CLINICAL FOUNDATIONS ACA ACTIVITY LOG & PHYSICAL EXAM

60 Pages·2013·0.7 MB·English

SOMC 224

CLINICAL FOUNDATIONS

ACA ACTIVITY LOG & PHYSICAL

EXAM S KILLS CHECKLIST

2013-2014

 BLUE BOOK 
UCSD Ambulatory Care Apprenticeship (ACA)
SOMC 224 MS1

ACA ACTIVITY LOG & PHYSICAL EXAM SKILLS CHECKLIST

C e r t i f i c a t i o n

STUDENT’S PRINTED NAME:
First name MI Last Name

DATE CHECKLIST BOOK RECEIVED BY STUDENT:

DATE CHECKLIST BOOK COMPLETED:

CERTIFICATION BY STUDENT:

My signature below certifies that I have performed each of the listed tasks the required number of times. I also certify
that each person signing off on each task did observe my performance of the task and also indicated to me the
adequacy of my performance.

SIGNATURE OF STUDENT: DATE:
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UCSD Ambulatory Care Apprenticeship (ACA)
SOMC 224 MS1

Blank
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UCSD Ambulatory Care Apprenticeship (ACA)
SOMC 224 MS1

Dear Clinical Foundation Students:

As a requirement for the Ambulatory Care Apprenticeship (ACA), complete this activity log after each session. This log
will provide us with valuable information about the experience that you have during this component of the Clinical
Foundations course. We are interested in understanding the interactions that you have with both patients and your
preceptors. This log will also help you to review your experience with your preceptor throughout the apprenticeship so that
you can adjust your sessions to provide broader opportunities if necessary.

Resource TEAR OUTS: Discuss with your ACA preceptor
We have included in this log, 2 copies of each sessions’ learning objectives. One copy is your resource to keep; and 2 nd
copy is for you to tear out and give to your preceptor as their resource and as a focus for discussion with your preceptor at
each session.

From the very first meeting with your ACA preceptor you are building a relationship. Being an engaged and active
participant in each ACA session is crucial to your success. You have a limited number of sessions to build a successful
relationship with your ACA preceptor over the two year ACA timeline. Being absent from even one session significantly
diminishes your experience and your opportunities for clinical skills development.

Patients Seen: Please fill in the number of patients, for whom (1) you were an observer only (2) you elicited components
of the history or performed components of the physical alone (i.e. without preceptor observation) (3) were observed by the
preceptor for part of your interaction with the patient, either taking a history or performing PEX components or (4) were
observed by the preceptor during your entire interaction with the patient. If there were patients for whom a “hybrid” of
these descriptions occurred, please choose the one that describes the encounter most accurately (i.e. the # column
should add up to the total number of patients seen).

Types of Clinical Encounters: Please record the number of patients who were seen for (1) a comprehensive H&P (2) a
focused visit for chronic problem(s) (3) a focused visit for an acute problem.

History Components Elicited and Organ Systems Examined: Please circle all of these that you had a chance to elicit
or examine during your session.

Written Medical Records: Please record (1) the number of full or partial SOAP notes you wrote, (2) the number of full
H&Ps you wrote during the session or assigned by your preceptor to be done after the session (3) any other
documentation in the med record you did (e.g. problem lists, medication lists, health maintenance logs etc.) - describe the
type of record and number of each.

Other: Here you can record things like topics your preceptor assigned you to look up between sessions.
Write Ups: At the end of this booklet you will find guides for H&P and SOAP notes.
Please feel free to contact us with any questions.
Rusty Kallenberg, M.D.
ACA Director

Shawn Harrity, M.D.
Clinical Foundations Director

Charlie Goldberg, M.D.
Clinical Foundations Director

Kristin Cadenhead, M.D.
Clinical Foundations Director

Michelle Johnson, M.D.
Clinical Foundations Director
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UCSD Ambulatory Care Apprenticeship (ACA)
SOMC 224 MS1

Blank
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UCSD Ambulatory Care Apprenticeship (ACA)
SOMC 224 MS1

Session 1-2 Preceptor Resource

These one-pagers provide an orientation to the tasks of your ACA session each week. There are tasks for you to do,
specific things for you to observe, skills to practice, items to record, topics to learn about and questions/issues upon
which to reflect.

