DGIM Generally Speaking

Spotlight on Education: Susan Seward—A Champion of Ambulatory Primary Care Medicine Education

By: Lessie Robb-Nicholson, Associate Chief for Education

	Dr. Sue Seward

Many of us in the DGIM enjoy teaching Harvard medical students in our ambulatory practices; but few of us have had the sustained longitudinal perspective of our own colleague Dr. Susan Seward, the Director of the Primary Care Clerkship (PCC) at MGH.

Sue has been committed to teaching primary care medicine in the ambulatory setting since her general medicine fellowship when she garnered funding from the ‘New Pathway’ to design a new Introduction to Clinical Skills for second year students at HMS. About this time, a national conversation about teaching in the ambulatory was taking off. As hospital stays for patients shortened, medical educators looked to the ambulatory setting as a good place for students to learn clinical skills. Over the next decade, this idea crystallized along with the notion that students could benefit from a longitudinal experience with patients.

In 1997, Sue participated in the HMS-wide design and implementation of the PCC as our MGH representative at HMS, as well as the Director at MGH. Later, when the Principle Clinical Experience (PCE) began, the PCC continued as the longitudinal arm of the clerkship year for students. Nowadays, students benefit from an ever-increasing emphasis on longitudinal primary care teaching, and Sue remains active as a teacher and leader at MGH and HMS. I interviewed her after a busy patient session in Internal Medicine Associates.

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Lessie Robb-Nicholson (LRN): What is the advantage of a longitudinal primary care experience for students?

Sue Seward (SS): In a longitudinal experience, students get to follow patients over time and the course of an illness. They become comfortable interviewing and examining patients. A student may learn how to give bad news about a test result, not in an OSCE, but in a real situation. Students observe how patients manage their illnesses outside the hospital. They learn to apply their knowledge to a practical differential diagnosis. They also learn how to work with other professionals and about systems of care.

LRN: What is the advantage of teaching in the PCC?

SS: If you work with a student over a longer period of time, you get a better assessment of her strengths and weaknesses, and you can help the student to address them over time. You will also find yourself giving lots of feedback, and continuing to grow that skill as a teacher. The longitudinal relationship fosters a special mentoring experience in one of the most formative years of a student’s career.

LRN: What is it like to teach and direct the PCC at MGH?

SS: This has been a real joy. Students work in almost all MGH-affiliated health centers and on-campus primary care practices. The preceptors are enthusiastic and willing to put their hearts into teaching. During the overlap of students when HMS was converting to the ‘Pathways’ curriculum, I was amazed to see the willingness of DGIM faculty come forward so we could handle twice the number of students for that time. I want to acknowledge how they really stepped up to meet the challenge!

For me, I love the enthusiasm of students. It reminds me why I went into medicine. This is the good stuff!

Read more articles from the Fall 2017 edition of Generally Speaking