DEPARTMENT OF FAMILY MEDICINE
Clerkship title: MED 404.6 Family Medicine
Sponsoring department Department of Medicine
Name of clerkship director: Dr. Mark Lees (Saskatoon)
Dr. Jennifer Kuzmicz(Regina)
1. The family medicine rotation will be six weeks in duration, divided into a two
week regional/urban portion and a four week rural portion. Approved
urban/regional sites include only Saskatoon, Regina, Moose Jaw and Prince
Albert. Rural sites will include all other approved locations in Saskatchewan. A
copy of the approved preceptor list can be obtained from the Department of
2. Applications to change a rotation placement must be made in writing, stating the
reason for the proposed change, and will be considered on a case by case basis.
Approval will be granted based on the timing of the request and the merits of the
reason for change.
3. The schedule of the assignments will be available from:
Saskatoon JURSI Rural and Urban/Regional rotations – Corinne Andersen
Regina JURSI Rural rotation - College of Medicine office in Regina (766-
Regina JURSI Urban/Regional rotation – Melinda Martyn Department of
Family Medicine in Regina
A letter of notification will confirm all final arrangements.
4. At the end of both the urban and rural rotations, each JURSI must complete site
and preceptor evaluations. Completion of these forms is mandatory and must
be returned prior to a final mark being released to the College of Medicine.
5. If the student on-call has performed assessments in the emergency room or
delivery suite after midnight, the student is relieved from clinical and educational
responsibilities by noon the following day. The student must inform his/her
preceptor before departing from any scheduled clinical or educational activities
6. Urban rotation:
The two week urban/regional portion of the rotation will be spent at
either West Winds Primary Health Centre (Saskatoon), the Regina
Family Medicine Unit (Regina) or an approved community based
preceptor in Regina, Saskatoon, Moose Jaw or Prince Albert.
On-call responsibilities may include up to three days of call, including
one Saturday or one Sunday. JURSIs may call in advance to obtain
the call schedule:
o Saskatoon: Colleen Brockbank (655-4202)
o Regina: Melinda Martyn (766-4068)
o For other community preceptors, please contact your
7. Rural rotation:
Each JURSI will be assigned to a four week rural placement within the
province of Saskatchewan. Placement ranking forms are distributed
in advance and will be considered in the creation of the schedule. As
can be expected with such a complicated schedule it is not always
possible to accommodate each student’s preferences.
Written requests for special consideration should ideally be submitted a
minimum of six weeks in advance of the JURSI year and will be
honored on their merit and time of submission.
Accommodation will be provided at all sites.
JURSIs will not be assigned to a preceptor who is an immediate family
member. This would constitute a conflict of interest in terms of
Call responsibilities are up to 1 in 4 days throughout the rural portion of
the rotation. This will include three weekend days (Friday, Saturday
and Sunday) in the month. Arrangement of call duties usually is
completed with the site preceptor on the first day of the rural rotation.
Students should perform an entrance, mid-term, and end of rotation
interview with their preceptor.
VACATION, EDUCATION, AND SICK LEAVE
A maximum of five (5) days holidays/leave may be taken during the rural portion of
the rotation only. A maximum of five working days will be allowed for vacation,
education, or sick leave. Time off must be approved by the JURSI Coordinator and the
preceptor. Any requests for vacation or educational leave during the urban rotation will
be considered on a case by case basis. Requests for vacation and education time must
be submitted at least 6 weeks prior to the start of the rotation.
Vacation and education leave forms are available from the College of Medicine in
Saskatoon (966-8556) or Regina (766-4282).
APPLYING FOR AN ELECTIVE IN FAMILY MEDICINE
The rotation expectations are the same as for the scheduled Family Medicine rotation.
Rotation assignments (see below) are not required during electives. Be sure to start
arrangements with the Department at least six weeks in advance of your proposed
elective time. An elective form from the Dean's Office must be completed and
forwarded to the appropriate JURSI Coordinator for approval and signature. It is the
student’s responsibility to ensure that the approved form has been returned to the Dean's
Availability of electives, particularly in the FM Teaching Units in Regina and Saskatoon,
is dependent on having adequate supervisor resources at the time requested. If an
elective is not available in the teaching unit at the time requested, it may be
recommended to complete an elective with a community-based preceptor. Elective time
in the FM Teaching Units cannot exceed the time available for regularly-scheduled urban
FM rotations (maximum 2 weeks).
