WWAMI Rural Integrated Training Experience (WRITE)

Program Requirements

All WRITE sites offer 3 weeks of outpatient Pediatrics, 3 weeks of outpatient Psychiatry, 6 weeks of outpatient Internal Medicine, and the entire 6-week FM Clerkship. Some sites are approved for OB/Gyn, in which case students will complete OB/Gyn rotation while at WRITE.

Department Requirements Tracker: https://courses.washington.edu/fmclerk/wordpress/write/ 

WRITE Requirements | Family Medicine | Internal Medicine | Pediatrics | Psychiatry | OB/GYN | Advanced Outpatient Clerkship


WRITE Requirements

Overview

The student must complete all educational requirements of the clerkships and WRITE Program as well as participate in any activities planned by the WRITE Program. Additionally, students must complete the entire WRITE rotation during the specified academic year and scheduled rotation block; i.e., a portion of the rotation cannot be taken at a later date.

Tracking

  • Clinical Encounters are a list of diagnoses and procedures that students must encounter by the completion of both Patient Care & Explore and Focus clerkships.  Each department has a specified list that students must complete and that information can be found on the clerkship department’s website (linked below).  All clinical encounters will be logged in the E*Value system.Visit the Clinical Encounters page for links, helpful videos, and how-to manuals: https://sites.uw.edu/medevalu/clinical-encounters/
  • Achieving stated program/curriculum goals and objectives and fulfilling specific course requirements for the UWSOM Family Medicine, Internal Medicine, Pediatrics, Psychiatry, and/or OB/GYN clerkships at WRITE (using the WRITE Curriculum Tracker; students have found that when they set up these components on the scheduling grid early in the WRITE rotation, the completion of the requirements can be more easily accomplished).

WRITE Assignments

  • Healthcare Professional Checklist.
  • Completion Community Project/Service
  • The accomplishment of required readings (recommend 10 hours per week minimum) as detailed by respective UWSOM clerkship departments; additionally, students must utilize the current clerkship texts
  • The completion of necessary examinations, assignments, and forms
  • Attendance at and participation in:
    • Orientation (date to be determined prior to start of new WRITE session)
    • Student-led Teaching Sessions & WRITE Student Forum sessions using ZOOM
    • Faculty Visits and Case Presentations

Community Project or Service

The WRITE Community Project or Service aims to engage the student with the community outside of the clinical setting while providing an opportunity for the student to engage with their community in a meaningful way. This project is not part of any Department Clerkship and will not be given separate credit or a grade, but is required in order to receive a passing grade in the WRITE Program.

The Community Project or Service is a chance to use the concept of Community Oriented Primary Care (COPC) during your WRITE experience. Please read the following article on COPC: Longlett SK, Kruse JE, Wesley, RM. Community-Oriented Primary Care: Historical Perspective (PDF). J Am Board Fam Pract 2001; 14:54-63. The extended longitudinal experience of WRITE gives you a unique opportunity to engage your community.

The WRITE Community Project or Service can take one of two forms:

  • Students can complete a Community or Clinic-based Project
    1. TRUST students are encouraged to continue community projects started during RUOP, including applying for grants to implement their projects
  • A community service option for students
    1. Community service would be volunteering with a community service organization such as Free Clinic, Food Bank, Meals on Wheels, Hospice, or similar service programs
    2. Volunteer for 20 hours minimum (over a 22-24 week WRITE experience)

About one month into WRITE, the student is required to submit for approval a brief write-up describing either the project or service plan to their WRITE Site Director and to their WWAMI Regional Dean. Please answer the following questions when drafting the description:

  1. What will be done?
  2. How much time will be put into the project/service and what is the time frame?
  3. What are the goals and objectives of the project/service?

Throughout the WRITE rotation, all students are required to complete the Community Project/Service Proposal. This form will describe a summary of the community, identify the community or clinic/hospital partner(s), provide 1-2 annotated sources reflecting the mission/outcome for the service or project. At the end of the WRITE experience, students will submit a minimum written 500-word summary and reflection on their service or project.

