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UF Health University of Florida
Office of Educational Affairs College of Medicine

MDC7010
CONTINUITY CLERKSHIP

CONTINUITY CLERKSHIP SYLLABUS 2025-2026
Duration: One Year
Clerkship web pages: https://elearning.ufl.edu


Clerkship Director & Staff Information:

Ryan Nall, MD Dr. Nall, Clerkship Director,
Associate Professor of Medicine
Division of General Internal Medicine
Phone: 352-273-5211
Email

Jamie Roosenraad
Clerkship Administrator
Office: CG-37
Email

CLERKSHIP INFORMATION

Clerkship Description

The Continuity Clerkship is designed to create an opportunity for you to develop continuity with patients, a clinical preceptor, and a clinical teaching site. Through these continuity experiences we expect you to focus on your growth in the clinical environment. There will be many opportunities for self-assessment and formative feedback with your clinical preceptor in order to support your continued growth. Moreover, the clerkship is pass/fail with a goal of creating a clinical practice space in your third-year clerkships where you can feel more comfortable pushing yourself.

Over the course of the year, you will have the opportunity to follow patients longitudinally. Through this experience I hope you take the opportunity to build a deeper patient-doctor relationship. Continuity will also provide the space to reflect on your medical decision making. At your clinical site you will be viewed as a member of the interprofessional team, and we hope you will view this clinical site as your medical education home for the 3rd year.

Learning Objectives:

Recommended Textbooks, Resources, and Computer

Recommended Textbooks and Educational Resources

  • Aquifer
  • UpToDate

Based on clinical site:

Computer Requirement

Personal Laptops
Personal laptops can be utilized in clinical spaces and should meet the computer requirements laid out by the College of Medicine (https://osa.med.ufl.edu/support/policies-procedures/computer-requirement/). While desktops are typically available on all clinical rotation sites it is recommended that you bring a personal laptop in case a desktop is not available. Laptops can be safely stored at clinical sites. Safe storage locations should be discussed with preceptors on the first day of rotations.