If an elective is done with a family physician outside of the Department of Family
Medicine, the student must make his/her own arrangements for the elective directly with
the preceptor. The student must complete an elective form from the Dean's Office.
Ambulatory and hospital patient contact under direct supervision, with graded
Morning sign-in rounds
Academic ½ day presentations
Small group learning (chart audits)
Project preparation and presentation (see below)
Optional community based clinical experiences with direct supervision
Self-directed learning cases (see below)
Self Reflection exercise (see below)
FAMILY MEDICINE ASSIGNMENTS
1. Urban/Regional Project
During the urban/regional family medicine rotation, each learner will be required to
complete a project and submit it in written form as well as prepare a brief (10-15 min)
presentation. If a learner is completing the urban rotation at West Winds Primary Health
Centre (Saskatoon) or the Family Medicine Unit (Regina), this will occur at morning sign-in
rounds sometime in the second week of the rotation. If a JURSI is placed with a community-
based preceptor, he/she will either come to the Academic Teaching Unit to present his/her
project, or present it to their preceptor and his or her colleagues at a mutually agreed upon
time. If the learner wishes to come and present their project at the academic teaching
unit, he or she should contact the Phase D Coordinator at the start of their rotation to
make the necessary arrangements. Detailed written instructions regarding the project
requirements are available on one45.
In summary, the project should illustrate one of the Four Principles of Family Medicine and
will fall within one of the following broad categories:
Clinical problem or case with a focus on evidence-based medicine
Screening in Family Practice
Clinical Practice Guidelines
2. Rural Project
During the rural family medicine rotation, each learner will be required to complete and
submit a small project relating to community resources. The steps involved in this project
Identifying a community need in your preceptor's practice (e.g. immunization
awareness, smoking cessation strategies, etc.)
Searching the literature for approaches used by others
Describing a potential community-based intervention
Identify a list of barriers and facilitators to implementing this intervention
Detailed written instructions regarding the project requirements are also available on one45.
3. Self Directed Learning Cases
Throughout the 6 week rotation, each student must complete and submit a set of self-
directed case based learning exercises which will increase exposure to and familiarity with a
variety of online resources essential for evidence-based practice. The cases center around
common presentations in primary care, with a focus on prevention and screening. A
complete description of how to complete the exercises, as well as the resources necessary to
complete it, can be found on one45. Though no mark is assigned to the submitted exercises,
failure to submit the cases to the JURSI Coordinator will result in a failed rotation.
4. Clinical Exposure Tracking
Before completing the six week family medicine rotation, each student will encounter, or
discuss in depth with their preceptor, the following clinical conditions / scenarios at least
A. Undifferentiated symptoms:
Cough / dyspnea
B. Chronic disease management:
Coronary artery disease
Mental health (e.g. anxiety, depression, addiction)
Lung disease (e.g. COPD, asthma)
C. Counselling / prevention:
Preventive care visit (e.g. periodic health exam, well child visit)
Sexual health (e.g. contraception, STI, counselling)
Exposure to these clinical conditions / scenarios will be tracked for each JURSI using one45.
Failure to track exposure to these conditions will result in a failed rotation.
5. Reflective Exercises
Each student must submit, via one45, a short reflection on any six of the above clinical
exposures encountered (2 from each category). At least one reflection should be completed
each week and should focus on a key ‘take home’ message of what was learned, and how
this new piece of knowledge will impact their future practice. The focus of the write-up
may be on any element of the clinical encounter (e.g. communication, clinical skills,
pharmacotherapy, screening, determinants of health, etc.). Each submission should not take
more than 10 minutes to compose and should be limited to 300 words. It is highly
recommended that they be completed on the day the clinical encounter occurred. Logs and
reflections will be reviewed by the preceptor halfway through the rural rotation and again at
the end of both the urban and rural rotations so that deficiencies can be addressed.
