Outpatient US Clinical Experience in Internal Medicine in Washington D.C.

Information about this clinical experience:

You will be under the supervision of a board-certified internal medicine physician who has an extensive background in teaching internal medicine residents and health professions students. The preceptor was an Associate Program Director of an IMG-friendly residency program in the Washington DC/Baltimore region for over 10 years. The attending is on staff at Luminis Health Doctors Community Medical Center.

The outpatient practice serves individuals from South Asian, Southeast Asian, African American, Middle Eastern, and many other communities. Therefore, you will encounter patients from a wide range of cultural, ethnic, and socioeconomic backgrounds. This will help you learn how to provide culturally sensitive, patient-centered care by recognizing and respecting each patient's unique beliefs, values, and healthcare needs.

The preceptor is known for having a wonderful bedside manner and is well regarded for the amount of time spent with patients. Attentive listening, genuine care and concern, and a warm, empathetic demeanor are hallmarks of this doctor’s bedside manner. Observing how this physician manages the entire encounter, including the initial greeting and introduction, elicitation of focused but detailed histories, and explanation of management plans, will show you how you can make patients feel comfortable and respected while still gathering the clinical information needed for diagnosis and treatment. 

Rotators will encounter a range of patients with acute complaints and chronic conditions. Rotators will have the chance to exercise their problem-solving skills to make differential diagnoses, formulate assessments, and develop treatment plans. Refining important critical thinking skills for the practice of medicine will be a priority in this experience. Regardless of the reason for the patient's visit, rotators will perform medication reconciliation, a crucial part of the encounter. By reviewing and verifying the medication list, you will make impacts on patient care by spotting and resolving discrepancies, ensuring safe care. 

The preceptor is a strong proponent of empowering patients through education. Through this experience, you will be able to further develop your own skills in educating patients. As many patients will have chronic conditions like diabetes, hypertension, or obesity, opportunities to teach patients how to make lifestyle changes will be abundant. 

Technology is embraced in this physician's practice. For example, with diabetes patients, you will observe how continuous glucose monitors (CGM) are placed, how monitors are connected to the patient's phone, and how glucose measurements are interpreted. As many patients will be new to this technology, you will learn how to educate them about CGM data and trends, differences between interstitial and blood glucose readings, device calibration, setting and managing alerts/alarms, and sharing data with the medical team. Your efforts will allow patients to feel more confident in managing their diabetes. 

As the clinic has a weight loss program, you will gain experience in how a primary care physician manages this challenging problem. Recommendations are made to help patients lose weight based on full knowledge of their medical history, lifestyle, and needs. A key part of the overall strategy is careful diagnosis of the reasons contributing to the patient's weight gain followed by the development of a weight loss program that is tailored to the individual's particular situation. Every effort is taken to provide the patient with a safe and nonjudgmental environment to discuss questions or concerns about weight. 

After one week of observation, you will take on an increasing role in patient encounters and learn the following under the preceptor’s supervision:

• Taking patient histories under supervision.

• Performing exams under the physician's supervision.

• Presenting patients.

• Entering information in EMR (Athenahealth 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.

If you wish to get involved in a practice improvement project while completing this clinical experience, please let the preceptor know as soon as possible. The availability of projects is at the discretion of the preceptor.