Chapter 3: Introduction to Outpatient Clinical Medicine

INTRODUCTION

A trend in healthcare today is moving patient care to the outpatient setting. In order for students to successfully navigate this change, they must understand the differences in dynamics between outpatient and inpatient settings. Compared to the inpatient setting where the patients are available for evaluation over an extended period, the outpatient clinical environment is much more fast paced; students need to be able to evaluate, diagnose, and design a treatment plan under a time constraint. The volume of patients seen over a given period is also much greater than that of inpatient services. The general principles of outpatient care discussed here are similar for all medical, pediatric, and surgical disciplines.

UNDERSTANDING YOUR ROLE

The first step for a student to become a successful member of the outpatient team is to understand their role. If you put the welfare of your patients first and use that as your guide, you are more likely to have a positive experience. In your role as a student, you will quickly become very close to many of your patients. You are likely to have more time to give to your patients than the residents or attendings, who might be caring for their patients in 15- to 20-minute intervals. You will often hear important details of the patient’s health that the attending or resident is unaware of. Students are often seen as less threatening to patients and thus more comfortable opening up to you. The history you gather might provide an opportunity to really improve your patient’s health. You should not underestimate the important role you can play for your patients.

It is important that you constantly think of ways to improve your clinical skills and basic medical knowledge. Rotations are a time to think about your growth as a student, a clinical learner, a team member, and a healthcare provider. Set aside time every week to reflect on your progress. Think critically about what you enjoyed in a given week as well as about ways in which you can improve as a learner and as a team member. The more you invest in your development, the more interested you will be in your patient encounters. This enthusiasm will likely be apparent to your supervisor. While self-reflection is key to a successful experience, it is also important to internalize feedback from other members of the team. You should regularly ask for feedback from residents and attendings with whom you work. In a busy office session, it is important to arrange a few minutes at least each week to receive feedback. If you feel like you are struggling with some aspect of your performance, you ...