Second-year medical student Joe Deters says he never questioned going to medical school and becoming a physician; he did, however, put a lot of time into choosing where he’d receive his training.
"I’m very happy I ended up here,” he says. "The clinical experience you gain within your first year at UC is unparalleled to other schools across the country.”
This clinical experience is known as the Longitudinal Primary Care Clerkship (LPCC), a course within the new College of Medicine curriculum that began last January and allows each first-year medical student to be paired with a community primary care physician. The experience begins in the latter half of the first year and extends through year two; 130 community primary care physicians are participating.
Through observing and completing reflective exercises, students achieve first-hand experience in the clinic from the very beginning, making their transition into actual patient care more seamless.
"It is a fairly unique course that focuses on the eight steps of the clinical methodand uses selected readings from historical literature, direct observation, role modeling and reflection to teach the steps of this method,” says Philip Diller, MD, PhD, chair of the department of family and community medicine and director of the course.
These steps include the healing milieu (creating an atmosphere for healing), data gathering (structured history and physical examination), clinical reasoning, diagnosis, prognosis, treatment, narrative communication (documentation and oral presentation) and patient-based learning.
"We have a theme for each session to help identify these fundamental steps that all physicians use,” he continues. "We build on what is learned during each section of the course; each student experiences patients with different problems, but the steps of the clinical method apply in every case.”
Teaching the Artistic Side of Medicine
Diller says this course, which could be viewed as the "art” of practicing medicine, helps students assess the clinical situation, giving them guidance on ways to interact with a patient, effectively diagnose and treat the patient and educate him or her about their care.
"It’s different than shadowing—we give them things to look for, like a check list, and they directly observe the situation and surroundings so that they are made aware of what it takes to understand and design care for the patient,” he says. "All of the steps are centered on the patient, the physician and the amount of information that can be gathered by merely observing.
"An important part of the experience is learning how to uniquely care for each patient. For example, diabetes may mean the loss of limbs for one patient but may just be a nuisance to another. A lot of it is understanding a patient’s perception of his or her disease and responding appropriately.”
Diller says that, as the director of the course, it’s important to make sure that it’s making a difference for students. So far, he says, feedback from the community preceptors suggests it’s quite an improvement.
"We’re operationalizing the teaching of the clinical methods through this course, and these students seem to have an easier time talking to patients and becoming comfortable with doctoring in general,” he says. "We’re demystifying the issue of talking to patients, which is a big step in medical education. In the beginning, students are always on edge; they don’t want to make a mistake but are still trying to be themselves. This gives them a taste of what it’s like from the very beginning and weaves them into the fabric of patient care. It gives them a conceptual framework of the fundamentals of what doctors do.”
Making Patient Communication Less Daunting
Deters, who will have his first clinical session as a second-year student in a few weeks, says he feels that this experience elevates students’ understanding of medicine and improves their skills.
"As first-year students, we’re essentially operating at the capacity of a third-year,” he says. "We learn the basics of taking a patient’s history and of giving a physical exam. It’s incredible how comfortable you become in speaking to patients in a medical setting.
"Talking to patients in a medical situation can be daunting, but I was equipped with a framework of questions to ask—and I learned that it’s OK to ask questions. We don’t have to know everything, but it’s great to be in there and learning things first-hand.”
Allyson Best, another second-year student, said that the program has helped with her patient interactions as well.
"I have found that when a patient presents with one of the conditions we are learning about in lecture, I find the information I am learning much more interesting and never forget it,” she says, recalling one particular case last year that stuck with her. "I remember a woman coming in that was about ready to have brain surgery to remove a pituitary tumor. Having just recently learned about endocrine dysfunctions, I was fascinated by the surgical procedure that would be used to remove the tumor.
"However, within a matter of minutes I came to realize that the woman was not interested in how the surgery was performed or the incredible technology used to keep it minimally invasive. She was worried and scared and wanted reassurance. For all of the time I had spent studying endocrine disorders, there was one thing you just couldn't learn from a textbook: knowing how to treat not just the condition but the patient herself. This skill is vitally important. Patients are the only thing that differentiates physicians from scientists, and LPCC has given us all an opportunity to interact with patients, and therefore, become the best physicians we can be.”
Forming Long-Term Relationships
Diller adds that for many of the volunteer physicians, this course provides a way to give back to these future physicians and the field of medicine as well.
"It’s very fulfilling for them, and it only takes about 5 percent of their clinic time,” he says.
Kevin Bundy, MD, Deters’ preceptor at West Chester Medical Group, says there are many positives to the program, including providing students early access to patients as well as an opportunity to observe and develop effective communication skills and the chance to build a long-term mentoring relationship with a practicing physician.
"As a long-term preceptor, I have always been impressed with the caliber of students coming from UC,” he says. "My experience with UC students has been uniformly positive. This newer, earlier exposure has been no exception. The most valuable tool a student can have is a hunger to learn. Letting students ‘get their hands dirty’ a little earlier simply fuels that fire by putting them ever closer to their end goal of caring for patients.”
Deters describes the program in one word: "wonderful.”
"Being in a small family practice, building relationships with patients and physicians and getting that first-hand experience … it’s remarkable, and it’s making a difference in the way we learn.”