1.2 Direct Primary Care Clinical Rotations with Allison Edwards MD

10/09/19 • 26 min

Rounds to Residency (from MedEd University)

Dr. Allison Edwards is the owner of Kansas City Direct Primary Care. Though she works in the community, she still hosts students from the University of Kansas and other locations at her clinic. DPC is a movement as well as a clinical environment that is designed to eliminate the middle-person and reduce costs for patients. Direct Primary Care provides a low-volume yet diverse learning experience and is great for shadowing or students requesting a break between intense rotations.

DPC preceptors are unique in that they are entrepreneur-physicians to a greater degree than hospitalists. As small business owners, they navigate the two complex worlds of medicine and business. DPC physicians are also free from the hospital and administrative constraints other physicians are regulated by. This potentially allows preceptors and students to run more tests and provide in-house support that a hospital setting may pass off to a tech. There is a great focus on learning how to learn now so that students can use these critical thinking and technical skills more effectively later.

Students interested in a Direct Primary Care clinical rotation must be concerned with time-constraints and customer service. Though there is generally lower volume at DPC clinics, patient time expectations (more so than hospital time restrictions) are of paramount concern. Customer satisfaction is an important consideration in all small businesses.

Students should prepare for their externships by being open-minded and energetic. They should plan for downtime and have a general plan for self-directed studies. Showing passion and being proactive are great ways to assure a student's Letter of Recommendation will display their strengths and ambitions. Also, students that remain humble and understand they are still learning will benefit more from their clinical experience than those that are abrasive or overstep their boundaries. The preceptor-student relationship is that of a dynamic team. Understanding each person’s level in the hierarchy and personal limitations provide a smooth transition of knowledge from one individual to another.

Most links related to DPC:

DPC Alliance

DPC Frontier (map of local DPC clinics)

Atlas.md & Bagel.md (EHRs that serve DPC)

D4PC Foundation (host of the Nuts & Bolts Conference)

AAFP’s DPC Toolkit

HintHealth DPC Software

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Most links related to DPC:

DPC Alliance

DPC Frontier (map of local DPC clinics)

Atlas.md & Bagel.md (EHRs that serve DPC)

D4PC Foundation (host of the Nuts & Bolts Conference)

AAFP’s DPC Toolkit

HintHealth DPC Software

Follow Chase here - https://www.linkedin.com/in/chasedimarco/

Visit our Website - MedEd University

Email us at - [email protected]

Facebook: https://www.facebook.com/MedEdUniversity/

Instagram: https://www.instagram.com/MedEduniversity

Twitter: https://twitter.com/Mededuniversity

LinkedIn: https://www.linkedin.com/company/mededuniversity

Pinterest: https://www.pinterest.com/mededuniversity

YouTube: http://youtube.com/mededuniversity

Previous Episode

1.1 Medical Education Philosophy with the Alliance of Clinical Education Bruce Morgenstern MD

Dr. Bruce Morgenstern is the Vice Dean of Academic and Clinical Affairs at Roseman University College of Medicine and President for the Alliance for Clinical Education (ACE). His medical history as a board-certified pediatric nephrologist led him on his path to becoming the Clerkship Director for Pediatrics at Mayo, working with The Council on Medical Student Education in Pediatrics (COMSEP), and he eventually became the President of ACE which collaborates with numerous medical education associations.

Preceptors: Dr. Morgenstern believes in medical education and the importance of precepting for healthcare students. Physicians should be encouraged to seek out faculty development training if available to them if they wish to continue to progress in their mentorship roles. However, the most important aspect of any student-teacher relationship is setting clear expectations early on. He also confirms the importance of a basic education model, such as the one-minute preceptor model, in medical education. Though many preceptors may not be aware of the exact model, they often implement a similar structure into their educational environment.

Students: Dr. Morgenstern feels students should also express their level of education to preceptors early on. This helps to facilitate material being disseminated in a manner appropriate for each individual’s level of education. Students that lay out their hopes for the rotation or that discuss topics they would like to learn more about are more likely to receive specific training. Those that don’t may fall the wayside.

When asking for a Letter of Recommendation (LoR), it is best to ask a preceptor that knows the “unwritten code” of a strong letter. Many physicians may have good intentions, but do not always know what current residency directors are looking for. Also, do not ask “will you write me an” LoR, but instead specify that you are looking for a “strong” LoR. This can make all the difference in the preceptor's interpretation of your desire for that field and the letter.

Keep updated with education meetings via the ACE Calendar.

For more education information, check out the Medical Mnemonist Podcast or other shows in the network via the InsideTheBoards (ITB) website. For those earlier in their education, we recommend our book, Read This Before Medical School. For board-review and q-bank questions, iOS users can download the freemium ITB Audio Q-bank or join the conversation via the ITB Slack Community!

*Please note my mistake in calling it the Alliance for Clinical EducatORS in the audio when, in fact, it is the Alliance for Clinical EducatION.

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Next Episode

1.3 Community Obstetrics and Gynecology Rotations with James Gomez MD

Dr. James Gomez is board-certified in Obstetrics & Gynecology in the Chicago area and has been a clinical educator for over 10 years. As a community physician, he handles both in-clinic patients and prenatal care as well as hospital deliveries and surgeries. This specialty uniquely borders between primary care, surgery, and other subspecialties depending on each physician’s scope of practice.

Preceptors in OBGYN (OB/GYN) often have a particularly sensitive population and special care is often needed when preparing students for the patient population. They must also assess their students for their level of knowledge and interest in order to best plan how to approach the individual's clinical education. Proper mentorship is key. Gaining the respect of one’s students is never a bad idea, and being too strict is unnecessary. However, Dr. Gomez cautions that boundaries must be set between the student and preceptor in order to keep a professional and proper learning environment.

Medical students are required to participate in several weeks of clinical education in OBGYN for their core rotations. They may also choose to gain more experience in OBGYN during their elective rotations. Students that show an interest in the topics and patients likely to present in this clinical setting are likely to more involved and gain the attention of their preceptor. A student is expected to gain basic ultrasound technical skills, read the US monitor, monitor lab and hormone changes, and follow these assessments to a diagnosis and treatment plan.

Some key takeaways would be:

It has to make sense. Not all lab results and patient's signs or symptoms add up to the typical case. Atypical presentations are much more common in the clinic than on the boards.

Develop a preceptor-student bond and get on the same page. The relationship between clinical preceptor and student may be strained and distant or maybe inappropriately close. Make sure to foster a healthy learning environment.

Be active with your education. Forcing a preceptor to repeat his/herself multiple times may demonstrate a lack of interest by the student and strain the rest of the medical externship.

Follow Chase here - https://www.linkedin.com/in/chasedimarco/

Visit our Website - MedEd University

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