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Clerkship Requirements

Table of Contents

  1. Introduction
  2. PCC Educational Goals
  3. PCC Learning Objectives
  4. The Clinical Experience
  5. The Community Project
  6. Problem Based Learning and Doctor Patient Communication Sessions
  7. Suggested Textbooks
  8. PDAs, Video Recorders, Books
  9. PCC Attendance Policy
  10. Transportation
  11. Professionalism
  12. PCC Requirements
  13. PCC Final Exam
  14. Evaluation and Grading
  15. PCC Course Administration
  16. Frequently Asked Questions

1 - Introduction

Welcome to the Primary Care Clerkship!

Over the next eight weeks, we sincerely hope that you are challenged, intrigued, frustrated and delighted by this rotation.

  • Challenged, because the content of primary care is vast, and human reactions to their illnesses are widely varied.
  • Intrigued, for the same reasons. You will never know exactly what awaits you behind the exam room door.
  • Frustrated, because our health care system has many inequities and barriers to care, payment processes that are often counter-productive, and often seems geared more toward fixing problems than preventing them. If you don't ever feel frustrated, you are probably not 'getting it'.
  • Delighted, by the mutual caring between primary care physicians and their patients, the opportunities to help people improve and maintain their health, and the many ways that primary care physicians can make a difference for their patients and communities.

This guide to the Clerkship Requirements lays out the 'nuts and bolts' of the course. Using it will enhance your learning and performance. Many questions that you may have are answered therein.

Best wishes,

John Brill, MD, MPH
PCC Director

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2 - Primary Care Clerkship Educational Goals

By the completion of this clerkship the student is expected to possess the knowledge, attitudes and skills to:

  1. Describe the nature and scope of primary care practice and how it interacts with other health professions.
  2. Assess and manage common acute and chronic ambulatory medical problems.
  3. Determine the health risks of patients and populations and make recommendations for screening and health promotion.
  4. Identify community resources available to enhance patient care as well as barriers to optimal care.
  5. Establish effective relationships with patients and families using patient-centered communication skills.
  6. Practice life-long learning skills, including the application of scientific evidence in clinical care.

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3 - Primary Care Clerkship Learning Objectives

The Learning Objectives constitute the curriculum for the clerkship for which you may be tested. Collectively they are the most frequent issues encountered in primary care practice.

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4 - The PCC Clinical Experience

Each student works with community-based family physicians, general internists or pediatricians. These physicians volunteer their time to provide students exposure to primary care. Students are expected to take advantage of the many learning opportunities available during the rotation. Student-patient encounters frequently afford independent learning opportunities for the student to explore in depth when not in clinic. Students will also discuss selected topics in depth in small group problem based learning sessions.

In addition to learning from patient issues encountered during the clinical sessions, students are encouraged to take time to note the importance of the physician-patient relationship, to assess the health problems and resources of the community in which they practice, and to participate in the coordination of health care.

Generally, students are scheduled to work in two clinics, one family medicine and one internal medicine or pediatrics; you will be at each 3-4 half days a week. Most clinics serve a broad spectrum of patient needs. Some clinicians may have areas of particular interest that serve a more specialized group of patients. Be sure to take advantage of both of these opportunities. The level of student independence may vary from clinic to clinic. Current Medicare guidelines restrict student documentation to the following: students may enter a patient's past, family, social history and review of systems; in some locations, students may be allowed to dictate, noting that they are "dictating as a scribe for Dr. ____." Each of our partnering institutions interprets Medicare guidelines slightly differently, so expect some variability. You are encouraged to get permission from your preceptor to enter background information and write orders and prescriptions in either paper or electronic records.

Your clinical experience should be a mix of shadowing, observing clinical encounters as well as independent activities. Preceptors often have their student shadow at the beginning of the rotation to determine the student's level of clinical expertise. Your level of independence should increase as the preceptor becomes more familiar with the your strengths and weaknesses. PCC preceptors are encouraged to observe their student performing all aspects of patient care: history acquisition, physical examination, care plan development and discussion of the plan with the patient. All students should have both supervised and independent patient interactions throughout the rotation. Students are also strongly encouraged to assist your preceptor and office staff in clinical procedures

Helpful Hints When Working in a Clinic

1. Get to know the clinic staff. Interactions with the clinic staff will allow a better understanding of the demands of ambulatory medicine.