Required Activities

  1. Clinical Care
    Students will spend one-half day approximately every other week in their assigned clinic for a minimum of 20 clinic sessions. During these sessions, students will independently gather a history, physical exam, and other data for at least 2 patients. This information will be presented orally and as a written note that includes an assessment and plan. The student should also follow up with the patient on tests ordered at the visit as well as clinically as warranted (i.e. Follow up by phone to determine if back pain is improving with intervention). Effort should be made to schedule the patient in on the student’s continuity day to facilitate patient continuity. There will be certain times you need to miss the assigned clinic half day for a conflicting requirement on one of the other clerkships. You will collaborate with your continuity clinic preceptor to identify a time to reschedule your clinic. The clerkship administrator should be notified of this change.
  2. Mini-CEX
    A mini-CEX should be completed every 2 months (or 4 clinics). The student should ask their preceptor to observe them evaluating a patient and fill out the mini-CEX assessment tool.
  3. Notes (ALL Submissions must be HIPAA compliant)
    Student notes should be used as the note of record once reviewed and edited as needed by the preceptor. Thus, students will have feedback on notes every session. In order to track growth, students will submit a reflection, as part of their formative feedback reflection, every 3 months summarizing the feedback and where they have made progress and their next steps.
  4. Deliberate Practice Journal (ALL Submissions must be HIPAA compliant)
    This journal will provide a space for you to track your personal QI project and your clinical skills growth. Throughout the year you will be asked to submit portions of the journal on Canvas. We would suggest starting a word document in a protected space like one drive which you can add to throughout the year. Do NOT add identified patient information into this deliberate practice journal to avoid patient privacy concerns.
    • Personal QI Project (Details under QI Project below)
      You and your preceptor will identify at least one high quality patient outcome that affects a variety of patients (e.g., blood pressure control) and you will implement a plan to track your patients’ outcomes and improve them if they are not meeting the pre-determined goal. You will monitor this outcome quarterly and submit one progress summary at 6 months and one final report with a reflection on why the patients did or did not meet the quality outcome goal. We highly recommend that you create a patient list in Epic of all the patients you have seen during your continuity rotation to make tracking outcomes easier.
    • Clinical Skills Growth
      You will create SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) goals (two minimum) during your first week on the clerkship. Prior to your quarterly feedback session with your faculty preceptor meeting, you will submit an overview of your SMART goals with reflection on your progress and review with your preceptor. When you review your goals, you will determine if your goals have been successfully met and develop new goals as appropriate.
  5. Reflective Writing (ALL Submissions must be HIPAA compliant)
    Every 6 months please reflect on one of the four prompts below and write a brief reflection based on your experience in your continuity clinic and medical school. By the end of the year, you will have reflected on all two of the prompts. You will share one of your reflections in a small group discussion. Please share all your other reflections with your faculty preceptor.
    • Reflect on the value of continuity of patient care in the development of trust between patient and physician
    • Reflect on the value of the patient-doctor relationship in physician well-being
    • Reflect on the communication and patient safety challenges in transitions in care
    • Reflect on your cognitive and implicit clinical biases that reveal themselves as the patient-physician relationship develops
  6. QI Projects
    • Create a clinic process map
      The goal of this project is to practice using a quality improvement tool (process mapping). It will help you better understand how specific processes occur within the clinic. It will also give you insights into the clinic experience from the patient’s perspective. You may work with other students at your clinic site. Groups should be no larger than four students. All submissions should clearly note who contributed to the project.
      • Choose a process that occurs in your clinic (patient moving through clinic visit, refill request processing, patient call to clinic for medical concern).
      • During the first month investigate every step in the process, completing the flowchart worksheet. (This will take time to do completely. It will require you to interview clinic staff involved in each part of the process).
      • Upload flowchart worksheet to Canvas, note who contributed to the work.
      • Reflect on why you chose to investigate the process, the patient experience, the role of other health professionals in the clinic, and comment on potential threats in the process that threaten patient safety. Propose one solution for process improvement based on your findings. (2-3 paragraphs)
      • Upload submission to Canvas, note who contributed to the work
      • Review reflection with faculty preceptor
    • Patient Care Improvement (QI)
      The continuity site personal quality improvement project is a yearlong project based on a high-quality patient care outcome identified by you and your preceptor. Quality improvement can take many forms and have an impact from the individual to the system level. For this project you will focus on individually improving a high-quality measurable patient care outcome. A proposed monthly outline for the project is presented below to help you stay on track
      The clerkship has provided an orientation to this project with an overview of the Plan Do Study Act (PDSA) cycle that is core to quality improvement. The clerkships Canvas page also has a wealth of resources to aid in your project. Your project will be evaluated by your faculty preceptor and progress will be reviewed during your quarterly formative feedback meetings. The HSS faculty are also available to help advise you and they will also help faculty assess the projects as needed.
      While you may identify your patient care outcome and plan an intervention with other students working with your preceptor we would like for you to follow your individual data and submit a summary and reflection independently.
      • Identify at least one high quality measurable patient outcome with your preceptor that is appropriate for your clinic and affects a variety of patients (e.g., blood pressure control)
      • Implement a plan to track your patients’ outcomes and PDSA cycles to develop interventions to improve outcomes and study impact. (See QI activities document in Canvas)
      • Monitor outcome quarterly with your preceptor, track in deliberate practice journal
      • Submit 2 PDSA cycle worksheets and 2 progress summaries on canvas (6 month and final) with a reflection on why the patients did or did not meet the quality outcome

Formative Feedback

Students are required to obtain written formative feedback from their continuity faculty member every three months using the continuity clinic narrative evaluation form. The completed form should be uploaded to the clerkship’s Canvas page.

Summative Feedback

At the end of the yearlong continuity clerkship evaluators will be asked to complete a continuity clinic summative narrative evaluation form. Determination of satisfactory performance will be based on summative narrative comments and completion of clerkship assignments.

