Teaching family medicine: a longitudinal and modular competency‐based approach

What problems were addressed? Our graduate medical school is located in Singapore. It runs a 4-year curriculum which closely follows the curriculum at Duke University (Durham, NC, USA). Basic sciences are taught during Year 1; clinical clerkships and electives are held in Years 2 and 4, and Year 3 is dedicated to research. The challenge was to design an innovative clerkship that complements the school’s unique curriculum. We abandoned the 4-week programme in Year 2 as taught at Duke University and adopted a modular competency-based approach. We created a year-long programme, allowing our students to experience care continuity and patient-centredness in the community. The first cohort of students completed the year-long clerkship in 2010 with encouraging results. What was tried? The family medicine clerkship is taught in three modules. The first is a knowledge foundation module, which is completed in the first 2 weeks of Year 3. Knowledge and skills learned during Year 2 clerkships are consolidated. Students learn to translate them to a family medicine setting, using team-based learning and clinical scenarios. These are supplemented with lectures and smallgroup discussions on conceptual topics in family medicine. Topics include family medicine principles, organisation of primary care, chronic disease management, preventative care and consultation skills. This is followed by two other modules, which are conducted in the community over the rest of the year. The continuity clinic module focuses on professionalism, patient care and system-based learning. Students are placed under the tutelage of two preceptors in community clinics. They complete a minimum of 20 clinic sessions distributed over a 1-year period. They are required to record their reflections after each session, using an electronic log book. In the patient-centred care module, students follow up two patients with chronic health issues, whom they encountered in their Year 2 clerkships. Students work in small groups of up to six and are supervised by a faculty member. Students make home visits and are encouraged to discover the perspectives of the patients and their caregivers as they cope with their illnesses. Students are encouraged to study system issues as they follow their patients’ journeys through the health care system. They are required to reflect on the impact of illness on the patients’ lives. Students ‘blog’ their reflections in their personalised web logs. We use a closed-access network which is shared only with team-mates and assigned faculty staff to maintain confidentiality. Students and teachers are encouraged to comment and interact with one another as they share experiences. What lessons were learned? An extended clerkship in which students are dispersed in the community is logistically challenging. Use of information technology, such as a web-based personal journal and electronic log books, is helpful. The programme was well accepted by faculty staff and students. On a scale of 0–5, the clerkship achieved a score of 4.21 in the students’ evaluation of the programme’s ability to achieve the goals and objectives of the rotation. Overall, 29.0% of students in the class gave the programme a score of 5 and 62.5% gave it a score of 4.