Traditionally, medical students spend their first year buried in biochemistry and anatomy textbooks. But first-year students at the School of Medicine have already started applying their classroom lessons to actual patients.
In 1996 the medical school established a two-year-long course that allows each student to work with a local physician for one afternoon every other week, said Dean of Medical Education Dr. Dan Blazer. During the other weeks, the course-named Progressive Responsibilities and Competencies Through an Interactive Clinical/Curricular Experience-students attend lectures and small group discussions designed to supplement their clinical work.
Blazer said the PRACTICE course was created to enhance students' familiarity with outpatient care. "They're learning what it's like to practice as many community-based, primary care physicians do," he said.
Many students said they enjoy the opportunity to perform hands-on clinical work so early in their careers.
"The biggest benefit is that at an early stage they really introduce you to the clinical setting," said first-year medical student Ryan Scannell. "That's the reason we all came here."
Over the course of their PRACTICE experience, Blazer explained, students begin the transition from learner to doer. "A lot of initial work is just looking over the shoulders of physicians," he said. As students gain experience, he added, they are given more independence. Many now perform initial examinations and then reenter the room with the doctor for a more complete analysis.
Scannell said his mentor-doctor, Dr. Neil Prose, gives him a lot of freedom. Although Scannell has only been at the clinic since January, he already meets with patients initially without Prose's help. "I think it's a wonderful way to allow him to get to know patients," said Prose, a pediatric dermatologist.
All of the approximately 200 participating physicians underwent a training program, and as part of a North Carolina program to encourage physicians to teach, they also receive small stipends, Blazer said. But he added that this pay does not account for all their time.
Prose said contact with students helps make the task worthwhile. "I really enjoy teaching medical students about how to take care of patients in a compassionate and humane way," he said.
Before this program began, the University's medical students did not begin clinical work until their second year. However, they still enter this early hands-on training-which begins in the second semester of their first year-with sufficient background knowledge.
During their first semester, the students attend lecture and small group discussions each week, in which they learn diagnostic basics, such as taking blood pressure and performing physicals, said first-year medical student Dan Zlogar. By the end of the first semester, he added, "You have basic skills that definitely need to be worked on."
Although students praised their time in the clinic, some felt that the assignments given in lecture are tedious. Zlogar compared the assignments to "sixth-grade" homework.
"Maybe down the road I'll see the importance," he said. "[The clinical portion of the course] got me excited about what I'm going to be doing for my life."
Blazer said the out-of-clinic aspect of the course provides a framework for the students' time in clinic. "The logistics of putting this curriculum together is exactly one of the areas where we are focusing efforts to improve this course," he said.
In addition to the primary care experience, the course also tries to give students more facility with computer databases, Blazer said. When the students become practicing physicians, he explained, they will not always have immediate access to textbooks.
Zlogar said he rarely uses a computer during his clinical work. "I know that [practice course coordinators] would like you to bring your computers to clinic," he said, but its usefulness varies depending on the cooperating physician.
Many other students agree with Zlogar. Second-year medical school student Stacy Marcus said she used the computer when she was less familiar with the drugs being dispensed; now she almost never takes time out from her clinic work to look at the database.
Blazer said that he has been pleased with the fledgling program. "[Students] really do like getting out there and doing what they came to med school to do," he said.
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