For over 20 years I have been a teacher of medical students. I began my first year in practice with a third year medical student spending one morning a week in my office for a year. The one on one year long program lasted for 5 years. It was fun observing each student grow and mature as the weeks passed. Some students experienced remarkable intellectual and professional growth, transforming into doctors before my eyes. When UCI decided not to use community doctors for that program I was disappointed, but I transitioned into teaching second year students who were learning how to interview patients and perform basic physical exams. The students were green and lacked medical knowledge so the challenge was much greater, but the commitment was less extensive as they were in the office much less.
Over the last few years I have participated in two different programs. UCI’s family medicine curriculum now calls for students to spend a month in a doctor’s office (I say a month, but the students are often scheduled for lectures and meetings so they are in the office for a total of 13 days.) The second program was a new one in which first year medical students spent one day a week in my office for three months. It was their very first exposure to actual medical practice
As the curriculum has evolved it is not only the structure of the programs that has changed, the expectations of the students has changed as well. There is a sense of entitlement that I did to see 20 years ago. This was most evident with the first year medical students. Their medical knowledge was non-existent, as they had barely started their course work in anatomy and had not taken any courses in diseases, diagnosis or pharmacology. They did not even know how to diagnose a common cold! In spite of this lack of knowledge they all expected to spend time alone with patients conducting interviews and doing basic exams. They had no idea what questions to ask or the significance of answers given by the patients, but that did not stop them from grueling personal interviews or from giving misinformed advice. The students had been given only basic training in physical examinations and were ignorant about what to do with what they saw and heard. Patients were seen more as learning opportunities than people.
One student I had complained about not being assigned enough patients per day, oblivious to the fact that many patients were not comfortable spending an additional 30-60 minutes in the office so they could answer medical questions from an ignorant stranger. The student cared little for the time or comfort of the patients. It was all about her.
The third year students recently in my office were little better. They had more training and knowledge than did the first years, but they still lacked awareness of their limitations and how they impacted patient care. When a longstanding patient pulled me aside and told me about the wildly incorrect advice given by one medical student I knew I had to make a change.
I no longer teach medical students in my office.
It was a difficult decision at first, as teaching has always been a passion and there have been some students who were outstanding. I know with certainty that I have had a significant impact on some of the students, even converting some of them to pursue family medicine. Nevertheless, when I stopped and considered the negative impact teaching had on my practice the decision became easier. Electronic records and other documentation requirements have compromised the quality of patient interactions as it is and medical students were making quality interactions even more difficult. Since ending my participation in these teaching programs I have realized how much better patient interactions are when there isn’t a student in the room. Patients have my undivided attention in a safe and private setting. The office runs more smoothly and I do not fall behind as often. Patient care is better, and this needs to be my primary goal.
-Bart