October 1999

For the Office-based Teacher of Family Medicine

Paul M. Paulman, MD
Feature Editor

Editor's Note: 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.

In many ways, the community preceptor gives medical students their first view of what really happens in medicine. First-year medical students usually have been planning for years on a career in medicine—taking premed classes, writing application essays, volunteering in hospitals—but may have little understanding of the ongoing work of a physician.

These students find themselves in lectures on anatomy and biochemistry that are only remotely reflective of a clinician’s actual daily work. And, although medical school curricula hopefully address ethical and humanistic elements of a doctor’s task, formal classes do not always offer an ongoing discussion of issues and do not necessarily fit the context of the clinical practice.

Thus, medical schools are moving to place first-year medical students in longitudinal ambulatory preceptorships.1 These early experiences offer the student insight into the issues and situations facing a doctor and, of course, a closer view of who the patients are. The preceptorships offer students swamped with scientific minutiae the chance to reflect on why they originally applied to medical school, providing them not only clinical knowledge but also the opportunity to identify their own moral and philosophical intentions as future physicians.

Preceptorships offer opportunities for students to gain practical skills, as well as a sense of what it means to be a physician. This is especially true for beginning students, whose knowledge or skill base may restrict their involvement in the examining room and who may be confronted with more fundamental questions of purpose and philosophy.

Unfortunately, busy office schedules do not always include time for an in-depth discussion of the day’s events, let alone more-abstract questions students may have about how their preceptors feel about their work roles and personal ideals. As well, seasoned physicians may not remember the disorientation of being a student. For the first time, students will be expected to touch, inject, or cut a stranger. They will hear the intimate details of patients’ lives, listen to their fears and hopes, and respond to questions about challenging personal concerns.

A supplemental reading program, drawn from sources that are not part of the formal medical school curriculum and that expand directly on the knowledge and experience of a community physician, is a means to integrate many different elements of the medical student’s first year.
In this article, we present a year-long supplementary reading program (Table 1). The reading program can provide students with a forum in which to synthesize the torrent of information and issues with what actually takes place in practice.

Giving students articles to take home and read at their leisure creates an opportunity for reflection, not only on the experience found in the preceptor’s clinic but also on the new world that the student has entered.

A reading program offers preceptors a method by which to teach, even on a busy day, and an approach to taking on the more challenging questions with answers that cannot be determined by a lab test or seen on a microscope.

This reading program is the result of a shared experience of a student with limited clinical experience and a clinician, 10 years into practice, who has (fortunately) forgotten much of his early student years. We worked together to create this reading list, specific to the concerns and questions of both student and preceptor, allowing the list to be an exercise of interest that expanded our experiences together.

Our list includes readings of diverse topics, at an appropriate level for first-year students. The themes are responsive to both the clinician’s sense of importance and the student’s interests and questions. None of the articles focus on specific diseases or exam skills, since these elements are better taught in the classroom or examining room. Rather, the articles address topics both wide and narrow, ranging from what it is to be a doctor or a patient to how physicians deal with issues of death or mistakes.

The articles are drawn from easily accessible medical journals or books. We used our reading program as a weekly article with informal discussion, but a spectrum of possible uses exists—from a formal reading assignment to a simple resource list physicians could provide to students. Of course, this is not a comprehensive list but simply our framework.

A reading program is a way for community physicians to relate to beginning medical students what they have learned since the first 2 years of medical school. In this way, preceptors can model the need for physicians to continue their education. A reading program supports a process-oriented, reflective view of medical practice and provides students with additional perspectives to help them identify and resolve their own feelings of excitement or apprehension at a critical juncture, the start of their professional education.
We welcome any additional themes or suggestions of specific articles that others have found useful and informative.

Corresponding Author: Address correspondence to Dr Ventres, Providence Family Medicine Southeast, 8001 SE Powell Boulevard, Suite H, Portland, OR 97206. 503-775-9117. Fax: 503-775-7612. E-mail: bill_ventres@phsor.org.

References
1. Fields SA, Toffler WL, Elliott D, Chappelle K. Principles of clinical medicine: Oregon Health Sciences University School of Medicine. Acad Med 1998;73(1):25-31.

Click here for Table 1