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What is Family Medicine?
Family Medicine Clinical Rotation Workflow
Important People to Know
What to Keep in Your White Coat
Common Assignments & Evaluations
How to Present
Resources
How to Find Time to Study
High Yield Topics
Commonly Asked Questions
How to Improve on Rotation
Shelf Tips for Medical Students
If Family Medicine is Your Chosen Specialty
Advice for Your Family Medicine Rotation
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Feeling nervous about starting your family medicine rotation? This guide is here to help you bridge the gap from classroom learning to clinical family care. From what to expect on Day 1 to key topics to review and who to team up with, we’ve packed this blog with practical family medicine rotation advice to help you feel prepared, confident, and ready to thrive.
What is Family Medicine?
Comprehensive and continuing care for patients of all ages and health conditions (“from the womb to the tomb”).
Family medicine clinicians manage a wide range of acute and chronic medical conditions and coordinate care for their patients with the appropriate sub-specialists when indicated.
Big focus on preventative care (lifestyle counseling, check-ups, immunizations, screenings).
Watch our full interview with Family Medicine doctor, Julian Hinson, to hear his advice and perspective on the specialty.
Family Medicine Clinical Rotation Workflow
This really depends on your school/rotation site, but family medicine is classically associated with its practice in the outpatient setting.
Check the Schedule
The clinic that you are at most likely has multiple physicians with various patients scheduled for them throughout the day. Determine what clinician you are working with and check their schedule on the electronic medical record interface (if you don’t know how to do this, then ask someone!)
Briefly glance over the patients scheduled for that day, noting their age and chief complaint (aka what they are coming in for).
Read up on the Patients
This is rotation-dependent, but many preceptors you work with will let you know in advance (the day before or the morning of) which patients they would like you to see for a given day. If you get this knowledge, then definitely take at least 10-15 minutes reading up on each patient.
If you aren’t told ahead of time, take the initiative to identify some patients you would like to and later, go ask the physician if you can see them.
How to Read up on a Patient
Determine why they’re having the appointment (ex. left ankle pain)
Go into their chart and mentally or physically note the following details:
- Age
- Gender/Sex
- Race
- Problem list
- Current medications
- Any medical encounters within the past few months (hospitalizations, trip to the ED, outpatient appointments)
- Immunizations, screenings, etc.
Note if this is a wellness or a problem-based visit
Wellness
- Annual check-up, screenings, checking in on existing problems (ex. hypertension)
- Includes a comprehensive head-to-toe physical exam and basic lab work (ex. CBC, CMP)
- Some patients will also bring up 1-2 new problems that they want to be seen for as well (see next section ‘Problem-based’)
Problem-based
- Focuses on new or ongoing/existing conditions
- Includes a focused physical exam and work-up for the specific problem they are presenting with
- Example: follow-up for diabetes
- Note: even during problem-based visits, we still check if the patient has any screenings/immunizations that we can knock out during that appointment (ex. flu shot at the end of the appointment)
Depending on the reason for the visit, spend 5-10 minutes consulting your chosen clinical resource to read up on specific physical exam maneuvers to try, differential diagnoses for the presenting condition, possible treatment plans depending on what you determine the potential diagnoses to be, etc.
See the Patient!
This is clinician-dependent, but a good rule of thumb is to spend half (or less) the patient’s total appointment with them, so you have time to present the patient to the clinician and leave time for them to go see the patient too
Focused interview + physical exam! Don’t take too much time and slow down the flow of the clinic. This will be hard at first but will get easier over the course of the rotation. Depending where you are, the pace can be intense
Present the Patient to Your Preceptor
Quick, concise, highlight what’s going on. If you want a deep dive into case presentation check out this blog series on an overview of every rotation and presentation guidelines.
Go See the Patient Again (This Time with Your Preceptor)
Self-explanatory – the clinician will normally drive this conversation and send them out!
Go chart your encounter!
Chart Your Encounter
Establish a clear plan with your preceptor regarding what your role in approach to documenting will be (this can be site and preceptor specific). Generally speaking, your preceptor’s note templates are likely the most appropriate guide.
Important People to Keep a Good Relationship with
Overall Rotation Director
There is normally someone who oversees all of the sites and the entire rotation at your school as a whole. You may or may not even directly interact with this person, but it is always good to know how to get in contact with them if needed.
