Med students: Want to step out of the classroom and into the exam room?
By Herbert Rosenbaum
By the end of my first year of medical school and destined for my “last summer ever,” I left my rigorous preclinical curriculum with an unsettling combination of exhaustion and frustration. I came to medical school to help the sick, not sit in some stuffy lecture hall, spend innumerable hours meticulously studying complicated biomolecular pathways, or learn about the zebras among zebra diagnoses. Despite my excitement at the beginning of medical school, the sobering realization of the academic and impersonal nature of preclinical years disturbed me immensely. I felt my zeal slowly seeping away. And, despite the strong push for students to pursue research activities during that precious summer, I knew neither pipetting for hours nor endless analysis of chart-reviewed data could ever recharge me.
In short, I needed a doctor – a mentor who could help me reinvigorate my passion for medicine.
A Google search later, I found the Texas Family Medicine Preceptorship Program, funded by the state in an effort to increase the number of primary care physicians throughout Texas. Physicians seek eager medical students to spend 2-4 weeks in their clinics, each one with a personalized description and listed specialized interests (women’s health, sports medicine, et cetera). In contrast to shadowing, as preceptees, students work alongside physicians as members of the clinic, taking histories, doing physical examinations, and learning the foundations of medical assessment and planning. (And the stipend certainly did not hurt!)
I remember thinking to myself, “I don’t know if I am interested in family medicine. Sure, my passions rest in geriatrics and primary care, but I don’t know if I should apply if I am not committed to family medicine. Maybe I should just do research like everyone else.” That night, I filled out the application. I refused to again entertain the thought of doing research. A few weeks later, I matched with San Antonio-based physician Dr. Sara Apsley-Ambriz.
Immediately Dr. Apsley-Ambriz expected me to practice my history-taking and physical examination skills and present to her with diagnoses and a plan, just like third- and fourth-year medical students. But if you think I only saw ear and urinary tract infections all month, think again. A highlight of my month was diagnosing what was later confirmed to be a cerebellar tumor uncommonly seen in adults—as a preclinical medical student in a family medicine clinic! Therein rests the beauty of family medicine: anything can enter your door. Family physicians serve on the front lines to detect and prevent virtually every disease, and specialists rely on the findings and clinical judgement of family physicians to first catch potential diagnoses. In my patient’s case, my observations allowed diagnosis of cancer in its earliest stage and thus provided her with the best possible prognosis.
My four weeks provided so many educational opportunities, including seeing the therapeutic benefits of osteopathic manipulation, performing well-child examinations, learning breast examinations, speculum exams, and Pap smears in an amazing introduction to women’s health. The most impactful element of my experience was gaining a better understanding of medicine’s socioeconomic barriers including access issues, prior authorization paperwork for adequate coverage of appropriate therapies, and language barriers. I left my month with a strong and informed desire to serve as a health care advocate, a promise to perfect my Spanish to help reach more patients, and a clear vision of the central role of the family physician in the greater context of American medicine.
Two years later and in the midst of residency applications, I realize this program is perhaps the very reason I am now proudly pursing family medicine.
So if you’re a preclinical medical student and you find my experience intriguing, check out the Texas Family Medicine Preceptorship Program at www.tafp.org/preceptorship. And if you’re a family doctor who wants to help shape the future of family medicine in Texas, consider signing up to be a preceptor. Your influence could be helping patients across the state for years and years to come.
Herbert Rosenbaum is a fourth-year medical student at UT Southwestern Medical Center. Reach him at @hbrosenbaum.