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Continuity of care: The benefits of adding a long-term option to medical school rotations

Medical student describes how continuity clinic helps him gain real-life outpatient medical training that's essential to his residency.

In my previous posts, I’ve written about how one of the major challenges of being on medical school rotations is the necessity of changing rotations every four weeks, and how adapting to each new specialty feels like going through the first day of school all over again.

In this post, I’d like to share my experience on other side of the coin. About a year ago, I started participating in Stanford’s Continuity of Care program, a clerkship in which I am excused from my regular rotations one afternoon a week to work in the same clinic each week, with a consistent supervising physician.

In other words, unlike traditional rotations, in which the structure is an intensive, full-time immersion in one particular field of medicine for a brief period of time, the continuity clinic offers a longitudinal experience that prioritizes relationship-building and growth over many months. I participate in a clinic in neuro-oncology, where we treat patients with brain tumors or those with neurological complications related to other cancers.

Working with a single mentor over a long time period is incredibly important to the experience. After several months, I have a solid understanding of my mentor’s style as a physician and as a preceptor, and I’ve learned a lot over time about the specialty of neuro-oncology and how we approach some of the common problems. Similarly, my preceptor is very familiar with my strengths and weaknesses as a senior medical student and allows me to essentially act as a resident, seeing patients independently and proposing a treatment plan. As a result, I’ve been able to take on an increased level of responsibility — for example, going over new scan results with patients alone, something that would be rare in a traditional outpatient rotation.

In the bigger picture, the continuity clinic fills another critical void in our clinical medical training, which is the lack of meaningful exposure to real-life outpatient medicine. It is no secret that medical school and residency are heavily skewed towards inpatient training (taking care of hospitalized patients), despite the fact that the majority of physicians practice in outpatient clinics. Even our four-week long family medicine rotation, while excellent, simply can’t show us what it’s like to take care of patients over time. Nuances of an outpatient schedule, such as how to follow up on test results and communicate with families after the office visit, are more difficult to appreciate. At the end of the day, this kind of exposure can even influence career decisions.

Finally, and perhaps most importantly, one of the best things about the continuity clinic is the feeling that it is a home base for me. When I introduce myself to patients, I can truly say that “I’m a medical student, and I work in this clinic” — without the uncomfortable feeling of knowing that I might never be back in the same clinic ever again. Even better, when those patients return the next time, I have the joy of seeing a familiar face, similar to what you might feel when reconnecting with an old friend.

Surprisingly, although continuity clinics are common in residency, my word-of-mouth experience suggests that many medical students do not have the opportunity to participate in one. Needless to say, it has been a valuable experience for me, and I would encourage any medical student who does have access to such an experience to take full advantage.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Nathaniel Fleming is a fourth-year medical student and a native Oregonian. His interests include health policy and clinical research. 

Photo by webandy

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