Wendy Caceres’s Early Focus Is on Education and Service
Just a few years out of her own residency in internal medicine, clinical instructor of general medical disciplines Wendy Caceres, MD, is enjoying several roles as clinician, mentor to medical students and residents, and educator. Her clinical interests include mental health, nutrition and obesity, and health disparities; she considers the tools of quality improvement in addressing issues in clinic; and she has an active practice as a primary care physician at Stanford Hospital.
The Pacific Free Clinic
Caceres has a significant role at the Pacific Free Clinic, a student-run clinic where she saw patients as a medical student and resident herself. “I spend about 10% of my time as one of the co-medical directors,” she says. “I mentor medical students as they carry out their projects. Recently they have been working on a free vaccine program for the patients who come to the Free Clinic. Pharmaceutical companies such as GSK and Merck have prescription drug programs for patients who meet certain income requirements, and the students work to get the patients enrolled in these vaccine programs.
“The Free Clinic is a way of exposing students to an early supervised clinical experience while providing a service to the community -- a way to give back and often in a leadership role. They manage their own projects with feedback and guidance from us. They develop the connections to local community-based organizations and offer patients referrals to these resources through a service they call Bridge to Care. They are trained in and do health education and interpreting. A lot of mentorship and education happens at that level.”
While the Free Clinic sees about 1500 patients a year, it operates only on weekends and therefore cannot be the medical home of its patients. Caceres explains that the “whole point is to get the patients plugged into the larger medical community, so we have partnerships with federally qualified health centers and federally qualified lookalikes in the area so that our patients have access to primary care going forward.”
Caceres’s role at the Pacific Free Clinic gives her the chance to focus on educating medical students and residents. She also attends in the resident clinic at Stanford Internal Medicine where she supervises residents as they see their patients. She often precepts a medical student in the clinic.
Developing Primary Care Presentations
Introducing students early in their medical education to the application of new knowledge in a clinical situation led Caceres to develop a lunchtime course called Primary Care Presentations. She explains that “in the first and second year of medical school you’re learning so much that it’s likened to having a fire hose directed at you. I just don’t want these students to lose sight of the ‘why’ of medicine. So I developed this course together with Lars Osterberg, MD, MPH, who is one of my key mentors, and Sarah Waliany, a fourth year medical student who is interested in internal medicine.
“The course is based on de-identified actual patients we’ve seen in clinic. I unveil a case in the way it really unfolds in a clinic visit to the 30 or 40 students in the room and another primary care doctor there who doesn’t know anything about this case. As I tell the story of the patient, the primary care physician explains his or her clinical reasoning while taking in and interpreting the information, formulating an assessment, and coming up with a plan. To make it really interactive we encourage students to participate in the clinical reasoning throughout the case.”
This window into the actual thinking of a clinician just learning about a new patient has a special appeal for the students. As Caceres says, “It’s not often that medical students get to hear how master clinicians think about the data. In medical school they learn the convention of the history and physical, the specific way you organize the data that you have about the patient and the way that you communicate it to your colleagues and other medical professionals. What I’m trying to get them to understand is that the way they gather the information isn’t in that neat packaging.”
The Free Clinic is a way of exposing students to an early supervised clinical experience while providing a service to the community -- a way to give back and often in a leadership role.
As the students’ eyes are being opened to how physicians think, those physicians are enjoying sharing their thoughts. “The master clinicians, who have been in practice around 10 to 15 years, find it very refreshing to do their thinking out loud in front of the students. I think they have fun showing medicine this way. There is nothing wrong with looking at a patient in the traditional organized way, but in real life, even after just knowing a few details about a patient and the vitals, there is already a great deal of information that the clinician is taking into account as he or she thinks about this patient.”
The medical students who have attended Primary Care Presentations rated it very highly, which has led Caceres to consider embellishments that will make it more interesting and useful. For example, she says, “I will probably add to next year’s iteration a little bit on challenging some of the implicit biases that people have. It’s been shown that physicians can have unconscious implicit biases that can affect patient outcomes. A woman having very similar symptoms of chest pain as a man often won’t be sent to have a catheterization while the man usually will. I’m trying to bring awareness of these other aspects of medicine right when the medical students are having the fire hose coming at them.”
Wendy Caceres seems to be enjoying her early focus on education and service.