The Community Project/Service Proposal and final summary and reflection will be submitted based on due dates within the student’s WRITE calendar and should be sent to the WRITE Site Director and their WWAMI Regional Administrator.

Examples of Community Service Projects

Contact Information

Michele Fleming
WRITE Adminstrator
flemingm@uw.edu

Danielle Bienz
Education Specialist
dbienz1@uw.edu


Family Medicine Clerkship

Overview

Link to Info for Student’s Website: http://depts.washington.edu/fammed/education/courses/clerkship/info-students/

Read the FMC syllabus. This also includes our FMC Goals and Objectives and Curricular Requirements.

The Family Medicine Clerkship web site is set up for the traditional 6-week clerkship. Taking into account the expanded nature of the WRITE program, it is not required that WRITE students complete at the same pace the weekly activities of the FM “Assignment Tracker,” but should integrate the “weekly” requirements into their clerkship experience as it makes sense to do so, making sure to complete everything by the time of the Family Medicine exam.

Assignment Tracker

Link to tracker: https://courses.washington.edu/fmclerk/wordpress/write/

Failure to update the form on a regular basis (~ every 2-3 weeks), will have an impact on your grade. All requirements must be logged and tracker must be complete by the end of WRITE. Any missing requirements will result in a make-up assignment to be determined by the Seattle FMC office. Be sure to document your encounters with Common Conditions.

Orientation

Students are expected to participate in an online webinar orientation on the first Monday of the WRITE session, from 12 to 1PM Pacific Time. You will receive an email from the Clerkship Manager with login details and exact time/date, roughly a week before the webinar.

Clinical Reasoning Practice Test

Here is the link: https://canvas.uw.edu/courses/1249083/quizzes/1054933

This Clinical Reasoning Practice Test is composed of 14 multiple choice questions that are IDENTICAL IN FORMAT to the final exam and will be based on four fmCASES: Case 2 (Adult Prevention), Case 4 (Ankle Sprain and UTI), Case 6 (Diabetes), and Case 21 (Flu, Pneumonia, Pediatric Obesity). You should receive an email from the Clerkship Manager with details and exact time /date, roughly a week beforehand.

Attend conference call with clerkship Co-Director if you have questions about Clinical Reasoning Practice Test.

This time is when you can call to discuss material with one of the Director. If you choose to call, make sure to schedule this with your site. The clerkship Co-Director will be available to help answer questions about any of the 14 multiple choice questions in the Clinical Reasoning Practice Test. Calling in for this conference call is optional, it is only intended to answer questions about the Clinical Reasoning Practice Test.

Family Medicine Exam

This exam will test your application of the clinical knowledge you have gained from the clerkship, as well as from the recommended study guide. More information in FMC Syllabus.

Mid/End of Clerkship Reviews

The purpose of these reviews is to provide you with formative and summative feedback on your performance and track your completion of the clerkship curriculum. Reviews are held with your Primary Preceptor or the Site Director. Print out two copies of your Assignment Tracker to bring to each review session. Your Mid-Clerkship Review (PDF) should be held during the ninth or tenth week of the clerkship. Your End-of-Clerkship Review (PDF) should be done in the last week of WRITE. In both review meetings, your Site Director will share feedback about your performance in the rotation. Feedback may include things you did well and things that you should focus on for future rotations. You are encouraged to ask questions during these meetings if it is unclear or if you need further guidance about improving your performance.

