How to Prepare for a Day in Primary Care Clinic
Written by Alisa Malyavko, MS
Whether you’re just starting clinic rotations or are a seasoned pro, rotating through at a primary care clinic is something that all of us will do during our clinical years in medical school. While some students look forward to their primary care rotation, others do not. I went into my primary care rotation with an open mind and enjoyed it more than I initially thought I would! Primary care was my first rotation, and I explored different ways to prepare for clinic days. In the end, I found a process that worked well for me, and I wanted to share it with others looking for advice on how to approach clinic days.
1. Contact your preceptor.
Once you find out who you’re working with, email them to introduce yourself and confirm your scheduled workdays. Some additional questions to ask include: What time should I arrive? Is the attire business casual or scrubs? What is the patient population like? Is there anything I need to know about your clinic before starting my rotation/is there anything I can read up on to be prepared for the first day?
Asking questions is a great way to show initiative and interest in participating actively.
2. Check if you have access to the EMR you’re working with.
Whether you’re working with a physician at your institution or a partnering institution, having access to their electronic medical record is critical to being prepared for the clinic. You can also ask about this in the initial email if you do not have access already. Each EMR is different, so take some time to familiarize yourself with the system, where to find patient notes, labs, and imaging results. If online EMR trainings are available, I recommend watching those before the first day!
3. Prepare for clinic.
I will describe my approach to preparing for clinic, but remember that everyone has their way of organizing, and there is no right or wrong way to do it! If I know who I’m working with, I usually like to start my prep the night before. Suppose it is a patient returning for a follow-up. In that case, I will read through the note from their last office visit and jot down some of the highlights including 1) main patient concerns 2) labs/imaging 3) key physical exam findings, and 4) important points from the assessment and plan. Then I look through the rest of the chart to gather information regarding past medical history and current medication list. I will also check if they have any updated labs, procedures, or imaging since the prior visit. If they do, I’ll list the labs they had done and determine whether they need any labs repeated as well as which new labs may need to be ordered. For imaging, I’ll skim through the report and pull up the images if I can access them.
If I come across a diagnosis, I don’t know or a medication I haven’t encountered, I’ll take some time to browse through various resources and read up on the topic. Some of the resources I’ve found helpful include UpToDate, AMBOSS, Pubmed, DynaMed, and Epocrates. Our institution also provides us with recommended resources for each rotation, which have also been immensely helpful. For primary care specifically, knowing the USPSTF guidelines will not only help in clinic, but will also help you score points on your shelf exam. You can download the app to your phone from this website!
Once I have all of this information, I’ll write down some key questions I’d like to ask the patient during the interview. I usually make a list of symptoms I want to be sure I ask the patient about, as well as a list of potential side effects from the medications the patient is on. Then I’ll think through some of the physical exam maneuvers I’d like to perform and look up videos on YouTube if I need a refresher on certain parts of the exam. Using the information I read up on and my plan for the patient encounter, I think of a couple of differential diagnoses and accompanying orders, images, and prescriptions that may be necessary. I usually don’t write these down, but having thought through the possibilities once makes it easier to come up with a differential diagnosis if asked for one in clinic.
If a new patient is coming in, I follow a similar format as described above with some minor changes. I’ll check the chart the night before to see if there are notes from other physicians that may hint at why the patient is coming in and whether there is a history of the presenting concern. Specifically for new patients, I re-check their charts in the morning when I get to clinic to make sure I don’t miss any documents that were uploaded last minute.
4. Keep a log of cases you see.
Lastly, each day is an opportunity to learn something new and grow your skill set. As the days go by and you switch from rotation to rotation, the patients you work with may start to blend. While most rotations require a case log to be submitted for academic purposes, I suggest you keep your log of patients that stood out to you. Some things I’d include in the log are reasons why the patient was unique, new information you learned from preparing for and interacting with the patient, how the patient interaction made you feel, and whether there is anything you would’ve done differently or something additional you thought of after the encounter ended. I believe this is a great way to reflect on some of the patients you see during your third year, and before you know it, the case log will be thousands of patients long!
