INTEGRATING MEDICAL
STUDENTS INTO THE
OFFICE SETTING
Basics Program for New Faculty
Day 2: November 14, 2013
Dr. Steve Kahane, MD CCFP, FCFP, Assistant Professor, DFCM
Dr. David Palmer, MD CCFP, Assistant Professor, DFCM
Find this presentation online
This presentation can be downloaded from
www.dfcmopen.com/item/basics-medstudents-office.
About this presentation
This module is one of a series from the
Department of Family and Community
Medicine, University of Toronto. It is part
of a three-day workshop that is provided to
new family physician teachers, that is,
faculty members in our Department
Presentation Overview
In this presentation and accompanying
checklists, you will learn how to welcome
and orient medical students into your
practice. We describe how to prepare
patients and staff for medical students,
how to adjust your schedule for teaching
and plans for what to do when you are
behind. The checklists summarize and
help you the the orientation process with
your medical students.
INTEGRATING MEDICAL STUDENTS INTO
THE OFFICE SETTING
Slides adapted from
original iteration of The Basics Program
Dr. Merilee Brown, MD CCFP
Dr. Steve Kahane, MD CCFP
University of Toronto DFCM
FACULTY/PRESENTER DISCLOSURE
• Faculty: Steve Kahane and David Palmer
• Relationships with commercial interests:
• Not Applicable
DISCLOSURE OF COMMERCIAL SUPPORT
• This program has received NO Commercial
support
• This program has received NO in-kind support
• Potential for conflict(s) of interest:
– Not Applicable
MITIGATING POTENTIAL BIAS
• Not Applicable
OBJECTIVES
• Describe how to welcome & orient students into
your practice
• Describe how to prepare patients for medical
students
• How to prepare staff for medical students
• Describe how to adjust your schedule for teaching
• Plans for what to do when you are behind
• Provide checklists summarizing the orientation
process
WELCOME & ORIENTATION
• Student Orientation Checklist
• Contact student prior to start date – email/phone
• What should student bring? – stethoscope, tools,
dress code, ID badge
• Plan student’s schedule, dates in office
• Get student’s contact information, give your info
• Any special needs?
WELCOME & ORIENTATION
Student Orientation Checklist
Orientation Topics:
General

