During my family medicine residency, I enjoyed spending time with the medical students. While not the easiest arena in which to teach—given general stressors and time constraints—I could tell that student interaction was something that I was interested in making part of my career after residency.
As much as I enjoy teaching, I enjoy my relationship with patients and the practice of family medicine even more. This alone would steer me away from a career of pure academic medicine. Therefore, I needed to find a situation that would allow me to incorporate teaching into my practice. In my first year after completion of residency, I became preceptor for the family medicine clerkship for Brown Medical School (ie, Warren Alpert Medical School). This is a required core clerkship that some of the students refer to as “family vacation.” The rotations are 6 weeks in duration. We choose to participate in every other one to keep ourselves fresh. My position allows me to have a medical student in the office every other rotation, as well as to pursue a career in family medicine.
The students are in the office 7 sessions per week. We have 3 physicians in the office, so we divide the students’ hours accordingly. This lightens the load for each of us and keeps us fresh. The first day the students arrive, we make sure to have a sign posted in the waiting room, announcing to patients that we are hosting a medical student and to feel free to ask questions or voice concerns. This serves a dual purpose. Besides informing patients of student participation, it also makes the students feel welcome from the beginning.
On their first day, I introduce them to the entire staff while giving them a tour of the office. It is helpful to let them know your expectations and to outline the role that they’ll be playing over the ensuing weeks. This is a good time to define some basic parameters, such as where to park, when you expect them to be there, and to let you know if they will be unable to attend a session. I don’t require white coats to be worn by the students, as I have not used one in 20 years. I do, however, require that they wear their ID badge.
I continue to be impressed with the students from Alpert Medical School at Brown.
During the students’ rotation, they truly become integral members of the office, and they even attend all our staff meetings. Realizing that only a few of them will go into family medicine, I stress that no matter how specialized a field they might pursue, each ought to focus on becoming a complete physician. For example, even if you become an orthopedic surgeon, if you are going to listen to a patient’s lungs, you may as well lift up the shirt and listen properly. This would provide a better lung exam, and who knows? You might even find a melanoma on the patient’s back.
The other thing that preceptors and instructors should keep in mind is that the students have been studying pathology for the preceding couple of years. In the real world, they need to learn to focus on the patient and not just the disease state.
The presence of a medical student can even improve the morale of an office. I am not sure of the mechanism here; however, the staff members are typically more attentive, and they seem to display a little more enthusiasm. Another benefit is that, as a teacher, the American Academy of Family Physicians will award you 20 hours of CME per year.
Teaching in this clinical setting has been very satisfying for me. I am happy to be part of the students’ education. It is important to remember that, like everyone else, medical students can be impressionable. If I can impart just a few things to them, one lesson is to remain practical. When a patient presents with an unknown condition, the student ought to consider the most likely causes first. During one rotation, one of my students questioned each time a child came in whether I thought that the symptoms indicated Kawasaki disease. I reminded him that while it is important to consider uncommon explanations in the differential diagnosis, he should remember that “common things are common” and therefore to remain practical.
While having a medical student in the office can result in some increase in pressure—mostly in terms of time management—the benefits unquestionably outweigh any concerns. I would encourage you to give it a try.