A while ago a commenter asked how the osteopathic medical students (OMS) were doing on their rotations in Rural. I've had a few interactions with them and have had one young woman run around with me on hospitalist rounds. They're a nice bunch of people, very motivated to learn and with the luster of the beginning of 3rd year not yet worn off. I don't think I ever had that luster, but that's another story.
As I mentioned in an earlier post, I had some misgivings about the placement of so many OMS in Rural. These misgivings had more to do with the osteopathic program than the students themselves. I was worried about the lack of administrative support and learning objectives provided to preceptors. I was very concerned about the lax attitude expressed by the rotation coordinator. I still struggle with these concerns, as I'll explain below.
Now, to be fair to the OMS, most of the interaction I've had with the students has been with two OMS on an outpatient medicine rotation. These two students have been assigned a primary preceptor who has them in the office most days out of the week. From what I'm told, they are assigned to a "shadowing" role, following the preceptor into exam rooms and listening/watching the patient encounter. So far, they are not seeing patients independently.
One problem is the limited schedules the preceptors keep. One only sees patients in the morning and one afternoon a week, which has left the OMS with nothing to do in the afternoons. She's managed to fill in a little bit with me on hospitalist rounds in the afternoon, but this has been a do-it-yourself solution. Joining me in the afternoons doesn't really give me the chance to have her see patients on her own, so I feel bad. I think it is suboptimal, to put it mildly, to dispatch a medical student to a 3rd year rotation which isn't fully scheduled. Usually an outpatient rotation will have students run from one clinic to another, but this was not organized for the OMS, an example of the laxness I have been worried about.
Another problem is the absence of residents in Rural. The OMS rely upon their attendings to provide the entirety of their clinical experience. Because most of the doctors around here are well into their career arc (I'm the third youngest hire in the county), the students are therefore seeing the professional aspect of clinical medicine from their mature preceptor's eyes. By itself, this is not a bad thing. However, I now realize that part of the apprenticeship of medicine is learning from the junior members of the profession.
My 3rd year experience was marked by the team model of hospital medicine. A team consisted of a couple of MS3s, an MS4 (during the first half of the year, as the seniors did subinternships in their area of interest), an intern, and an R2 or R3. Not only did this lend a certain camaraderie to daily life on the wards, but it also meant a certain essential amount of teaching was done by doctors who were close to my level of training. I believe students learn a lot from interns, just as interns learn a lot from senior residents. Why? Because no one can teach you like someone who just got through learning the same subjects, and there is elegance and hope in seeing a frazzled intern turn into a pragmatic R2, who will in turn become a resourceful and diplomatic R3. (Of course, if you have terrible residents, then the learning process is correspondingly awful, but there are useful lessons in that experience as well.) Where is the team experience for these OMS? It has been replaced, apparently, by the single-view lens of their individual preceptors.
I really hope someone will take the ball and run with it so we can offer a better learning experience in Rural. There is plenty of medicine to do here and I would like to get back into teaching clinical medicine regularly. If the new hospitalist solution is successful--read all about it tomorrow--then we may soon have the staff to provide a rigorous inpatient rotation for medical students.
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