Learner work space, reference materials *

Dress code: name tag, lab coat? *

Hours/ days patient care provided, schedule

Parking, phone system, email *

Introduce staff, each one’s responsibilities *

Unique learning opportunities (clinical activities, patient
population,

provider interests)
Orientation to community

Community characteristics *

Community resources, arranging visits to them *

Where to buy groceries, do laundry *
Overview of rotation

Relate rotation to learner’s career plans
Introduction to learner

Rotations completed *

Experience and skills mastered

Areas needing work
Expectations of School or Residency

Course objectives

Criteria included in evaluation form
Learner Objectives

Specific knowledge, skills, and attitudes to develop

Grade expectations
Rotation objectives

Requirements based on practice’s unique learning opportunities

Specific knowledge, skills, attitudes you notice learner needs to
work on
* Topics that office staff might go over with learners
Preceptor Expectations:
Daily routine
Hours/ days learner in the office
Learner’s level of responsibility and autonomy in providing patient
care
Hospital rounds, night/weekend call
Times preceptor is off; what to do
Amount of reading expected
Office policies
Directions for writing chart notes, dictating, writing Rxs, referrals
How pts selected for learner to see
Length of time to spend with each pt
Hospital policies
Values
Show respect to pts & staff; how? Professionalism
Get to know patients
Preceptor/learner interaction
Format for case presentations
Regular time & process for feedback
Integrate teaching and learning styles
Learner needs to explain needs
Criteria to evaluate learner (“what it takes to get honors”)
Learner self-evaluation before discussing preceptor’s evaluation
If a problem arises
Absentee policy, how to notify office
A contact for questions or problems
How to reach preceptor in emergency
From http://www.mahec.net/pdp/e-Learning_Tools.asp
WELCOME & ORIENTATION
Meet and Greet:
•15-30 min before first clinic starts
•Complete student information form
•Review student’s experiences, rotations, career goals,
interests, hobbies
•Review course objectives
•Review preceptor expectations
•Student objectives – expectations, specific learning needs,
goals
•Review evaluation criteria
•Review office policies, procedures
WELCOME & ORIENTATION
Student Information Form
STUDENT NAME: ___________________________________________________________________________
MEDICAL SCHOOL: _________________________LEVEL OF TRAINING: ______________________________
DATES OF ROTATION: _______________________________________________________________________
CONTACT INFORMATION: PHONE:____________________________________________________________
PAGER:____________________________________________________________
EMAIL:_____________________________________________________________
WHAT I DID BEFORE MEDICAL SCHOOL: _______________________________________________________
ROTATIONS/ELECTIVES COMPLETED:_________________________________________________________
AREAS OF MEDICAL INTEREST: ______________________________________________________________
AREAS OF INTEREST OUTSIDE MEDICINE:______________________________________________________
AREAS THAT I FEEL CONFIDENT ABOUT MY SKILLS:_____________________________________________
AREAS OF DEFICIENCY/AREAS I WANT TO WORK ON:____________________________________________
WHAT I HOPE TO DO AFTER I COMPLETE MY TRAINING: __________________________________________
___________________________________________________________________________________________
OBJECTIVES FOR THIS ROTATION:_____________________________________________________________
___________________________________________________________________________________________
LANGUAGES SPOKEN:_______________________________________________________________________
IS THERE ANYTHING THAT YOU DO NOT EAT? __________________________________________________
DO YOU HAVE ANY SPECIAL NEEDS I NEED TO ACCOMMODATE (CHILD CARE SCHEDULES,
TIMES NEEDED OFF, ETC.)?___________________________________________________________________
WELCOME & ORIENTATION
Office Walk-Through:
•Orient to office space, exam rooms, supplies, patient flow,
bathroom, place for student’s stuff, desk space
•Introductions – staff, MDs, Allied Health Care
•Orient to charts – paper/EMR (?login and password)
•Record keeping - Soap notes, format
•Orient to requisitions, diagnostic imaging, labs
•How to track student results, follow-up on tests? Mailbox?
•Exam room set-up 1 or 2+ rooms?
•Where will the student stand in rooms? Extra chair?
•Video camera for taping student interviews
•Access to Information: Internet, library, guidelines, handouts
PREPARE PATIENTS
•
•
•
•
•
•
•
•
•
Avoid Surprises!
Signs – front desk, exam rooms
Reception to advise patients when booking
Reception to ask patients when arriving
Nurse to ask patients when going into exam rooms
Physician to ask patients before seeing them
Students to ask patients as they enter room
Patients can refuse – have a backup plan
Negotiate with patients – observe only, see student
first, see with preceptor, see on own
SAMPLE WALL SIGN
The University of Toronto has recognized this practice for training of
family physicians.
During your visits to the clinic, you may be cared for by a family practice
physician in training. These doctors work under the supervision of a
faculty staff physician.
Please speak with the staff if you have any questions.
