Dear PCC Preceptor,

I hope your first week with your PCC student went well.

Week 2 Key Task: Teaching Physical Exam Skills

There is little literature available on the best way to teach physical exam skills in the office, but we do know that students frequently report desiring more feedback on their developing skills.

Here are two strategies that may be useful:

• If a student has already done a focused exam, the preceptor may ask the student to demonstrate exactly how she/he did the exam, and give feedback/suggestions. This tends to work well for examination of the ears, abdomen, heart.

• For ‘paired’ organ systems (e.g. lungs) and visible features, such as moles & rashes, the student and preceptor can examine the patient together, with the preceptor asking the student to describe his/her findings, and then give feedback.

What's Going On? Problem Based Learning Case 1 - Abdominal Pain
Most likely your student has completed his/her first problem based learning case in the first weekly small group session. The case deals with a teenage girl with abdominal pain that ultimately proved to be irritable bowel.

Clinical learning opportunities for PBL Case 1

• Abdominal pain, alcohol/ substance use/abuse, headaches, costs of health care, cancer screening, STD screening, adolescent prevention

To supplement this session you could:

• Discuss how you decide to refer a patient to a specialist, and how you handle 'demanding' patients
• Talk about how you incorporate cost concerns into your clinical management

Doctor Patient Communication session 1: Motivational Interviewing

In this session, students will do a role-play comparing a Motivational Interviewing approach: with a more directive approach. Each student will present an outline of an assigned chapter of Motivational Interviewing in Health Care, a required text.

Reminders: Community Projects
Each student is required to complete a Community Project during the clerkship. This should be done in partnership with one of the student's preceptors. At this time, students should be thinking about their options and selecting a condition to address.

Resources: Evidence Based Medicine
Students are encouraged to look up information while seeing patients. This can cause difficulty with patient flow. One technique is to have the student see every other or every third scheduled patient. This will allow you time to see the patients not being seen by the student, keeps patient flow moving and allows time for the student to look for information to present about the patient. Fewer visits that involve active learning by the student are preferable to a large number of encounters where the student does not search for the information themselves.

• Preceptor Resources

Thanks for your time and contribution to medical education. Let me or Claire Ann Boyce ( claire.boyce@fammed.wisc.edu ) know if you have questions or problems.

John Brill, MD
Director, Primary Care Clerkship
John.brill.md@aurora.org