Contact Information

Sam Griffin
Clerkship Administrator
UW Department of Family Medicine
Tel: (206) 616-7890
Email: fmclerk@uw.edu


Outpatient Internal Medicine Clerkship

Overview

Internal Medicine (Outpatient): https://imstudents.uw.edu/

The internal medicine clerkship is a twelve week clinical experience: eight weeks are focused on care of hospitalized adults and four on primary care internal medicine. Students who are doing internal medicine as part of WRITE will spend six weeks (either prior to or after WRITE) learning inpatient medicine at a large hospital at many of our Puget Sound area hospitals or at Sacred Heart in Spokane. While at their WRITE sites, students will work with ambulatory internists or family physicians to complete the primary care portion of their internal medicine training.

The core of the IM training experience during WRITE is working with a primary care physician, preferably an internist. A WRITE student who spends one day per week working with a primary internist during their entire WRITE block will have a good opportunity to meet the educational goals for the primary care portion of the clerkship. Alternatively, 4 – 5 weeks full-time in an internist’s office would also satisfy this clerkship requirement.

We also hope students will have an opportunity to work with adult and geriatric patients in other settings, particularly by taking advantage of the opportunity WRITE offers to follow patients they meet in clinic. Seeing those patients in the hospital, making nursing home and home visits, and visiting subspecialists with patients can all be very high-yield. Students may also benefit from working directly with subspecialists, hospitalists, or in emergency department settings but this does not meet the core requirement for primary care internal medicine.

Internal Medicine Exam

Final Exam is to be taken at the end of the inpatient portion of the internal medicine experience. Study information is available on the IM web site: https://imstudents.uw.edu/medicine-clerkship/final-exam. If you have questions about the internal medicine requirements or scheduling your exam, please contact Carmelita Mason-Richardson (carmelit@u.washington.edu) – 206 543-3237

Internal Medicine Patient Logging

Logging Patients for IM: https://imstudents.uw.edu/medicine-clerkship/logging-patients

Students log internal medicine patients in E-Value under the department of medicine. This logging is in addition to logging patients in E-Value using PxDx.

Review of Inpatient Rotation

What they see

For students at the five academic hospitals, they will be part of a resident team, usually made up of a faculty attending, a senior resident, one or two interns, and one or two medical students. On average, students admit 1-2 patients every 3-4 days and carry 3-5 patients at a time, although specifics vary widely based on the logistics of the hospital and the abilities of the students. Each hospital serves a different population: UWMC has more patients with organ transplants and other esoteric problems, while patients at Harborview are more likely to have illnesses associated with poverty or homelessness, and the patients at the VA are a mix of older and younger veterans with differing medical problems. While at Virginia Mason, students will see a broad range of patients, including many who have illnesses typical for a urban, academic medical center (pneumonia and CHF) as well as a significant number of patients who come from all around the region for tertiary specialty care (ERCPs, severe acute pancreatitis, pancreatic cancer). Sacred Heart in Spokane is a regional tertiary care center drawing from not only the Eastern Washington area, but also Idaho and Montana. They typically have at least one to two diagnostic dilemmas on each service a week. As the major community hospital for Spokane, the student receives an excellent perspective of the community internist’s scope of practice–ranging from COPD exacerbations to GI bleeds. Sacred Heart also functions as the county hospital for the Eastern Washington area, so there is also a fair amount of indigent patients and the accompanying medical diseases associated with drug use and other poverty related illnesses.

What they don’t see

Because of changes in residency work hours, most residents no longer take overnight call; many students do not spend overnights in the hospital despite being scheduled for six weeks on an inpatient medicine rotation. Students also see very few patients with chest pain or heart disease, because cardiology is a separate service at the academic hospitals. A few students may be exposed to ICU but most won’t. Ambulatory experience is also very limited.

Outpatient Rotation Requirements

Alaska & Washington – WRITE students who complete their inpatient IM clerkship in the greater Puget Sound or Spokane area prior to WRITE are required to complete ALL 12 of the required online case modules (SIMPLE cases), 6 of the 12 required lectures, and 9 of the 12 required patient logging prior to going to WRITE (preventative care, hypertension and Joint and back pain can be completed at the WRITE site).

