Department of Medicine

Primary Care Medicine course

The Primary Care Medicine course is an Advanced Clinical Experience (ACE) offered during the Immersion Phase.  

The heart of the students' experience is individual time with faculty preceptors in the clinic. In advance, students will choose whether they wish to work with a primary care internist, pediatrician, or family practitioner in that faculty member's private practice. Students will work one-on-one with the attending for the month. They will see the patient on their own, present to their preceptor, and then return to the patient to initiate the diagnostic and therapeutic plans. Students will keep in touch with patients during the month to provide them reports of labs and x-rays. They will also have an opportunity to see patients again during necessary follow-up appointments. Each student will work up 2-3 patients per half day. 

With a few exceptions each student will be assigned to a community preceptor or preceptors on campus. The goal is to have students work with less than four different preceptors during the rotation to allow continuity of teaching and patient care.


What is primary medical care? 

An essential element of any health care system is primary medical care. All Americans should have access to a health professional trained to provide quality primary medical care as their entry point to the system. Such primary care physicians provide: 

  • First-contact care for persons with any undiagnosed sign, symptom, or health concern 
  • Comprehensive care for the person which is not organ- or problem- specific 
  • Longitudinal or continuous care for the patient 
  • Responsibility for coordinating other health services as they relate to the patient's care 

What are primary care competencies? 

Physicians who deliver comprehensive primary medical care are uniquely trained in how to: 

  • Recognize early symptoms of serious disease 
  • Distinguish between self-limited illnesses and problems requiring further medical intervention 
  • Perform time-efficient histories, physicals, and diagnoses carried out at the quick pace required in most ambulatory care settings 
  • Provide screening and counseling to prevent disease 
  • Communicate with a variety of patients in a long-term relationship 
  • Access and utilize social and financial resources for patients

Learning Topics: Medical students will encounter common presenting problems during their interactions with patients on rotation. Learn more about this at the Vanderbilt Core Clinical Curriculum site.


Goals and Objectives 

At the end of the Primary Care Ambulatory Medicine Clerkship, the third and fourth-year medical student should have a well-developed foundation of skills, knowledge, and attitudes needed to provide for patients in office settings. 


Goal: You will develop and refine the basic clinical skills required to provide effective and efficient primary care. 

Important areas: 

  • History and physical examination: obtain a patient's history and physical exam in a logical, organized and thorough manner while adapting to the urgency of the medical situation and the time available 
  • Diagnostic decision making: formulate a differential diagnosis based on the key findings from the history and physical examination 
  • Therapeutic decision making: understand risks, benefits, and compliance issues in choosing a treatment 
  • Procedures: be able to perform such procedures as throat cultures, PAP smears, gram stains, wet mounts, and EKGs 

Goal: You will recognize the spectrum of problems that occur in primary care and will understand how to provide, continuous comprehensive care to patients and their families. 

Important areas: 

  • Assessment of undifferentiated presentation, separating those problems that are serious and require immediate evaluation and consultations from those that do not 
  • Exposure to extended care centers including community clinics 

Goal: You will develop effective communication skills with patients, families and other health care providers. 

  • With patients: Identify hidden agendas, recognize psychosocial issues, demonstrate listening skills with probing and clarifying, work with multi-problem patients, angry patients, and somaticizing patients. 
  • With colleagues: Make concise, accurate, and well-organized clinical notes and oral presentations and write prescriptions. 

Goal: You will learn the principles and the application of health promotion, risk factor assessment, and disease prevention interventions.

Important areas: 

  • Screening: Criteria for incorporating a screening test and preventive measures routinely addressed in the clinic
  • Risk identification in the medical interview 
  • Personal and cultural beliefs that influence patient participation in health promotion
  • Patient education and techniques for counseling toward behavioral change 

Goal: You will gain appreciation for the personal, economic, ethical, and legal issues that influence the patient and the physician in primary care. 

Important areas: 

  • Personal: Balance in physician's personal life, independent learning and self evaluation 
  • Economic: Practice management including managed care, billing, insurance, and reimbursement 
  • Ethical: Advanced directives and informed consent in the office 
  • Legal: Risk management, including communicating with difficult patients and proper documentation. 

You are encouraged to participate in all activities of the practice. Assume an active, interested role as a partner in the practice as you participate in the office evaluation of patients. Although not required, you may also arrange with your preceptor to take part in administrative planning, hospital rounds, emergency room visits, night call, or home visits of his or her patients. In the office, you are encouraged to work independently as well as observe the preceptor. 