2. It is not necessary for you to see every patient. Try to see every second or third patient and spend time between patients looking up clinical care information to discuss with the preceptor. This can be a particularly useful strategy if you are working with a very busy clinician who has limited time for discussions between patients.

3. Arrange to see patient conditions that meet your educational needs. Use the Clinical Learning Plan (CLP) to anticipate, with your preceptors, the patient visits that are most valuable to your learning as well as any potential problems with seeing the required conditions.

4. Respect differences in patient care decisions. Occasionally you may observe patient care decisions that seem to be in conflict with the information you discover when completing your learning objectives. If done tactfully, these can be significant opportunities for learning with your preceptor. If, for example, you see a patient whose cholesterol is higher than would seem appropriate based upon your understanding of the current guidelines, it would be better to ask a general question such as "Dr. X, could you explain to me how you use the NCEP guidelines in cholesterol management?" and not "Doctor X, according to what I read you should be treating Mrs. Smith's cholesterol more aggressively." Please remember that you are a guest in your preceptor's office and that such discussions are probably best to have away from the patient.

5. Be prepared to take advantage of valuable learning opportunities. Preceptors may require students to accompany them on hospital visits, home visits or evening call. Students are expected to take advantage of these valuable learning opportunities. Contact your site coordinator if your preceptor reduces your schedule to less than three half-days a week.

6. Bring your stethoscope. The only equipment you are likely to need is your stethoscope.

Tracking Experience Requirements

The UWSMPH has asked that each third year clerkship to identify up to 10 core conditions and require that students track what experiences they have in regard to these conditions.

From the list of PCC learning topics, we identified 10 primary care core conditions for you to track on OASIS

1. Hypertension
2. Diabetes Type 2
3. Depression
4. Asthma/Chronic lung disease
5. Chest pain
6. Headache
7. Abdominal Pain
8. Acute respiratory infection
9. Well Child Check
10. Adult physical or Wellness visit

Note: There are several learning topics which are not among the core conditions you will be tracking, such as back pain and substance abuse. By the end of the rotation you will required to be competent in (and may be tested on) all PCC Learning Objectives.

How to Elicit Feedback From Your Preceptor

Preceptors have different approaches to teaching and providing feedback to students. Most preceptors have busy clinical practices and must adapt their teaching styles to meet the time constraints of their practice. Here are ways in which you can elicite feedback from a busy physician.

1. Ask. Start by asking your preceptor how he/she would like to provide you with feedback (between patients, with patient, at the end of the day). When convenient, ask your preceptor specific questions as "Would you like for me to do something different in my presentations". This will more likely to elicit constructive feedback than a more general 'How am I doing?'

2. Prepare an Clinical Learning Plan (CLP) before you start at your clinics, During the first or second week, review your Clinical Learning Plan with each of your primary preceptors. Throughout the rotation, use this form when asking for feedback on your progress in meeting your goals.

3. Review your Mid Rotation Feedback form with your preceptors. Toward the end of the third week of the rotation ask each of your primary preceptors to suggest a time when you could sit down to go over your Mid Rotation feedback form. Turn your completed forms into your regional site coordinator, preferably by the end of Week 4 but no later than the end of Week 5. OASIS will send you a reminder email to complete and turn in this form.

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5 - The Community Project

New for 2009-2010 is a requirement that all students complete a community project. We strongly suggest that you read through the entire project description, including the evaluation process and forms, before beginning.

See the documents below for a complete description of the Community Project.

  • Community Project Assignment
  • Sample Community Project Presentation (PowerPoint Slides) Video and Sample Patient Education Handout. Note that these materials are not intended to be a perfect or ideal example - indeed, I went past the 10 minute time limit on the presentation-but simply to give you a better sense of the requirement.

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6 - Problem Based Learning and Dr/Pt Communication Sessions

One morning or afternoon a week, PCC students at your site come together discuss a series of problem-based learning (PBL) cases. In this learning format, students are expected to develop a differential diagnosis, decide what further tests are needed and determine a patient care plan. This process is intended to reflect the clinical interactions of information-gathering, processing, formulating and narrowing hypotheses. Each case should generate a set of learning points that require further investigation. Students will present the answers to the learning topic they choose to investigate to the group the during the next PBL session. What is unique about learning in the PBL format is that the sessions are student-directed and driven. A faculty moderator is present to provide minimal guidance and direction to the group.

