The classroom is an entree to the clinic for most medical students. But for those looking to get meaningful patient encounters their preclinical years, there are avenues.
How can medical students find experiences that offer early exposure to clinical environments? And when is the right time to pursue them?
AMA member Wayne Bond Lau, MD, is dean for student affairs at Thomas Jefferson University's Sidney Kimmel Medical College in Philadelphia. In a recent interview with the AMA, he offered his guidance on how medical students should approach clinical opportunities before starting clerkship.
Mastering material matters most
At most medical schools, students don’t begin clerkship until their third year. That leaves two years for other types of exposure. But Dr. Lau cautioned that seeking clinical experiences too early can distract from mastering the science of medicine, which is typically the central focus of years one and two in medical school.
“I recommend that students first get comfortable with their academic program,” said Dr. Lau. “You have to know how to take care of your academic responsibilities first, know how to pass the examinations and know how to comfortably do well with your exams—because that is the name of the game for the first two years of medical school.”
It is a matter of time management. Medical students must first make sure they can handle the classwork load before adding more to their plates.
“Doing well on the wards is a combination of book knowledge—aka the pathophysiology of diseases—and interpersonal skills,” he added. “It’s about seeing how the team functions and anticipating the needs of patients and the team. Doing a lot of shadowing in the hospital beforehand does not automatically translate to success on the wards.”
Summer break presents an opportunity
On a traditional calendar, medical students typically have about six weeks between the first and second year of medical school. That final free summer is an ideal time to gain clinical experience.
“That summer period offers the time and freedom to shadow a physician without fear of impacting your academic performance,” Dr. Lau said.
Jefferson Health, which is the home of Sidney Kimmel Medical College, is part of the AMA Health System Member Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Look on campus
In citing the opportunities that might be beneficial, Dr. Lau touted the value of shadowing physicians, scribing, or working in free clinics. At most medical schools, student-run organizations or service groups can provide early opportunities for clinical involvement.
“Different schools will have different kinds of clinical-facing organizations,” Dr. Lau said. “lf students feel passionate about community service I recommend they seek out an organization offering patient-care opportunities earlier than year three.”
Don’t worry about getting granular
Medical students who enter preclerkship clinical opportunities hoping to sharpen their procedural skills are likely to be disappointed, Dr. Lau said.
When it comes to preclerkship clinical opportunities, students should understand it’s “not necessarily my place right now to work on my skills of being a student doctor. It is my job to watch and learn from experienced physicians who have been doing this and enjoy positive rapport with their patients.”
What does medical student success in a preclinical opportunity looks like? Dr. Lau said “the answer is not going to be learning how to do a joint arthrocentesis as a first-year student. Understanding the fundamental cornerstones of a positive patient-physician relationship, however, is key.”
Watch and learn
The most value that preclerkship medical students can obtain from the act of scribing, shadowing or any other clinical exercise comes with close and careful observation.
Students “can learn a lot by just watching the interactions that result in great patient satisfaction and great patient outcomes,” Dr. Lau said.
“Students should observe a physician who listens to a patient—not interrupt a patient. Students are very fortunate if they can watch a physician be a methodical detective, asking the right questions that yield the information needed to solve the diagnostic puzzle appropriately. That necessitates observation—on both the part of the physician teaching, and the student learning.”
