Medical students today are getting richer clinical training

I recently served as a preceptor for first year students at our Hofstra-North Shore LIJ School of Medicine who were doing one of their RIA (reflection, integration and assessment) sessions. The students do these sessions every 12 weeks, and are generally scheduled with the same preceptor over time. It may be routine for the students, but I found it absolutely remarkable.

Each student is responsible for doing a complete history and physical examination on a standardized patient as the preceptor watches through one-way glass and listens in with headphones. After 40 minutes, the students exit the room and have 10 minutes to organize their thoughts and enter their write-ups into a computer-based tool. The student then presents the case to the preceptor, and feedback is provided to the student by the patient and the preceptor. Preceptors and patients also use computer-based tools to document the student’s performance at interviewing and examining.

The whole thing blew me away.

First, the venue. The RIAs are done at our system Center for Learning and Innovation (CLI) a state of the art educational center, which includes classrooms, simulation facilities, and over a dozen exam rooms equipped to allow the observation and recording of students interacting with standardized patients. The patients are professional actors who are extensively briefed on the details of the case and trained to observe and evaluate the students’ performance. They were great: absolutely credible, and insightful in their comments to the students about how the encounter felt from the patient’s perspective. There was also clearly a lot of prep work that had been done behind the scenes to develop the case, including creating an elaborate back story for the patient so that virtually any question the student might have asked — any pets at home? — would have been answered in a standard fashion.

Even with all that, the students were the real stars of the day. Sure, most of the students got caught for time and were unable to take a complete history and do a complete physical exam in the time allotted. Some got sidetracked, spending time on, for example, probing the choice of contraceptives of a post-menopausal woman, or failing to pursue a really important detail of the presenting complain.

And yes, their physical exams were a bit awkward: One student used her own right eye to examine the patient’s left eye, another listed to the heart from the left side of the exam table, and one seemed to be listening for the Korotkoff sounds over the ulnar nerve.

But here’s the thing. These were first-year students, and they were doing a complete history and physical. How many of us even knew which end of the stethoscope to stick in our ears when we were first year students? It struck me that being critical of their performance is a little like complaining about the musicality of a singing dog — it is a miracle that the dog can sing at all!

I think it is fabulous that our students are getting much richer clinical training and more effective feedback than I ever got, and it made me proud to be a part of it.

Ira Nash is a cardiologist who blogs at Auscultation.

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