Session #1 will be held at your AHEC campus, typically during the second week of the clerkship (see schedule).
During the first several days of the clerkship each student will select a patient with several complex chronic health challenges (multiple chronic illnesses, maybe with concurrent mental health illness and/or with complicated psychosocial context). It does not need to be the most complicated patient ever. The preceptor should be enlisted to help select an appropriate patient. The student will interview the physician who has been taking care of the patient and identify the challenges and or questions the preceptor has had managing this patient. At the same time, the student will identify all relevant evidence based guidelines that apply to patient and prioritize recommendations that would be most beneficial to the patient (finding the balance strongest evidence from studies and the patient’s own goals). The student will then interview the patient and explore the patient’s understanding of their chronic illnesses, including the patient’s psychosocial context. The student works with patient (using Motivational Interviewing techniques) to set realistic goals to improve the patient’s health. Interviews can take place in the office, the patient’s home, or the patient’s workplace. The interview should be recorded using the Flip recorder given out at orientation. It is important to carefully read instructions on getting patient consent and ensuring patient privacy. Follow this link to read these instructions and for the permission form.
In preparation for the small group Session #1 at the AHEC campus, each student should reflect on the strength of available guidelines, their interview with the preceptor as well as the patient and their Flip recording video.
Ideally, students should choose to review guidelines for chronic illnesses listed on this website. Students should review the applicable guidelines from at least 3 sources and be prepared to compare and contrast them. Students are not expected to have these memorized.
In reviewing the guidelines, the guideline template provides a helpful structure. Also using high value resources will make preparation easier. We recommend first reviewing the FM text book, perhaps reading what UpToDate has to say. The AAFP Topics and Guidelines.gov are also extremely helpful.
In reviewing the video, students should reflect on what sections will be most helpful to their peers. Segments in general should be limited to 8-10 minutes total and can demonstrate things that went well or things that did not go well. Some of the best learning comes from things that did not go well! Students should not edit their video but rather record the time marks for the beginning and end of segments.
During the small group session on the AHEC campus, student will discuss and prioritize chronic illness guidelines relevant to their patients. Students will review each other’s video recordings, reflecting on the cultural and behavioral factors that influence the health of patients and refining their motivational interviewing skills.
Based on reflections from the video and review of the guidelines, the student should begin to develop a management plan that answers preceptor’s questions, integrates most beneficial interventions and responds to patient’s context and goals. This will become part of the CARE consultant note that the student turns in at the end of the rotation (described further under CARE Assignment tab).
What is due for Session #1? Video clips demonstrating motivational interviewing and be prepared to discuss the relevant guidelines for 2-3 of your patient’s chronic illnesses