Med students? Bring them on!

August 4, 2006

This doctor learned an unexpected lesson from a medical student.

Every year, our primary care group hosts a number of medical students from Wake Forest University School of Medicine who do one or two-week rotations in community medicine. For them, it's a chance to test their knowledge in the real world of patient care.

What do I get from these exchanges? The sheer joy and excitement of seeing these students turn into compassionate physicians over the two-to-four years they rotate through our office. By putting their heart and soul into medicine, they remind me of why I entered this honored profession. And, occasionally, I learn as much from them as they learn from me.

My patients generally enjoy their interaction with the students. They feel like they're playing a part in the students' education-and they definitely are. Some of my colleagues shy away from serving as clinical mentors, however, questioning their ability to "teach." But teaching isn't the most important factor in mentoring these novice caregivers. They already have much of the factual knowledge they need. What they really need are role models who can share their experience in the real world of medicine.

By the time I'd seen the other two patients my student was just leaving the exam room. After presenting the results of his history and physical, he proudly diagnosed sinusitis and recommended appropriate treatment. After listening to my minitutorial on the nuances of nonspecific upper respiratory tract infections, and the diagnosis and treatment of rhinosinusitis, the young clinician asked, "Will you also check the mass in the patient's abdomen?"

Surprised by this clinical disconnect, I exclaimed, "Why in hell were you checking his belly?"

"I told him I needed the practice," the student answered sheepishly, "and he didn't seem to mind."

I know that profanity isn't an effective teaching tool, but I was shocked by the student's request-and by the patient's acquiescence in allowing the abdominal exam. After regaining my composure, I examined the patient myself and diagnosed the mass as a ptotic or "dropped" kidney. I explained that it had little clinical significance in an otherwise healthy patient.

To be safe, however, I ordered an ultrasound-which suggested a malignancy. I then ordered a CT scan, which showed that the mass was a localized renal cell carcinoma. I referred the patient to a general surgeon who successfully removed it. Luckily for me, the patient was so grateful to the medical student, who had probably saved his life, that he forgot-or was kind enough to overlook-my earlier pontification on the clinical insignificance of his ptotic kidney.

Looking back on this experience, I realize once again that the greatest reward I receive from mentoring medical students is the opportunity to learn the valuable lessons they can teach me.