April 1999

For the Office-based Teacher of Family Medicine

Paul M. Paulman, MD
Feature Editor

Ensuring a worthwhile experience for first- and second-year medical students in an office-based practice is challenging. My solo practice is located in a small, rural community 120 miles from the affiliated medical school, Louisiana State University in New Orleans. This article presents my approach to bridging the gap between the classroom and clinical office practice.

Philosophy
One of the most important tasks during the rotation is introducing students to the art of medicine. From the start, they are asked to observe how doctors interact with patients, families, physicians, office and hospital personnel, and members of the community. Using a Clint Eastwood analogy, they can incorporate the good things they see, take note of the bad, and throw out the ugly. How students accomplish this depends on their evolving medical personalities. It is never too early for students to begin learning about their preferences and prejudices and how these influence future career choices and job satisfaction. This is an ongoing process that should continue throughout their training.

Community Contact
While each student has a write-up and picture in the newspaper, he/she meets the majority of our community at mealtime. Rotary, the country club, restaurants, and my home are social gatherings where the new visitor in town can be introduced. My office is involved with local schools, and medical students participate during their rotations. Teachers and pupils enjoy hearing about medical school from the students, and they are frequent guest speakers in the classrooms.

Learning Skills
With the assistance of the office nurses, students are introduced to venipuncture, finger sticks, lab tests, and ways of taking vital signs. Talking with patients while putting them into exam rooms and helping front office staff answer the telephone strengthen a student’s confidence. Being comfortable asking, “How can we help you today?” is the key to acquiring future skills necessary in obtaining patient histories.

Vary the Schedule
Since preclinical students are not seeing patients on their own like third- and fourth-year students, their schedules need variation. Outside the hospital, students accompany home health care nurses on house calls. In the hospital, students see deliveries, surgeries, and happenings in the emergency room. My observe them doing procedures in their milieu. This is particularly pertinent when it involves a referral from my office. A student’s experiences outside the office are always discussed from a family practice viewpoint.

Two-way Street
Students feel that if you just spend enough time with a patient, then you will ask the right questions and ultimately diagnose and cure them. Their idealism is great. After years of practice I know better, but it is fun being reminded of the days when I felt the same way. Students’ perspectives are wonderful antidotes for cynicism. Preclinical students can also be teachers. Recently, an article mentioned the striatum. I remembered vaguely that this was hooked on the brain “somewhere” and did “something.” Fortunately, a second-year student was rotating through the office and updated me on the pertinent neuroscience. Articles are easier to understand if you comprehend the lingo. Colleagues, let’s continue teaching and learning from medical students. It’s a great therapy.

Corresponding Author: Address correspondence to Dr McCormick, Family Care Center, 606 Haifleigh Street/Box 1186, Franklin, LA 70538. 318-828-1153. Fax: 318-828-4265. E-mail: buckylou2@aol.com.