June 1999

For the Office-based Teacher of Family Medicine

Paul M. Paulman, MD
Feature Editor

In this column, Martin S. Lipsky, MD, and Mari Egan, MD, examine the value of medical students in community physicians’ offices. Dr Lipsky serves as department chair and Dr Egan is the preclinical coordinator in the Department of Family Medicine at Northwestern University in Chicago. I welcome your comments about this feature, and I also encourage all predoctoral directors to make copies of this feature in its entirety and distribute it to their preceptors. 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. Submissions should be no longer than 3-4 double-spaced pages. References can be used but are not required. Count each table or figure as one page of text.

Reflecting the growing acceptance of family medicine as a core medical discipline, most US medical schools now require family medicine clerkships. The opportunity to train more students in family practice has created a challenge in finding enough clinical clerkship sites for students. Many institutions turn to community physician preceptors to meet the increasing demand for family practice training experiences. A 1991 review found that 46% of schools use community training sites for at least part of their students’ training and that 31% use community preceptors exclusively.1

Most community preceptors are enthusiastic about teaching and working with students. However, recent changes in the health care system and the influence of managed care place increasing demands on physicians to see more patients. Although evidence regarding the impact of students on clinical activity varies,2-5 many community-based physicians view teaching students as a detriment to maintaining their productivity. Practices may also experience expenses and a strain on resources to create an environment conducive to educating medical students. Concern about increased expenses and reduced productivity may make an interested preceptor decline an invitation to teach. However, when preceptors consider the impact of students on their practices, the students’ potential as an asset is often overlooked. In this article, we list ways that students may be of value to their preceptor.

1. Once trained, students can perform valuable, but time-consuming, counseling activities. For example, after appropriate training and supervision, a student can counsel patients on issues such as smoking cessation, safe sex, and weight reduction. This can improve patient care and at the same time provide an opportunity for students to practice communication skills and learn more about preventive medicine.
   
   
2. Telephone medicine is a regular activity for a family physician. Students can assist preceptors by making follow-up phone calls to monitor a patient’s clinical progress or to report lab work. For example, a phone call by a student to check on the status of a young child seen the previous day for a high fever provides a valuable service to the practice. It also educates the student in using the telephone as a practice tool and the importance of follow-up and continuity of care.
   
   
3. Many medical students have computer skills that may exceed those of their preceptor. Preceptors can assign these students to conduct literature searches that can contribute to managing patients and save time for the preceptor. For a technologically challenged” preceptor, students may provide training and either teach or upgrade the preceptor’s computer skills.
   
   
4. Part of a student’s family medicine experience includes performing minor office procedures, such as taking vital signs, running EKGs, measuring visual acuity, performing dipstick urine analysis, and screening for hearing problems. Appropriately trained students might perform these procedures and help free up office personnel at busy times.
   
   
5. Students can review the medical records of patients new to the practice and summarize important information. This provides a service to the preceptor and gives the student a useful training experience.
   
   
6. As students become familiar with office procedures, they can help with office paperwork. Examples include completing insurance forms, writing prescriptions, and filling out referral forms. This type of experience exposes students to educational opportunities and gives them an insight into the realities of practice that they may not get in other rotations.
   
   
7. Learning through teaching can be invaluable for the preceptor. Reviewing a case with a student can stimulate the preceptor to think more deeply about the case and to incorporate an evidence-based approach into management plans. The challenge of having a student may also encourage a preceptor to read about the latest clinical developments. Students may also be able to share knowledge that a preceptor may not have mastered, particularly if a student recently encountered a patient with a similar condition in another rotation.
   
   
8. Every family practice has patients who need attention more than anything else. These patients frequently are talkative and time-consuming. Involving the student in the care of these patients can contribute to education and also help preceptors use their time more efficiently.
   
   
9. Patients tend to view those practices that train students as being of high caliber. This marker of excellence may be valuable in building a practice and in fostering therapeutic relationships with patients.
   
   
10. Many medical students are fluent in languages other than English. Involving students as interpreters can be an asset. In addition, students from different backgrounds could give presentations to preceptors and staff on cultural attitudes and practices, which might help them better understand their patients. Finally, training students can be fun and emotionally gratifying. The intellectual stimulation and the satisfaction of helping the next generation of physicians can help keep preceptors fresh and make their day more enjoyable. Although not an easily measurable benefit, this may be the greatest asset to having a student.

Corresponding Author: Address correspondence to Dr Lipsky, Northwestern University Medical School, Department of Family Medicine, 303 East Chicago Avenue, Morton 1-658, Chicago, IL 60611. 312-503-1273. Fax: 312-503-1377. m-lipsky@nwu.edu.

References

1. Lang F, Ware BR. A national study of required family medicine clinical rotations. Fam Med 1991;23(7):516-20.
2. Vinson DC, Paden C. The effect of medical student teaching on family physicians’ use of time. J Fam Pract 1996;42(3):243-7.
3. Vinson DC, Paden C. The effect of teaching medical students on private practitioners’ workloads. Acad Med 1994;69(3):237-8.
4. Packman CH, Krakov SK, Groff GD, et al. The Rochester practice-based experience: an experiment in medical education. Arch Intern Med 1994;154:1253-60.
5. Fields SA, Toffler WL, Bledsoe NM. Impact of the presence of a third-year medial student on gross charges and patient volume in 22 rural community practices. Acad Med 1994;69:S87-S89.