Bruce Peyser, MD, FACP
Provider, Duke Primary Care Pickett Road
Professor of Medicine, Duke University School of Medicine
Director of Education and Teaching, Duke Primary and Urgent Care
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Should we train our nurse practitioner and physician assistant students in a similar manner to how we teach our medical students?
 The goals and objectives for the programs that place students in Duke Primary Care are mostly focused upon clinical skills. The learners need help and practice interviewing patients, examining them, and then communicating that information succinctly to us. Some of the more advanced students can assist with generation of a differential, and can create a work-up and treatment plan. These clinical skills are well recognized, and I believe all our students should receive equal training, coaching, and feedback so that by the end of their rotation, they have hopefully made progress in their ability to gather a history and present that information in an organized fashion.
We are in a unique position to be able to encourage and promote achievement of these clinical skills, and I urge you to think about, observe, and provide feedback to your learners as they work toward perfecting their clinical skills. There have been times I have learned a lot about my learners when I have sat in a patient’s room and just observed the learner for a few minutes as they interview, examine, or even counsel a patient. This “fly on the wall” approach can be quite effective, and many of our students desire more direct observation of their clinical skills.
Note writing skills are equally important, and a lot of attention has been focused recently on collaborating with medical students who can assist with note writing. It’s vitally important that NP and PA students also practice the skill of note writing, and I urge you to have them write notes in a separate Word document that you can review. Just remember you are not able to cut and paste any parts of their notes into your clinical note. Hopefully soon legislation will be passed allowing NP and PA students to also help prepare notes.
I like to spend time at the beginning of a rotation with a new student by learning about their background and experience. I ask about their skills and interest, and I try to model curiosity about each profession. I also try to dispel myths about traditional hierarchies in medicine that have been more prevalent in the past. In some cases, the questions my students ask my patients reflects a different focus than my own; I have learned to recognize some of this variation is actually hugely valuable to patient care, as I find out things I might not have ever asked if I were alone with the patient.
We have amazing students who rotate in our clinics. The competition for slots in our NP and PA programs is intense—2,500 individuals apply for 90 spots in Duke’s PA program—and both programs are ranked among the top five in the country, per the U.S. News & World Report evaluation each year. (Did you know the very first PA program in the country originated at Duke in 1965?)
We have completed assignments for this next academic year, and we have expanded our involvement in both the NP and PA programs. I thank you for taking the time and making the effort to teach these students. It is hugely appreciated by them, their programs, and our health system.
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