May 6, 2002

Chances are good that one of Jaime Paul's patients during her student continuity practice over the next three years will work at the Wiremold Co., a small manufacturing plant in West Hartford, less than a mile from her office.

When they meet, Paul will have a good idea of the patient's work environment and the potential impact on his or her health, thanks to a tour of the plant she and her colleagues took as part of their first-year course on principles of clinical medicine.

The student continuity practice is a three-year primary care rotation that was introduced in 1995 as part of a new curriculum at the School of Medicine that places greater emphasis on community-bas ed education.

The student continuity practice begins in the fall of the first year and continues through the third year. Students spend half a day per week in a physician's office under the supervision of a physician preceptor. It provides students with experience in a community-based generalist practice, and gives them an opportunity to integrate their understanding of medicine and skills in history-taking, physical examination and clinical reasoning in a clinical environment. It also exposes them to the personal and professional development issues that accompany medical training and practice.

Paul and seven other first-year medical students spent an afternoon recently touring the Wiremold Co. with Eileen Storey, an associate professor of occupational/environmental medicine. The students watched workers feed ribbons of thin metal into a machine that cuts it and folds it into small boxes or long strips. And they saw the boxes being painted and packaged for shipping. Occasionally, the students had to move out of the way, as small trucks sped across the factory floor.

Dr. Storey said it is important for students to see the kinds of work the employees do and how that might impact their health and well-being.

"We want the students to see whether employees are exposed to solvents or other chemicals," she said. "If they're working on machines, we want the students to see how the company deals with employees of different heights. We want them to see the kind of repetitive motions and the kinds of force employees have to use on the job."

Michael R. Grey, associate professor and acting chief of the occupational/environmental medicine division, said that understanding a patient's work environment plays a crucial role in the students' ability to take a thorough medical history. Dr. Grey and other faculty members took every member of the first year medical school class out of the University and into the community. Altogether, 80 medical students and faculty preceptors in groups of eight to 12, were assigned to tour one of nine industrial facilities throughout Connecticut.

Students visited different types of work site, from traditional manufacturing and aerospace firms to high tech and service companies. One group visited a large horticulture facility.

"We tried to make sure students would tour sites near their Student Continuity Practice sites. That way, it's at least possible that one of their patients will actually work at the site they visited," said Grey.

"Employers are usually delighted to have a physician from the community visit their plants or sites, but few physicians do it," said Storey. "We want to make sure our students are exposed to the occupational and environmental aspects of medicine early in their careers."