This is not your father’s (or your) Medical School

I recently served as a preceptor for first year students at our Hofstra – NSLIJ School of Medicine who were doing one of their “RIA” (reflection, integration and assessment) sessions. The students do these sessions every 12 weeks, and are generally scheduled with the same preceptor over time. It may be routine for the students, but I found it absolutely remarkable.

Each student is responsible for doing a complete history and physical examination on a “standardized patient” as the preceptor watches through one-way glass  and listens in with headphones. After 40 minutes, the students exit the room and have 10 minutes to organize their thoughts and enter their write-ups into a computer-based tool. The student then presents the case to the preceptor, and feedback is provided to the student by the “patient” and the preceptor. Preceptors and “patients” also use computer-based tools to document the student’s performance at interviewing and examining.

The whole thing blew me away.

First, the venue. The RIAs are done at our system Center for Learning and Innovation (CLI) a state of the art educational center, which includes classrooms, simulation facilities, and over a dozen exam rooms equipped to allow the observation and recording of students interacting with standardized patients. The “patients” are professional actors who are extensively briefed on the details of “the case” and trained to observe and evaluate the students’ performance. They were great – absolutely credible, and insightful in their comments to the students about how the encounter felt from the patient’s perspective. There was also clearly a lot of prep work that had been done behind the scenes to develop the case, including creating an elaborate “back story” for the “patient” so that virtually any question the student might have asked – any pets at home? – would have been answered in a standard fashion.

Even with all that, the students were the real stars of the day. Sure, most of the students got caught for time and were unable to take a complete history and do a complete physical exam in the time allotted. Some got sidetracked, spending time on, for example, probing the choice of contraceptives of a post-menopausal woman, or failing to pursue a really important detail of the presenting complain. And yes, their physical exams were a bit awkward – one student used her own right eye to examine the patient’s left eye, another listed to the heart from the left side of the exam table, and one seemed to be listening for the Korotkoff sounds over the ulnar nerve. But here’s the thing. These were FIRST YEAR STUDENTS, and they were doing a COMPLETE HISTORY AND PHYSICAL. How many of us even knew which end of the stethoscope to stick in our ears when we were first year students? It struck me that being critical of their performance is a little like complaining about the musicality of a singing dog – it is a miracle that the dog can sing at all!

I think it is fabulous that our students are getting much richer clinical training and more effective feedback than I ever got, and it made me proud to be a part of it.

What do you think?

3 thoughts on “This is not your father’s (or your) Medical School

  1. I think that the PCPs in my HMO need that course. Since they are not first year med students-they should know that too much thyroid increases blood pressure-and I told this to several PCPs. I kept saying -No- and waving lab results.

    I love that they are doing this with a computer, etc. The medical community complains that EHRs prevent them from paying attention to the patient and having enough time. I have a 77 yr old GYN that does much better juggling all of this than doctors that are in their early 40s. I’m 72-and I did have a problem–so he was doing oral history from me that wasn’t on EHR, and going over the EHR at the same time.

    Like I tried to tell PCPs that my family had lots of cancer on both sides. I never was asked about cancer on HMO paperwork- until I was sent to oncology because a biopsy said that I did have cancer. The PCPs said the HMO is interested in diabetes and heart conditions. I’m glad that they have a wonderful radiation unit with board certified, and a nice oncology unit. I have a nice team leader. He called up my current PCP and told him to quit fighting with me, accept the new BP standards for elders. That in his (oncology) office my BP was 130-140, but at the PCP-it was 190-210. My BP is now 120 @ any office, because I’m not scared of a fight, being labeled again as combative, non-compliant-maybe being kicked out of the HMO. I did have several administrative counselors tell me that I should leave the plan and clinics. One did it in @ one of the offices, where they think I’m a sweet heart. They got the head nurse, who came in and asked me if I was being treated well, and I was such a good patient.
    @ the next visit my doctor apologized, and said that he had a serious talk with administration–

    I asked my head oncologist that I don’t understand the HMO @ all. It provides such wonderful and knowledgeable specialists, but primary care seems dedicated to killing or crippling me. Nobody understands why my heart valves haven’t been wrecked or I didn’t stroke out. I carried copies of my TSH labs to show everybody that the thyroid was the problem.

    Seriously–I wish that I could trade my PCP in for one of those students.

  2. Fully agree with your observation.
    Dean Smith and faculty have changed education of drs. We are fortunate to witness and even participate in it.

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