I cherish the relationships I’m able to build with my patients

I spent my first two years of medical school at the University of Utah frantically cramming for Step 1. My limited exposure to patients was restricted to shadowing only. My actual interactions with them were spotty at best.  Those first two years of medical school didn’t at all reflect what I would go on to love about primary care: building relationships with patients that would span many years.

I now teach at a very changed University of Utah where students are performing complete physical exams by the end of their first semester. Through this innovative curriculum, after students have learned the physical exam, they spend the next year and a half in a primary care clinic working with preceptors, interviewing and examining patients rather than waiting until traditional third-year rotations to have these kinds of experiences. I now lead this Longitudinal Clinical Experience that provides students opportunities I never had in my first years of medical school: the early exposure to primary care that is crucial to the future of health care.

In addition to directing the program, I have the privilege of precepting students, which allows me to see them having these experiences first-hand. At first, I was self-conscious about my teaching abilities until I was reminded that many aspects of my day would be fascinating to first- and second-year students and truly bring the classroom material to life.

My first student set the bar high. I was seeing one of my well-controlled schizophrenics who, after many years of medication, suffers from tardive dyskinesias. My student had just learned about this side effect and was in awe to observe what he had only read about in a textbook.

I had also forgotten how great it is to finally feel proficient in examination skills. In an email following up on a patient he’d seen in clinic, my student said, “I think I’m just a pelvic exam away from finding a cervix.” In his very next clinic session, he easily found the cervix.  I’m not sure who was prouder.

Seeing the expansion of students’ knowledge and understanding is also very rewarding. Students start out in our clinic system as medical assistants so they can understand the roles of all members of the team. They progress from administering a questionnaire based on the chief complaint and taking vital signs to taking the history, performing the physical exam, and coming up with a differential – a list of all possible causes of the patient’s problem. Their understanding grows exponentially throughout the second year. Another of my students had a light-bulb moment in clinic last week saying, “I finally understand all those different things we keep talking about as part of the differential!”

I cherish the relationships I’m able to build with my patients as a primary care physician. And now I cherish the opportunity to expose medical students, early on, to those types of relationships. I can only hope that I am able to transfer a small amount of my joy and passion for continuity of care to my students so that they too may develop a connection with a patient. I look forward to the day when involving students in primary care in the preclinical years is the standard of medical education – and when I am able to see my primary care physician and develop a relationship with her student.

Karly Pippitt is a family physician and clinical instructor in the Department of Family and Preventive Medicine at the University of Utah. She blogs at
Primary Care Progress.

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