HIV Pre-Exposure Prophylaxis Education in Family Medicine Clerkships: A CERA Study.

BACKGROUND AND OBJECTIVES: Little is known about human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) education in family medicine clerkships during medical school. Our study aimed to describe coverage of PrEP education in family medicine clerkships and explore barriers if this education was absent. METHODS: Data were collected through the 2023 Council of Academic Family Medicine (CAFM) Education Research Alliance (CERA) Family Medicine Clerkship Director Survey. We inquired about provision of PrEP to patients, faculty expertise with PrEP, PrEP curriculum in the clerkship, barriers to including PrEP in the clerkship curriculum, and willingness of directors to add PrEP online modules to the clerkship if available. RESULTS: The response rate was 56.8% (96/169). Nine participants did not complete the PrEP questions and were excluded from analyses. Nearly two-thirds of clerkship directors perceived PrEP as an important topic in the family medicine clerkship; however, only one-third of clerkships included PrEP curriculum through clinical experiences (58.5%), didactics (17.1%), or both (14.6%). Barriers to including PrEP were lack of time in the curriculum (63.5%) and having other more important topics to cover (25.7%), but 38.9% said they would include PrEP in the clerkship if free online modules were available. CONCLUSIONS: Clerkships were more likely to include PrEP curriculum in the family medicine clerkship if they had faculty with sufficient expertise or if clerkship directors believed it was important to teach PrEP in the curriculum. Offering accessible educational content can enhance educational opportunities on PrEP for medical students.

Promotion Committees and Attending Meetings Improve Promotion Rates for Early Career Faculty.

INTRODUCTION: Academic promotion is an important goal in an academic physician's career trajectory. Understanding the factors that influence success in academic promotion is important in providing appropriate guidance and resources. METHODS: The Council of Academic Family Medicine Educational Research Alliance (CERA) conducted a large omnibus survey of family medicine department chairs. Participants were asked about recent promotion rates within their department, as well as about whether their department had a promotion committee, whether faculty regularly met with the chair regarding preparation for promotion, whether faculty had been assigned mentors, and whether faculty attended national academic meetings. RESULTS: The response rate was 54%. Most chairs were male (66.3%), White (77.9%), and aged 50 to 59 (41.3%) or 60 to 69 (42.3%) years. Attendance at professional meetings was associated with a higher rate of assistant-to-associate professor promotions. Departments with a committee to help faculty with promotions had higher rates of promotion for both assistant-to-associate and associate-to-full professor levels than departments without a committee. Promotion was not associated with assigned mentorship, support from the chair, departmental or institutional sponsorship of faculty development regarding promotion, or annual assessments of progress toward promotion. CONCLUSIONS: Attendance at professional meetings and the presence of a departmental promotions committee may be helpful factors in achieving academic promotion. An assigned mentor was not found to be a helpful factor.

People, Not Programs: Improving Diversity in the Family Medicine Workforce.

BACKGROUND AND OBJECTIVES: Patients are best served by a health care workforce that reflects the diversity of their community. Increasing diversity of family medicine requires a long-term effort to recruit more medical students from underrepresented in medicine (URiM, defined as people of Black/African American, Hispanic/Latino, Native American or Pacific Islander heritage) backgrounds into family medicine residencies. This paper examines factors that influence URiM medical students to choose family medicine residencies. METHODS: Data were collected via a Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine clerkship directors. Correlations examined associations between the percent URiM faculty, percent URiM preceptors, percent clerkship cases addressing health equity, and the percent of URiM students choosing family medicine residencies. t tests determined associations between clerkship director race, preclinical electives on health equity, department faculty champion for diversity, and department diversity activities; and the percentage of URiM students choosing family medicine residencies. RESULTS: Survey response rate was 49%. Two factors had a positive relationship with the percentage of graduating students who were URiM choosing family medicine residencies: having a higher percentage of faculty who were URiM (r=0.33, P=.004) and having a higher percentage of preceptors who are URiM (rs=.386, P=.001). We found no such association for having cases addressing health equity, offering preclinical electives, departments with a faculty champion for diversity, clerkship director race, or a department's diversity activities. CONCLUSIONS: The presence of teaching faculty and community preceptors from URiM backgrounds is correlated with the rate at which students who are URiM choose family medicine. People, rather than activities, seem to influence the career choices of students from URiM backgrounds.

