October 1997

For the Office-based Teacher of Family Medicine

Paul M. Paulman, MD
Feature Editor

Editor's Note: This month's column addresses orientation of students to community rotations, a critical  part of any educational experience. The author, David J. Steele, PhD, is the director of the Integrated Clinical Experience Program for freshman and sophomore students at the University of Nebraska and has extensive experience in medical education and community rotations. I welcome your comments about this feature. Send your submissions to Paul Paulman, MD, University of Nebraska, Department of Family Medicine, 600 South 42nd Street, Box 983075, Omaha, NE 68198-3075. 402-559-6818. Fax: 402-559-6501. E-mail: ppaulman@mail.unmc.edu.
 

    Nancy White, a third-year medical student, pulls into the parking lot of the Pine Tree Family Physicians Clinic. She hesitates before parking in a "Patients Only" parking space. Entering the building, she sees an empty waiting room. The clock reads 8:01 am. Though she hears the muffled voices of two or three women, no one is in sight. She stands by the reception desk and waits. At 8:05, the phone rings, and a young woman emerges from a small room adjacent to the waiting area. "Pine Tree Family Physicians. May I help you? Sure, Mrs Jones, no problem. I'll have Dr Smith call the pharmacy. Goodbye." Putting down the receiver, the young woman looks up at Nancy, "Yes, how can I help you?" Nancy explains she's a third-year medical student and will be spending the next 6 weeks at Pine Tree Clinic for her family medicine preceptorship. "Dr Smith told me on the phone to be here at 8." "Oh yes," the young woman responds, "Dr Smith told us we were going to have students here this year. Dr Smith has nursing home rounds this morning, but he'll be here before 9. Why don't you have a seat in the waiting room. Would you like a cup of coffee?"
    Nancy sits down and starts paging through old magazines. By 8:30, the waiting room is beginning to fill. Names are called, and patients disappear behind a door adjacent to the reception desk. Nancy glances at the clock. It's 8:45. She notices that her palms are wet, and she begins to feel the flush of irritation. At 8:50, a man in his 30s rushes into the waiting room from behind the reception area. "Hi. Are you Nancy? I'm Brad Smith. I'd like you to do a well-baby check on Amy Thorsen in room 3, and then we'll talk." He hands Nancy a chart. "What do I do now?" Nancy asks herself. "I've never touched a baby, let alone examined one!" Nancy stands facing the closed door of examining room 3. Her face feels warm. "What have I gotten myself into? This is going to be a long 6 weeks!


Student Orientation in Ambulatory Education
    While it may seem so obvious as to go without saying, orientation is an important aspect of teaching in the office setting. Unfortunately, many students report not being adequately oriented to the office, its procedures, and its personnel. Many students can relate to Nancy's experience. No doubt, Nancy's story has reminded you of similar occurrences in your own training. Powerful messages can be sent by the way a preceptor manages the introduction of the student into his or her office. The orientation (or lack of one) sets the tone for the entire experience. When done well, an orientation can significantly reduce student anxiety and enhance the educational value of the experience.
    Table 1 summarizes the points that should be addressed in orienting students. The importance of the mutual sharing of expectations and goals cannot be underestimated. Spending a few minutes with students at the beginning of their rotations to find out about their backgrounds, prior experiences, personal learning goals, and program expectations can provide information for making decisions about how to structure the experience and how to maximize the resources available in your practice setting. A clear and explicit discussion of goals and objectives also facilitates the process of providing feedback and grading the student's performance.
    Orientation need not be a time-consuming process. Much of the information students need can be written and included in an orientation packet. Brief biographical sketches of the office personnel and descriptions of their roles and duties can also be produced in advance. Once produced, this packet can be sent to all students prior to their arrival. Much of the orientation can also be delegated to your office nurse or clinic manager. She/he can show the student around the office, discuss the clinic schedule, go over the office charts, and answer questions about the nuts and bolts of the clinic operation. This will enable you to devote time to sharing expectations and to reviewing the student's learning needs. Fifteen to 30 minutes of the preceptor's time may be all that is required to discuss mutual requirements. The important thing is to schedule this time in advance. Orientation is important. It sets the tone for the rest of the experience and it can reduce student anxiety. It also communicates the message that you care about the student's experience and learning needs. This contributes to a positive learning climate, which will enhance student perceptions of their own competence and increase their interest in, and respect for, the preceptor's discipline.
 

Table 1: Issues to Address in Orienting Students to Your Practice

Staff

• Names, titles (brief biographical sketches, including special interests and roles)

• Housing arrangements

•  Location (address, maps)
• Phone numbers
• Parking instructions
• Arrange a tour

•  Satellite offices
•  Hospital
•  Nursing home(s)

•  Summary of demographic characteristics
•  Brief description of payment sources, managed care contracts, etc
•  Areas of emphasis, resources (eg, obstetrics, geriatrics, sports medicine, diagnostic procedures, etc)
•  Office resources (eg, lab and X-ray facilities)

•  Office hours, scheduling pattern
•  Preceptor schedule (eg, hospital rounds, nursing home visits)
•  Medical records
•  Call schedule

•  Student schedule
•  Expected patient care role
•  Dress code
•  Who the student should contact for questions, problems

•  Scheduled time for feedback and debriefing

Correspondence: Address correspondence to Dr Steele, University of Nebraska, Department of Family Medicine, 600 South 42nd Street, Omaha, NE 68198-3075. 402-559-6820. Fax: 402-559-8118. E-mail: djsteele@mail.unmc.edu.