April 2000 • Volume 6 • Number 4
Can students add value to your practice?
BY JANE STOEVER
Washington D.C.Are you worried about Mrs. Wilson's recurrent back pain but figure she'll call you when it gets bad enough?
Do you need to read the latest research on urinary tract infections to identify the most cost-effective length of treatment?
Have you put off starting a preventive home care program for your chronic heart failure patients?
Would you like to arrange group sessions for your diabetic or stop-smoking patients?
Do you wonder whether the home health aide is giving you the whole picture?
Patient Sheila Brown-Cooper, top photo, talks with Gene Kallenberg, M.D., right, about an ad for new arthritis medicines. "Look them up," Kallenberg tells medical student Zachary Ibrahim. Lower photo: Kallenberg and Ibrahim hear regular "thub-dubs" from Harry Rosenberg, occasionally troubled by rapid heartbeats.If you're saying yes, you're not alone.
Gene Kallenberg, M.D., chair of the family practice division at George Washington University, and his colleagues asked primary care preceptors, including FPs, to list things they wish they had more time to do. Their endless "to do" lists are reflected in the questions above.
Kallenberg asked the preceptors, "What if you had help from a highly intelligent, college-trained person who wants to grow up to be like you?"
Enter the medical student. With two caveats: The medical school needs to teach students more pragmatic skills early on, and the school needs a longitudinal curriculum so preceptors can come to know and trust the students' abilities.
At GWU, first- and second-year students work as apprentices to their primary care preceptors one half-day every other week. Each student chooses a patient to follow, one expected to need regular care.
"I always come into the clinic when my patient comes in," says Andrew Fenton, a first-year GWU medical student. When his patient was admitted to the emergency room for shortness of breath, Fenton took the patient records and lab reports to the ER, stayed with the patient awhile and visited him each day he was hospitalized.
GWU plans to inform preceptors about the students' abilities. "In the near future, we should be able to tell preceptors the students will know how to counsel patients on smoking cessation, how to help the preceptors find information on the Web and how to make home visits," says Kallenberg.
Since the mid-1990s, studies have shown that medical students take 30-45 minutes of a physician's time per half day. On the day they precept, physicians stay at work longer to get caught up and tend to eat lunch with students instead of having down time. Students reportedly cost physicians one or two patients per half day -- but at least one study said preceptors' weekly productivity exceeded that of other physicians.
Kallenberg and Thomas Schwenk, M.D., chair of the family practice department at the University of Michigan in Ann Arbor, listed ways preceptors might make the most of students while teaching them. Kallenberg and Schwenk propose that students be trained to carry out activities including those mentioned above, plus:
- find and organize patient education materials,
- investigate practice populations and community demographics,
- conduct patient satisfaction surveys,
- review patient charts to assess care of various types of patients,
- give in-service training to your staff,
- conduct patient-based literature searches,
- perform sports preparticipation and other screening exams, and
- make and document follow-up phone calls.
Kallenberg and his colleagues polled preceptors across the country last year to see whether they would be more willing than they currently were to have students in their practices if the students had some of the skills noted in this story. About 47 percent said yes, about 6 percent said no, and about 47 percent said it wouldn't make any difference. "We concluded having the students learn pragmatic skills early on would augment our efforts to attract physicians to answer the call to teach," says Kallenberg.
If you're interested in precepting the next generation of family physicians, contact the family practice department at the nearest medical school. You may be impressed at the ways even new medical students can add to your practice while they're learning to be physicians.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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