Use of Telemedicine in the Family Medicine Clerkship: A CERA Study.

Background: In March 2020 with the onset of the COVID-19 pandemic, clinical rotations abruptly ceased, and telemedicine became an alternative to in-person patient care. This study investigates factors associated with long-term adoption of telemedicine during family medicine clerkships. Methods: Data were gathered from the 2021 CERA survey of family medicine clerkship directors. Participants answered questions about the use of telemedicine in the clerkship, adequacy of telemedicine resources, how well telemedicine visits helped students meet course objectives, quality of course evaluations, efficiency of students seeing patients using telemedicine, and likelihood of continuing use of telemedicine once in-person visits are reinstated. Results: The response rate was 48.8%. While most clerkship directors did not use telemedicine prior to the COVID-19 pandemic with their own patients, most had medical students utilize telemedicine during the pandemic. Clerkship directors were more likely to continue having students use telemedicine in the clerkship if it helped them meet clerkship objectives, if telemedicine visits were efficient, and if course evaluations were positive. Adequacy of resources was not associated with likelihood of retaining telemedicine in the clerkship. Conclusions: Family medicine clerkship directors will likely continue to have students see patients via telemedicine, particularly if feedback is positive. Family medicine educators need to develop and evaluate new telemedicine curriculum for learner benefit, patient acceptability, and overall care quality.

Changes in the Shortage and Quality of Family Medicine Clinical Training Sites.

Background and Objectives: This study examined changes over time in the shortage and quality of clinical training sites for students. The surveys provided baseline and milestone measurements for the Society of Teachers of Family Medicine's (STFM) Preceptor Expansion Initiative. Methods: Data were gathered in 2016 and again in 2020, through the Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey of family medicine clerkship directors. Clerkship directors answered questions concerning number of students requiring placement, number of precepting sites used, frequency of negative comments about family medicine as a specialty, and about opportunities for students to experience comprehensive care, patient-centered care, and document in electronic health records. Results: The number of students who annually required placement at family medicine preceptor sites increased slightly from 2016 to 2020, but the number of sites utilized per family medicine department did not. There were no changes in the percentage of sites having Patient-Centered Medical Home or similar recognition or providing comprehensive care with or without obstetrics. However, more students were allowed to enter data and write patient encounter notes in 2020 than in 2016. Conclusions: Clerkship directors continue to struggle to find high-quality family medicine training sites for students. STFM's Preceptor Expansion Initiative has made strides to help students become active, productive members of care teams, to reduce the administrative burden of teaching, and to promote the precepting of multiple students at once.1 These efforts to incentivize precepting are ongoing, but won't be enough to compensate for the rapid growth in the number of students and the increasing demands on physicians for high-volume patient care.

Gender-Affirming Care Curriculum in Family Medicine Residencies: A CERA Study.

BACKGROUND AND OBJECTIVES: Family physicians are positioned to provide care for transgender patients, but few are trained in this care during residency. This study examines associations between program directors' (PDs) perceptions/beliefs on transgender health care and inclusion of gender-affirming health care (GAH) in residency curriculum. METHODS: Questions regarding current training in GAH, provision of GAH, competency in GAH delivery, barriers to GAH training, resident desire for GAH training, access to GAH curriculum, and feelings/perceptions about GAH were included in the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey. RESULTS: Challenges to including GAH in residency curriculum were inadequate numbers of transgender patients for residents to provide care (35.4%) and lack of faculty expertise in GAH for transgender patients (24.6%). PDs were more likely to include GAH into curriculum when they provided care for transgender patients in their own practice, completed continuing medical education in GAH since completing residency, had confidence in teaching GAH to residents, had residents who requested training on GAH, or had access to a GAH curriculum. PDs who believed that GAH should be a core competency in residency curriculum were more likely to have residents who requested increased education in GAH and wanted to provide GAH to transgender patients in their future practices. CONCLUSIONS: Barriers persist for training family medicine residents in GAH for transgender patients, but further training opportunities for faculty could help to decrease identified barriers. Further research should explore how best to increase family medicine faculty comfort/competence in educating residents in GAH.

