After spending a lot of time listening to lectures, studying and learning in labs, University of Vermont College of Medicine student Eric Day and his Class of 2018 classmates had an opportunity to do some actual “doctoring” this spring as part of the Doctoring in Vermont (DIV) course. Speaking with patients, confronting complicated health problems and developing solutions that sometimes have little to do with medicine are all part of the experience.
The DIV course, led by Dennis Beatty, M.D., assistant professor of medicine and primary care specialist, pairs first-year medical students with local primary care physicians who supervise them as they examine and interview patients in the physician’s office. For many, it’s their first time addressing the health concerns of real people.
"Doctoring in Vermont allows students to refine and expand their clinical skills, including history-taking, physical exam, clinical reasoning, and verbal presentation," says Beatty. "It also gives them an opportunity to observe, learn from, and build a mentoring relationship with a clinician in the community."
“My main goal was just to have some exposure to the doctor-patient interaction and gain some comfort in navigating that,” Day says of his participation in the course’s activities.
Most importantly, DIV helps students develop communication skills and a knack for asking the right questions, says Christopher Hebert, M.D.’02, a Burlington internist and College of Medicine alumnus who has served as a preceptor for the course and supervised Day in his office.
“The science will come,” Hebert tells his students, “but you need to be personable. You need to relate to the patients.”
Drawing out crucial information from patients is key, so Hebert encourages students to probe, particularly with patients who are less forthcoming or short on details. “We practice open-ended questions – ‘How are you feeling?’ ‘Is anything bothering you?’ – that may lead to a conversation on things they can talk about.”
Hebert adds that students need to consider the less-obvious sources of ailments and look beyond the typical symptoms. A heart attack patient might talk about chest pain, but the student also needs to ask about arm pain. A patient who passed out might think she has low blood pressure, “but let’s think about other possibilities it might be,” Hebert tells the students.
Students complete four DIV visits in the spring of their first year and another four in the fall of their second year. At Hebert’s office, the students start by shadowing him for a couple of hours, but move quickly into taking a patient’s history themselves. Then, they report back to him.
“I think they’re surprised by the complexity of patients,” Hebert says. “A lot of what I do is see patients with multiple medical problems who are here for their third or fourth follow-up.”
His patients might have diabetes, heart problems and other ongoing concerns – all at once. “It’s more management of their care, rather than one diagnosis.”
Day recalls that one patient suffering from dementia who was recently transferred from an assisted-living environment to a full-time care facility came to see Hebert in distress – not from physical problems, but from confusion over the changed living situation.
Hebert pledged to talk to the patient’s family so they could better address his concerns. The solution involved no medicine, no treatment, but “seemed to help (the patient) at least a little bit,” Day says.
In addition to Hebert’s Burlington-based practice, students are also working with community providers in, Essex, Georgia, South Hero, St Albans, Shelburne, Waitsfield, among other locations.
Before medical school, Day worked as a phlebotomist, medical researcher and HIV test counselor. His experience in DIV gave him a different perspective on patient care, he says.
“I really enjoy the scientific aspects of medicine and the diagnostic process,” says Day. “But I like the humanistic aspect as well. We spend so much time in class focusing on the science, so I appreciate getting to see the practice of medicine side.”