The outpatient clinic is a rich setting for educating medical students. There are ways to optimize the student’s learning and contribution to the clinic. Students may be an integral member of the clinical team, bringing patients into the clinical room and obtaining vital signs or by providing patient education. You may consider scheduling patients in order to streamline your patient flow while also incorporating the student into the culture of your clinic.
To participate in clinical teaching of FIU HWCOM students, you must have a clinical faculty appointment and undergo an initial orientation with the clerkship or course director, or their designee. The following information is designed to supplement and reinforce what you gain from orientation.
You may consider scheduling patients to optimize your time. For outpatient scheduling with medical students, a "wave" schedule can be used, particularly in settings where space allows the student to use a separate examination room. With the patient’s permission, the student can start with a patient and then be joined by the faculty. A sample schedule is below.
- Orienting the learner to the site and preceptor
Orienting students and setting expectations are the foundations of a good clinical learning experience. Skilled clinical teaching will be lost on a student who is preoccupied with trying to figure out what they should do, what they are supposed to learn and know, what and how much they are supposed to do with a patient, or even how they will find the bathroom
In some sites, ancillary providers or staff may quickly provide this on the student’s first day. If you would like to write any specific and consistent expectations of your site for students to review prior to the first day, the clerkship director or clinical faculty director can provide this before the rotation begins. Some clinical sites may provide an "Orientation PowerPoint." If you would like to do this with narration, FIU has very easy-to-use PowerPoint narration software provide by the IT support staff.
This is a tool adapted from Boston University that you can use when you first meet the student to orient them to your teaching and site:
ONE MINUTE LEARNER, adapted from Boston University
- GOALS: Learner’s level of experience; Learner’s and Your Goals
- GETTING GOING: When, how and who should the learner see?
- HOW MUCH and HOW LONG Focused or Full?
- PRESENTING: Where and how?
- CHARTING: When and how?
- QUESTIONS: When is a good time to ask questions that come up?
- USE OF TECHNOLOGY* When can learners use phones/ipads to look up the answers to clinical questions? At the moment of care or later?
- UNSTABLE PATIENTS* How would you describe an unstable patient? When should the learner immediately get you to assess a patient?
- LOGISTICS* who’s on the team/reporting/residents, lunch, bathroom, entry codes, daily schedule/activities/roles for student (even if faculty not on floor)
*added by S.Minor at FIUFor further information about the One Minute Learner, click here:
You can also ask your staff to orient the students to:
- How patients move through the office
- How the student may help
- How to contact the office or hospital team in case of personal emergency
- Where to put personal belongings and any possible independent workspace
- Exam rooms equipment, supplies, and organization
- Clinical tests performed in the office
- Patient education materials
- EMR Access
- Retrieving test results
- Ordering tests and consultations
- Scheduling follow-up appointments
- Ways Students Can Contribute to Patient Care While LearningStudents can contribute to patient care! Consider these opportunities for students to practice their skills while enhancing patient care. Full document from STFM
- Before the visit, students can:
- Help with pre-visit planning, put in orders for preventive services where appropriate, pend orders for medication refills, determine what labs are needed, and call patients in advance of visits to discuss any pertinent issues.
- Conduct concurrent visits with the preceptor (preceptor can complete one or more visits while student conducts components of another visit).
- Participate in goal setting in advance of patient visits (i.e., what will we ask and how?, and what is the anticipated outcome of the visit?).
- Review social histories and participate in huddles in order to understand patients. The student will not only be more effective in the office but will also become a better doctor!
- During the visit, students can:
- Room patients (empower nursing staff to help educate students).
- Help patients and families complete developmental screening questionnaires, school physical forms, etc.
- Help document care in EHRs.
- Update problem lists and medication lists.
- Write and pend orders and prescriptions.
- Complete after-visit summaries and review them with patients.
- Write encounter notes (limitations apply to patients with Medicare where only ROS, PMH, FH, SH can be referred to in billing).
- Perform medication reconciliation.
- Discuss medication side effects with patients.
- Assess for medication interactions.
- Give immunizations, draw blood, perform EKG’s.
