|One of my colleagues doing a botulinum toxin injection|
1) Discuss communication and encourage empathy: I spend a lot of time talking about how
I try to shift my approach from a communication standpoint with each patient. We talk a lot about how I approach patients who may have personality quirks or special circumstances. As many of the patients in my clinic have been seeing me for years, I try to provide background for the students about how other aspects of their care have affected their lives in general, and how I've needed to make adjustments to their dystonia treatment over time. I can talk about a wide-range of conditions including some very deep discussions I've had with patients about end-of-life issues in the past. This allows each patient encounter to create a space to talk about more than just "This is another cervical dystonia," and turn it into a more rich discussion of this is how I I talked to this patient about cervical dystonia in the light of a new cardiac diagnosis and what changes we made. Those changes don't have to be made that day for it to be a salient discussion point with the student.
2) Even small amounts of participation is appreciated: This works better for first year students who often have little clinical experience, but I think it does help even with more experienced learners. In the botulinum toxin injection clinic, I will have the students only observe for the first day or so. After that I have them clean the injection area with alcohol swabs, and hook up the EMG ground and reference leads. Although that doesn't sound like much, for a student, it makes them understand that they are being helpful and are a valued part of your team. In truth, it does make things go faster as it takes about the same amount of time to wash my hands as it does to prep the patient for the injections. As possible, I also try to let the students do one injection in a relatively straight forward site by the end of the ten weeks. It doesn't always work out that a good patient/ injection works out on the last day of the rotation. But, even doing one injection for a student is potentially a big deal. Not as big a deal if they were in healthcare prior to med school, but most of the students who have worked with me would probably put that .25 cc IM injection on their list of highlights for the year. You just need to put yourself back in the shoes of a first year student to remember how excited you were to do just about anything back then. Then let the student do a very low risk part of the procedure. Let's be clear, I'm not advocating for the student to do an injection into the iliopsoas (an injection with an EMG needle into the anterior thigh very near the femoral nerve/ artery/ vein). But doing something on a small scale is good.
4) Show them a bit of the business side of medicine: This again sounds boring to you and me, but most students don't have much exposure to how the billing system works. At least once or twice during the course of their experience with me, I'll have the students look over my shoulder as I input the billing codes for the patients. I explain briefly the difference between a CPT code and an E&M code. I talk about how I put in the prescription for the toxin. I understand this system will probably change a bit before they are billing, but I again try to put myself in the position of where I was as a first year student, and I had no clue what that stuff was all about.
There are a few lessons I've learned in the ambulatory setting. But using these thoughts, I recently had a student write on one of my faculty reviews how they were worried once they found out they were in a procedure clinic for 11 weeks, but were amazed how interesting it was each week. I also have had students who have been requesting to work with me for the past several years. I'm sure this is not a novel list, and others have thought about this before.