Active Learning Versus Traditional Teaching Methods in the Family Medicine Clerkship.

BACKGROUND AND OBJECTIVES: Active learning, defined as a variety of teaching methods that engage the learner in self-evaluation and personalized learning, is emerging as the new educational standard. This study aimed to evaluate how family medicine clerkship directors are incorporating active learning methods into the clerkship curriculum. METHODS: Data were collected via a Council of Academic Family Medicine Educational Research Alliance survey of family medicine clerkship directors. Participants answered questions about the number and type of teaching faculty in their department, the various teaching methods used in their family medicine clerkship, and what challenges they had faced in implementing active learning methods. RESULTS: The survey response rate was 64%; 97% of family medicine clerkships use active learning techniques. The most common were online modules, problem-based learning, and hands-on workshops. The number of teaching faculty was significantly correlated with hours spent in live (not online) active teaching. One-third of clerkship directors felt challenged by lack of resources for adopting active learning. Clerkship directors did not cite lack of expertise as a challenge to implementing active learning. Time dedicated to clerkship director duties or the presence of a dedicated educator in the department was not associated with the adoption of active learning. CONCLUSIONS: The use of active learning in the family medicine clerkship is required both by educational standards and student expectations. Clerkship directors may feel challenged by lack of resources in their attempts to adopt active learning. However, there are many methods of active learning, such as online modules, that are less faculty time intensive.

Changes in Family Medicine Clerkship Teaching Due to the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: On March 17, 2020, the Association of American Medical Colleges recommended temporary suspension of all medical student clinical activities due to the COVID-19 pandemic, which required a rapid development of alternatives to traditional teaching methods. This study examines education changes spurred by COVID-19. METHODS: Data were collected via a Council of Academic Family Medicine Educational Research Alliance survey of family medicine clerkship directors. Participants answered questions about didactic and clinical changes made to clerkship teaching due to the COVID-19 pandemic, how positive the changes were, whether the changes would be made permanent, and how prepared clerkship directors were for the changes. RESULTS: The response rate was 64%. The most frequent change made to didactic teaching was increasing online resources. The most frequent change made to clinical teaching was adding clinical simulation. Greater changes were made to clinical teaching than to didactic teaching. Changes made to didactic teaching were perceived as more positive for student learning than the changes made to clinical teaching. Clerkship directors felt more prepared for changes to didactic teaching than for clinical teaching, and were more likely to make the didactic teaching changes permanent than the clinical teaching changes. CONCLUSIONS: The COVID-19 pandemic caused nearly all clerkship directors to make changes to clerkship teaching, but few felt prepared to make these changes, particularly changes to clinical teaching. Clerkship directors made fewer changes to didactic teaching than clinical teaching, however, didactic changes were perceived as more positive than clinical changes and were more likely to be adopted long term.

Promotion of Clinical Educators: A Critical Need in Academic Family Medicine.

BACKGROUND AND OBJECTIVES: Academic family medicine departments have traditionally promoted faculty using research and scholarship criteria augmented by teaching, clinical care, and service. Clinic-focused faculty who spend significant time in direct patient care may not have enough time to meet promotion criteria, although they are critical for training future family physicians and for rebalancing the system of academic promotion. METHODS: We surveyed family medicine department chairs on the effects of protected time for scholarship, presence of promotion and tenure (P and T) committees, salary increase, and special promotion tracks on promotion of physician faculty. RESULTS: Promotion rates to both associate and full professor were higher for faculty with 25% time for scholarship than for clinic-focused faculty. For clinic-focused faculty, promotion rates to associate professor were higher than they were to full professor. No differences were found for promotion to associate professor and full professor for faculty with 25% protected time for scholarship. No differences were found in promotion rates for either rank between departments that had P and T committees and those that didn't, whether promotion came with a salary increase, or if departments had a special track for physician faculty whose job is patient care. CONCLUSIONS: Promotion rates are higher for faculty with protected time for scholarship than for clinic-focused faculty for promotion to both associate and full professor. Clinic demands on faculty may reduce the likelihood of engaging in scholarship or research that in many academic family medicine departments is necessary for promotion.

Moving Toward a Standardized National Family Medicine Subinternship Curriculum: Results From a CERA Clerkship Directors Survey.