Site-Specific Director
This is going to be the person that is most in charge of your time at a certain site. Chances are, you will directly meet with them before your rotation starts and at the end for a feedback meeting.
Site Administrators/Coordinators
These are the people in charge of your schedule, coordinating your time off, etc.
Clinicians at Your Rotation Site
The main people grading you! Unlike almost every other rotation where you’ll probably interact with residents a lot, you may not see residents in Family Med at all, depending on where you’re rotating. You never know - you may also find a mentor here!
Other Medical and Office Staff
You’d be surprised how often the clinicians ask the nurses, social workers, receptionists, etc. about how a certain student was. They all work together day in and day out, so they talk! Treat everyone with respect and be professional. These people can vouch for you (or burn you).
What to Keep in Your White Coat
Stethoscope
Less essential tools (will normally have in the exam room already)
- Reflex hammer
- Tuning fork
Your preferred note-taking method
- Blank printer paper
- Small notebook
- Note: in the outpatient setting, there really is no “patient list” to print out like there is for inpatient (I suppose you could print out the entire schedule for the day – up to you!)
Resources to reference
- Phone/apps/internet
- American Academy of Family Physicians (AAFP): This will have your work-ups, differentials, everything! Just with a family medicine lens to it.
- Membership is free, so sign-up! Very worth it.
- Epocrates app: Look up different drugs, weight-based dosing, formulations
- United States Preventive Services Task Force (USPSTF): Contains all of the current screening guidelines/recommendations (an essential!!!)
- MD Calc: Scoring tools such as CHADS2-VASC for stroke risk, PUCAI/PCDAI for IBD, Wells score for DVT/PE, ASCVD risk for MI risk, etc.
- Sketchy: Have easy access to all high-yield Sketchy FM and preclinical sketches for review.
- For NPs! American Academy of Nurse Practitioners (AANP): Clinical resources for NPs organized by specialty and therapeutic areas. Some content is publicly accessible (including by hyperlink to external source sites) and some requires a subscription to AANP content.
- Print
- Pocket Primary Care
- Can carry around in your white coat
- Divided by chief complaints (ex. back pain)
- Used to quickly read up on work-ups/basic differentials
Snacks
- You will (should) get time for lunch every day, but stuff happens and your clinic may be way behind! Always good to have some quick snacks on you, and your white coat has many pockets for this very reason (among others)!
Common Family Medicine Assignments & Evaluations
- Getting along with staff/patients
- Strong, concise presentations
- Especially clear and well thought-out differential diagnoses that are well-defended by you
- Easy-to-follow and descriptive chart notes
- Explain your thinking very clearly in the assessment portion of the notes
- Efficiency
- Keep an eye on the clock while seeing patients and do not be the reason the clinic falls behind
- You are here to learn and absorb information, but do not let this take priority over making sure patients get seen on time
- Finding ways to make the clinic run more smoothly / make life easier for your preceptor
- Patient needs help finding where the lab is? That’s you
- Someone needs to call the pharmacy to confirm medications that a patient is taking at home? Grab a phone
- Plan is decided upon for your patient? Pend those orders (don’t know how to do this? Ask!)
How to Present on Your Family Medicine Rotation
ID/CC
- Who the patient is + relevant medical history for why they’re here today + chief complaint
Subjective
- Quick history of what’s going on (the story)
- Other important details to know about the patient
- Ex. if they’re here for occasional lightheadedness, and you see they’re on a medication that is known to cause that, then be sure to mention it!
Objective
- Vitals (some preceptors want the exact values instead of “vital signs stable”)
- Relevant physical exam findings
- Any labs/imaging/objective findings gathered that can relate to why they’re here
Assessment and Plan
- Assessment = what you think is going on and/or not going on
- Differential diagnoses + your arguments for/against certain diagnoses
- “I think the most likely diagnosis is ____ because ____. I also considered ______, but ______. Additionally, _______.”
- Plan = what you think we should do
- Even if you’re unsure or likely wrong, state this confidently!
- Ex. Ibuprofen 400 mg q6h
- Ex. Continue to monitor salt intake
Family Medicine Rotation Resources
- UWorld
- Sketchy Family Medicine rotation videos (especially chief complaint focused lessons + Pharm/Micro/Path as you see relevant. Get Sketchy preclinical courses here.
