Medical Professional Publications

Teaching in the Primary Care Office

(From the March 2018 Issue of MedStat)

Primary Care Matters

Written by Gwynn Williams, MD

Gwynn Williams, MDDr. Gwynn Williams is a pediatrician at Riverside Pediatrics. She has been on the Natiionwide Children's Hospital medical staff since 1986. Dr. Williams went to medical school at The Ohio State University and completed her residency at Nationwide Children's.

Many of us have had the opportunity over the years to teach students and residents in our primary care offices. I’ll admit, when I first signed on to be a preceptor for a PECS (Pediatric Education in the Community Setting) resident, I did it out of a sense of responsibility. I felt that it was the right thing to do, but I was not sure that I really wanted to have a resident in my office for half days most weeks. I did not believe my colleagues when they told me that it was “fun.” On top of that, I did not feel that I had very much to offer in the education of a hospital-based resident.

The experience has turned out to be far better than I had expected.

Anyone who has been in primary care for more than a couple of years realizes that a hospital-based residency does not fully prepare one for an outpatient office. That’s where we as preceptors come in. Goals have actually been set for the residents’ time in the office. The stated curriculum covers seeing children for well child visits; managing recurrent otitis media; outpatient treatment of pneumonia; constipation; celiac disease, and so much more of what we do in our daily practices.

It is the unstated curriculum that is so much more rich and extensive, however. Much of what we have to offer in teaching the residents is not so much what we do, but HOW we do it. Here the resident has the opportunity to see us go from well child to well child, providing anticipatory guidance in a way that each of us has developed individually over time. We have a flow that has come about with continued practice. As time progresses, as they see more and more of our healthy patients, the residents can start finding their own voice in guiding parents through myriad situations and questions. I will often have the resident , even in their third year, shadow or act as scribe, just to continue to have opportunities to hear how common situations might be handled.

The private office might also be the first place that the trainee realizes that the vast majority of cases of RSV never get close to a hospital; how, often, families come in daily as the child seems worse, and we need to decide whether they should be able to spend another night at home, and how we can lead the parents in deciding at home if they need to call for more treatment. This demonstrates a different aspect of decision making from what happens in the hospital setting.

The pediatric resident can witness in our office how life continues for families with children who are living with devastating diagnoses. Often, these diagnoses are made in the hospital setting, but the long term management is never addressed. It is very eye opening to be the PCP for a child with complicated health care needs, and to be the one who parents turn to, for guidance and emotional support. Sometimes, I will have my resident just sit with the family and talk to them about some of their experiences as parents of children with special needs or unusual diagnoses. Hearing the parents’ perspective can surely open up channels of understanding for soon-to-be practitioners.

So much of what we do can also benefit those residents who plan to sub-specialize. The information we receive from the specialists contributes to our own understanding of the patient care. Often, we help parents interpret the information they heard from the specialists. Our residents witness how the PCP is the interface for the family and their specialists and how communication is the key to good patient care.

Beyond this, our office is often a respite from the stressful, high intensity workload that the resident experiences through most of their time in training. It can be a place to see how the practice of medicine can be fun. The continuity of care we provide is far different from any they see in their clinic settings. This often results in a more comfortable familiarity with many of the families and offers a glimpse of what practice can be on the outside. We can set an example of the collegial nature of medicine. Our interactions with our partners in the office, our office staff, and our hospital-based colleagues will provide a backdrop for all of the other activities that make up the day to day events in the practice of medicine.

Finally, it turns out that having the residents in the office is fun after all. The teaching definitely keeps me on my toes. And there is always more that I can learn from the residents themselves as new ways of medicine come along faster than I can keep up. After many years of having PECS residents in my office, I highly recommend it. One more thing: possibly the best part is the lifelong friendships that are being made each time a resident steps through that door.

The opinions and policies expressed in MedStat are those of its contributors, and are not necessarily the opinions or policies of Nationwide Children’s Hospital. Nationwide Children's Hospital does not endorse or recommend any specific opinions, policies, tests, physicians, products, procedures, or other information that may be mentioned in MedStat. The content made available on MedStat, such as text, graphics, images, and other material contained on the website are for general educational and informational purposes only and do not constitute medical advice; the content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Reliance on any content provided by MedStat is solely at your own risk. 

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