BACKGROUND AND OBJECTIVES: Although the subinternship (sub-I) is considered integral in many medical schools' curricula, family medicine does not have standardized course recommendations. Given the variable nature of this clinical experience, this study investigated the potential role of a standardized sub-I curriculum in family medicine. METHODS: Questions about sub-Is were created and data were gathered and analyzed as part of the 2019 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey of family medicine clerkship directors. The survey was distributed via email to 126 US and 16 Canadian recipients between June 19, 2019 and August 2, 2019 through the online program SurveyMonkey. RESULTS: A total of 101 (71.1%) of 142 clerkship directors responded to the survey. Most (84.2%) schools require sub-Is. There was a positive association between students matching into family medicine and having family medicine sub-Is at residency programs (P<.001). There was no relationship between higher family medicine match rates and the presence of family medicine sub-Is at nonresidency sites (P=.48) or having an advanced ambulatory rotation requirement (P=.16). CONCLUSIONS: A sub-I is a way to further expose students to family medicine, and increasing sub-I positions at residency programs may influence the number who pursue the specialty. Creation of a standardized sub-I curriculum presents an opportunity to enhance a critical educational experience in family medicine.

Teaching Chronic Pain in the Family Medicine Clerkship: Changes From 2014.

BACKGROUND AND OBJECTIVES: The management of chronic pain is an important topic for training competent family physicians. The purpose of this study was to determine factors in teaching about chronic pain and whether state overdose death rates were associated with teaching chronic pain topics. METHODS: Data were collected as part of the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) Clerkship Directors' Survey. The response rate was 71%. Respondents answered questions about the amount of time spent teaching about chronic pain diagnoses, approach to chronic pain, opioid medications, nonopioid medications and nonpharmacologic treatments for chronic pain. RESULTS: The most frequent topic was chronic pain diagnoses, taught by 64% of clerkships with an average of 92 minutes spent on the topic. Each chronic pain topic was taught by nearly 50% of clerkships, and 72.3% of clerkships taught at least one topic. More clerkships were teaching about opioids, nonopioids, and nonpharmacological treatments for chronic pain than in 2014. Time currently spent teaching about opioids was positively correlated with clerkships' state 2014 drug overdose death rate. CONCLUSIONS: The majority of family medicine clerkships teach about chronic pain, and the amount of time dedicated to this topic has increased over the last 5 years. A state's opioid overdose rate correlates with the amount of time spent teaching about opioids, but does not correlate with the amount of time teaching about other chronic pain subtopics. It is possible that the opioid crisis is causing a shift in the subtopics of chronic pain teaching.

Learning Outcomes From Lecture and an Online Module in the Family Medicine Clerkship.

BACKGROUND AND OBJECTIVES: With younger generations of learners and readily available technology, medical educators are challenged to include active learning methods that may be better for student learning than traditional lecture. Some of these methods, like online modules, can also reduce the demands on clerkship faculty time. We examined how content delivered via interactive, online module compared to traditional lecture for student learning and satisfaction. METHODS: Third-year family medicine clerkship students completed questionnaires following either an online module or lecture on orofacial pain. We conducted the study over four consecutive rotations, alternating who received the content via classroom lecture or interactive online module. Students completed a questionnaire comprised of six multiple-choice knowledge questions, five questions with a clinical vignette format to assess application of knowledge, and six questions to assess satisfaction with elements of the course. The Centers of Excellence in Pain Education developed the online module and questionnaire. RESULTS: We found no differences in knowledge between the in-person lecture and the online module. However, students who completed the online module performed better on the application questions. Students in the lecture group reported greater satisfaction with the course than students in the online group. CONCLUSIONS: Lecture resulted in adequate knowledge recall, but the interactive method resulted in better scores on applying knowledge to new situations. Providing an online module where students can practice applying knowledge is important for higher levels of learning, but it should be noted that satisfaction ratings may decline.

Prescribing Patterns and Use of Risk-Reduction Tools After Implementing an Opioid-Prescribing Protocol.