- Anki (AnKing Deck)
- NBME practice tests
- UpToDate
- RoshReview
- Smarty PANCE
- Osmosis
How to Find Time to Study on Your Family Medicine Rotation
- Downtime in the clinic (if there is any)
- Doing a handful of questions in the morning and reviewing them at night
- Most clinics are closed weekends, so these are great opportunities to get most of your studying in!
High Yield Family Medicine Topics
- Diabetes
- Hypertension
- Congestive heart failure
- Pneumonia
- Asthma
- COPD
- Anemia
- Menstrual cycle
- Screening guidelines
Commonly Asked Family Medicine Rotation Questions
- All things MSK (musculoskeletal)
- Knee physical exam maneuvers (Apley’s, Lachman, etc.)
- Shoulder physical exam maneuvers (Drop arm test, etc.)
- USPSTF guidelines and screening criteria
- When to put someone on a statin, breast cancer screening guidelines, etc. c. Medications/work-ups/general ideas for common outpatient problems
- Diabetes
- Hypertension
- Congestive heart failure
- Pneumonia
- Asthma
- COPD
- Anemia
- Menstrual cycle
How to Improve on Your Family Medicine Rotation
Find natural pauses (or build in structured opportunities) throughout the day to elicit specific feedback on how to improve.
- "Anything I could have done better today?"
- "Any suggestions for the next time ___?”
- "Can we talk about my assessment and plan in my note on X patient from yesterday?”
- "Can you give me feedback about the organization of my oral case presentation on our patient ______?”
Receiving timely feedback over the course of your rotation (instead of batched and more exclusively at the end of your rotation) will allow you to more continuously grow your clinical skills and make progressive improvements with every patient encounter.
Family Medicine Shelf Tips for Medical Students
Whatever is seen on UWorld questions is fair game and important to know, topic-wise. Let these questions largely guide your studying. Consult other resources if you want to learn more in-depth about them (since sometimes, the UWorld answer descriptions don’t make total sense). You can just consult the corresponding Sketchy video, etc.
Do all the NBMEs available! These are retired Shelf questions, so definitely good to be familiar with them! Try to do all of them (~4-5 available currently) in the later half of the rotation.
The Family Medicine Shelf (and rotation as a whole) is difficult in that you kind of have to know a bit of everything – pediatrics, OBGYN, internal medicine, psychiatry, etc. It can be overwhelming to bounce from topic to topic in your studying, but slowly chipping away at the UWorld question bank every day is the way to have it all (hopefully) fall into place towards the end of the rotation. Keep sticking with it!
If Family Medicine is Your Chosen Specialty
Identify preceptors that you enjoy working with and have practice styles that you want to emulate
- Make it clear to these preceptors as well that you are seriously considering going into family medicine. (They will often times recognize this and go out of their way to explain more things, find more opportunities for you, etc.)
- Find natural pauses throughout the day to get specific feedback on how to improve.
- "Anything I could have done better today?"
- "Any suggestions for the next time ___?”
- "Can we talk about my assessment and plan in my note on X patient from yesterday?”
- "Can you give me feedback about the organization of my oral case presentation on our patient ______?
- Current residents (if at your site) are a great resource for advice since they’ve recently gone through the process!
Get the whole spectrum of what family medicine has to offer
- Go to as many procedures as you can.
- Make a point to see patients with conditions you haven’t seen before.
- Get used to using a language interpreter for visits when needed.
Put yourself in the shoes of an family medicine clinician
- Work up to seeing 4 patients per half day (not a necessity, but a good goal to shoot for).
- Directly interact with the nurses/medical assistants
- Go to them after they room your patient so they can give you the scoop.
- If you have a few minutes of down time, see if there’s anything they need help with.
Advice for Your Family Medicine Rotation
Your family medicine rotation is a chance to build real clinical skills, explore what kind of provider you want to be, and maybe even fall in love with primary care. It’s okay to feel overwhelmed—but with the right mindset, prep, and resources (like this guide), you’ll be ready to step into clinic with confidence. Stay curious, be kind to yourself, and don’t forget: every great student started exactly where you are.
Contributors:
- Elissa Naglieri, PA
- Christine Hudoba, NP
- Andrew Oh, M4