There are five PBL cases that will be discussed during the clerkship, covering all of the learning topics in the course. The cases will help you master the clerkship objectives. Students will discuss the same patient scenarios regardless of the location of their clinical experience.

Each week, we will email your clinical preceptors to inform them of the PBL case you will be discussing that week. Ask your preceptors if they expect to see a patient with a problem similar to your PBL case. Arrange to spend some time with your preceptor to discuss these patients.

EBM Write-Ups for Problem-Based Learning (PBL) cases.

In order to enhance student experience in Evidence-Based Medicine, your student group and small group leader should designate at least one report per case to address a clinical question in the PICO (Patient/Intervention/Comparison/Outcome) format. Here are several questions written in the PICO format: PICO Write-up Examples (pdf)

You have experience in this process from your M2 Patient-Doctor-Society course. You can review this curriculum if you need a refresher at http://www.med.wisc.edu/education/md/curriculum/patient-doctor-society/278

This responsibility should be rotated among the students in your small group so that each student completes at least one write-up in the PICO format.

Some examples of previous student write-ups can be reviewed here:

PCC Simulated Cases:

In addition to the weekly PBL sessions, students can review additional online simulated cases. These cases and questions were collected to provide an alternative for students who do not encounter a required core condition in the clinic, as well as to enhance learning for all students.

Doctor-Patient Communication Curriculum

Students at each site come together for three, 90-minute, structured Doctor/Patient Communication (DPC) sessions. These sessions are designed to develop competencies related to communication issues commonly encountered in most patient care settings, with an emphasis on use of Motivational Interviewing (MI) techniques to assist patients in changing behavior. The Doctor-Patient Communication curriculum builds the skills initially learned in PDS. The required text for this curriculum is Motivational Interviewing in Health Care. You will be loaned a copy of this required text at the general clerkship orientation.

The first DPC session will provide an overview of effective communication skills, including a review of history taking skills and discussion of skills to enhance patient adherence to recommendations. You will compare and contrast MI with more directive approaches. At the first or second session, each student will present an outline of one or two assigned chapters from the required text and will be expected to have read the entire book.Your small group instructor may email you with a more specific schedule for this activity.

The 2nd and 3rd sessions will be centered on videotape review and discussion. Each student in your group will be asked to video tape one patient encounter for review during these sessions. You are required to obtain patient consent from each videotaped patient. The purpose of the taping session is to evaluate your communications skills, not your medical knowledge. Please review the instructions for videotaping. Your preceptor will be sent an email reminder of your need to videotape a patient interview. Don't hesitate to ask your preceptor for help in selecting a patient to tape. The PCC videotape is designed to build upon previous videotape experience in PDS, ideally by going beyond obtaining a patient history to demonstrating use of MI with a patient with a chronic medical condition. After taping, review the video and complete the Videotape Self-Assessment.

Each student will also be assigned a particular perspective of Motivational Interviewing to assess as you watch your peers' videotapes.

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7 - Suggested Textbooks

There is no officially recommended textbook for this course; rather, we suggest that you concentrate on the resources listed in Learning Objectives and Competencies Matrix. If you do find that textbooks enhance your learning, the following are resources that other students have used:

Goroll AH, May LA, Mulley AG. Primary Care Medicine (5th Ed). Philadelphia, J.B. Lippincott, 2006.

A problem-oriented textbook addressing adult medicine.

Reilly BM. Practical Strategies in Outpatient Medicine. 2nd Ed. Philadelphia: WB Saunders, 1991.

Not a comprehensive textbook, but instead offers detailed, readable, and practical discussion of 22 selected common problems in adult ambulatory care. Has not been updated since 2nd edition however.

Barker LR, Burton JR, Zieve PD. Principles of Ambulatory Medicine, (6th Ed). Baltimore, Williams and Wilkins, 2002. (1900 pp)

A readable and coherently organized text; useful overall for general internal medicine and family medicine issues, but doesn't address pediatric issues. The first section, "Issues of general concern in ambulatory care," could stand alone as a treatise on the craft of practicing primary care medicine.

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8 - PDAs, Personal Computers, Video Recorders

Plan to use your personal computer and PDA during the clerkship. You be provided with a video recorder and tapes for Doctor-Patient Communication. Recorders distributed at orientation must be returned to Claire Ann Boyce, HSLC Room 4265 at the end of rotation.

