Before this selective, I had mostly experienced Internal Medicine
through the Clinical Teaching Unit environment. Although the CTU setting offers
a rich environment for learning and teaching, I knew the ambulatory setting had
many unique opportunities for learning and wanted to experience this. After a
month, this selective has not only shown me the valuable learning experiences
that lie within ambulatory medicine, but has also allowed me to explore medical
education research and practice my teaching skills. During these past weeks in
clinic, I have been involved in cases I had never seen before, I have sharpened
my ability to develop differentials, and also feel more confident in proposing
management plans (even if I am wrong)!
The learning in the ambulatory setting is quite different compared
to the inpatient service. On the wards, you often care for the same patients,
get to know their medical history in depth, and often manage the same issues
until they are safely discharged. In the clinic, you are seeing several
patients in a day, who you may have never met before, often working up new issues, and
following chronic issues. You need to be able to review their chart quickly and
determine the reason they are being seen in clinic. In a short amount of time,
you must decide if their clinical state is improved, worsened, or stable, and
what your management plan will be. These assessments and decisions need to
happen fairly rapidly to ensure all patients are seen in a timely manner.
This faster pace of patient care and learning was initially
challenging for me. I often took a long time with patients, had difficulty
expanding my differentials, and was unsure of my management plan. My preceptors
allowed me to take my time and reassured me that ambulatory medicine is
difficult even for Internal Medicine residents. Despite the challenges, this
experience allowed me to become more comfortable in the ambulatory setting and
showed me which areas I could improve on. I learned to focus on the most
important issues for each patient and gained strategies to see patients more
efficiently. For example, after reviewing the chart for a new patient, I would
take a few minutes outside the room to think of my differential based on their
referral and past medical history, and brainstorm which questions I would want
to ask to help narrow my differential. Taking the time to do this allowed me to
take more concise histories, focus my physical exam, and figure out which
investigations I wanted.
All of my preceptors also fostered a positive learning environment
and helped me get the most out of each patient encounter. They would push me to
explain my reasoning, encourage me to formulate my differential in a systematic
way, and help me review the most recent guidelines for my treatment plans. They
would also provide their own clinical pearls and insight from their years of
experience. This helped consolidate my knowledge and made me feel that my
learning experience was valued.
This selective has further validated my decision to pursue my
training in Internal Medicine. During clerkship, I had loved my experience on
CTU, taking care of sick patients and building strong relationships with them.
However, I had also really enjoyed seeing patients longitudinally in my Family
Medicine rotation. This selective made me realize that a career in Internal
Medicine can provide me with both aspects. I am grateful I was able to
experience the ambulatory side of Internal Medicine and gain more exposure to
medical education. I am eager to begin my residency in Internal Medicine and will definitely
continue to seek involvement in medical education moving forward!
-MB-
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