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Tuesday Jun 28, 2016

Give Back: Making a Plea for Family Medicine Preceptors

"This is so cool!" my medical student says as we run from the clinic to the ER.

I agree. It is only 50 yards or so, but my heart is beating hard -- not because of the distance, but because of the urgency of the nurse's phone call. We were called out of a well-child exam to examine a patient with chest pain and hemodynamic instability.

"I had no idea family docs did so much," the student says.

My clinic has a rotation for medical students, and we also make time for pre-med students, such as Isaac Mitchell (left) of Northwest Nazarene University.

I hear this from many medical students, who often don't realize the full scope of family medicine, especially as practiced in small communities like mine. When I look at my practice through the eyes of a medical student, it tends to shake me out of my complacency and makes me appreciate the incredible diversity of what we do. It really is cool.

This is a plea for more community preceptor sites. We need medical students to experience family medicine away from academic medical centers. If students don't see what we do and where we do it, how can they possibly choose to become community family physicians themselves?

Bringing medical students into your community and clinic is incredibly rewarding and useful. My practice has been accepting medical students for years, and it has become an integral part of our practice.

After 20 years, my practice fits me like a glove. It is easy to become comfortable and even blasé about the day-to-day care my community needs. Mentoring medical students keeps me on top of my game, especially with a generation of medical students who fact-check most of the things I tell them. Indeed, I use them to stay abreast of the latest in medical research, both by keeping me interested in pursuing the literature and by having them teach me. They question everything, which makes me do the same.

I enjoy seeing them realize the incredible breadth of knowledge required in family medicine, as well as the complexity of an office visit, and I tease them about whether they think they're smart enough to be a family physician.

I also explain that they are only seeing the tip of the iceberg when it comes to a patient's history. I spend a lot of time talking about who is related to whom and what unspoken stressors are present -- the whole backstory of why the patient is in the exam room.

I used to worry that my patients would object to having medical students in the exam room, but I have rarely seen this. Rather, most enjoy being a part of medical education.

I often hear patients ask students why they are doing a rotation in our clinic in Valdez, Alaska, although it often comes out as, "Who did you piss off to get assigned here?"

When students answer that they had to beat out 10 of their peers to get the opportunity, my patients leave with a thoughtful expression. The rotation is competitive because we don't have enough community preceptors.

I get it. Teaching medical students does take time, especially if you do it right. But I see my role as not only teaching about family medicine, but also about work-life balance, good relationships, a good medical team approach, a healthy diet and exercise. We take students on adventures to model the concept of work hard, play harder. I freely admit that my partner, Michelle, is an enormous part of this.

The medical students earn their keep, though, seeing patients when it is busy and being an integral part of the health team. Like all family physicians, I have many patients who are complicated and require more time than I can give. I have found medical students are able to address many of the social determinants of health that complicate care, as well as spend the time that many of my patients need.

Given our isolated location on the Alaskan frontier with limited resources and hours away from a tertiary care center, the students often play a critical role. On one occasion, a school bus carrying teenage skiers hit a semi truck on an icy road. Our medical student became an essential part of a system completely overloaded by a mass casualty event.

Another student assisted me in an emergency cesarean delivery of twins during a snowstorm. Students have helped me with severe hypothermia cases and often do a better job than I do on counseling teenagers about health issues.

More than 32,000 medical students are AAFP members, and many of them will gather to learn and share their enthusiasm at the National Conference of Family Medicine Residents and Medical Students, July 28-30 in Kansas City, Mo. They all need our assistance and expertise. There is a shortage of family medicine rotations, made worse by competition with students of nurse practitioner and physician assistant schools, many of which pay clinic sites to precept their students.

These medical students are our future, and they need places to experience the full range of family medicine. I know they won't all go into family medicine as a specialty, but I do expect them to treat family physicians with the same respect as they would members of whatever specialty they ultimately choose. I want them to understand the value of family medicine and how they will work with family physicians if they choose another specialty.

Most importantly, these students remind us who we are as family physicians and why we do what we do.

John Cullen, M.D., is a member of the AAFP Board of Directors.

Posted at 02:37PM Jun 28, 2016 by John Cullen, M.D.

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