Foundations of Clinical Medicine

Time: Longitudinal 18 month curriculum with 4-hour, bi-weekly in-hospital tutorials

Audience: First-year and second-year medical students

Teaching Method: Clinical Precepting, coaching on rounds and with patient interactions

Description: During these bi-weekly tutorials, I work with the students at the bedside, teaching them physical exam skills and modeling patient-centered care and professionalism. Students gain extensive experience interviewing and examining patients, building differentials, presenting bedside oral case presentations and practicing clinical reasoning. After every college morning I send our group summaries of learning points from our sessions, clinical pearls, as well as drawn diagrams to help the visual learners of the group (can click the image below to expand). The curriculum also included afternoon clinical skills workshops. Workshop sessions often include standardized patients and involved observing students interview the patient, review studies and build their differential diagnosis. Sessions taught thus far include, acute dyspnea, syncope and teaching motivational interviewing.

Reflections: This experience has been an exceptional learning opportunity for me. Teaching students that are so early in their medical career has challenged me to keep clinical teaching points simple and target to their level of clinical knowledge. I also saw my role as a near-peer to model professionalism and patient-centered care. Early learners also ask the best questions, which pushed me to think critically about things that seem common-place on the wards.

Harborview Medical Center Student Evening Clinic

Time: 3-4 hour clinic sessions, at least 7 sessions per academic year

Audience: Fourth-year medical students in a primary care continuity clinic experience through Harborview Medical Center’s Adult Medicine Clinic

Teaching Method: Clinical Precepting

Description: Fourth-year medical students have their own small panel of primary care patients seen in the Adult Medicine Clinic. I served as a clinical preceptor for these students both with direct observation of patient interactions, demonstration of physical exam skills and fostering clinical reasoning skills by helping them to develop management plans. I was also responsible for leading a pre-clinic conference on COPD for the students (you can view the handout below). This was an overview of COPD as a syndrome with an emphasis on primary care management in preventative medicine.

Link to COPD Pre-clinic Conference Hand-out

Reflections: This experience was rich with opportunity to provide “in the moment” feedback, demonstrate clinical exam findings, modeling patient interactions particularly with sensitive topics (such as newly diagnosed HIV and safe sexual practices) and practice “on the fly” teaching as questions in climic arose. My teaching was directly observed by attending providers and enabled me to receive directed feedback on my own teaching skills, pushing me to be a better educator in the clinic setting.

Wards Chalk Talk - Alcohol Withdrawal

Time: 20 minutes

Audience/Learners: Third and fourth year medical students, interns on the wards of the VA Puget Sound and HMC.

Teaching Methods: Chalk-Talk

Learning Objectives:

• Outline the underlying pathophysiology of alcohol withdrawal

• Breakdown the symptoms and timeline of alcohol withdrawal

• Discuss how the underlying pathophysiology of withdrawal determines treatment

Description: I have given this chalk talk now three times while on the wards of HMC and VA Puget Sound when we have admitted a patient with acute alcohol withdrawal. It is a simplified description of the underlying physiology that applies with withdrawal in chronic alcohol users. Additionally time is spent discussion the difference between delirium tremens and other withdrawal symptoms, particularly in the context of symptom timelines. I finish discussing medications used for treatment and how that relates back to the underlying pathophysiology.

Evaluations: No formal were completed.

Reflections: The level of physiology is appropriate for medical students, while the interns appreciate practical management of alcohol withdrawal and I feel would benefit from more details regarding the specifics of treatment. Additionally the pharmacokinetics of phenobarbital are more complicated than outlined on the board, and has often prompted further discussion.