The Junior Family Medicine Clerkship

Suggested practicum for integrative care in the junior family medicine clerkship

Practicum Objectives


  1. To recognize and internalize the responsibility the physician has for integrative care, to include the physical, mental/emotional, social/relational, and spiritual.
  2. To cultivate attitudes and awarenesses which enhance physician/patient relationships and promote an optimum atmosphere for healing.
  3. To acquire skills in observing, interpreting, understanding, and active caring for the multiform needs of broken and ill persons.
  4. To evaluate physician assets, reactions, and limitations in the delivery of integrated care.


  1. To integrate physical, mental, relational, and spiritual events and concerns into the assessment and management of patient brokenness and illness.
  2. To experience interdisciplinary consultation in integrative care.
  3. To individualize and experiment with some approaches for integrative care in the ambulatory care setting.
  4. To explore ways of including the varying aspects of integrative care in patient histories and progress notes

Practicum Approaches

Patient Workups

  1. Seek to learn as much about the patient by careful observation of how the patient presents: dress, nonverbal phenomena, observable affect, eye contact, facial expression.
    • Note if your early impressions suggest how you should approach both history taking and physical examination.
  2. As you take the history of the present illness and the past medical history listen carefully to the story of the illness the patient tells you and the answers given to your history questions. For example the tone of the patient's voice, the length of the answers, how much the patient seems to be in touch with their illness, any clues to possible concerns and meaning the illness has for the patient, and the questions the patient may ask.
    • When you finish taking the medical history, and before you begin the physical examination, go over the history you have just taken with the patient to see if any information has been missed or needs to be clarified.
  3. While you are conducting the physical examination be aware of the patient's reactions to what you are doing. Be aware of your own reactions to what you are doing. Be especially aware of the need to ask permission and take time to explain what you are doing. Especially in cases of of invasive examinations such as the pelvic exam.
  4. During the patient workup, if the patient is not in apparent pain or distress, seek to ask simple meaningful questions about their illness or brokenness such as:
    1. When you began to feel ill? What were your main concerns? What did you think might be going on? Was it scary?
    2. Is there anything going on in your life or work these days which might help me better understand your illness?
    3. Is there anything I need to know about you to help us to give the care you want or need?
    4. When you are ill, what or who helps you manage what is happening?
  5. See if any of the answers to these or similar questions, along with your own observations or thoughts, are helpful in understanding the patient's illness, either for diagnosis or management.
  6. Keep in mind any of the answers to the above questions, or those you might ask, as information on which to base further questions in the future.
  7. Where allowable, include any pertinent information in the written workup as part of the patient's record. If some information is given in confidence this, of course, will not be written.
  8. Using all the information you have gathered from the patient's history, BATHE, genogram, any other psycho-social concerns, and from the physical examination, try to see how each of the pieces of information fit together toward understanding the illness and caring for the patient.
  9. Since the spiritual dimension of the person's life seems the most difficult to integrate into your care of the patient, pray and listen to what the patient shares of this deepest part of his or her life. Try to see how you can help them be in touch with and nurture this part. Look for what you can do by way of affirmation or gentle questioning about the patient's attitudes. Be aware of what you might share from your own experience. When you feel it appropriate and are led to do so, it is often helpful to pray with the patient. Be sure that your attending physician is comfortable with you praying with his or her patients.
  10. Keep seeking to be sensitive to integrative care issues in patient care and work on approaches you feel will be helpful to you in learning integrative care and applying it to each patient.