BACKGROUND: The literature on results from primary care-based opioid-prescribing protocols is small and results have been mixed. To advance this field, we evaluated whether opioid prescribing changed after a comprehensive protocol was implemented and whether change was associated with the number and type of risk reduction tools adopted. METHODS: Electronic medical record data were obtained for 2607 patients. Demographics, Patient Health Questionnaire-9 scores, body mass index, and utilization levels of protocol elements were measured for 24 months prior and 18 months post implementation of an opioid-prescribing protocol within a federally qualified health center. χ2 and t-tests were computed to estimate change in opioid prescribing, morphine-equivalent dose, comedication prescribing, and number and type of protocol elements utilized. RESULTS: The opioid protocol was associated with an increase in urine drug screens from 18.3% to 26.8% from pre to postimplementation (P < .0001). There was no significant increase in opioid treatment agreements. Tramadol (21.4% to 16.8%, P = .0006) and antidepressant (56.0% to 51.6%, P = .012) prescribing significantly decreased. Total opioid prescriptions and maximum morphine-equivalent doses were similar from pre to postimplementation. Protocol elements were more often used when patients had a higher opioid dose and were receiving benzodiazepines. CONCLUSIONS: Implementing a multi-faceted opioid-prescribing protocol was not associated with change in number or dose of opioid prescriptions but was associated with greater use of urine drug screens, and risk reduction tools were used more often in high-risk patients. Implementation research is needed to identify barriers to maximizing adherence to opioid protocols.

Grade Inflation in the Family Medicine Clerkship.

BACKGROUND AND OBJECTIVES: Medical educators perceive grade inflation to be a serious problem. There is some literature discussing the magnitude of the problem and ways to remediate it, but little literature is available in the field of family medicine. We sought to examine what methods of remediating grade inflation have been tried by family medicine clerkship directors, and what factors influence the chosen method of addressing this problem. METHODS: We conducted a national Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey of family medicine clerkship directors, inquiring about their perceptions of the seriousness of grade inflation, whether it was perceived as a remediable problem, and what methods had been tried within the last 3 years to address this problem. RESULTS: The response rate was 69%. Clerkship directors' perceptions that grade inflation is a serious problem either nationally or in their own clerkship did not correlate with how they weighted the objective versus subjective portions of the clerkship grade. Clerkship directors who agreed that grade inflation was a remediable problem had a higher percentage of nonexamination objective criteria and a lower percentage of subjective criteria in their grading formula. Clerkship directors who agreed grade inflation is a problem in their clerkship were more likely to have tried giving feedback to graders on grade distribution than those who didn't think grade inflation was a problem. CONCLUSIONS: Family medicine clerkship directors perceive grade inflation to be a serious problem, both at a national level and in their clerkships. Various methods of addressing grade inflation have been tried by family medicine clerkship directors.

Factors Associated With Successfully Filling Faculty Vacancies in Family Medicine.

BACKGROUND AND OBJECTIVES: Faculty vacancies are a concern for chairs of academic family medicine departments who regularly face having to recruit new faculty. Faculty physicians who report lack of support for research and teaching or excessive time in activities that are not meaningful may experience burnout resulting in leaving academic medicine. METHODS: Data were collected via a Council of Academic Family Medicine Educational Research Alliance (CERA) survey of US family medicine department chairs. To determine characteristics associated with success in hiring new physician faculty, chairs answered questions about the number of vacancies in the previous 12 months, the number of vacancies filled in the previous 12 months, the months the longest vacancy was open, starting salary, whether signing bonus was offered, and the full-time equivalent (FTE) for clinical, research, teaching, and administrative time. RESULTS: The response rate was 52%. Chairs reported an average of 3.9 vacancies in the previous 12 months, and an average of 2.5 (66%) were filled. Chairs who didn't offer protected time for teaching filled a higher percentage of their vacancies, but they did not fill them faster than departments that did offer teaching time. Higher salary and a signing bonus were associated with filling positions faster. Chairs who offered a signing bonus filled positions nearly 4 months sooner than those who didn't. CONCLUSIONS: Offering protected time for teaching or research and FTE allocation for clinical, teaching, research, and administrative time were not associated with success in hiring new faculty. Chairs who offered higher salaries and signing bonuses were able to hire faculty more quickly than those who didn't.

Teaching Chronic Pain in the Family Medicine Residency.

