What you will do:

This outpatient clinical experience will be under the supervision of a board-certified family medicine physician with years of experience educating heath professions students, international medical graduates, and residents in both internal medicine and family medicine. The physician holds hospital appointments at a hospital within Scripps Health.

The clinic in which the preceptor works is affiliated with an internal medicine residency program. Residents from the San Ysidro Health internal medicine residency program rotate through the practice. Of note, the preceptor is also part of the faculty at a family medicine residency program based at Scripps Health. One week out of every two months, the attending teaches family medicine residents in the hospital. Please note that hospital policies do now allow rotators to enter the hospital.

In the clinic, you will see patients with both acute complaints and chronic disease. You will learn how to evaluate these patients through focused history-taking and examination and synthesize the data to form an assessment and plan. During discussions with the attending, important teaching points related to these cases will be shared with you. There will also be an emphasis on ensuring patients are current with age-appropriate health screening. In a typical day, the physician will see approximately 20 patients, half of which are in-person. The remainder will be seen as virtual visits.

Every other Thursdays, you will be able to observe in the procedure clinic. This will be an excellent opportunity to appreciate the broad range of procedures and skills family medicine physicians possess and perform. During your family medicine residency training, you will be required to perform procedures as procedural training is a requirement mandated by the Accreditation Council for Graduate Medical Education (ACGME). Among the procedures you will encounter include lipoma/cyst removal and I&D among others.

Of note, the practice serves a diverse patient population. You will encounter patients from all over the world, including new immigrants and refugees. With increasing numbers of refugees settling all over the U.S., this experience will allow you to better understand the challenges encountered by this population in terms of access to quality care and disparities in treatment. Because some patients are not English-speaking, the experience will also introduce you to best practices in communicating when there is a language barrier. Given that most U.S-based residency programs will have significant numbers of non-English speakers, this will help you prepare for the care of these patients when you are a trainee.

After a few days of observation, you will take on an increasing role in patient encounters and learn the following under the preceptor’s supervision (please note that this experience remains within the regulations of California pertaining to the unlicensed practice of medicine. Externs will not be practicing medicine but will be learning under the guidance of the physician preceptor):

• Taking patient histories under supervision.

• Performing exams under the physician's supervision.

• Presenting patients.

• Writing or entering notes in the EMR (Epic EMR)

• Researching the literature to answer clinical questions at the point of care.

• Educating patients under supervision.

• Spending time with other healthcare professionals to understand their roles and responsibilities.