When working independently let the following steps be a guide: 

  • See patient alone, introduce yourself, informing the patient that you are a medical student, working with the patient's physician 
  • Perform a focused interview and physical examination, formulate a differential diagnosis, and decide on the diagnostic and therapeutic strategies needed 
  • Tell the patient that the preceptor will return with you to review the situation 
  • Present the patient's history and physical examination, reevaluate the patient with the preceptor 
  • Discuss the assessment of the problem and the recommendations with the patient 
  • Order appropriate tests and write prescriptions with the preceptor's approval 
  • Write or dictate a progress note and have the preceptor approve it 
  • See the patient in follow-up, if possible 
  • Pay attention to your schedule and the patient's - try not to keep patients waiting 
  • When observing the preceptor, observe the preceptor's style of interaction and interview techniques 
  • Participate in the interview when appropriate 
  • Participate in the physical examination with the preceptor. 
  • Interpret diagnostic tests and formulate treatment plans with the preceptor. 

You are encouraged to be an independent learner. Get involved in the care of patients and read about the problems that you see. 

Talk with your preceptor about preventive medicine, cost containment, insurance and billing, staff relations, balancing the professional and personal aspects of your life, etc. Do literature searches to help you and your preceptor learn about the case and determine a course of action. 

Gaining an understanding of the community based pediatric practice so that the student can make a knowledgeable career choice requires learning about: 

  • Pediatric manpower needs and health care models such as HMOs, small and large group practices and PPOs 
  • Health promotion, disease prevention, child advocacy, child and adolescent behavior and development 
  • Practitioner involvement in medical student and resident education and office-based research 
  • The lifestyle of the practicing pediatrician 
  • The pediatrician's involvement in the community 
  • The characteristics of practice that are professionally rewarding and enjoyable as well as those that are less desirable 

Gaining an understanding of professional attitudes that promote good health care practices in primary care settings. These professional attitudes include: 

  • Care that is family-centered, accessible, comprehensive, coordinated and continuous 
  • Cost-effective use of laboratory tests and screening methods 
  • The importance of independent lifelong learning that is achieved by primary care providers 

Acquiring the skills that are effective in time-limited patient encounters. Skills that are needed include: 

  • Utilizing interviewing skills with patients during a focused encounter 
  • Performing a focused physical examination 
  • Learning to collect and synthesize limited data to develop appropriate diagnostic hypotheses and treatment plans 
  • Recording and documenting patient information, diagnoses and treatment plans in a concise, organized manner 
  • Learning about using the telephone as a means of effective counseling, of identifying illness, of initiating treatment and of obtaining follow-up information 

Acquiring knowledge. The student should learn about: 

  • The pathophysiology, epidemiology and treatment of acute and chronic diseases common to a community-based primary care setting 
  • Methods used to prevent accidents 
  • Methods used in disease prevention, including immunizations and screening tests 
  • Methods used for health promotion, including developmental screening, anticipatory guidance and counseling 
  • Using computers in patient care and office management 

Developing an introductory understanding of how community resources relate to child development, education and health care.

  • Resources include day care, preschool programs, schooling (including special education), parent support groups, and other community agencies. The observation and evaluation of children at different ages provides a unique opportunity to understand the development of children and how community resources are integrated in the care of children. 


More information

Evaluation of student performance 

Your grade will be determined by the evaluations from your preceptors. They will be asked to consider and comment on your performance in the categories below. A final grade of Honors for the course means that the student performed excellently in all areas, a High Pass means the student performed excellently in most but not all areas, and a Pass means the student performed satisfactorily in all areas. 

Communication skills 

  • Problem-focused interviewing 
  • Interaction with patients and colleagues 
  • Concise and well-organized oral presentations and progress notes 

Clinical skills and knowledge 

  • Focused physical exam 
  • Diagnostic and therapeutic reasoning skills 
  • Knowledge of primary care problems 

Personal Attributes 

  • Dependability and participation 
  • Curiosity and enthusiasm 
  • Maturity and professional manner 
  • Independent learning 
  • Interest in evaluation and constructive feedback 

For your information, an attending is looking for the presence or absence of each of these behaviors and skills in formulating the evaluation of the student. 

