February 28, 2023

Question and Answers about teaching in the clinic – December 2021

  • After you finish working with a learner and you are asked to complete a written evaluation, you make a concerted effort to write 5-6 detailed sentences to include

your observations about the performance of the student.   These comments are hugely appreciated by course directors as well as the students.



Answer- True.  Summative feedback that you provide helps determine learner competence.  In addition, it identifies learner strengths and weaknesses.  Here is a direct quote from one-course director commenting upon  the concerted efforts of our providers to write more about the learners:


“The narrative comments are sooo much better than I have ever seen. I am quite literally receiving a paragraph of feedback on each student… This allows me to organize and directly quote this material, and then I can submit it for their final grade and evaluation.”


  • You receive a request from a student not attending a Duke training program asking if they could work in your office with you, especially since they have heard that you are a great teacher. This is ok to do as long as you tell your HCA, and you can expect to receive the teaching stipend for this work as well.


Answer- False.   We currently train about 250 different students from the Duke Medical School, the Physician Assistant program, and from Nurse Practitioner program.  Each year, we have more students than we can place, and unfortunately, we cannot even accommodate all of the requests from these programs.  As a result, we prioritize our placements in these three programs and do not accept other students from outside programs.  Also, the teaching stipends are only available for the training and support of Duke students.


  • You hear that you have a new student arriving next week to work with you. Lately, you have been seeing a lot of COVID in your clinic.  You heard that the School of Medicine is now going to allow students to see patients who might be ill with COVID, beginning November 1.  To be on the safe side, it is ok for you to ask your learner if they have received all of their vaccinations.


Answer- False.  You ought not to be asking any learners about their vaccination status.  Their status is been monitored through their own programs and student health, and we ought not to be asking them about their vaccination status.  For that matter, we ought not to be asking our colleagues about their vaccination status. Note also that some students may opt out of seeing a COVID patient- This is permissible as long as this has been approved by their individual program in advance.


  • You have a student join your group for the month, and the student is able to obtain a good history from patients and can present to you in a clear and succinct manner. The student is asked to write notes.  You can expect that the student will be able to write about 5-6 notes per half-day session.


Answer- False.  Even the most accomplished and gifted students require about 60 min to review a record, obtain a history, carry out a physical exam, present to you the attending, and then compose an entire SOAP note.  It is reasonable to plan that a student might help write up 3 patients in the course of a half day.  The student might see a fourth patient with you, but oftentimes he/she might present that patient but not write the note.  Too much focus on note-writing takes away from the overall educational experience- so please don’t overload the students.  And while an occasional reference is helpful, do not expect them to quote from the literature in the note.  The main focus should be to be sure the student has recorded a thorough history, and that the student has a sound assessment in place.  A cause for any unexplained symptoms should be proposed so that you can have an opportunity to appraise their skill at critical thinking.