Family Medicine JURSI Objective
Family medicine is now recognized as a specialty based on a body of knowledge and an
approach to care unique to its discipline. Because family physicians’ commitment is to the
person and not to a particular organ system, age group, or technique, they must be skilled in
accepting responsibility for the full scope of care of patients in health and illness at all stages of
the life cycle. While facets of this comprehensive patient-centred approach are present in the care
provided by others, no other discipline has all of these tenets as its core raison d’être.
This approach is described according to the four principles of family medicine:
1. The family physician is a skilled clinician,
2. The patient-physician relationship is central to the family physicians role,
3. The family physician is a resource to a defined population,
4. Family medicine is community based
1. The Family Medicine Expert Perspective
THE LEARNER WILL:
1.1. Be able to describe how illnesses present and are managed differently in the
family medicine setting compared to other specialist settings:
Less diagnostic certainty due to patients often presenting at an early
undifferentiated stage of their illness
Use of time as a diagnostic tool
Use of evidence-based step-wise investigation
1.2 Be able to describe how family medicine practice varies depending on location,
Potential for wide scope of practice and opportunity for application of enhanced
skills in a rural setting
Range of different management decisions for similar clinical problems based on
community resources, distance, and patient cultural and financial considerations.
1.3 Demonstrate a patient centered approach to the diagnosis and management of
common patient problems that present to family physicians, with emphasis on
key clinical exposures for Family Medicine for Saskatchewan JURSIs.
1.4 Be able to identify and demonstrate an evidence based approach to health-
promotion and disease-prevention activities appropriate to particular populations as well
as to individual patients and patient encounters.
1.5 Demonstrate knowledge of reportable illnesses, as defined by public health
1.6 Be able to identify pharmacotherapeutic approaches to primary care conditions
based upon the patient’s context and issues.
1.7 Be able to identify and use non-pharmacologic modalities based upon the
1.8 Demonstrate the correct technique for procedural skills that they perform.
1.9 Understand the family physician’s role in maternity care, palliative care and other
settings in which family physicians work.
1.10 Appreciate the value of continuity of care for developing a deep knowledge of
patients in rural and regional/urban settings.
1.11 When faced with an ethical dilemma, demonstrate application of an ethical
framework in the clinical decision-making process.
2. The Family Medicine Communicator
THE LEARNER WILL:
2.1 Recognize that the patient-physician relationship is central to the practice of
2.2 Demonstrate a willingness to become involved in the full range of difficulties
which patients bring to their physicians and not just their biomedical problems.
2.3 Recognize the difference between illness and disease and explores both areas in
2.4 Demonstrate skills in finding common ground with patients in the formulation of
a management plan.
2.5 Carry out a patient centred interview.
2.6 Describe the legal and ethical requirements for obtaining informed consent and
demonstrate skills in discussing consent with patients based on these requirements.
2.7 Recognize a range of approaches to collaborating with patients.
2.8 Respect patient confidentiality, privacy and autonomy, including accepting
patients who are making decisions that are at variance with learner’s value systems.
2.9 Demonstrate cultural competence when working with patients and families and
encourage a culturally-safe environment which facilitates mutual respect, understanding
2.10 Maintain clear, accurate, and appropriate records (e.g., written and electronic) of
2.11 Utilize an electronic health record during interviews that enhances collaboration
between physician and patient and does not create a barrier or distraction.
2.12 Present verbal reports of clinical encounters that will summarize the key findings
in a succinct, well-organized manner that highlights the clinical reasoning process and
provides a clear rationale for investigation and management.
3. The Family Medicine Collaborator
THE LEARNER WILL:
3.1 Experience working with collaborative teams in rural and urban/regional settings,
recognizing differences in how inter-professional teams may function based on location,
size of community and community needs and resources.
3.2 Consult other health care professionals in the care of the patient.
3.3 Recognize and respect the diversity of roles, responsibilities and competencies of
health care professionals
3.4 Demonstrate the ability to liaise with appropriate community resources in the care
of a patient and recognize that community teams are distinct from hospital based teams
3.5. Demonstrate a respectful attitude towards other colleagues, teachers and members
of an interprofessional team and work collaboratively for patient-centred care.