BACKGROUND AND OBJECTIVES: Chronic pain is a significant condition affecting many Americans. Primary care physicians play an important role in chronic pain management, but many residents and physicians feel poorly prepared to manage it. METHODS: Data were collected as part of the 2016 Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey, which was sent electronically to 484 program directors in the United States. The authors sought to determine whether residency directors' attitudes about treating chronic pain were associated with the amount of time devoted to teaching family medicine residents about chronic pain assessment, therapy (use of opioids, use adjuvant pain medications, use of other nonopioids, use of nonpharmacological treatments), and risk management (risk assessment, use of pain management contracts, informed consent when prescribing opioids, and urine drug monitoring). Attitudes were assessed by asking whether: (1) chronic pain is best managed by a primary care physician (PCP); (2) prescribing opioid medications is time consuming; (3) prescribing opioids is high-risk; (4) prescribing opioids contributes to opioid misuse; and (4) effective nonopioid treatments exist. An additional question assessed confidence in treating chronic pain. RESULTS: The response rate was 53%. The average family medicine residency devotes about 33 hours to education about pain management topics including 5.4 hours on chronic pain assessment, 16.2 hours on therapy, and 11.4 hours on risk assessment. Residency directors' belief that there are effective nonopioid treatments for chronic pain was the only attitude item that was associated with teaching about chronic pain. CONCLUSIONS: Residency directors' attitudes do not predict the time devoted to teaching chronic pain in family medicine residencies.

Identifying Prevalence and Characteristics of Behavioral Health Education in Family Medicine Clerkships: A CERA Study.

BACKGROUND AND OBJECTIVES: Many patients with behavioral health disorders do not seek or receive adequate care for their conditions. Among those that do, most will receive care in a primary care setting. To best meet this need, clinicians will need to demonstrate proficiency of behavioral health skills and evidence-based practices. We sought to explore the degree to which these skills are being taught in family medicine clerkships. METHODS: The Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) 2016 survey of clerkship directors (CDs) was sent to 141 CDs at US and Canadian medical schools with a required family medicine run course. CDs were asked about the inclusion of behavioral health topics, tools, and techniques in the clerkship, as well as rating the importance of these items. RESULTS: Eighty-six percent of CDs completed the survey. Mood disorders (81.4%) were most frequently taught, followed by anxiety disorders (77.8%), substance use disorders (74.4%), and impulse control disorders (39.1%). Screening tools and behavioral health counseling skills were less commonly taught. CONCLUSIONS: Many behavioral health topics are not taught universally to all family medicine clerkship students. Gaps exist between what is included in current curriculum and what is recommended by the National Clerkship Curriculum for family medicine. These gaps may represent challenges for improving the care for patients with behavioral health disorders.

Untapped Potential: Performance of Procedural Skills in the Family Medicine Clerkship.

BACKGROUND AND OBJECTIVES: While family medicine residency directors have expressed concern about low procedural skills proficiency among incoming residents, curricular recommendations do not provide widely accepted guidance. This study was designed to describe requirements and experiences in procedural skill training during the family medicine clerkship and test the hypothesis that more rural placements may support this training. METHODS: The survey was conducted as part of the CAFM Educational Research Alliance (CERA) Family Medicine Clerkship Director (CD) 2013 survey. All Liaison Committee on Medical Education (LCME)-accredited medical schools in the US and Canada with a family medicine educator as family medicine or primary care CD were surveyed. CDs answered questions about clerkship structure and procedure experience and requirements for students. Choosing from a list of procedures, respondents detailed how often students perform specific skills during a rotation. RESULTS: The response rate was 73% (94 out of 129). Thirty-six procedures were performed during the family medicine clerkship. Of the procedures performed at least once, the most common were Pap test (57.1%), vaginal swab (42.9%), ECG recording (41.9%), urinalysis (40.0%), and throat swab (39.0%). Of the procedures performed more than three times, the most common were Pap test (21.0%) and sterile technique (20.0%). Learners in rural rotations were more likely to perform a range of procedures. CONCLUSIONS: Though exposed to a wide range of procedures during the family medicine clerkship, students did not often repeat procedures. Creation of a core list of procedures and taking better advantage of rural placements may improve procedural skill training in the family medicine clerkship.