Idaho, Montana, & Wyoming – WRITE students who do not complete their inpatient IM clerkship prior to WRITE are required to complete 3 of the 12 patient loggings for internal medicine: preventative care, hypertension and Joint and back pain while at WRITE. Please make sure you submit these via E*Value and in the INTERNAL MEDICINE program.

Additionally, we recommend you work on the 12 required SIMPLE case requirements. The SIMPLE cases are designed to enhance your experience while on the Medicine Clerkship. This must be completed by the end of your inpatient rotation with medicine.

Resources

Web site – The Department of Internal Medicine Clerkship web site is at https://imstudents.uw.edu/. On the site you will find the core clinical concepts, expectations, grading using P/RIME, and educational resources.

Textbook and Online Resources – Each WRITE student is responsible for bringing a copy of the course syllabus/orientation materials and Internal Medicine Clerkship Guide, by Paauw DS, Burkholder L, Migeon M, eds. 2007. They also have access to the full online content of the UW library system through the HealthLinks care provider toolkit, http://hsl.uw.edu/toolkits/care-provider. We strongly recommend that preceptors encourage students to use their library access to look up relevant clinical topics when they see patients; we find that this real-time use of the literature both helps the student retain knowledge and encourages them to develop efficient search strategies that will serve them well later in practice.

Contact Information

Chris Knight, MD
Associate Clerkship Director for WWAMI & WRITE
cknight@uw.edu
(206) 552-9260

Carmelita Mason-Richardson
UW Medicine, Manager Student Programs
carmelit@uw.edu


Outpatient Pediatric Clerkship

Overview

WRITE Students earn 3 weeks of Pediatrics credit during the on-site portion of the WRITE program while working with the family medicine preceptors and/or a faculty-appointed pediatrician in the community. Students will be given a Peds Clerkship Manual which covers pediatric clerkship requirements and will have the opportunity to complete portions during their first 3 weeks of their inpatient pediatric rotation or during their first few weeks at WRITE. Students are responsible for entering and logging assignments in the Pediatric Tracker upon completion of the clerkship. Students are asked to complete all CLIPP cases by time of pediatric exam.

Pediatrics Exam

The student will be responsible for successfully completing a Pediatrics exam (either at the WRITE Site if the student has completed the inpatient portion of pediatrics or at the end of the inpatient portion of the clerkship away from WRITE site). For students taking the exam during WRITE, it will be scheduled about mid-way through WRITE. The exam is ONLINE and will need to be proctored–more details to come. The exam is based on CLIPP cases.

Mid/End of Clerkship Reviews

Click to view the Peds Mid-End Clerkship Review Form (PDF)

The purpose of these reviews is to provide you with formative and summative feedback on your performance and track your completion of the clerkship curriculum. Reviews are held with your Primary Preceptor or the Site Director. Your Mid-Clerkship Review should be held during the ninth or tenth week of the clerkship. Your End-of-Clerkship Review should be done in the last week of WRITE. In both review meetings, your Site Director will share feedback about your performance in the rotation. Feedback may include things you did well and things that you should focus on for future rotations. You are encouraged to ask questions during these meetings if it is unclear or if you need further guidance about improving your performance.

Resources

The UWSOM Department of Pediatrics Clerkship web site is at http://www.washington.edu/medicine/pediatrics/students/current/third-year; here you will find curriculum requirements including CLIPP and ethics & professionalism cases: www.med-u.org. The Peds Educational Objectives (PDF) lists the basic pediatric competencies. It is suggested that students and preceptors review this guide.

Click to view the Clinical Encounters: Pediatric 3rd Year WRITE Clerkship Form (PDF)

Click to view the Peds Educational Objectives (PDF): it is suggested that students and preceptors review this guide to determine if basic pediatric competencies are being met.

Contact Information

Please contact the Pediatric WWAMI Program Coordinator, My Linh Nguyen, with any questions about your pediatric WRITE requirements, to obtain a clerkship preceptor manual, or to gain access to the Pediatric Tracker.

