Mission to teach

Published 12:00 am Saturday, March 8, 2003

In 1910, reformer Abraham Flexner spurred a revolution in medical education with his landmark report criticizing the lack of hands-on experience for students in our nation’s medical schools.

Universities then began to broaden their curricula, looking for ways to better train their medical students and residents &045; not only as scientists in lecture halls, but also as practitioners in real hospital settings.

By developing a network of rotations with community hospitals, medical schools were able to give their students opportunities to learn about patient care under the guidance of experienced physicians.

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During the past 30 years, Field Memorial Community Hospital and Field Clinic in Centreville have been a vital exchange in that network, providing Tulane University with one of its most popular and well-rounded family medicine clerkships.

Core curriculum

Will Cronenwett and Salina Poon are the most recent pair of third-year medical students from Tulane to be assigned to the Field clerkship, a two-month training period with Dr. R.J. &uot;Dick&uot; Field Jr. and his son, Dr. R.J. &uot;Rich&uot; Field III &045; both Tulane graduates and surgeons at FMCH.

Family medicine clerkships are part of Tulane’s core curriculum for junior medical students, and Dr. Dick estimates that more than 300 undergraduates have passed through the Field clerkship. But students are never sure where they will assigned.

&uot;They publish a list of the family medicine rotations, but it’s not really a formal interview process. They try to match the students with sites where they think there will be a good overlap,&uot; said Cronenwett, a 34-year-old Norman, Okla., native who flew commercial flights as an airline pilot for Trans-World Express before pursuing a medical career.

&uot;I had gone as far as I could go in aviation, and it just hit me that the thought of doing that for 30 more years would leave me feeling pretty empty when I retired. I would not have contributed much to the world around me,&uot; Cronenwett said.

So, with an undergraduate degree in German, Cronenwett took his pre-med courses at Goucher College in Baltimore before entering medical school in 2000.

Among Cronenwett’s classmates at Tulane was Poon, a 27-year-old native of Los Angeles who started a career in tax accounting before applying for medical school.

&uot;I always had medicine in the back of my mind, but I ended up getting a business degree,&uot; said Poon, who attended the University of California at Berkeley before earning a master’s degree in tax accounting from the University of Southern California.

Poon worked a year for the Arthur Andersen firm in Los Angeles before changing her mind.

&uot;I just realized that I didn’t want to be 40 and think ‘what if I had been a doctor?’&uot; she said.

For Poon and Cronenwett, the Field clerkship offers a unique continuity of medical training that is difficult to obtain elsewhere.

&uot;We will see a patient come in with a complaint and talk to Dr. Rich. A couple of days later, we can observe when Dr. Rich does the surgery. Later, we get to see the patient again in the clinic for follow-up,&uot; Cronenwett said.

&uot;It’s really harder to get that at Tulane, because we do so many other rotations that we don’t really get the follow-up,&uot; said Poon.

The students, who are given room and board at the hospital during the clerkship, typically spend their mornings with Dr. Dick and Dr. Rich in surgery. They also interact with other staff physicians and specialists during afternoons in the clinic and alternate call nights until midnight in the emergency room.

&uot;We get the individual attention of the attending physician. Back home, we see the attending physician for 15 minutes &045; maybe an hour tops each day. Here, we get access to them all day long,&uot; Cronenwett said.

The FMCH emergency room is not as hectic as Charity Hospital in New Orleans, but Cronenwett said it affords students a better chance to gain priceless experience with patients.

&uot;In the accident room at Charity Hospital, the medical students are so low on the totem pole that what we do there is just run around and grab equipment for all the other people that are busy taking care of the patients,&uot; said Cronenwett.

At FMCH, nurses see the emergency room patients first, followed by the staff doctor. But the medical students observe the whole process, and are given a chance to guess at the diagnoses.

&uot;If we are wrong, the doctors correct us. If we are right, they congratulate us,&uot; Cronenwett. said

In addition to the family medicine clerkship, the Fields also offer Tulane students a one-month pure surgery clerkship. And while Cronenwett and Poon are both leaning toward specialties in surgery, their options remain open.

&uot;This is our family medicine clerkship, and it may be a little odd that we do it with surgeons instead of family medicine doctors, but the greatest part of our day is spent doing family medicine &045; such as observing in ER. We see just as much family medicine as people in other clerkships,&uot; said Cronenwett, who doubts that many other clerkships offer such a wide range of opportunities to learn.

&uot;I’m sure we work longer hours than any other family medicine clerkship by quite a bit, because nobody else goes from 7 a.m. to midnight,&uot; Cronenwett said.

The chance to work closely with doctors, nurses and other health care technicians in a small setting is just one of the benefits that make the Field clerkship so valuable to medical students.

&uot;It’s not only having great interaction with the staff, but the business side of medicine &045; the administrators, the secretaries, even the people who clean the rooms&045;they have all been teaching us things about their jobs that we can’t learn elsewhere,&uot; Poon said.

Enjoyable experience

Albert Einstein once said it is a miracle that curiosity survives formal education. The Nobel Prize-winning physicist said teaching should be such that &uot;… what is offered is perceived as a valuable gift, and not as a hard duty.&uot;

Einstein believed that education should be enjoyable &045; for both the student and the teacher. For Cronenwett and Poon, the Field clerkship embodies that idea.

&uot;I’ve just been overwhelmed by the warmth of the people in Centreville. They have been without exception open, friendly, and inviting &045; introducing themselves and making us feel part of the team,&uot; Cronenwett said.

The students say each day they are challenged and humbled, learning more about how much there is to learn, but in an environment that encourages thought.

&uot;I don’t feel intimidated by asking questions here,&uot; said Poon.

And through the clerkship, the students breathe new life into the hospital.

&uot;The students bring brightness, they bring curiosity, they bring an eager-to-learn attitude which keeps us on our toes, because they expect us to know,&uot; said Dr. Dick, who also serves as a clinical professor for medical schools at the University of Mississippi and Louisiana State University.

&uot;I’ve said many times that we learn more from them than they learn from us,&uot; he said.

Dr. Rich said the Field clerkship has not changed much since he attended it as a senior Tulane medical student in 1979.

&uot;We still try to handle the students the way we always did. We try to give them a lot of primary exposure. The one thing that has gotten better is that we’ve involved the hospital more with us. The facility and accommodations have improved for the students, but the philosophy has not changed,&uot; said Dr. Rich, who joined his father on the FMCH staff in 1985.

Part of that philosophy includes teaching students that, even in today’s era of bottom-line, managed care, it’s imperative that doctors get to know their patients and listen to their concerns.

&uot;It’s a strange paradox that we now have the greatest medicine the world has ever seen, but we have less trust between patient and doctor than we had 100 years ago. We get so tied up in MRI’s and CAT scans and laboratory results that we forget to sit down and talk to the patients,&uot; Dr. Dick said.

Teaching the importance of this diminished element of patient care as part of the Field clerkship is a mission that Dr. Dick is honored to perform.

&uot;I think it is an unwritten code of medicine that those who learn ought to turn around and teach. Our hospital is geared toward teaching. It’s so easy for us to do, and it’s fun.&uot;