Thank you for your cooperation.
The Department of Family and Community Medicine
University of Toronto
Faculty of Medicine
500 University Avenue
Toronto, ON M5G 1V7
SAMPLE WALL SIGN
PREPARE PATIENTS
Introduce the student:
• “Hello Mr. Jones. This is Kim Rogers; she is a 3rd
year medical student from U of T working with me
today. Would you mind if she observes our visit
today?”
Have student introduce themselves:
• “Hello Mr. Jones, I am Dr. John Smith. I am a
Resident from U of T working with Dr. Palmer. He
has asked me to see you first, and then he will
come in to review after we are finished. Is this ok
with you?”
PREPARING THE STAFF
•
•
•
•
Tell your staff ahead of time!
Educate staff about student and teaching
Describe benefits of having student
Describe how the student will be involved –
observer, seeing from your list, or own list
• Any need to change booking methods?
• Give student’s schedule to staff
• Give student’s contact information to staff
PREPARING THE STAFF
• Get feedback from staff on how to integrate
trainees – they know your schedule best!
• Get feedback from staff on trainee for
evaluations
• Tell other MDs about students and teaching
• Ask other MDs or Allied health care team if
student can see interesting cases,
procedures, spend time with them
• Staff attitudes toward teaching are critical
PATIENT SCHEDULING
Getting Organized:
•Extra 15-30 min/half-day …
•3 exam rooms ideal (2 for you, 1 for student)
•Students take longer (20-30 min/patient)
•Medical Students: 1-2 per hour
•Residents: 2-5 per hour
Type of Schedule?
•Separate student schedule or work from yours?
•Leave empty space in schedule or book full?
•Review schedule with your staff ahead of time
•See examples of booking
PATIENT SCHEDULING
Selecting Patients:
•Review your schedule with student before start of clinic
•Preceptor selects cases for students - avoid certain patients
•Student selects cases - based on needs, objectives
Seeing Patients:
•Student shadows preceptor (often at beginning)
•Student sees patients independently
•Focus or prime student - take history, limited exam, task
•Student sees patient with preceptor – have student perform a
skill while you watch (BP, take history), be a fly on the wall
•Set time limits, review tasks, plan when/how to review case
•You see 1 or 2 patients, while student sees 1, then review
PATIENT SCHEDULING
Other things to consider:
•Book specific types of patients for student day
•Pull learner in for interesting cases
•Continuity of care - get student to see patients in follow-up,
rebook with student
•How will the student follow-up on cases, results? (ie. add
student’s name to lab requisition, put results aside, mailbox,
EMR)
•Consider other office activities – spend time with Office
Manager, Reception, Nursing, Dietitian, etc
•Teach them basics of billing, diagnostic codes
•FHG, FHO, FHT, etc.
•Scheduling and work-life balance
PATIENT SCHEDULING
Sample Schedule: No change, student shadowing
9:00 am
9:10 am
9:20 am
9:30 am
9:40 am
9:50 am
10:00 am
HTN
DM
Cholesterol
Well Baby
Sprain
Flu
Depression
(Student + Preceptor)
(Student + Preceptor)
(Student + Preceptor)
(Student + Preceptor)
(Student + Preceptor)
(Student + Preceptor)
(Student + Preceptor)
Dr. David Palmer - Integrating Medical Students into the
Office Setting
PATIENT SCHEDULING
Sample Schedule: No change, but select patients for student
9:00 am
9:10 am
9:20 am
9:30 am
9:40 am
9:50 am
10:00 am
HTN
DM
Cholesterol
Well Baby
Sprain
Flu
Depression
(Student + Preceptor)
(Student)
(Preceptor)
(Student + Preceptor)
(Student + Preceptor)
(Student)
(Preceptor)
Dr. David Palmer - Integrating Medical Students into the
Office Setting
PATIENT SCHEDULING
Sample Schedule: Leave empty space
9:00 am
9:10 am
9:20 am
9:30 am
9:40 am
9:50 am
10:00 am
10:10 am
10:20 am
HTN
(Student)
DM
(Preceptor)
Cholesterol (Preceptor)
Well Baby
Sprain
Flu
(Student)
(Preceptor)
(Preceptor)
Depression (Student)
Dr. David Palmer - Integrating Medical Students into the
Office Setting
PATIENT SCHEDULING
Sample Schedule: Separate rooms (“Double Book, Book, Review”)
9:00 am
9:10 am
9:20 am
9:30 am
9:40 am
9:50 am
10:00 am
Room 1 (Student)
URI
Room 2 (Preceptor)
HTN
DM
Review
Cholesterol
Sprain
Flu
Review
Well Baby
Depression
Dr. David Palmer - Integrating Medical Students into the
Office Setting
ENSURING PATIENT FLOW
•
•
•
•
•
•
•
Trainee doesn’t have to see every patient
Student sees case, then break to read around it
Avoid difficult or problem patients
Focus / limit your teaching (One Minute Preceptor)
Basic principles vs. detailed medical knowledge
Teach at breaks / between patients
Review cases at end of day, take home points,
reading
• Non-teaching time for student
WHEN BEHIND
•
•
•
•
•
•
•
•
Ask learner to chart /read / look up question
Set strict time limits for slower trainees
Go and rescue student
Have student shadow you for a few cases
Have the trainee work with your staff
Choose simpler patients if appropriate
Save it for later – write it down, and discuss after clinic
Just stop teaching, and have student take a break
ATTITUDE IS EVERYTHING
•
•
•
•
Role Model
Positive Attitude
Professionalism
Work-Life Balance
SUMMARY
•
•
•
•
•
•
•
Welcome and orient the student
Prepare your patients
Prepare your staff and colleagues
Adjust your schedule
Maintain flow, and find time to teach
Have a positive attitude
Use the Checklist for help
STUDENT INTEGRATION CHECKLIST
WELCOME AND ORIENTATION:
PREPARE PATIENTS:















Orientation Checklist
Contact student prior to start date – email/phone
What should student bring? – stethoscope, tools, dress
code, ID badge
Plan student’s schedule, dates in office
Get student’s contact information, give your info
Any special needs?
Meet and Greet

15-30 min before first clinic starts

Complete Student Information Form

Review student’s experiences, rotations, career goals,
interests, hobbies

Review course objectives

Review preceptor expectations

Student objectives – expectations, specific learning needs,
goals

Review evaluation criteria

Review office policies, procedures
Office Walk-Through

Orient to office space, exam rooms, supplies, patient flow,
bathroom, place for student’s stuff, desk space

Introductions – staff, MDs, Allied Health Care

Orient to charts – paper/EMR (?login and password)

Record keeping - Soap notes, format

Orient to requisitions, diagnostic imaging, labs

How to track student results, follow-up on tests? Mailbox?

Exam room set-up 1 or 2+ rooms?

Where will the student stand in rooms? Extra chair?

Video camera for taping student interviews

Access to Information: Internet, library, guidelines, handouts
Avoid Surprises!
Signs – front desk, exam rooms
Reception to advise patients when booking
Reception to ask patients when arriving
Nurse to ask patients when going into exam rooms
Physician to ask patients before seeing them
Students to ask patients as they enter room
Patients can refuse – have a backup plan
Negotiate with patients – observe only, see student first, see with
preceptor, see on own
PREPARE STAFF:












Tell your staff ahead of time!
Educate staff about student and teaching
Describe benefits of having student
Describe how the student will be involved – observer, seeing from
your list, or own list
Any need to change booking methods?
Give student’s schedule to staff
Give student’s contact information to staff
Get feedback from staff on how to integrate trainees – they know your
schedule best!
Get feedback from staff on trainee for evaluations
Tell other MDs about students and teaching
Ask other MDs or Allied health care team if student can see
interesting cases, procedures, spend time with them
Staff attitudes toward teaching are critical
STUDENT INTEGRATION CHECKLIST
SCHEDULING:
• etting Organized
G

Extra 15-30 min/half-day …

3 exam rooms ideal (2 for you, 1 for student)

Students take longer (20-30 min/patient)

Medical Students: 1-2 per hour

Residents: 2-5 per hour
Type of Schedule?

Separate student schedule or work from yours?

Leave empty space in schedule or book full?

