Perspectives From One Preceptor
An article by Deb Edberg, MD 

I arrived at clinic 5 minutes ahead of my first scheduled patient.  As I entered the office I immediately felt myself becoming tense.  Standing just inside the door to my office was my new medical student, Marissa.  She was looking fresh and hopeful in her short white coat and her new stiff stethoscope slung awkwardly around her neck.  I had forgotten that she would be here and today was already proving to be a busy day.  I took a deep breath, counted to ten, and extended my hand to introduce myself. 

Marissa was a 3rd year medical student from the local medical school.  I had agreed to begin accepting students intermittently to shadow and work with me in the hopes of encouraging them to become family doctors.  In theory, the idea had sounded like a great way to educate about the field I loved, but I was concerned that in practice I was taking on too much.  I knew that students could slow down an already busy day and it could be frustrating waiting for a student to conduct an interview.  How would I have time to do an appropriate level of teaching while still doing all that was necessary to care for my patients?

That first day along with the few days following did prove to be a bit challenging as I took some time to show Marissa around the office and orient her to the charts and our system.  She was an eager learner, however, and quickly adapted herself to our clinic.  Most days I found she had already begun interviewing patients before I even arrived.  When I was falling behind she took it upon herself to look up test results and attach them to charts before I had a chance to review the chart.  She befriended the staff and would spend time in the lab or with the nurses learning how to give vaccines or check urines when my schedule had gaps.  She was a compassionate listener and had the time to spend with my patients who needed someone to listen to them more than they needed the quick prescriptions that I had only enough time to write for them.  I found myself reviewing basic medicine and rediscovering the joys of diagnosing illnesses through explaining to her how to evaluate patients and how I arrived at treatment plans.  I certainly had days when I stayed at the office longer than I would have had Marissa not come to work with me, but I found that time did not bother me as much as I had thought.  It was refreshing to remember how I had felt when I was on the brink of choosing a career and what had made me finally decide on family medicine.

 Marissa was an exceptional student and really was a pleasure to have in clinic.  Not all students will be as proactive as she was.  Here are some tips to help make having a student join you in clinic more enjoyable and productive for you both.  

1)      Share the student.  I work with two other family docs in my clinic.  Even with a student as bright and eager as Marissa, it was helpful to have days when one of my partners would work with her so I could catch up on paperwork and see patients at a quicker pace.  On days when I needed to get out on time I had one of my partners work with Marissa.

2)      Use two or three rooms to see patients.  If you have the space, it is helpful to have an extra room for the student to conduct interviews.  I would often steer Marissa to a patient who I knew enjoyed or needed to talk and would let Marissa spend as much time as the patient needed.  By the time they were ready for me, the patient had generally exhausted his or her need to talk and we could go straight to a treatment plan which helped expedite my day.

3)      Save questions for the end of the day.  We saw a great many complicated cases during Marissa’s rotation and it could be very time-consuming to try to discuss them throughout the day.  I told Marissa to write down questions she had and at the end of each day we took a few minutes to go over her questions.  I often would have her do research on her own, with some initial guidance, to answer her own questions.

4)      Take the time to conduct a thorough orientation at the beginning of the rotation.  I took the time at the beginning of Marissa’s rotation to give her a thorough orientation to our clinic and my expectations of her.  Students are generally very attentive, especially at the beginning, and eager to please.  This helped give her the freedom to exercise her own independence to help me with lab results and initial work up plans throughout the rest of her rotation.

5)      Utilize your other resources.  Marissa had never worked in a doctor’s office before and therefore found all aspects of it new and exciting.  When my schedule was particularly packed and I found myself running too far behind, I had Marissa spend half days working in the lab or with the nurses.  It is important and interesting for students to learn the responsibilities of all people involved in an office setting.  She learned how to take vital signs, give shots, test urine samples, triage patients, etc.  Check with your CLIA rules in your office lab regarding whether or not your student is able to draw blood or run lab tests.

6)      Train your student in patient education.  Many of my patients have similar medical problems.  I taught Marissa the basics of these illnesses regarding patient education and was able to leave her with patients at the end of a visit to take the time to do the diet and lifestyle education that I often did not have time to do.  She was able to answer questions and photocopy hand outs in addition to the basic education.

7)      Teach your student all aspects of what it means to be a family doc.  I told Marissa about my family life and how it fit into my professional life.  I took her to the hospital for rounds and deliveries.  I told her the reasons why I chose family medicine.  Remember why you love what you do and be sure to share that with your student.

If you still find that having a student in your clinic would be too stressful, try to think of other ways to make yourself available to students in your area.  I volunteer one half day a week teaching a Patient Centered Medicine course to first year medical students.  It is a class that requires very little preparation and basically gives first year students exposure to clinical medicine and history taking skills.  I also volunteered for a week long “medical mission” trip with medical students to help them deliver care to underserved people in the third world.  Other family docs often volunteer to give lectures or workshops at their local medical schools.  You can volunteer to precept at community or homeless clinics that are staffed by medical students.  Students tend to pick specialties of people they know and admire.  Give them the chance to get to know you and the specialty that you love.