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Day One in the Office: The Most Important Day

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Checklist for Orientation to Outpatient Offices

  • Well in advance of First Day:
    • Alert your staff to expect the student and provide them with a student bio
    • Make provisions to allow the student access and receive training for the EMR or office records
    • Develop method to identify “student patients” in the charts or EMR
  • First Day:
    • Have student arrive before first patient appointment
    • Office manager or staff member can show the student around the office, break room, bathrooms, etc. and demonstrate office procedures and sign confidentiality forms
    • Student should shadow one of the nursing staff to see their procedures for checking in patients
    • Assign the student a space to chart
    • Student should also spend 20 minutes or so with office scheduler to learn the procedure for making appointments and referrals , what to do in case their patients need appointments
    • Student should only have one patient scheduled near the end of the half-day

 The physician should meet with the student at the end of the patient care session to talk about:

  • How much charting you wish them to do
  • What constitutes an appropriate office visit presentation
  • How the student can help office flow, efficiency, etc
  • What to do if one of “their” patient calls them- e.g., how they can reach you, what to handle and what not to handle, how to deal with labs and reports and any other of your expectations
  • When you expect to give them your first evaluation and review the criteria for clinical grading
  • Carefully review the first patient encounter and critique:
    • The presentation
    • The approach to the patient
    • The length of time of the encounter
    • The charting- enough? Too much?
    • What to do about follow up, how to maximize continuity
    • Explaining the program to the patients – did it work? What could be done differently

 Maximizing Learning:

  • Teach the student what you have time for, if you have only one thing you can do, show them by example, the approach to diagnosis, follow up and treatment, the art of dealing with ambiguity
  • Direct the student to learning from the patient encounter. By example of their first case, explain what to record in their “Osler Diary”:
    • Diagnostic dilemmas- what don’t I know, where can I learn it rapidly?
    • What parts of the patient’s therapy did I not understand? What are my learning needs?
    • What are the ethical issues in this case? Who can I discuss this with?
    • What are the ambiguities and points of discomfort?
    • Was I not listening or distracted? Why?  What can I learn from this encounter?
  • What if any, assignments do you have for them. Examples:
    • Give me a five minute update on what you studied and learned from your self study of this patient
    • Schedule a visit or referral for this patient, let you know the results if the student gets them first or let the student know how to access the results
    • Call a consultant for a curbside, how and when to give you follow up
The Difficult Learner - Peyser