a genogram is available at The Family Connection.  A genogram or family map may aid your discussion about interactional patterns in the patient's system, and how those patterns will affect and effect ultimate health outcomes. As you collect patient-centered information, consider issues like family rules (expressed or unexpressed), interdependence, boundaries, and triangulation, and how those issues impact the patient's health and health seeking behaviors.