Microskills: Putting power to form ambulatory experiences into students' hands

To further our reading about medical education, we fittingly focussed on articles this week relating to ambulatory internal medicine teaching.  Being honest, the articles themselves didn’t really reveal any ground-breaking new ideas to me but I think they highlighted some points from the many conversations I have had with my colleagues about our clinic experiences in the past two years.  Many of the suggestions would be things any resident or medical students could tell you first hand if asked. 

 There are certainly things, such as more coherence between preceptor and student scheduling, longitudinal clinics and setting aside time for teaching, that have enriched my own ambulatory experiences.  There were also more system based suggestions that I think are lacking in a lot of training programs and would greatly benefit students.  These included making ambulatory training a priority, prioritizing orientation for students in new clinics and having faculty development/training.  These articles seemed to set out a guideline for the ideal, but I think where they were lacking was in providing tangible solutions or suggestions to improving the current state of ambulatory medicine and how medical schools might accomplish these goals.  All of these suggestions are well and good but they are challenging for school curriculums to instate and enforce with large class sizes and widely distributed clinics.  Although I think some fundamental curriculum changes can help with accomplishing these goals, the article we read by Lipsky, Taylor and Schnuth gives some practical tips how students can enhance their own ambulatory experiences.  I think this would be a useful article to provide to medical students at the beginning of their clerkship so that they have an idea what they should be able to expect of a rotation.  By providing it to faculty as well, it could act as an important starting point and guideline to the ambulatory experience in a variety of specialities.  One of the strengths of the article is that is provides easy and straightforward tips to help students know how to go about accomplishing these tasks, putting the power back into the students’ hands.  I think this would also help to alleviate some pressure off institutions regarding evaluations and goal setting and probably generate a more meaningful experience for students if they are initiating the endeavours and know their preceptors are expecting these things of them.  In retrospect I think it would have had an impact on my ambulatory experiences early-on in my clerkship.

Ashlay