the MEDICAL EDUCATOR VOL 3, No 3, March 2001  A day in the life . . . Doctoring curriculum remains popular among first-year students, preceptors  It is shortly after two o’clock Wednesday afternoon in the offices of Plantation Pediatrics and parents and their children are filing into the comfortable waiting room. In an office at the end of a hallway lined on either side with examination rooms, physicians Philip McGaha, Todd Vasko and John Traynham and medical students Philip Strange and Matthew Johnson discuss medical ethics, a topic on which Vasko lectured a day earlier at MUSC. A few minutes later, the group breaks up to see patients. Strange teams with McGaha and Johnson with Vasko. § § § Pairing first-year students with practicing physicians in the community is part of the Doctoring Curriculum in the College of Medicine. Begun in the spring of 1999, it continues as one of the most popular courses for students and professionals alike. “It continues to be a universally well-liked part of the curriculum,” said Carolyn Thiedke, M.D., course director. “The students say it’s the best thing about their courses, and the feedback from our preceptors is generally very positive.” Lynn Wooldridge coordinates the visits between the students and the preceptors. More than 120 students spend time with 32 specialists and 24 primary care physicians. The inclusion of the specialists is a new addition this spring. Thiedke said specialists were asked to take part in order to relieve the load on the primary care physicians, but there has been little attrition. In fact, a recent survey of preceptors involved in the program indicated most of them would continue their participation. Holding a stack of surveys, Thiedke said 42 of 56 physicians responded to the survey, and 32 “got a kick” from it, although 15 admitted it was “burdensome.” In a few words, the respondents listed reasons why they enjoyed the program. Among the popular responses were the students’ eagerness, enthusiasm and excitement. Others liked their questions and the conversations they shared.  All but one agreed to continue.  The reward for their participation is a discount coupon toward an MUSC-sponsored continuing medical education course, but “they do it out of goodwill,” Thiedke said. “We feel such gratitude to our preceptors,” she added. “It is somewhat of a burden and it would be easier on them if they just didn't do it. So for their participation we’re very appreciative.” § § § It is Strange's third visit to Plantation Pediatrics, the second since the practice moved into its new offices on Savage Road in West Ashley.  The first patients for Strange on this day are a two-month-old girl and her older brother—the former for  a well-baby visit, the latter for a sick visit. McGaha detects a  slight heart murmur in the infant, and invites Strange to take his stethoscope and listen. After Strange's examination, McGaha explains to the mother that the murmur’s presence at this stage is no cause for alarm. “ I think she looks wonderful, wonderful, wonderful,” he tells the mother, gently patting the baby. Following the patient visit, McGaha and Strange return to McGaha’s office and discuss the exam. They both imitate the “swish” sound they heard from the infant’s heart. “When you’re listening for something like that, it’s like having a radio playing over here and another one over here,” McGaha explains, his arms stretching out. “You have to tune out one while you listen for the other.” Across the hall from where they sit, a nurse places the  charts for the next patient in the holder by the exam room door.  McGaha and Strange end their conversation, cross the hallway and walk in.  § § § Approximately 29 students travel around Charleston every week to visit their preceptors, either on a Monday or Wednesday afternoon. During a rotation, or a semester, they will go out four times. Participating physicians never get more than one student a day. The objective, of course, is to get students’ feet wet by exposing them to an actual clinical practice and everything that goes with it. “It puts them in touch with why they came to medical  school,” Thiedke said. That sentiment is echoed by first-year students. Michael Rossi “I can't say enough good things about it,” said Michael Rossi. “The idea of actually seeing and experiencing what you’ll be doing for the rest of your life should have a tremendous impact on the quality of physicians this university will produce.”  Rossi’s preparation for medical school was different from the majority of his classmates—he was a medic in the U.S. Army for nearly 10 years. The training was literally “hands on” as he learned by doing procedures on his comrades, just as they learned by doing the same procedures on him. He appreciates the approach used in the Doctoring Curriculum. “Almost on the first day of school, you enter the clinical realm,” said Rossi, 34. You encounter that fear and trepidation of dealing with another human being in the same room. You can overcome it early in your education. By the time you get to your third year, there’s no adjustment period.” § § § The third young patient McGaha and Strange see this afternoon is an infant suffering from chest congestion. McGaha puts a stethoscope to the baby’s chest and listens intently, picking out a wheezing sound amid the breathing. He asks Strange to listen, and after a few moments of equally intense concentration, he looks at McGaha. “I think I hear it,” he says. § § § “To me, this is the most fun part of the first year,” Strange said after shadowing McGaha for three hours. “You gain experience while learning clinical medicine. It beats sitting in Baruch Auditorium.” On those days when the students remain on campus instead of shadowing physicians, they meet in small groups and discuss cases they encountered at their preceptors’ practices. On other occasions they practice their skills on standardized patients.  