3.6 Be able to formulate a written or verbal referral plan and justify this plan with
respect to clarity, appropriateness, and succinctness.
4. The Family Medicine Manager
THE LEARNER WILL:
4.1. Appreciate how physicians manage patient flow to accommodate the needs of
their patients in rural and urban/regional settings.
5. Family Medicine Health Advocate
THE LEARNER WILL:
5.1 Understand that the patient is part of a network that can be drawn upon (e.g.
family, community, workplace) for support, but also recognize that stressors related to
these networks can limit advocacy and care.
5.2 Be able to describe the attributes of a population they have worked with or are
working with and be able to identify the initial steps on how to work with this population
to improve its health.
5.3 Identify social determinants of health for an individual patient, and advocate
appropriately, optimizing those determinants of health.
5.4 Demonstrate an understanding of the range of organizations in different
communities that promote the well-being of his or her patients (e.g., community agencies,
self-help groups) and how to identify and work with these groups when appropriate.
6. Family Medicine Scholar
THE LEARNER WILL:
6.1. Demonstrate self-directed learning based on reflective practice.
6.1.1 Identify learning needs in all the CanMEDS FM roles.
6.1.2 Find appropriate resources.
6.1.3 Integrate the new knowledge in family medicine settings.
6.2 Be able to demonstrate an evidence-based approach to decision making within a
patient centered clinical method. .
6.3 Prepare a learner centered educational presentation or activity for peer colleagues
and/or patients and families.
7. Family Medicine Professional
THE LEARNER WILL:
7.1. Demonstrate an understanding of the key components of a professional
7.2. Be seen to be altruistic, behaving in a manner consistent with putting a patient’s
best interests first.
7.3 Be respectful to patients, their families, colleagues and other members of the
health care team.
7.4 Be known as being honest, disclose areas of uncertainty, and promptly and
voluntarily identify any errors of omission or commission.
7.5 Be seen to be responsible by completing required tasks (including documentation
of patient encounters and following-up on clinical tasks), meeting timelines on schedule
and promptly bringing to their preceptors’ attentions when task completion is delayed or
7.6 Maintain appropriate boundaries with patients, refraining from using the doctor-
patient relationship to their own benefit (other than their own development as a doctor).
7.7 Strive towards personal balance (health, family, social, etc), and appreciate how
this may be accomplished in both urban and rural/regional practice environments as this
will improve their ability to maintain professional standards of practice.
7.8 Understand the patient, personal, and professional impact of medical error.
EVALUATION AND ATTENDANCE
The end of rotation evaluations are based on the rotation objectives outlined above. one45 is
utilized for the purpose of evaluation. Each learner is encouraged to review the evaluation
parameters with the preceptor during orientation. Evaluation of the project, self-directed case
based learning, and clinical reflections will all make up a part of the learner’s final assessment
and be used in consideration for awards and prizes. Evaluation forms should be reviewed at the
midpoint of the longer rural rotation by the JURSI and preceptor as a part of the mid-term
interview, and MUST be reviewed at the end of the rotation.
Unexplained absences will be treated very seriously and considered unprofessional
conduct. These absences may be reflected in the final grade and may constitute
grounds for failure of the rotation, even if the composite grade for other aspects of
the evaluation exceeds 50%. The Dean’s office should be notified of any prolonged
or unexpected absences.
AWARDS AND PRIZES:
Several prizes are awarded in Family Medicine by the College of Medicine and the College of
Family Physicians of Canada. Criteria vary and for some are based on the JURSI’s mark on the
clerkship rotation. For more information contact the Department of Family Medicine 655-4200
(Drs. Lees or Dr. McKague).
Primary Care Portal: web.mac.com/malees
"An Introduction to Family Medicine", I. McWhinney.
"Family Medicine - A Guidebook for Practitioners of the Art", D. Shires, B. Hennen, &
“Patient-Centered Clinical Method” M. Stewart, et. al.