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Wednesday Apr 27, 2016

Keeping a Promise to Share What I Know

When we take the Hippocratic Oath we pledge, among other things, to share our knowledge and teach the next generation of physicians. Like a lot of promises, however, this one isn't always fulfilled.

I was a volunteer community preceptor for a decade in my small town, which is near the University of Wisconsin School of Medicine and Public Health. Three afternoons each semester, or six times a year, one first-year medical student and one second-year student would come spend time in my clinic.

Here I am answering a question from Tyler Grunow, a first-year medical student at the University of Wisconsin School of Medicine and Public Health, between patients. I have been a volunteer community preceptor for more than a decade.

My role was to help students develop history taking skills (illness, chief complaint, past history, family history, current meds, etc.), practice physical skills (such as listening to the heart and testing reflexes) and understanding the doctor-patient relationship and why it's valuable.

It sounds simple enough, and yet our specialty finds itself in a situation where far too few family medicine practices are willing or able help. I get it. A few years ago I was chair of an AAFP commission while also serving on the local board of health and working full time. Something on my overloaded schedule had to go, so I took a break from precepting.

It was a mistake.

While I was on that break I was asked to talk about precepting during a panel discussion at a family medicine conference. One of the questions, ironically, was how do you find time to help students and meet all your other commitments.

I was reminded of a student named Scott, who came to visit my clinic for the fourth time on a particularly busy day. I told him before we got started that he could shadow me that day but that I wouldn't have time for didactic learning.

I felt guilty because I didn't stick to our usual routine, and at the end of the afternoon I apologized. "I hope you got something out of that," I said.

He looked at me surprised.

"Dr. Schwartzstein," he said, "that was our best session yet. I learned so much from watching you interact with patients. It was wonderful."

Scott had learned by observing. He got a sense of the doctor-patient relationship and how it is at the core of what we do. Family medicine is about relationships, and he saw how I interacted with my patients and the level of comfort they had with me.

As I told that story at the conference, I realized precepting wasn't something I could give up in good faith. And I realized it wasn't something I had to give up to maintain productivity. I can do this.

So the med students are back in my clinic, three afternoons a semester, six times a year. Physicians are pressed for time, and many likely think med students will slow them down, hurt their productivity or force them to work late. The reality is that it shouldn't be that big of a burden. In fact, students can add value to a practice(www.teachingphysician.org).

I find out what students are studying before they visit. If, for example, it's cardio, I make sure they get to listen to patients' hearts. I start by asking if there something specific they want to get out of a visit, and if there is I try to help them with that particular interest.

I try to answer questions between patients or at the end of the day. I ask, did you learn anything today? And I'm eager to hear their answers. Students have different perspectives about new ways to do things, and their questions keep me on my toes.

In addition to teaching when we have students in our clinics, we are recruiting future family physicians. While they no doubt notice the administrative burdens and imperfect EHRs and ask about that, I am careful in how I address those issues. Despite these challenges, I still love being a family doctor, and I am careful to talk about, and show students, that love as I see patients with them.

A long time ago during med school graduation I pledged that I would share what I learn. Now, and until I retire, I will follow through on that promise.

Alan Schwartzstein, M.D., is the vice speaker of the AAFP Congress of Delegates.

Posted at 10:00AM Apr 27, 2016 by Alan Schwartzstein, M.D.

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