Overcoming Uncertainty through Experience

By Michelle Sergi

Coming out of my first year of medical school I struggled with my sense of confidence.  After endless nights of studying, a multitude of experiences at our Clinical Training and Assessment Center, and specialized clinical experiences, I felt that I could take on the challenge of counseling patients.  On the other hand, when I thought about being on my own to take care of patients, I was terrified.  My pharmacology knowledge was insufficient, and even though I knew how to conduct a full physical exam, did I really know what was normal compared to abnormal?  These questions proved to me that I lacked the clinical experience necessary to become a good physician.

When I heard of the opportunity to apply for the Leroy Rogers Preceptorship, I immediately knew that it could help bridge the gap between my medical textbooks and clinical knowledge.  This program gives preclinical students the opportunity to choose a preceptor for a four week, hands-on family medicine clinical experience.  I had shadowed a family physician, Dr. Andrews, in my hometown several times before so I knew he would be the perfect preceptor.  I also felt that I would learn from his patients, especially because many are medically underserved.

My very first week in the program, Dr. Andrews helped me to realize how much of my first-year knowledge I remembered and what I still needed to work on.  He ensured that each patient interaction was beneficial by quizzing me and then explaining how the information applied to treatment of the patient.  For example, when he would ask about diabetic treatment guidelines, we would then discuss why the chosen medication was most appropriate for that specific patient based on their current medical conditions, access to care, and insurance plan.  In addition, he always reminded me to think simply and commonly instead of looking for the “zebras” of medicine.  This was the first landmark of the experience because it provided me with the clinical mindset that I was lacking.  Since this was my first time completely submerged in clinical medicine, my thought process seemed to lean towards the rare diagnosis instead of ruling out the more common ones first.

The second week, he asked me to enter patients’ rooms by myself.  He instructed me to get to know their story, review their chart, and suggest a plan.  Once I was finished he would enter the room, have me present the patient, and then go over my SOAP note.  At first, I was nervous about being alone without guidance, but after a few patients and a bit of encouragement, I felt more confident. Soon enough I learned how to choose medications appropriately, counsel patients on making lifestyle changes, and perform a focused physical exam.  Of course, he also threw in highlights of information for board exams and clinical pearls to keep in mind.

There were many heart wrenching moments in the third week including breaking bad news to a family I had known since childhood.  I questioned my ability to stand in the room as they were told the unfortunate news of metastatic cancer.  When the family saw that I was shadowing Dr. Andrews, they immediately welcomed me and voiced how proud they were of my medical school journey.  This acknowledgement made my feelings of sympathy and sadness stronger for them.  As Dr. Andrews discussed the MRI and their options, I realized that there would be many times in my career that similar situations would arise.  I enjoy having a strong relationship with my patients, which means that I must prepare emotionally and mentally for the possibilities of these occurrences through consistent reflection.

During my four weeks with Dr. Andrews, I learned more than just clinical knowledge, including how to truly impact a community of underserved patients.  My improved competency was evident to me as I began my second year during clinical experiences, simulated patient opportunities, and even on my exam scores.  I had learned how to write a focused SOAP note, about many abnormalities of the body, write prescriptions, and work with insurance companies when ordering tests and considering medications.  I had assisted with several procedures that usually a family physician would refer a patient for, but out of convenience and financial purposes for the patient, he did the procedures in the office for them.  This experience has definitely been a milestone in my medical school training because I was able to enter my second year more confident and truly feeling like I can make a difference in the lives of others.

Dr. Andrews is truly a community focused physician, and I feel privileged to have worked alongside him.  Not only is he a family friend of mine, but he is my own family physician.  After a recent appointment in his office for my annual check-up, I updated him on my progress as a now third year medical student. I was excited to tell him of my many wonderful rotations and experiences while also thanking him for the strong knowledge he had passed onto me during the preceptorship.  To my surprise he told me that he has always noted my love for the community and drive to become a physician and that is why he is proud to be my mentor.

As I continue my medical education, I will always owe my strengths in clinical skills and counseling underserved patients to Dr. Andrews and the Leroy Rogers Preceptorship program.  Each time I am complimented on my compassion and empathy for patients, I remember the role models who guided me.  I hope that physicians realize that students look to them for guidance and will incorporate the way they practice in their own career. I, myself, have mentees ranging from 16 years old to 2nd year medical students because I believe it is never too early to teach future physicians and help them become even more successful than you were at their stage of learning.

Michelle Sergi
is a third year medical student at Ohio University Heritage College of Osteopathic Medicine Cleveland Campus. She is passionate about pediatrics and underserved populations, and founded Meritage of Miracles a non-profit organization to increase access to care for children and families in the pediatric palliative care program.

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