SAFE Opioid Prescribing: Strategies. Assessment. Fundamentals. Education
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"GIMSPP isn't just good for the students, it's good for the preceptors," Dr. Susan Andrew, TXACP member and long-standing preceptor, said of her experience, "I have enjoyed GIMSPP over the years. I have found that a student just shadowing a physician can be less helpful and interesting than having the student be immediately involved in obtaining histories and performing physicals." GIMSPP offers what ordinary shadowing experiences cannot: immersion in the day-to-day workings of internal medicine.
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"I think I was drawn to Internal Medicine because as a student the Internists seemed like the smartest people in the hospital. There were several situations where complicated patients were puzzles to solve and the Internists were called to piece things together and look at the big picture. As I was exposed to more specialties and it came time to choose a career path I was also drawn to the flexibility of Internal Medicine. After an IM residency, you can care for both inpatients and outpatients, giving you the option to be a Hospitalist or have an Outpatient practice - or do both. You can practice in any setting - rural or urban. You can stay in an academic center, being involved in a teaching program, or practice in a private setting. You can tailor your practice to taking care of young adults or geriatric patients. I also liked the option to further specialize within Internal Medicine if I later decided I would rather practice Cardiology, Endocrinology, Rheumatology, etc.
I first learned about the GIMSPP program as a first year medical student, in 1998, and signed up to do a rotation the following summer. I spent a full month at my preceptor's clinic in Pasadena, Texas. I was excited about it being driving distance from my home... I really enjoyed the experience and got a good feel for what it is like to be an outpatient internist in the community. Since Internal Medicine can be practiced in so many different ways, it was great to experience it in a non-academic setting and be exposed to the unique challenges seen in a community clinic. It was a real breath of fresh air coming after the rigorous first year of medical school, consisting mostly of classes, studying, and tests. It reminded me why I wanted to go through all of this training - because I wanted to take care of patients. I had started to lose sight of that being buried in books for a year.
As soon as I was established in my own practice, I signed up to be a preceptor myself. I wanted to give students an experience similar to the one I had had. I wanted to show them how I had chosen to practice. I continue to sign up to do this every year and truly enjoy it every time. It is refreshing and rejuvenating for me to have a student every summer. I sometimes get lost in the day to day stresses of seeing patients and running my practice, and I find this gives me perspective to work with a student. As I am explaining to a student why I practice the way I do, why I chose Internal Medicine, I am also reminding myself that I am doing exactly what I want to do - taking care of patients. What I hope the student gains from this is an appreciation for Internal Medicine and flexibility of its practice. I want them to be exposed to something that is not a part of their typical training. It is great if they want to eventually want to be an Internist, but I think after working with me they should realize that they at least want to be cared for by an Internist."
My father was a family physician and loved medicine. I had grown up listening to him recount “great cases” and talk about his experiences as a physician. However, I never considered medicine as a career path for me until I had my first job out of college. I worked as a laboratory technician under Dr. Carol Reinisch at Sidney Farber Cancer Institute in Boston. There was a physician in the lab doing research who would moonlight in the Boston Children’s Hospital emergency department. He took another lab technician who was interested in becoming a doctor and myself to shadow him in the emergency department. There were a number of patients that he saw with a variety of problems; one patient needed a lumbar puncture and another needed stitches. I loved the experience and subsequently applied to and was accepted at medical school as well as graduate school. I loved medicine, but I also loved research. Dr. Reinisch gave me wonderful words of advice by saying that I could do research as a physician and becoming a physician would give me more options in the future.
Why I chose to go into internal medicine has to do with the internists I met and experiences I had during medical school. The internists were all extremely bright, and the complexity of the patients were intellectually stimulating.
As far as what is unique about internal medicine versus other specialties - it has to do with the complexity of the patient as well as the patient being able to give you feedback. The patients will open themselves up to me as a physician. I get history from them that includes much more than just their physical condition; I can share and have shared in many aspects of their lives. Trying to decipher what medical problem a patient has and how best to treat the problem holds my interest to this day.
I signed up to serve as a GIMSPP preceptor the first year that I knew about it about 20 years ago. The physicians who were involved in the organization were excellent role models and I followed their lead.
Even if the student has an idea that they might want to sub-specialize or possibly go into something other than Internal Medicine, they can have a worthwhile experience wherever and with whomever they get placed in GIMSPP. The student should take advantage of the clinical experience to the fullest extent that they can. The system for medical care is important for the student to know about as well as the clinical aspects. Not only shadow the physician, talk to the staff and shadow them as well. If in an office, see what the people who answer the phone do. If in the hospital, observe not only the physician, but also the nurses and floor staff.
For the students, I hope they gain confidence in being able to interact with patients, families and staff. I hope that they feel comfortable with getting a history, doing a physical exam, coming up with a differential diagnosis and plan and then presenting the patient’s case. I hope the students will learn how to research medical problems and treatments. Since it might not be another year before further clinical experiences, I hope the students have had a sufficient clinical exposure “to keep them going.”
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ACP has had intensive discussions with the American Board of Internal Medicine over the past several months about developing a Collaborative Maintenance Pathway.
Texas Chapter Annual Scientific Meeting
November 17-18, 2018, JW Marriott Austin
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