Honors: 

  • Will ask to participate in all aspects of attending's professional activities 
  • Broad knowledge base of common problems 
  • Interview skills above expected level, e.g. responds to patients' emotions, negotiates with patients, works to understand patients' experience of the illness 
  • Focused physical exam, accurate in most situations 
  • Little trouble sorting through complex clinical information to formulate a diagnosis and plan 
  • Well-organized and prioritized case presentations and write-ups 
  • Questions the use of diagnostic tests and is aware of costs 
  • Reads about the case and brings helpful information back to the attending 
  • Takes responsibility for follow-up care (e.g. tracks lab data, calls patients with results) 

High Pass: 

  • Offers to help attending but does not seem as aware of various activities of the attending's work as the superior student 
  • Broad knowledge base of common problems 
  • Interview skills are good; establishes rapport and collects the needed information 
  • Focused examinations are strained at first but become easier by the end of the rotation 
  • Sometimes misses important information in the H & P but accepts input from the attending and demonstrates improvement 
  • Needs direction from time to time to work through complex clinical information 
  • Written and verbal presentations become more pertinent and concise as the rotation continues 
  • Question diagnostic tests but not as critically as the superior student 
  • Independent learner but relies on direction from the attending for learning assignments 

Pass: 

  • Close supervision is often needed 
  • Participates in expected work but does not offer to help, is quiet about accepting responsibility 
  • Attending may have occasional concerns about the student's knowledge 
  • Interview skills focus only on establishing rapport and collecting information without thorough investigation and understanding of the patient's concerns 
  • Physical exam is adequate but may not always be accurate or applied to the appropriate clinical situation 
  • Needs direction with each complex case sorting through priorities 
  • Presentations and progress notes often disorganized or incomplete, but with time they improve 
  • Usually looks to the attending for a diagnostic and therapeutic plan rather than asserting his/her own 
  • Independently reads, but only with attending's prompting 

I hear that one can take the clerkship "in-town" or "out-of-town." 

Most students will take the clerkship in town, but one can arrange an out-of-town experience according to the guidelines below. Out of town is considered 55 miles or more away from campus.  

How do I sign up for the clerkship if I want to take it in town? 

At least 42 days prior to the month in which you will do your Primary Care rotation, students will take the Primary Care Request Form (IDIS 5100) to Reed Sparta at reed.sparta@vumc.org.   

How do I sign up for the clerkship if I want to take it out of town? 

Students can gain credit for the Primary Care Medicine requirement in a primary care setting in another area of the U.S., with approval of the course director. It is the student’s responsibility to find the out-of-town experience and to make travel and housing arrangements.  

The student must find a suitable mentor at the outside site who will agree to: 

  • Carry out the course objectives as outlined at this site 
  • Provide a clinical experience where students see patients independently but under the guidance of a preceptor in a primary care setting for at least 28 half days 
  • Take responsibility for monitoring the student's performance and for providing feedback to the course directors using the online evaluation form of this site 

Students who wish to fulfill this course requirement out of the Nashville area must complete the Primary Care Form (IDIS 5150) with the preceptor’s name, address, email, phone and fax numbers. The form should be delivered to the Registrar's Office no later than 90 days prior to the start of the rotation. She will then finalize any details with the away site concerning requirements and grading. 

It is the student’s responsibility to contact the practice to see if any additional paperwork is needed from the Registrar’s Office concerning enrollment verification or liability insurance. The practice may also require an affiliation agreement with Vanderbilt, so there must be time to complete this required paperwork. 

I don’t see my Primary Care month on my schedule. 

Primary Care will be added to your schedule 42 days prior to the start of your month’s work to facilitate any changes that may occur up to that time. 

I hear that I can do Primary Care through an immersion course. 

Students who wish to meet the requirement for Primary Care through an immersion course will need to see the Registrar for details. 

What is the best way to communicate with course directors and administrators?  

We ask the students email reed.sparta@vumc.org to contact faculty and staff.  

Reed Sparta, Program Manager

Phone: 615-343-6657 
Fax: 615-343-4466 
Email: reed.sparta@vumc.org 

Lyndi Hopkins, Senior Administrative Assistant 
Pediatric Residency and Clerkship Programs 
Coordinator, Pediatric Clerkship Program 
Phone: 615-322-0348 
Email: lyndi.hopkins@vumc.org


Program Leadership

Joseph Gigante, MD

Program Co-Director
Professor of Medicine, Department of Pediatrics

Rachel Wolf, MD

Program Co-Director
Assistant Professor of Medicine, Division of Internal Medicine