Email: mylinh.nguyen@seattlechildrens.org
Phone: (206) 987-2869


Outpatient Psychiatry Clerkship

Overview

The Department of Psychiatry Clerkship web site is at http://depts.washington.edu/psyclerk; here you will find Forms (grading, Mini-Cex, and evaluation), cases, clerkship objectives, and requirements. There is a WRITE tab on the website. Check the Psychiatry web site for links to lectures and information about electives.

The primary goal of the Psych experience is for students to see patients with psychiatric issues in the outpatient setting with longitudinal exposure and to increase their comfort level with this patient population. WRITE Students earn a total of six weeks of credit by merging the three-week evaluation from the formal clerkship site and the experience of seeing and working with patients with psychiatric or behavioral problems at the WRITE Site.

Psychiatry Exam

Students who complete the inpatient portion of their psychiatry clerkship prior to going to their WRITE sites will have had three weeks of inpatient psychiatry and will have completed their core requirements. These students will take their PBSCI exam while at their WRITE sites.

Students who do not complete the inpatient portion of psychiatry clerkship prior to WRITE will be given the opportunity to complete curriculum readings and lectures during their first few weeks of WRITE. They will take their exam during the inpatient portion of their psychiatry clerkship.

Contact Information

Gayle Schneider
Clerkship Administrator
UWSOM Department of Psychiatry
gschneid@uw.edu
(206) 744-3443


Advanced Outpatient Clerkship

AOC Goals

WRITE Advanced Outpatient Clerkship
GOALS:
1. Take on primary responsibility for patient care with appropriate supervision
2. Refine core clinical skills
3. Improve clinical reasoning and expand medical knowledge
4. Work as an integral part of the clinic team

AOC Objectives

Students will achieve the following skills through patient care, simulation and/or other instructional methods.

  1. Gather a history and perform a physical examination
    1. History-taking skills
      i. Obtain both comprehensive and focused histories in an organized and timely fashion.
      ii. Demonstrate patient-centered skills, cultural awareness, and humility.
      iii. Demonstrate clinical reasoning in gathering focused information relevant to patient care.
    2. Physical examination techniques
      i. Perform both comprehensive and clinically relevant focused physical exams
      ii. Demonstrate patient-centered exam skills that respect privacy, comfort, and safety
      iii. Identify abnormal findings
  2. Develop a prioritized differential diagnosis and select a working diagnosis following a patient encounter
    1. Collect and synthesize pertinent information based on prior records.
    2. Integrate new information as it emerges.
    3. Utilize evidence-based concepts for diagnosis and treatment.
    4. Discuss and document clinical reasoning contributing to the working diagnosis.
  3. Recommend and interpret common diagnostic and screening tests
    1. Incorporate high value care principles as part of a care plan
    2. Interpret basic test results
    3. Elicit and incorporate patient preferences into recommendations
  4. Enter and discuss patient orders/prescriptions
    1. Compose orders efficiently and effectively (eg. Selective use of order sets).
    2. Write prescriptions and attend to patient-specific factors (eg. Age, weight, allergies).
    3. Discuss orders and prescriptions in patient-centered manner.
  5. Provide documentation of a clinical encounter in written or electronic format
    1. Organize and prioritize information using a clear narrative.
    2. Update and organize problem list, working and differential diagnosis and plan.
    3. Document in a timely fashion.
    4. Document patient preferences into clinical decision-making.
  6. Provide an oral presentation/summary of a patient encounter
    1. Present accurate, concise, and well-organized information and acknowledge uncertainty.
    2. Adjust presentation to meet the needs of the listener.
    3. Assure closed-loop communication between presenter and receiver of information to confirm shared understanding.

EPA Evaluation Form

Contact Information

Danielle Bienz
WRITE Education Specialist
dbienz1@uw.edu
206-221-1587