To Do
At the Beginning of the ACA
1. Get to know your preceptor: where from originally, his/her educational background, a bit about his/her personal
life, professional practice history, etc. Share your own. This will be a long-term mentoring relationship and the
more you get to know one another the higher the likelihood that you will enjoy each other in the process.
2. Get to know the other physicians in the office too. They will sometimes stand in for your preceptor and are often
eager to share interesting patients and events with you.
3. Get to know the staff of the office and understand their jobs and how they make the place go.
4. Understand patient flow through the office and how patients check in, where they wait, how the nurses interact
with them and what happens after you and your doc leave the exam room.
At the Beginning of Each Session
1. Look at the schedule and see which patients are scheduled; talk with your preceptor and decide who it might be
inappropriate for you to see with him/her.
2. In a few sessions after your preceptor and you are more comfortable with each other, you can mutually decide
which patient(s) might be candidates to see alone for a few minutes.
3. After a few sessions – this is a good time to report on any learning issues you looked up or go over any SOAP
notes you might have written from the last session.

To Observe
1. During the first few sessions we want you to observe why patients are in the office. There are usually one or
more of the following simple “reasons for the visit”:
a. An acute problem
b. Follow up of one or more chronic problem(s)
c. A health maintenance visit
d. A problem stemming largely from an emotional/behavioral issue
e. An “administrative” issue – like needing a form filled out or a letter written
2. Observe whether this is a patient known to your preceptor or a first time visit for the patient; note any
differences in how your preceptor interacts or communicates with new vs. known patients. Note any other
variables in how the communication goes between your preceptor and his/her patients.
3. Observe how your preceptor elicits the history from each patient; how the agenda for the visit is set and how
many issues are discussed.
4. Observe what parts of the physical examination take place for each patient’s specific problems as this reflects
practiced efficiency on the part of your preceptor.

To Practice
1. Introducing yourself as a first year medical student working with your preceptor.
2. Asking occasional questions that strike you during the history taking. You might want to discuss with your
preceptor if this is ok before you try it out the first time.
3. After a while your preceptor might ask you to elicit the history of a particular problem while he/she is in the
room with you.
4. Performing vital signs on some of the patients you are seeing. You might want to work with the office’s nurses
initially at the beginning of each visit so you can practice performing the vital signs. These include: weight,
height, temp., respirations, pulse and finally, blood pressure.
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UCSD Ambulatory Care Apprenticeship (ACA)
SOMC 224 MS1

5. Performing parts of the physical exam as you learn them in POM and with your preceptor when the exam part of
the visit comes up. You should always bring your equipment (at least your stethoscope) with you to your ACA
sessions.

To Record
Record them in an orderly fashion on the blank pages in your Blue Book. When we activate the eportfolio section this
will be an even more convenient way to keep a record of patients seen.

To Learn About
1. Learning issues will come up during your ACA sessions. At times your preceptor might say, “This is a great topic
for you to look up!” Many questions arise every day during practice. Many physicians don’t have the time to
look them all up. One of the quid-pro-quos of having a student is to have some assistance in tracking down the
answers to many of these questions from practice. Having 1-2 areas to follow up on each session takes
advantage of a key fact of adult learning: having a reason (i.e. patient care) to find out something is a great
motivator to learning. Performing this function for your preceptor and his/her patients demonstrates your
interest in learning and sharing what you’ve learned is proper reciprocation for all the things your preceptor will
teach you.
2. Other issues you yourself will identify related to pure biomedical issues that the patients you saw bring to your
attention or other psychosocial, behavioral, spiritual, socioeconomic or practice management issues that are
important to delivering care in a primary care setting.

