Keep Things Moving

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Keep Things Moving

Keeping your patient flow moving along while teaching in a busy practice is a vital and ongoing challenge.

Several measures can help prevent you from getting too far behind in the schedule:

  • The student does not need to see every patient. You can go over the schedule in advance and indicate which patients the student should see. This allows you to select the most appropriate patients and fit in some time for the student to write notes and look things up - and time for you to see the rest of your patients.
  • You can develop a pattern:
    • You see a patient while the student sees another.
    • After you finish with your patient, you review the student's patient with him or her.
    • You see a third patient while the student writes his or her note.
  • Even if the student is not seeing every patient, you can still pull him or her in briefly for interesting findings or appropriate procedures.
  • Teaching Hints

    Encourage your partners to grab the student from time to time for interesting cases. This can give you a brief break and also is likely to enhance the education of the student.
  • Some preceptors have students present cases to them in the exam room, in front of the patient.
    • The student goes in first to conduct a history and physical.
    • The student's findings are presented.
    • The preceptor then conducts his or her exam.
  • Teaching Hints

    This strategy increases your "face time" with the patient, facilitates instant follow-up and feedback from the patient, and allows you to see how the student interacts with the patient (Ferenchick, Simpson, Blackman, DaRosa, & Dunnington, 1997). When using this strategy, you should instruct students to minimize use of medical jargon and to be careful about raising sensitive issues or tentative diagnoses. In addition, some students will be more comfortable receiving feedback out of the exam room, when they are not in front of the patient.

Helpful Hints

If you do get bogged down on a particular clinic day, here are some helpful hints for things you can do to catch up a bit:

  • Ask the student to work on his or her charts or to read about something until you get your head above water.
  • Teaching Hints

    Encourage your partners to grab the student from time to time for interesting cases. This can give you a brief break and also is likely to enhance the education of the student.
  • If you have a slow student, who is taking 45 minutes to see a cold, you can set strict time limits: "You have 15 minutes to get a basic history of the chief complaint and pertinent physical findings. I want you to come out after 15 minutes with whatever you have." If the student is not out when you are ready, go in and get him or her.
  • What other things can you do if you have a slow student?

    Teaching Hints

    It is important for you to discuss your expectations about the length of time spent in patient encounters during the initial orientation with the student. This discussion may need to be reinforced once the rotation is underway. It is also likely that the student will benefit from a discussion about strategies for being efficient. Many of the students have not yet had to deal with a restricted appointment time and will greatly benefit from your expertise.

Module 1: Taking a Student into your Office