Students must pay for any lost or damaged recorders, tripods or Motivational Interviewing book to receive their final grade.

The PCC recommended PDA-based resources will enhance the student's ability to access point of care information during their clinical experience. Students are encouraged to download a copy of Essential Evidence Plus into a PDA. Essential Evidence Plus has many useful components including EBM databases, clinical guidelines, clinical calculators and health maintenance recommendations. Essential Evidence Plus requires a PDA at least as fast as a Palm Tungsten e. The use of a slower PDA results in very long loading times as well as long waits to retrieve information. A memory card is also required to download the program.

Direct questions regarding how to download programs may be directed to Nate Gullick Although some students initially find Essential Evidence Plus difficult to navigate, continued use usually results in a rapid learning curve and ease of navigation.

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9 - PCC Attendance Policy

You are required to attend all scheduled clinical and curriculum sessions, and participate in after-hours call, nursing home visits, home visits, hospital rounds or other community health activities if requested by a preceptor. If special circumstances prevent you from participating in these activities:

1. Discuss the circumstances with your preceptor. Some preceptors may ask students to attend early evening and/or Saturday morning clinic.

2. Notifying your regional site coordinator or Claire Ann Boyce

A student missing more than 10% of any scheduled clerkship activity will be required to make up the deficiency. Check with your small group leader or site coordinator about how to make up missed time so that it does not affect your grade.

The PCC follows the medical school policy regarding excused absences. No more than three excused absences are allowed during a clinical rotation. If you have more than three absences you may be required to repeat the rotation. Absences must be approved by the PCC Clerkship Director, or, in his absence, the site coordinator or Claire Ann Boyce. Although clinical preceptors should be notified of any absences, approval for the time away must be obtained prior to the absence from the regional coordinator or the PCC office. Any absences that are not approved by the regional coordinator or the PCC office will likely result in a failing grade for the rotation.

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10 - Transportation

Students are required to have transportation during this rotation because clinic assignments may be up to an hour away. See Frequently Asked Questions for more info about travel.

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11 - Professionalism

Students are expected to maintain the highest standards of professionalism during the Primary Care Clerkship. It is a privilege to be invited into the practice of community physicians. You are an ambassador of the UW School of Medicine and Public Health. We rely on you to respect teachers, preceptors and patients and to display ethical behavior. Your clinical site will determine acceptable attire. Students are expected to adhere to these expectations. At some sites, you are housed in shared homes, apartments or call rooms. The use of good judgment is critical to your professional reputation. Check with your site coordinator for further details if you have any questions about professional expectations.

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12 - PCC Requirements

1. Attend Madison Orientation and, if applicable, the regional site orientation

2. Report to clinics, Problem Based Learning and Dr/Pt Communication sessions as scheduled and on time. Adhere to the PCC Attendance Policy (See Section 10)

3. Regularly elicit feedback from your clinical preceptors on your performance.

4. Throughout the rotation regularly track PCC experience requirements on OASIS Students who fail to track all experiences will not be allowed to take the PCC final exam.

5. As instructed by your Dr/Pt communication instructor, tape a patient encounter and bring the video tape to class.

6. As designated by your small group leader and group, complete at least one report to address a clinical question in the PICO (Patient/Intervention/Control/Outcome) format.

7. By the end of the clerkship, be able to demonstrate competency of the PCC Learning Objectives.

8. Complete the PCC final online exam and OSCE exam as scheduled.

9. Contact PCC Administrative staff as early as possible with problems

10. Review your Mid Rotation Feedback form with each primary preceptor. Return form to Regional Site Coordinator no later than the end of Week 5 (preferably by the end of Week 4). You will receive an email from the medical school reminding you to accomplish this requirement.

11. Complete and turn in the following at the end of the rotation:

  • Clinic Log (to Regional Site Coordinator)
  • Student Evaluation of the Clerkship (online)
  • Video recorder, if applicable (to Claire Ann Boyce)
  • Motivational Interviewing text book (to Claire Ann Boyce)
  • Clinic Learning Plan) (to Regional Site Coordinator)

12. If you are registered at the med school to receive special accommodations at the final exam, it is your responsibility to provide this information to Claire Ann Boyce by PCC Week 3 so appropriate arrangements can be made.

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13 - PCC Final Exam

There are three components to the final exam:

  • OSCE exam: 25% of final grade
  • Community Project Presentation: 5% of final grade
  • On-line Closed Resource multiple choice exam: 5% of final grade
  • Open Resource short answer/essay exam: 5% of final grade
  1. OSCE - Last Thursday AM of the Rotation, (see email from Claire Ann Boyce) HSLC Room 1188 (25% of final grade)
    The OSCE is a clinical or practical examination. Each station tests performance of a set of clinical skills from the clerkship objectives. Students are provided with a brief case scenario and specific tasks to complete. The student then interacts with a standardized patient trained to provide a similar experience for each student. In most stations an assessor is present and uses a checklist of competencies to evaluate the student's performance. Students will complete the OSCE in two groups, one starting at 8:00 AM and one starting at 9:40 AM. The PCC OSCE consists of 6 stations, each lasting 10-12 minutes and, because the OSCE is used for evaluation, students will receive minimal feedback on their performance in the station itself. Examples of skills that might be tested are: delivery of a problem assessment, negotiating a treatment plan, performing a focused physical exam, taking the history of a common primary care problem. Here are helpful hints for preparing for the OSCE exam.
  2. Community Project Presentation (5% of final grade)
    Students will complete their community project presentations opposite the OSCE timeline; first group starting at 8:00 AM, second group starting at 9:40 AM.
  3. Proctored, Closed Resource Exam (one hour): Last Thursday, 12:00-1:00 pm, HSLC Room 2121 (5% of final grade)
    Immediately after the OSCE and Community Project Presentation, students will take a short closed resource, aka 'shelf' exam. This exam consists of approximately 30 multiple choice questions designed to evaluate the knowledge and problem-solving skills students that are expected to learn on the clerkship. It is timed, but not designed to be time-constrained.
  4. On-line (Learn@UW), "Open Book" Exam (1.5 hours) (5% of final grade
    The on-line exam is available from 1:00 pm on the last Thursday through 6:00 pm the last Friday of the clerkship. The exam is open-reference to allow students to use references in which they are familiar; but has time constraints so that students will benefit from using on-line resources or creating their own. Students cannot use other people for help.
    The format is a Modified-Essay Quiz (MEQ), a series of short-answer questions based on a clinical case. Students are given a portion of case information and are asked about the next step in managing the case. Some of the questions require the use of evidence-based medicine concepts.

Note in response to student feedback, we have eliminated the online, Open Multiple Choice Examination for 2009-2010.

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14 - Evaluation and Grading

You will be responsible for demonstrating competency in the core learning objectives on the final exam whether they are taught via Problem-Based Learning (PBL), in the clinical setting or independent study.

Near the end of the rotation, your primary clinical preceptors and other preceptors who have worked with you more than three half-days will be required to evaluate your clinical performance using a standardized clinical evaluation form. If you work with many preceptors at a clinic, the primary preceptor will often summarize the evaluation ratings for the clinic.

Those grading you will receive an evaluation form and an accompanying grid for guidance.

Advanced Competent Needs Improvement Unacceptable: Needs Attention Not Evaluated

Typically, preceptors grade students as "Competent" or "Needs Improvement" unless the student has exemplary performance. If a preceptor's verbal feedback has been "You are doing great!!" it does not necessarily meant the preceptor will check boxes under "Advanced". It is the student's responsibility to elicit comprehensive feedback.

Each clinical preceptor who has worked with the student more than three half-days will evaluate the student's clinical performance, using the clinical evaluation form supplied by the Medical School's office. The small group leader will evaluate the student's performance in the Problem Based Learning sessions using the mentor evaluation form.

Each preceptor evaluation is weighted, based on the number of half-days with the student. In other words, the evaluation from a preceptor who worked with a student for 21 half days will count more than an evaluation from a preceptor who worked with a student for 6 half days. The final grade is determined by the Clerkship Director.