- Find and review quality patient education materials with patients.
- Create collaborative care plans with patients.
- Perform scribe functions (especially students in early training).
- After the visit, students can:
- Answer patient questions, with supervision, in EMR/patient portal “in basket” and communicate lab results to patients.
- Call patients after visits to ensure patients understand and are adhering to their treatment plans.
- Make calls to coordinate specialty visits, social work assessments, and/or referrals to other resources.
- Students can contribute to the team and enhance clinical skills by:
- Creating patient handouts that list reliable patient education websites.
- Bookmarking quality patient education sites on office computers or within the EHR.
- Using sophisticated computer knowledge to help clinicians work more effectively with EMRs.
- Answering clinical questions that arise during patient care and sharing the answers with the preceptor.
- Sharing information about high quality medical apps with preceptors and the practice team.
- Proactively reaching out to patients who need care (patients who have gaps in care, such as high A1C’s and those who haven’t received flu shots).
- Before the visit, students can:
- Direct Observation of the Student in Clinic
- Teaching in the Presence of the Patient (TIPP)
- Teaching in the Outpatient ClinicThis is a brief summary of "How to Be an Efficient and Effective Preceptor" from Family Practice Management:
This 3 page article from the Society for Teachers for Family Medicine describes "Strategies for Efficient Office Precepting."
This short article describes "How to Be an Efficient and Effective Preceptor" and is from Family Practice Management.
This short article from the ACP Internist describes tips for having medical students in the internal medicine clinic.
The University of Western Australia crafted the Teaching on the Run Tips Series. Each Tip is less than two pages.
- Teaching on the Run Tips Home Page of 14 Tips
- The Doctor as Teacher
- Teaching With Patients
- Effective Use of Questions
- Teaching in the Ambulatory Setting
This 17 minute voice over powerpoint describes clinical teaching:
- Giving FeedbackGiving feedback is an integral skill for medical educators. Characteristics of quality feedback include:
- Timely – don’t wait too long!
- Named – “I’m giving you feedback….”
- Limited – in bite size chunks, just as we provide patient education
- Requires a credible source and a culture of respect and support - It’s all about the relationship! Learners need to know you are looking out for their learning and well-being.
- Based on direct observation
- Uses questions, thus promoting self-reflection. Some great questions include:
- "What did you do well?"
- "What can you improve?"
- "What’s your SMART plan for improvement?" SMART=Specific, Measurable, Achievable, Relevant, Time-limited
- Focuses on the process not the person – giving feedback about the process of learning or development of a skill creates a growth mindset whereas feedback about the person creates a fixed mindset in which growth does not occur. This is an example of feedback on the process: "You took in the feedback I gave you about avoiding medical jargon and used layperson's language when explaining the patient's diagnosis. Well done!" This is an example of feedback on the person, which is not helpful to the student: "You are such a smart student."
Giving Feedback: The University of Western Australia crafted the Teaching on the Run Tips Series. Each Tip is less than two pages.
- Arranging the Computer in the Patient Care Room
Basic principles for success with the EMR and the patient include:The EMR is here to stay. These evidence based tips will help you be successful in your patient-EMR interactions:
- Position yourself for dual access to the EMR and to the patient. The computer can be positioned unobtrusively between the patient and clinician so that the computer can be used as a conduit for information flow and an opportunity for more active patient participation in their care.
- Ask permission or acknowledge that you will use the EMR.
- Use the EMR as a teaching tool.
- Preserve nonverbal contact with the patient.
- Organize what you want to accomplish before the visit.
- Demonstrate Internet resources that might contribute to patient activation.
These tips are from the American Society of Clinical Oncology:
This 2-pager discusses working the computer in to the visit:
This KevinMD article by a patient discusses computer arrangements in the room, this patient loved the use of a laptop, which was unobtrusive during the patient visit:
- FIU COM Online Teaching Modules for Free CME!Go to the FIU COM Online Teaching Modules on Giving Feedback, Narrative Comments, Orientation to Clerkship Teaching, the EPA’s (Entrustable Professional Activities) and the Patient Role in Teaching: