Predoctoral Education

History

Results of the 2000-2001 MedEd IQ Survey Project rated the
UTMB Family Medicine clerkship with very favorable results.

In 1989 the legislature of the State of Texas mandated that all Texas medical schools "incorporate a clerkship in family practice during the third core clinical year." While HB 18 did not specify the nature of the experience, two requirements were clear; it was to be a clerkship, not a preceptorship, and it was to be placed in the third year of the medical school curriculum. In response to this legislation, a four-week required clerkship, developed by the Department of Family Medicine, began at UTMB on June 25, 1990.

The model that was originally developed for the clerkship utilized the Family Practice Center (FPC) at UTMB, along with the Galveston County Community Coordinated Clinic (4Cs). Affiliated family medicine residency programs in Austin and Port Arthur provided additional sites, and a smaller number of students were placed at the Texas Tech-affiliated residency program in Odessa. Each student at a residency site also was paired with a practicing private physician faculty (PPF) in the community at least one-half day a week. Students were expected to see patients in the clinic or office, hospital, nursing home, and participate in at least one home visit. Students also participated in student case-based conferences conducted by residency faculty. Toward the end of the first year some private physician faculty were identified as exemplary teaching sites and were designated as Model Teaching Practices. A Model Teaching Practice (MTP) was defined as a practice with a single or group of physicians who agreed to commit their resources to meet the goals and objectives of the clerkship and to evaluate student progress toward these objectives. Each year an increasing number of students were sent to MTPs at which the experience with the private physician constituted the entire clerkship. At the present time Family Medicine clerkship sites extend south to the Mexican border, north to the Oklahoma state line, east to Beaumont and San Augustine, and west to El Paso.

Three excellent, experienced course directors have led the clerkship through the various stages of development. Barbara L. Thompson, M.D., the first director, oversaw the clerkship through its creation and the formative years. In 1994 Cecilia M. Romero, M.D., directed the clerkship through a time of expansion of learning sites with physicians in communities throughout Texas with emphases on sites along the border and in underserved areas. During this time the case-based "cluster" conferences were extended from the residency sites to rural areas where clusters of students were based, and the number of department faculty and support staff that concentrate on predoctoral education increased. Alice Anne O'Donell, M.D., became the course director in 2000, and is focusing on using Web-based technology to assure course objectives are delivered with consistency to students in clerkship sites through the state.

For the past three years, the family medicine clerkship has received the highest ratings of all clerkships by the third-year medical students in all five categories evaluated. They are: course administration, course experience, educational experiences, teacher experiences, and evaluation experiences.

Oversight of the clerkship is the responsibility of the Family Medicine Predoctoral Education Committee. It is comprised of the clerkship director, physicians, educators, community development specialists, and secretarial staff. The committee meets regularly to address issues that arise and to discuss and work on ideas for improving the clerkship. Each year it reviews the course goals and objectives, student assignments and related activities, evaluation instruments, final examination format, and the student syllabus and handbook. Setting the standards for grades, including "Honors," and determining the recipients of student awards are also responsibilities of the committee.

For many years the Department of Family Medicine offices and clinic were situated in an older building on campus. In November 1996 the entire department, including clinics, moved into larger space in the new Primary Care Pavilion at 400 Harborside Drive. The clinics and some offices are on the first floor. Offices for the predoctoral and residency education, research, and department administration faculty and staff are located on the second floor.