Because PCC final grades are determined by a number of carefully selected components, it is rare that a final grade is changed. If you have concerns about your grade, contact Claire Ann Boyce. If you wish to review the specific results of your OSCE or online exam, contact Doug Smith, MD. Only if you are able to provide new or revised information about your performance will a grade change be considered. These requests should be submitted in writing and with appropriate documentation to the PCC Director, John Brill, MD

Final Grade:
50% Clinical (average of all preceptors)
10% Problem Based Learning and Dr/Pt Communication sessions
40% Final Exam (25% OSCE, 5% closed resource Multiple Choice, 5% Community Project Community Project Presentation, 5% open resource Modified Essay)

PCC Grading Chart

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15 - PCC Course Administration

Director:
John Brill, MD, MPH
john.brill.md@aurora.org
(608) 265-8406

Statewide and Madison Administrator:
Claire Ann Boyce
claire.boyce@fammed.wisc.edu
HSLC Room 4265 (608) 263-0427

Regional Site Administrators

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16 - PCC Frequently Asked Questions

Why do we have to track the 'Core Conditions'?:
The Liaison Committee for Medical Education (LCME) is the accrediting body for US allopathic medical schools. In its recent Second Educational Directive (often referred to simply as 'ED-2'), the LCME created a number of requirements. Among these were a requirement that each student define the types of patients and clinical conditions that each student MUST encounter during the rotation, what level of participation the students must have, and what simulated experiences would be used if these clinical encounters were not available, and what tracking system would be used to ensure that all students have the required experiences.

The UWSMPH is preparing for a fall 2009 re-accreditation visit by the LCME. During the spring of 2008 each clerkship was asked to create a list of up to 10 Core Conditions that each student must encounter. The clerkship directors then reviewed for list for redundancy and inclusiveness. In this process, some clinical conditions that overlap were assigned to one or another clerkship. For example, 'back pain' and 'headache' were on the original lists created by both Neuroscience and Primary Care. In discussing the curricula, the directors determined to assign 'back pain' as a Core Condition for Neuroscience, since it is a specific focus of that clerkship, and 'headache' to the Primary Care Clerkship.

What are the criteria for 'counting' a Core Condition?
We have set the minimum level of participation in our Core Conditions as Assisting, which we define as obtaining the history, performing the exam, or delivering the assessment and plan under the preceptors' supervision.

Why is there a difference between the topics of the Learning Objectives and the Core Conditions?
The Learning Objectives constitute the curricula for the rotation; they are derived from the rotation educational goals and are composed of the most frequently encountered visit types in primary care practice as well as the tools to support these visits. Students should be familiar well and expect evaluation in these areas.

Symptomatic Conditions
1. Abdominal Pain
2. Back Pain
3. Chest Pain
4. Headache
5. Musculoskeletal
6. Acute Respiratory Infections

Chronic Diseases
1. Hypertension
2. Asthma/Chronic Lung Disease
3. Depression
4. Diabetes
5. Substance Abuse
6. Hyperlipidemia

Systems of Care & Learning
1. Evidence-Based Medicine (EBM)
2. Doctor Patient Communication
3. Preventive Services
4. Primary Care and Public Health
5. EKG interpretation

The Core Conditions are a subset of these topics that the clerkship has selected to track in order to ensure an appropriate variety of learning experiences.

1. Hypertension
2. Diabetes Type 2
3. Depression
4. Asthma/Chronic lung disease
5. Chest pain
6. Headache
7. Abdominal Pain
8. Acute respiratory infection
9. Well Child Check
10. Adult physical or Wellness visit

Thus, while the Core Conditions will be included in the evaluation process, they are not the entirety of the curriculum.

What do I have to include in the tracking on OASIS?
The only requirement is checking that you have participated at the 'assist' or 'perform' level, or completed one of the simulated cases as an alternative experience. A space is provided in OASIS for notes if, for your own learning purposes, you would like to include more information, but this is completely optional. You only need to log one experience, but, at your own choice, may include as many as you would like.
Why are some of my clinics so far away? Is mileage reimbursement available?


Unfortunately, recruiting volunteer preceptors has become more and more difficult, and we have had to go farther afield from our regional campuses to obtain strong learning sites. This is particularly true in the Madison area, where we regularly use preceptors as far away as Beloit, and in Milwaukee, where Kenosha is a frequent site.

The regional coordinators do take driving distance into account in making preceptor assignments, and do make an attempt to limit driving through assignment and schedule adjustments. However, since continuity of care is one of the major learning goals of the PCC, it is not possible to make driving distances completely equal for every student.
We regret that mileage reimbursement is not available through the UWSMPH for student commutes to training sites.

A national survey of primary care clerkships done in early 2008 did not identify any schools that reimburse students for driving unless this was funded through an external source, such as AHEC.

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