Excelling in the Clinic: A Concise Guide for Medical Students

Working in the outpatient clinic is a key training experience for medical students. Most of the third-year clerkships include several weeks of outpatient clinic work, and fourth-year students often have additional required primary care clinic rotations. When they arrive at the clinic, students may discover that their time on the inpatient wards does not necessarily prepare them to perform well in the outpatient setting. Everything is different in the clinic, from the nature and context of the patient encounter to the student's role in note-writing, oral case presentation, and case discussion with the attending physician.



The purpose of this book is to guide students as they transition to the world of 15-minute appointments, telemedicine, cyberchondriasis, motivational interviewing, shared medical appointments, and real-time informatics. The aim is to give students a clear understanding of their role in a variety of clinic settings, to evaluate and present their patients well, maximize learning, and provide excellent care for their patients. There are a few medical student handbooks that focus on the specifics of diagnosis and treatment in the outpatient clinic. However, none of these books prepare students for the full spectrum of their clinic experience. This book explains the process of becoming an effective, efficient, and scholarly worker in the primary care clinic.



The first two chapters discuss the importance of primary care in our society, the goals of care in the outpatient clinic, and the benefits and barriers to medical education in the clinic. Chapters 3 and 5 turn to the variety of clinic settings, schedules and structures that students may encounter, and their roles and responsibilities in these different settings. Chapter 4 focuses on the rapid rise of telemedicine in response to the COVID-19 pandemic, the benefits and limitations of telemedicine, and the implications for medical education. Chapters 6 through 11 describe the process of seeing and presenting a clinic patient, from reviewing the electronic medical record to performing an appropriately focused interview and physical exam, writing a concise note, and then tailoring the case presentation for new patients, follow-ups and urgent visits.



Chapter 12 describes service-learning opportunities in homeless shelters and student-run clinics, including the important role of students in working with community partners to design and implement effective programs. Chapter 13 ties it all together with a discussion of careers in primary care (both academic and traditional), the benefits and challenges of primary care, and thoughts on the future of primary care and the long-term outlook for medical education in the clinic.