To Reflect
“Reflection in action” is a key component of adult learning. In other words one should always be reviewing and
reflecting on how an episode of medical care delivery went. This is the way we identify gaps in care, be they
knowledge, skill or even attitude gaps. Once identified we can always pursue additional learning to improve our
performance. Below are listed some items to reflect upon during your first few sessions.
1. What influences might affect how you interact with patients in practice?
2. How do you handle “not knowing” something that you need to know or that the patient asks you about during a
visit? What resources are available to you to find answers to such questions?
3. Were you affected emotionally by anything you witnessed during the session? What was it and why did it affect
you and what will you do to process these emotions?
4. Were there any professionalism challenges that occurred during the session? How did your preceptor handle
these?
5. What do you want to share with your POM group of peers and mentors about your ACA experience?

REMEMBER: If you are having any difficulties in ACA – you should contact Dr. Kallenberg or the ACA support staff as
soon as possible to discuss them.
6
UCSD Ambulatory Care Apprenticeship (ACA)
SOMC 224 MS1

Session 1-2 Student Resource

These one-pagers provide an orientation to the tasks of your ACA session each week. There are tasks for you to do,
specific things for you to observe, skills to practice, items to record, topics to learn about and questions/issues upon
which to reflect.

To Do
At the Beginning of the ACA
1. Get to know your preceptor: where from originally, his/her educational background, a bit about his/her
personal life, professional practice history, etc. Share your own. This will be a long-term mentoring
relationship and the more you get to know one another the higher the likelihood that you will enjoy each
other in the process.
2. Get to know the other physicians in the office too. They will sometimes stand in for your preceptor and are
often eager to share interesting patients and events with you.
3. Get to know the staff of the office and understand their jobs and how they make the place go.
4. Understand patient flow through the office and how patients check in, where they wait, how the nurses
interact with them and what happens after you and your doc leave the exam room.
At the Beginning of Each Session
1. Look at the schedule and see which patients are scheduled; talk with your preceptor and decide who it might
be inappropriate for you to see with him/her.
2. In a few sessions after your preceptor and you are more comfortable with each other, you can mutually
decide which patient(s) might be candidates to see alone for a few minutes.
3. After a few sessions – this is a good time to report on any learning issues you looked up or go over any SOAP
notes you might have written from the last session.

To Observe
1. During the first few sessions we want you to observe why patients are in the office. There are usually one or
more of the following simple “reasons for the visit”:
a. An acute problem
b. Follow up of one or more chronic problem(s)
c. A health maintenance visit
d. A problem stemming largely from an emotional/behavioral issue
e. An “administrative” issue – like needing a form filled out or a letter written
2. Observe whether this is a patient known to your preceptor or a first time visit for the patient; note any
differences in how your preceptor interacts or communicates with new vs. known patients. Note any other
variables in how the communication goes between your preceptor and his/her patients.
3. Observe how your preceptor elicits the history from each patient; how the agenda for the visit is set and how
many issues are discussed.
4. Observe what parts of the physical examination take place for each patient’s specific problems as this reflects
practiced efficiency on the part of your preceptor.

To Practice
1. Introducing yourself as a first year medical student working with your preceptor.
2. Asking occasional questions that strike you during the history taking. You might want to discuss with your
preceptor if this is ok before you try it out the first time.
3. After a while your preceptor might ask you to elicit the history of a particular problem while he/she is in the
room with you.
7
UCSD Ambulatory Care Apprenticeship (ACA)
SOMC 224 MS1

4. Performing vital signs on some of the patients you are seeing. You might want to work with the office’s
nurses initially at the beginning of each visit so you can practice performing the vital signs. These include:
weight, height, temp., respirations, pulse and finally, blood pressure.
5. Performing parts of the physical exam as you learn them in POM and with your preceptor when the exam
part of the visit comes up. You should always bring your equipment (at least your stethoscope) with you to
your ACA sessions.

