Reflection on Clinical Experiences

Over the past three weeks, I have had the opportunity to experience very unique Internal Medicine clinics. Each one has a particularly salient feature that makes it an ideal learning experience. Whether it was the scope of the practice, or the way in which the clinic itself was run, I have learned several valuable lessons from my outpatient experiences.

First, I will try to put into words the fantastic time spent with Dr. Ho Ping Kong. His clinic is ideal for a medical student to learn from, as he sees patients in follow up for routine, "bread and butter" medical management as well as many very interesting and rare diagnoses. With these "zebras", he spends time in between patients describing the thought process that went into evaluating the patient, and explains how he arrived at his final diagnosis. While knowledge of all these rare conditions is not expected at the medical student level, it is a great opportunity to learn about the deductive skills and diagnostic reasoning that goes into arriving at the final diagnosis. Coupled with abundant teaching (often using his trademark style of showing photos of conditions he's treated), his clinic is an ideal setting for medical education. However, the one lesson he always imparts on his students that I will truly carry with me throughout my career is the role of communication and rapport-building in clinical medicine. He is an exemplary communicator and advocate for his patients, and it shows when every single patient I have seen of his has only the strongest words of praise and gratefulness for him.

The second experience I am reflecting on is the PGY3 Internal Medicine clinic (formerly known as the AIMGP clinic). I first participated in this clinic during my third year core IM rotation, and really enjoyed this clinical style. The afternoon begins with a teaching session with one of the Internists (such as a case scenario, physical exam teaching with a simulator, etc.). Then, the clinic begins in which each of the residents and medical students get one to two patients each over the afternoon. It is purposely not overbooked to ensure that an adequate amount of teaching around the case can occur before and after seeing the patient. From an educational standpoint, this clinic is also very ideal for learning, because there students do not feel rushed to talk to, examine and discuss the patient with the staff. The ample time allotted per patient allows significant reflection on the case, and for one of the staff members to discuss a differential diagnosis and ample teaching about the particular disease or symptom warranting referral to the clinic. It also goes without saying that all of the staff involved in the clinic are eager and willing to teach at any time during the afternoon.

Both of these experiences have been model examples of effective ambulatory medical education. I have learned a great deal about a variety of interesting medical cases, while also feeling reassured knowing that staff are always willing to answer any questions or teach on any topics I may be wondering about. Most importantly, I look forward to being able to apply these methods of education for future medical students in the ambulatory setting or at the bedside.

- Anthony