Clinical Evaluation Forms on Canvas Page

ASSESSMENT

  1. 3-4 Month formative feedback with self-assessment (total of 3 submitted)
  2. Summative faculty evaluation
  3. PMEX (4)
  4. Patient evaluations (12)
  5. Mini-CEX (total of 6)
  6. Continuity site quality improvement project (6-month summary, final report) with PDSA Cycle worksheet
  7. Clinic process report and reflection (GROUP ALLOWED)
  8. Reflective Writing (2 prompts)
  1. Formal Self-Assessment and Formative Feedback: Whether you recognize it or not, you will receive feedback many times a day during clinical rotations. Sometimes it is as obvious as being corrected on physical exam technique or being told your progress note was helpful. Other times it may be less obvious, perhaps even nonverbal, such as a smile of encouragement or having your rounds presentation interrupted and cut off. We know a key aspect of effective feedback is that it should be specific and linked to a behavior. We like to be positive and encouraging to you on this clerkship so you will frequently be told you are doing a “good job” or “great work”. While this certainly can improve your spirits, it is not very helpful feedback if you don’t know what you did to earn the compliment. One simple thing you can do is to ask for clarity on what specific behavior was being complimented so you will know how to reproduce it.
    Both you and your continuity clinic preceptor should complete a formative evaluation form that is exactly the same as the form used for your summative evaluation every 3-4 months and includes space to reflect on your progress with the other requirements of the clerkship. Prior to meeting for feedback, you should fill out an evaluation form for yourself. At the same time, you should provide your attending a form to complete. Next, you will arrange a time to meet and compare your evaluations.
    Many attendings will initiate this feedback. But, it is your primary responsibility to make sure the formative feedback sessions occur.
    A minimum of 3 formative feedback submissions are required (one every 3-4 months) over the course of the year. The reflection on the completed formative feedback evaluation form should be uploaded to the clerkship’s Canvas page.
  2. Summative Evaluation: The summative evaluation will be completed at the end of your continuity clerkship by your preceptor and reviewed with you at the final feedback session. The narrative feedback from this evaluation will be used in your MSPE for the clerkship.
  3. PMEX: Over the course of the year in your continuity clerkship you will work with many health professionals and administrative team members. You may work with these individuals in clinic, through the EMR, or over the phone as you care for your patients. Your preceptor will identify up to 2 health professionals to evaluate your performance by completing a PMEX. Your preceptor will also complete two PMEX surveys over the course of the year. It is recommended that you ask for an evaluation every 3 months (or 6 clinics).
  4. Patient Evaluation: The continuity clerkship provides a unique opportunity to care for patients over the course of your third year. It is our hope that through this clerkship you have the opportunity to develop deeper patient-doctor relationships with your patients. You should request evaluations from as many patients as possible. A minimum of 12 patient evaluations are required. Under the resources page on Canvas, you can print out paper copies of the patient evaluation or have the patient scan the QR code provided in the same location on canvas.
  5. Mini-CEX: The Mini-CEX is a tool to facilitate feedback and direct observation of your performance. Please complete at least one mini-CEX with your preceptor each month for a total of 6 over the course of the year. Do NOT wait until the end of the clerkship to complete these. While preceptors are aware of the need for you to complete mini-CEXs you will need to plan these direct observations in advance.
  6. Quality Improvement Projects: Two parts of this project include a clinic process map and personal quality improvement project. Your progress with the project should be reviewed with your clinical faculty every 3 months. Summaries of your project will be due at 6-month intervals.
  7. Reflective Writing: Reflective writing will be assessed as complete or incomplete.
  8. Deliberate Practice Journal: SMART goals, Self Assessment FOrms and patient outcome reflections will be assessed as complete or incomplete.

Assessment Summary Table

How Pass/Fail is Determined


The Continuity Clerkship is a pass/fail clerkship. A score of 75% is required to pass the clerkship. Over the course of the year, you will be evaluated by your continuity faculty preceptor in the professionalism, communications, patient care, practice-based learning and improvement, and systems-based practice core competencies of the College of Medicine. Additional assessment data considered in the pass/fail determination will include direct observation/mini-CEXs, PMEX, patient evaluations, reflections, deliberate practice goals and outcomes, and continuity site QI project. Unsatisfactory performance in any one competency will lead to an unsatisfactory final clerkship grade. Students at risk for failing will be identified at the 6-month mark and a formal learning plan will be developed by the faculty preceptor and course leadership.


Grade Grievance Policy
Medical students may appeal a grade or evaluation. The process is as follows:

  1. The student submits his/her written concern(s) about a grade or evaluation, and arranges a meeting to discuss the concern(s) with the relevant clerkship or course director within one month of the posting of that grade.
    If the student is not satisfied with the outcome:
  2. The student may submit their written explanation of the grievance to the Grade Grievance Committee consisting of the Chair of the Course/Clerkship Committee, or designee if it involves his/her course/clerkship, and three faculty familiar with the medical education program who are not involved in the same course/clerkship as the grievance, or are members of the ASC. A 4th year medical student from the ASC will serve as a non-voting member on the Grade Grievance Committee. The faculty members of the Grade Grievance Committee are appointed by the Associate Dean of Medical Education.
  3. After review, the Grade Grievance Committee will submit a recommendation to the Associate Dean for Medical Education and the Chair of the Academic Status Committee who will review the report and provide the response to the student.
  4. The decision of the Associate Dean for Medical Education and the Chair of the Academic Status Committee is final.

    The UF Office of the Ombudsman is another resource for students with a university related problem and/or concern. For additional information about the Office, see http://www.ombuds.ufl.edu/.

MDC7010 Continuity Clerkship Sample Schedule

  1. Students are expected to meet with their assigned preceptor at least 1 ½ day every
    other week, totaling a minimum of 20 clinic days.
  2. Students are expected to attend 1 reflective writing small group session by the end
    of the academic year.