The Challenges of Medical Students in Their First Times in Primary Care Outpatient Clinics: an Analysis of 4th Year Medical Students’ Reflective Log Books

Abstract

Background: The importance of learning experiences in outpatient setting for medical students has been emphasized in the past few decades.

Objective: To identify the 4th year medical students’ challenges during their first encounters with the real patients in primary care outpatient clinic. 

Methods: After the learning in OPD of primary care medicine clerkship, all 4th year medical students of Faculty of Medicine, Ramathibodi Hospital, were invited to write a log book pertaining the reflections on “What is the most challenging issue during your first experiences with patients in OPD?”. A content analysis of total 180 log books was done.  

Results: All students encountered problems in their first-time primary care clinic. The content analysis found four major challenges; 1. Taking patients’ history (taking personal history, taking notes in medical record during the history taking, capturing patient’s concerns, dealing with the third person during the history taking) 2. Doing physical examination (differentiating between the normal and abnormal signs, doing physical examination in the unfamiliar parts) 3. Giving advice and counseling (behaving professionally during the counseling time) 4. Managing their own uncomfortable feelings (creating trust, consideration, excitation, anxiety). The main themes and sub-themes are explained by using participants' direct quotations.

Conclusion: Most students struggled and required support.  The common core challenges that affected to the student’s confidence and their achievement of educational goals were identified. This provided new insights for medical teachers into what they should support for students and how to help students deal with this challenges.