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Thursday Jul 03, 2014

Help Wanted: Swelling Med School Enrollments Boost Need for Preceptors

Although everyone's medical school experience is unique, there are some things that most of our educational years had in common. Most of us trained at large academic medical centers with every subspecialty close at hand. This specialty-focused approach can result in an environment in which medical students -- who often are still pondering their specialty choice -- see deliveries that are done mostly by OBs, pediatric care that is almost exclusively provided by the pediatrics department and, meanwhile, family medicine is relegated to routine, in-office care.

Although there are institutions where this is not the case, what I hear from colleagues and medical students across the country is that in many locations, one or more of these scenarios presents a real problem. Barriers like these make it difficult for medical students to see the true scope and nature  of family medicine and to appreciate the opportunities the specialty has to offer.

The Hippocratic Oath includes a pledge to teach medicine to the next generation. Here I am reviewing results from a fetal monitor with University of Kansas medical student Jessica Parrish at my practice in Stockton, Kan.

So how can family physicians who enjoy a richer, more comprehensive style of practice help? It's deceptively simple: We can show students what we do every day.

With the marked growth in the number of medical schools and med school enrollment seen in the past few years, there is a bigger need than ever for preceptors. A new report from the Association of American Medical Colleges summarized the results of an online survey designed to gain insight into the experiences of allopathic and osteopathic medical schools, as well as nurse practitioner and physician assistant programs, regarding clerkship or clinical training sites. Across all four disciplines, most respondents had experienced increasing difficulty obtaining clinical training sites, and at least 80 percent of respondents in each discipline were concerned about the modest number of training sites available to them.

For most, respondents finding a primary care training site presented the greatest challenges, and up to 60 percent of allopathic programs reported difficulty locating family medicine sites.

The result? More than half of allopathic schools and nearly 75 percent of osteopathic schools are expanding the radius of their site searches, and more than half of all respondents from allopathic schools are using clinical simulations to help fill in the gaps.

In short, this study makes it clear that more of us need to step up and help train the next generation of family physicians. I shadowed a family physician during my first year of medical school and was surprised to discover that he rounded on his own patients in the hospital, delivered babies, saw patients in the nursing home and was director of the local hospice. All this was in addition to seeing patients in the clinic.

Based on what I had seen at med school, I thought his job would consist entirely of providing in-office care for minor conditions. How wrong I was!

As I have mentioned in previous blogs, I am where I am today -- practicing rural, full-scope family medicine, because of a family physician preceptor. Although I had determined family medicine was what I wanted to do, I had never even considered the option of rural practice. If my mentor Jen Brull, M.D., hadn't been willing to take me into her practice, teach me what she did, and show me the love she had for her job I would not have realized this was what I wanted to do.

Any physician who has opened his or her practice to students knows that it is not always an easy endeavor. In fact, it can slow you down. If you allow a student to see a patient before you do, formulate a plan and then present the patient to you, it takes twice as long as it would have if you had done it yourself. However, this is how that student learns what it is like to be trusted to see a patient on his or her own, what questions should be asked and how to make a thorough differential diagnosis.

It would be faster to complete the chart documentation on your own, but students need to learn to navigate an electronic health record system. It's easier to code without needing to explain how and why a visit meets criteria for a particular level of complexity, to not take the time to walk someone through sutures or joint injections, or to not take your lunch hour to outline current treatments for diabetes. But as any of us who precept know, the time demands are far outweighed by the benefit gained by student and preceptor alike.

Most of us can tell a story of an amazing preceptor, one who changed our idea of what we would specialize in, showed us the kind of physician we wanted to be for our patients, or modeled for us what we would like our future practice to look like.

Think of where you would be without these experiences, likely somewhere different from where you are now. As preceptors, we can be that person to a medical student. We can show them the full scope of family medicine and why we love what we do every day. We can show them, as was mentioned by my colleague Peter Rippey, M.D., in a recent blog, how to "prescribe a dose of yourself."

We know what precepting gives to students, but what does it give to us? I find having students in my practice to be energizing and a great reminder of how special my job is.

Seeing what we do each day from the perspective of a student reminds us that there is nothing routine about the things we get so used to doing day in and day out. Having someone come into a room and share with you their fears and concerns, allow you to poke and prod and examine their body, and trust your judgment about something as important as their health is not anything we should take for granted. Having someone excited to put in sutures for the first time or to learn to dictate a history and physical makes a call night much less tedious. Helping a student deliver a baby and seeing the pride and wonder of the moment is priceless. And knowing that you have helped shape someone's perception of family medicine is perhaps the biggest thrill of all.

I had a medical student who was trying to decide between OB and pediatrics when she started her rotation with me. A few weeks after she left my practice, she emailed me to say that she realized that she could do both, and more, if she chose family medicine.

Granted, this is an extreme example of the influence a preceptor can have. For me, just having the opportunity to have a student experience full-spectrum family medicine is worth the time and effort I put into it. And most days, even though I am supposed to be the teacher, I learn something from my students, as well: the importance of not forgetting that I have the most amazing job in the world.

Beth Loney Oller, M.D., practices full-scope family medicine in Stockton, Kan.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.