Presentation on theme: "Precepting medical students in ambulatory clinical settings: from barriers to opportunities… Tom Barber, MD Co-director, Ambulatory Internal Medicine Clerkship,"— Presentation transcript:
Precepting medical students in ambulatory clinical settings: from barriers to opportunities… Tom Barber, MD Co-director, Ambulatory Internal Medicine Clerkship, BUSM Associate Professor, BUSM
Moving from barriers to opportunities: what works?
Setting the agenda Orientation Introductions; staff, too Space, flow, workstations, schedules Establish expectations: student’s role; number of pts to be seen/session; format for presentations, documentation Learning goals (more to follow on this) Plan time for feedback – immediate, at mid-rotation, at the end
“Learning contracts:” McDermott, et al Medical Education 1999; 33: 374-81 Set learner-centered learning goals Establish discrete goals: knowledge (understand pharmacotherapy of diabetes mellitus ), attitudes (a change in attitude towards patients or adapting to a medical practice philosophy) and/or skills (cardiac auscultation) Specify for learner and teacher how and when goals will be assessed and accomplished
Home-grown guidelines Orientation, learning goals; brief morning “huddle” (to “prime” student) Make learning experiential rather than didactic in a formal sense Set realistic goals: fast pace, hands on, focused on teachable moments, practicing clinical skills Focus on our strengths: volume, diversity, opportunities to hone knowledge, skills, attitudes
Homegrown guidelines, p.2 Focus on skills and attitudes as much as, or more than on knowledge: History taking Physical dx Clinical reasoning and decision-making Ddx and synthesis Communicating effectively Making and carrying out plans Coordinating care Professionalism and ethics
Homegrown guidelines, p. 3 Avoid “the complete H&P” with full presentation and note; instead have the student Perform focused histories and/or exams Practice taking history from pts w special challenges (somatizing, tangential, etc) Actively observe (not “shadow”) your evaluation of a pt, debriefing afterward with or without pt about key moments Present in front of the patient, interrupting for clarification Participate in clinical decision making: use of testing, choice of drug, etc Research cultural, linguistic, anthropological questions that arise in caring for pts from other cultures
Homegrown guidelines, p. 4 Practice motivational interviewing skills Ask pt to give student feedback about interviewing skills, facility with physical exam, pt education, etc. Verbalize your thinking and reasoning, preferably in presence of the pt. Try to make precepting students a “win- win-win” experience for the student, the attending physician, and for the patient
Reflection (Arseneau, Exit rounds: a reflection exercise Acad med 1995; DaRosa Strategies for making ambulatory teaching lite: less time and more fulfilling Acad Med, 1997, Smith the roles of experience and reflection in abmulatory care education Acad Med 1997) What are your questions? What did you learn from seeing patients today? What troubled, surprised, moved or inspired you today? What progress have you made on your learning goals?
Moving from the ideal to reality while training the next generation of physicians to be expert clinicians