Monday, July 14, 2008

The failed mandate of our family practise course

Our medical school has a strategy to fight the sagging number of doctors choosing family medicine as a profession: expose students to the profession through a mandatory course in family medicine. Unfortunately, if you ask anybody in my class, it's quite apparent this strategy is probably doing more harm than good.

It involves exposing us to family medicine by arranging for us to shadow family physicians for a few hours per week in our first two years, assigning various time-consuming projects, and providing a number of family medicine-related lectures, attendance to which is encouraged (with limited success) more by sending threatening e-mails to the students than by providing interesting topics.

Then, we are given an exam for each of our first four semesters, asking medically relevant minute details from the lectures, such as, "How many people died in Somalia last year?" "Which of the following is an example of grey literature?" and "What does the E stand for in FIFE?" (the latter of which I know quite well after getting yelled at by a patient for using said technique).

I'm not sure who thought making medical students write exams on boring lectures that they've been guilted into attending would develop in us a passion for the field, especially when we're already overwhelmed with the study load for our other courses. It's a good thing we are instead able to develop this passion by spending time with family doctors, right?

Well, it's not that simple. Personally, I lucked out, and ended up with outstanding tutors. I'm among only a few people who had an excellent experience with all my various tutors, getting the chance to regularly see patients on my own and conduct histories and physical exams, and fill out prescriptions, referrals and lab requisition forms.

Unfortunately, for many people in my class, the taste of family medicine they got from this experience is a very bitter one.

First of all, urban family practice is very different from what family medicine used to be. While rural doctors still do a lot of procedures and deliveries, most of the doctors we shadow have cut down on the amount of these extra services, including following patients in the hospital.

Secondly, with the increases in class sizes, only a small number of students are one-on-one with the doctor, and even after grouping students, the faculty is still having a hard time finding
doctors willing to teach.

So, the preceptors they do sign up aren't all doing it out of a love for teaching, and the students suffer for it. Two students that I know spent most of their shifts with one physician sitting at the end of a hallway, called in only once to see patients. Two others I know spent a semester watching the doctor perform alternative medicine such as waving his hands over the patient (all of which he billed the government for), and they even spent a whole shift punching out pieces of aluminum foil, to build up the doctor's supply of tinfoil confetti to tape on to patients' hands as an (undoubtedly ineffective) alternative medicine method.

However, despite the lectures, exams, and poor shadowing experiences, the course is by no means a complete failure. Some students, like myself, have a fantastic experience with the doctors, getting to do and see a lot, including surgeries and infant deliveries. And even if it didn't convince anybody to become a family doctor, the amount of clinical and patient experience we got will give us a step up for when we start our medical student internships in the fall.

Additionally, the course also gave us the chance to practice a few office procedures, such as prescription writing, suturing, biopsies and excisions, which is the fun 'doctor stuff' that everyone looks forward to in med school. Unlike the medical students from some Canadian schools, though, we never got the chance to learn how to place IVs in our first couple years of med school.

As well, everybody in the class was exposed to the huge variety of sub-specialties of family practice that exist when we spent time with two specialized family physicians. Family doctors can tailor their practices with a focus in prenatal care, oncology, surgical assist, inner city medicine, emergency, hosptialist, sports medicine, and many other fields, something I didn't know before med school, and a realization that definitely piqued my interest as I search for a specialty that satisfies my desire for variety.

Finally, the rural exposure component of the course is one that is apparently a lot of fun. After two years of medical school, we get the chance to spend some time in a rural community, an experience I'm looking forward to right before I start my third year. This is evidently one of the redeeming factors for this course, and hopefully when I'm shipped out, I'll have a few interesting stores to share... and not spend the whole time punching out tinfoil confetti.


Anonymous said...

Am I reading this right? Doctors that are billing for alternative medicine... isn't naturopathic medicine a totally different field with a different degree (N.D.) ?

Zac said...

Yeah, I'm afraid family medicine is taking quite the beating nowadays. Our class is shying away just as hard... luckily we aren't forced to jump through that many hoops the first two years.

Beach Bum said...

As someone who wants to do rural family, this post makes me sad. For the right person (and I think I'm that), family medicine can be a great way to practice medicine. Shame on your school for not making a better effort to communicate that to you guys.

BB, the family practice wannabe.

Dragonfly said...

I'm at a rural clinical school where there is heaps of rural FP (called GP here). Some practices we have been attached to are terrible at teaching and put you right off. The first one I was attached to put me RIGHT off. Each of the doctors had a specific "type" of patient and the one who was mostly responsible for teaching saw basically only middle aged men on anti-hypertensives, who play golf on the weekends.
All I got to do was sit in a corner while he measured their BP and chatted about golf. About twice a day he would let me take a BP myself. I was like "I trained 5 years for this???"
The next one was awesome, I still have some more placements there. They actually let me do heaps (therefore learn heaps) and they have a variety of interesting patients. Hence, GP is now a possibility for me.
Lots of people do feel that pushing GP on us puts us off though.....certainly if the experience is average to poor it does.

Liana said...

Wow. Having just finished residency in rural family med, it's very disappointing to hear that your classmates are having so many negative experiences.

Am Ang Zhang said...

In England the opposite is happening, no one wants to be a Hospital Specialist anymore.
The Cockroach Catcher

Mayhem said...

I can never understand why some people volunteer to do these things. We have a particular internist who volunteers to run the 3rd year clerkship every year and has yet to teach one class. You'll only you see her once (at orientation)and almost never on rounds or in clinic but don't worry she somehow manages to evaluate everybody. I guess the money is good.