In the fall semester Strange shadowed a family practice physician. Although it’s still early in the educational process, Strange said he was interested in pursuing oncology as a career choice. He was impressed, however, with the work that went on within the walls of Plantation Pediatrics. “They spend as much time as necessary with each patient,” he said. “I've seen them spend an hour and a half with one patient.” § § § Once McGaha and Strange get rolling, it is virtually nonstop for the bulk of the afternoon. The afternoon brings a mix of  checkups and illnesses and summons all the persuasive power a pediatrician needs in dealing with infants and toddlers.  As McGaha examines the midsection of one young boy, he  asks, “Did you have lizards for lunch?”  The boy looks at the doctor, smiles slightly, and nods his head. They leave one examination room, McGaha returning the chart to the holder and they head directly for another patient, the physician plucking the chart up in one smooth motion as they pass through another doorway. One patient, however, gives them pause. An eight-year-old boy whom McGaha saw a day earlier is back. He suffers from a rash and pain in his joints, worse than the day before, and oddly enough, in joints that moved painlessly just 24 hours earlier. It is an intermittent affliction he has endured for a couple of years, his mother explains to Strange and another observer. McGaha has had the youth undergo some tests, some of which have results still outstanding.  He brings in Vasko, his colleague, to examine the youth.  Together they retire to their office and consult medical references, but reach no conclusions pending the results of the outstanding tests. This is the case Strange will present to his fellow students next week. § § § This is McGaha's second year of participation in the Doctoring Curriculum, and it is a concept he heartily endorses. “It's great for the students,” he said, relaxing in his office chair at day’s end. “When I was in medical school we never saw hide nor hair of a patient until the end of our second year.  I think this experience helps them keep their perspective and helps the facts they learn to stick better. “I know that the university wants them to learn to take a (patient) history and I want them to do that,” McGaha added, “but that's not my main goal for them. I want them to see  some medicine. Phillip heard a baby wheeze today, and he heard a heart murmur. You can read about those in a book, but until you hear it, you won't know what it is. Those are things that stay with you a lifetime. “I hope the students enjoy it,” he said. “I'm all for it.” § § § It is after 5 p.m., and Strange’s third session with McGaha draws to a close. He eases into an office chair and talks with a visitor while his preceptor finishes up with a patient. He has questions about the day’s patients that he wants to ask McGaha, and he has to gather information for his small group session next week. § § §  “Every profession has its rite of passage,” Rossi said, “and in medical school, for physicians, getting a taste of what you’re going to do is a strong motivator.”   Continuing Medical Education The following conferences are sponsored by MUSC. All conferences are to be held in Charleston  unless otherwise noted. April 4 - 6 McKee Memorial Cytology  Seminar Embassy Suites Historic District 16 - 18 2nd Annual Issues in Women's Health Charleston Place Hotel 20 - 21 EUS Tutorial MUSC Campus 26 - 28 Postgraduate Course in Surgery Mills House Hotel May  5 - 6 Sickle Cell Conference Lightsey Conference Center 25 - 27 Advanced Endoscopy Update Wild Dunes Resort 25 - 28 Medicine in the Vocal Arts Mills House Hotel May 30 - June 2 Update in Cardiology for the Primary Care Physician Charleston Place Hotel May 31 - June 2 Magnolia Otolaryngology Conference Mills House Hotel June  1 - 2 14th Update in Psychiatry MUSC Institute of Psychiatry 7 - 8 ERCP Tutorial MUSC Campus 7 - 10 Ophthalmology Update Kiawah Island Resort   Teaching Tips Techniques for Making Your Presentations More “Interactive” (from  Franklin Medio, Ph.D., assistant dean for Graduate Medical Education) A focused, “interactive” presentation is designed to: stimulate learning through active participation increase comprehension and understanding of material improve retention of material stimulate continued learning after the presentation. Suggested Interactive Techniques: Capture Interest and Attention at the Outset  1) “Show of hands survey” (e.g., How many people have ...) 2) Written survey, quiz or other task involving a written response 3) “Buzz pairs” (ask a question or questions, have participants write down their answer[s] and compare with their neighbors) 4) Brain teaser (e.g., an AV graphic, problem situation, patient information or clinical scenario with a challenging question) 5) A video segment or computer generated motion graphic. Don't miss this Association of American Medical Colleges (AAMC) Group on Education Affairs (GEA) Nov. 2 - 7, Annual Meeting, Washington, DC Call for Mini-Workshop proposals, Small-Group Discussion proposals, and Innovations in Medical Education (IME) Exhibits for the annual meeting are all available at the AAMC web site <www.aamc.org>.  Submission deadline for the Mini-Workshop and Small Group Discussion proposals is April 6.  IME Exhibit proposals are due June 1. The Generalists in Medical Education meets concurrently with the AAMC meeting in Washington, DC.  The call for proposals for this medical education conference can be found at the Generalists Web site at <http://www.thegeneralists.org>. Proposals are due May 11. First Annual Charleston Connections: Innovations in Higher Education Conference Friday and Saturday, June 1 - 2, at The Citadel. Program and registration information can be found at:  <http://www.citadel.edu/carnegie/information/Juneconf.htm>  5th Annual International Association of Medical Science Educators, July 21 - 24,  Rochester, Minnesota. More information can be found at the IAMSE web site:  <http://www.iamse.org>   The Medical Educator is produced by the Office of Public Relations

 

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