ARTE Student Module 2 - Understanding the Process of Care

The suggestions summarized below come from experienced medical students and family medicine clerkship teachers.

Tips for Students – Understanding Clinical Thinking

  1. Tell the teacher what you need to learn. Help the teacher understand the point you are starting from. Provide some context for your question. Experienced teachers know that different students have different needs, but the student can help identify the starting point.

  2. Ask the faculty physician to think out loud as you work together through a challenging case.

  3. Work out with each preceptor how he or she wants to deal with your questions about patient management. Some discussions can occur in front of the patient. Some work better outside the exam room, after you have finished you evaluation but before the attending goes in to see the patient. Other discussions need more time or reflection and work best during the “Question Time” you have set up with the preceptor.

  4. You must learn about the process of care, not just the content.

  5. Seek to understand the rationale for the decisions, not just the decision. Ask about the process when it is not clear to you. You are not responsible for reading the teacher’s mind.

  6. Be prepared to see a variety of approaches and rationales. Important decisions are rarely simple. Tough questions often have more than one answer. Good doctors do more than follow algorithms.

  7. Observe, ask and listen respectfully to the explanation. Ask more questions to help you square the picture with what you have learned and seen from other clinicians. Be prepared to follow up with reading and review of evidence. You will eventually need to make up you own mind.

  8. Use your question asking skills. Better questions get better answers.

  9. Remember that, although this may be the patient’s first visit with you, it may be part of a long-term relationship and process of care with the attending physician. The doctor and patient may share a history that is not apparent to you unless you ask about it.

Balance your focus between:

Not just the: But also the:
Facts Reasons the facts are important for this case
Problem Context of the whole patient
Decision Rationale for the decision
Managing patients Managing relationships
Biomedicine Biopsychosocial patient care