To Record
Record them in an orderly fashion on the blank pages in your Blue Book. When we activate the eportfolio section this
will be an even more convenient way to keep a record of patients seen.
To Learn About
1. Learning issues will come up during your ACA sessions. At times your preceptor might say, “This is a great
topic for you to look up!” Many questions arise every day during practice. Many physicians don’t have the
time to look them all up. One of the quid-pro-quos of having a student is to have some assistance in tracking
down the answers to many of these questions from practice. Having 1-2 areas to follow up on each session
takes advantage of a key fact of adult learning: having a reason (i.e. patient care) to find out something is a
great motivator to learning. Performing this function for your preceptor and his/her patients demonstrates
your interest in learning and sharing what you’ve learned is proper reciprocation for all the things your
preceptor will teach you.
2. Other issues you yourself will identify related to pure biomedical issues that the patients you saw bring to
your attention or other psychosocial, behavioral, spiritual, socioeconomic or practice management issues
that are important to delivering care in a primary care setting.

To Reflect
“Reflection in action” is a key component of adult learning. In other words one should always be reviewing and
reflecting on how an episode of medical care delivery went. This is the way we identify gaps in care, be they
knowledge, skill or even attitude gaps. Once identified we can always pursue additional learning to improve our
performance. Below are listed some items to reflect upon during your first few sessions.
1. What influences might affect how you interact with patients in practice?
2. How do you handle “not knowing” something that you need to know or that the patient asks you about
during a visit? What resources are available to you to find answers to such questions?
3. Were you affected emotionally by anything you witnessed during the session? What was it and why did it
affect you and what will you do to process these emotions?
4. Were there any professionalism challenges that occurred during the session? How did your preceptor handle
these?
5. What do you want to share with your POM group of peers and mentors about your ACA experience?

REMEMBER: If you are having any difficulties in ACA – you should contact Dr. Kallenberg or the ACA support staff as
soon as possible to discuss them.
8
UCSD Ambulatory Care Apprenticeship (ACA)
SOMC 224 MS1

A C A S e s s i o n 1

History Organ
Types Of
Components Systems
Patients Seen # Clinical # Written Medical Records #
Elicited Examined
Encounters
(Circle All) (Circle All)

Entire HX Vital signs
Observed only the preceptor- Establish care
Full SOAP notes written
patient interaction or new HEENT
HPI (focused
consultation
history)
(i.e. full H&P) Neck

Elicited some history alone with
Medications Chest Partial SOAP notes written
patient
Focused visit Allergies Cardiac
Performed physical exam pforro bchlermon(sic) Other PMH Vascular sWersitstieonn Ho&r Passs (idgonneed dfourr ing
component(s) alone with patient
Abdomen completion prior to next session)
FH
Observed by preceptor: Back Other:
Focused visit
* taking history for acute prob SH
Extrem
* performing PEX Annual exam HMS Neuro
established
ROS Other
Observed by preceptor during Patient
entire visit

ACA Preceptor Signature – Session #1 Date

A C A S e s s i o n 2

History Organ
Types Of
Components Systems
Patients Seen # Clinical # Written Medical Records #
Elicited Examined
Encounters
(Circle All) (Circle All)

Entire HX Vital signs
Observed only the preceptor- Establish care
Full SOAP notes written
patient interaction or new HPI (focused HEENT
consultation
history)
(i.e. full H&P) Neck

Elicited some history alone with
Medications Chest Partial SOAP notes written
patient
Focused visit Allergies Cardiac
Performed physical exam pforro bchlermon(sic) Other PMH Vascular sWersitstieonn Ho&r Passs (idgonneed dfourr ing
component(s) alone with patient
Abdomen completion prior to next session)
FH
Observed by preceptor: Back Other:
Focused visit
* taking history for acute prob SH
Extrem
* performing PEX Annual exam HMS Neuro
established
ROS Other
Observed by preceptor during patient
entire visit

9