What do American students do in outpatient rotation?

[donaldtang]

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I'm an international medical student and there is no outpatient rotation in my school.
However, I think that outpatient experience is valuable to medical students and now I plan to arrange my outpatient rotation by myself. And I want to make it a rewarding experience.
Then what do you do in outpatient rotation? Just shadowing a senior physician or interview the patient before him/her? Or anything else?
Thanks in advance for any imput！

 

[ZagDoc]

Depends on the physician but as a 4th year (senior) med student, the expectations are generally that you see the patient, do a complete history and physical exam, then present the patient to an attending (like you would a new admit or consult), distilling the H&P down into salient points then briefly describing your differential diagnosis and treatment plan. Then you two go see the patient together and hammer out the details. And you write the note and the attending co-signs. Somewhat analogous to an intern seeing the patient and then "staffing" with a senior member, except we don't have the power to write any orders without a co-sign.

 

[donaldtang]

Thank you, ZagDoc!

When you are doing history and physical exam, where is the attending? Some place that is invisible to the patient?
And what's the average amount of time for the whole process? (from the time that you start patient interview to the time that the attending co-sign your orders )
Another concern is that some patients are not willing to be interviewed by medical students. They ask to see the attending directly. How do you deal with that?

 

[nlax30]

Like he said, it depends on the physician, but as a 4th year you'd probably be expected to see the pt yourself, do a focused or full h&p depending on the situation, come up with a plan, and then present to attending. Sometimes a pt just didn't want a student so I'd just come back and put the chart in the pile for the attending to see himself, no big deal.

Just did a FP outpt rotation last month and had a ton autonomy. Pretty much was able to carry out my plan/scripts/referals totally unless it was really something crazy.

Will depend on the demographics of the pt population but most will probably be chronic disease followups/med refills or a simple sick visit and so doesn't require a full h&p and really may only take a few minutes. And usuall while you're seeing a pt the attending will probably be going to see some on his own to keep from getting behind.