Review schedule with your staff ahead of time

See examples of booking
Selecting Patients

Review your schedule with student before start of clinic

Preceptor selects cases for students - avoid certain patients

Student selects cases - based on needs, objectives
Seeing Patients






Student shadows preceptor (often at beginning)
Student sees patients independently
Focus or prime student - take history, limited exam, task
Student sees patient with preceptor – have student perform
a skill while you watch (BP, take history), be a fly on the wall
Set time limits, review tasks, plan when/how to review case
You see 1 or 2 patients, while student sees 1, then review
things to consider
• Other
Book specific types of patients for student day
Pull learner in for interesting cases
Continuity of care - get student to see patients in follow-up, rebook
with student
How will the student follow-up on cases, results? (ie. add
student’s name to lab requisition, put results aside, mailbox, EMR)
Consider other office activities – spend time with Office Manager,
Reception, Nursing, Dietitian, etc
Teach them basics of billing, diagnostic codes
FHG, FHO, FIT, etc.
Scheduling and work-life balance
ENSURE PATIENT FLOW:
•
Trainee doesn’t have to see every patient
Student sees case, then break to read around it
Avoid difficult or problem patients
Focus / limit your teaching (One Minute Preceptor)
Basic principles vs. detailed medical knowledge
Teach at breaks / between patients
Review cases at end of day, take home points, reading
Non-teaching time for student
WHEN BEHIND:
Ask learner to chart /read / look up question
Set strict time limits for slower trainees
Go and rescue student
Have student shadow you for a few cases
Have the trainee work with your staff
Choose simpler patients if appropriate
Save it for later – write it down, and discuss after clinic
Just stop teaching, and have student take a break
STUDENT INTEGRATION CHECKLIST
Sample Schedule: No change, Student shadowing
Sample Schedule: Leave empty space
9:00 am
9:10 am
9:20 am
9:30 am
9:40 am
9:50 am
10:00 am
9:00 am
9:10 am
9:20 am
9:30 am
9:40 am
9:50 am
10:00 am
10:10 am
10:20 am
HTN
DM
Cholesterol
Well Baby
Sprain
Flu
Depression
(Student + Preceptor)
(Student + Preceptor)
(Student + Preceptor)
(Student + Preceptor)
(Student + Preceptor)
(Student + Preceptor)
(Student + Preceptor)
HTN
(Student)
DM
(Preceptor)
Cholesterol (Preceptor)
Well Baby
Sprain
Flu
(Student)
(Preceptor)
(Preceptor)
Depression (Student)
Sample Schedule: No change, but select pts for student
Sample Schedule: Separate rooms
(“Double Book, Book, Review”)
9:00 am
9:10 am
9:20 am
9:30 am
9:40 am
9:50 am
10:00 am
9:00 am
9:10 am
9:20 am
9:30 am
9:40 am
9:50 am
10:00 am
HTN
DM
Cholesterol
Well Baby
Sprain
Flu
Depression
(Student + Preceptor)
(Student)
(Preceptor)
(Student + Preceptor)
(Student + Preceptor)
(Student)
(Preceptor)
Room 1(Student)
URI
Room 2 (Preceptor)
HTN
DM
Review
Cholesterol
Sprain
Flu
Review
Well Baby
Depression
Dr. David Palmer - Integrating Medical Students into the
Office Setting
REFERENCES
•
Brown, Merilee and Kahane, Steve. Original Presentation from The Basics Program,
Integration of Students into the Office Setting, 2006.
•
Palmer, David. Integrating Medical Students into the Office Setting. Presentation for
Orientation of New Faculty, Family Medicine Longitudinal Experience, 2011.
•
Rubenstein, W. & Talbot, Y. Medical Teaching in Ambulatory Care, Second Edition .
Springer (2003)
•
Mountain Area Health Education Center (MAHEC) Department of Continuing Medication
Education: Integrating the Learner into the Busy Practice. (http://www.mahec.net/pdp/eLearning_Tools.asp)
•
Sheet, KJ, Harris DL. Questions asked by family physicians who want to serve as
preceptors. J. Fam Pract 1996;42:503-11.
•
Langlois JP. Support of Community Preceptors: what do they need? Fam Med 1995;
27(10)641-5.
•
Freeman, Risa. Teaching 101. Power Point Presentation. Updated 2005