1. Applying the National Family Medicine Curriculum for Clerkship Evaluation and Development
Maureen Gecht-Silver, MPH
Richard Stringham, M.D.
Sagina Hanjrah, M.D.
Department of Family Medicine
University of Illinois at Chicago, College of Medicine

2. Goals
To describe a process to assess coverage of the National FM Curriculum in the UIC family medicine clerkship
To stimulate participants to review their own family medicine clerkship activities

3. The National Family Medicine Curriculum Structure
Five Principles
The Biopsychosocial Model
Comprehensive Care
Contextual Care
Continuity of Care
Coordination/Complexity of Care
Core Presentations for
Acute Care
Chronic Diseases
Health Promotion and Disease Prevention

4. Didactic Structure of the UIC FM Clerkship
Required Activities
Orientation
Dermatology
Solving Common Problems
FM Cases
Selectives (5-6)
Selectives  
Small group, interactive seminars, multi-disciplinary faculty
Students “select” sessions that match their personal interests

5. Selectives Acupuncture Communication with Adolescents
Complimentary and Alternative Medicine
Counseling and Managing Adults with HIV
Diabetes Management
Engage People with Intellectual/Developmental Disability (IDD) thru Education
GI: Top to Bottom
Immunizations
Low Back Pain
Narrative Medicine: Why Doctors Should Read Fiction
Occupational and Environmental Medicine
Orthopedics
Self-Management Support: Encouraging Pts to Manage Their Health
Over-the-Counter Medications
Trauma Survivors 

6. Question that Led to This Project
To what extent do our selectives address the scope of the National Family Medicine Clerkship Curriculum?
We are teaching a number of selectives and the question that led to this project is:
To what extent do our selectives address the scope of the National FM clerkship curriculum

7. Data Collection
This is the chart we used to collect data from our review. Along the top is the list of current selective offerings. Along the left side is the 5 principles and the three core presentation as outlined in the curriculum.
Let me review the steps of the process we went through
Divided list of current selectives between three reviewers
Each reviewer indep
Read selective write up and objectives
Discussed objectives listed under principles and core presentations with selective instructor to determine areas instructor addresses
In some cases observed selective
Reviewer tentatively rated 5 principles and core presentations acute, chronic, and preventive
Three reviewers met to review preliminary ratings and identify challenges

8. Challenges To ensure inter-rater reliability
To differentiate the terms “describe” and “demonstrate” used in the curriculum
To accurately measure the National FM Curriculum components addressed in each selective
Each principle had a different number of supporting objectives and each reviewer rated differently. We discussed several options (Initially +/- rating, didn’t work, tried # of objectives, impossible to compare) by group consensus decided that a 0-2 rating scale would allow better inter rater reliability. Defined as follows
0=not covered
1=covered less than half of objectives under related to principle
2=half or more points covered.
Some objectives stated describe while others demonstrate. When objective stated demonstrate, even if all objectives under the principle were addressed, selective could not be rated higher than 1
To accurately measure components addressed we:
Talked with instructor
Rated individually
Reviewed one another’s ratings esp when score seemed too high or low

9. Data Collection
Again this is the chart we used to collect data for our review. Along the top is the list of current selective offerings. Along the left side is the 5 principles and the three core presentation as outline in the curriculum.

10. Analysis of Biopsychosocial Model Component
Here is an analysis of the Biopsychosocial Model component as an example of what we reviewed.
Notice there were three subcategories each with objectives under the BPS principle. The total score is the sum of subcomponents
Gives you an example of the scoring challenges, e.g. PCCS has 10 items, PA has 2 items, Pt Ed has 6 items

11. Scope of National Curriculum Covered
This slide includes the scores from all of the subcomponents of each principle. Note that QI under coordination was not addressed in any of the selectives
The totals illustrate that some principles have more subcategories than others. This makes it difficult to compare scores.
What we learned is that:
The principles and core presentations are covered to varying degrees in our group of selectives
The results offer opportunities for future selective development

12. Implications
Help faculty maximize their selective(s) to better cover the National FM curriculum principles and core presentations
Reorganize the process of assigning students to selectives
Review our coverage of the National FM curriculum content throughout the Family Medicine Clerkship

13. Questions?

14. Contact Information
Maureen Gecht-Silver, MPH, OTR/L Rik Stringham, M.D. Sagina Hanjrah, M.D.