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How to Make the Most of a Healthcare Externship

Preparing for Your Practicum

Depending on your educational program, you may be assigned to a practicum site or you may have some choices. If you have choices, there are some important things to consider before making your decision.   Don’t choose a practicum site where you or your family members are patients. It’s best to choose a location where you can be viewed solely as a student. It’s also preferable to choose a site where you don’t know the patients.  Having personal relationships with patients at your practicum site can create issues with privacy and confidentiality.   

Pre-Practicum Observations and Research During Your Practicum

Keep a small notepad with you and take notes. Write down questions that you may want to ask later on. When you think of a question, it may not be the appropriate time to ask it. For example, if you have a question about the way a physician performed a certain patient procedure, it would be inappropriate to ask in front of the patient. Asking in front of the patient could make the patient feel uncomfortable as well as the physician. You may have questions that you want to hold until you meet with your program instructor again.  During the course of a week, many things will happen and your notepad will really come in handy.   

Keeping a Journal

Consider keeping a journal (a written record of your thoughts and experiences) during your practicum. Some educational programs require that you keep a journal and include certain types of information. Your program may be required to keep a copy of your journal in your student file. In such cases, it is best to record your personal thoughts and emotions in a separate document or notepad.  To protect patient confidentiality, you should not mention patient names in your journal. Take a few minutes at the end of each day to record what happened, how you reacted, how you felt about it, and whether you could have handled it differently or better. Journaling can help you regroup your feelings, process your experiences, and reflect on what you’ve learned.  Write about both the good and not-so-good things that you see and experience. Record both the things you do and do not want to do again in the future. Sometimes you may hear an employee being impolite to a patient.  Write down what you heard to remind yourself how others may perceive the things that you say.   You’ll likely see some things being done in a different way than how you were taught. By recording this, you’ll remember to bring it up when you meet with your instructor and classmates later on. Expect to be nervous and busy at the same time. If you don’t write things down, you may forget something important. If it’s written in your journal, you’ll have it as a reference whenever you need it. There are also some good pocket-sized reference books for different professions. Check with your instructor to find out if such a book check with your instructor to find out if such a book might be helpful during your practicum.

Protocol

Your site will have policies and procedures outlining what you may and may not do as a student. These policies and procedures are called protocol and they will vary from site to site. Familiarize yourself with these at the beginning of your practicum and comply with them. Find out how the site handles cell phones and computer use. Some sites won’t allow students or staff to use personal cell phones during work hours. In some situations, cell phones may interfere with technical equipment. Avoid making personal telephone calls and texting during your practicum hours. Keep in mind that the site’s computers may be strictly limited to business use. It’s always wise to ask before logging on to someone else’s computer.   Depending on the profession and site, this may include getting permission from each patient before you are allowed to observe or participate in a procedure. Some patients are comfortable with having a student present during their procedure whereas others are not. As a practicum student, you must keep the rights of your patients in mind. You also have rights as a student including the right to observe and participate in procedures related to your educational experience. But the patient’s rights always come first. If a female patient, for example, isn’t comfortable with having a male student present during her procedure, the male student will need to comply with the patient’s wishes. In most sites, there are a sufficient number of other patients who are comfortable with having students present to ensure that the students’ educational goals can be met. Make sure you know how your practicum site protects the rights of its patients and comply with protocol.

Confidentiality

Maintaining confidentiality and adhering to HIPAA and the HITECH Act rules are top priorities. During your practicum you may have access to patient medical records and other private information. You may even know some of the patients. What you see, hear, or read at the site must stay at the site. Never read a patient’s medical record unless instructed to do so. You will undoubtedly see and do things that you’ll want to tell your family and friends about. It’s natural to be excited and want to share your experiences.  But you must remember to never use the patient’s name or provide any other descriptive information that could reveal the patient’s identity.   Here’s an example of an acceptable comment:   You won’t believe what I did today. We removed a mole from a patient’s arm.  I got to prepare the patient for minor surgery and assist the doctor with the procedure. You described what you did without breaking confidentiality. Usually there will be times when you, your classmates, and instructor meet to discuss what you’ve seen and done during the week. Again, this is a time to protect the confidentiality of the site’s patients.

Samples

 Many sites have what’s called a samples room. This is a place (sometimes a closet) where they keep samples of drugs and medical supplies. You may be asked to go there and get samples of something for a patient. Just because the sales reps leave samples at the site at no charge, and the site gives samples to patients at no charge, you shouldn’t assume that you can help yourself to anything that you want out of the samples room at no charge.

Office Politics

No discussion about proper behavior during a practicum would be complete without talking about office politics (clique like relationships among groups of coworkers that involve scheming and plotting) and how to avoid them. If you’ve had more than one job, you’ve probably already discovered that all workplaces have office politics. Whether you’re doing your practicum in a physician practice, long-term care facility, or hospital critical care unit, there will usually be coworkers who don’t get along well with one another.

Initiative

 Once you’ve learned what is expected of you and you feel comfortable with the equipment and procedures, it’s important to begin functioning with less direct supervision. If you are uncertain about something, by all means ask!  But if you’ve been given a responsibility and it’s your job to do it, then do it.  If a patient has checked in and it’s your job to escort patients to the exam room and take their vitals, then that’s what you should do without waiting to

Language

Here’s a story that actually happened in a large medical office. A medical assisting student reported to the office on the first day of her practicum.  When she arrived, she couldn’t remember the name of her contact person.  As she was talking to the person seated at the receptionist desk, she became discouraged and used some profane (improper and contemptible) language.  As it turned out, the “receptionist” was actually the office manager who was in charge of hiring for the practice. Needless to say, the student’s practicum experience didn’t get off to a good start and there was no job offer from the site at graduation.   Unprofessional language should never be used in your practicum site.  That is not to say that you won’t hear it yourself, because you will, but just because you hear the employees using profane language is no excuse to use it yourself. Put yourself in the patients’ position. If you were sitting in the waiting room and heard the staff using profanity, how would you feel? What impact would it have on your opinion of the company? At each step of the way, put yourself in the patients’ shoes. Even though you are there as a student, the patients will consider you part of the staff. Your behavior not only affects your own reputation but also that of the site. Using profanity or any other type of unprofessional language will undermine both reputations. Teamwork   During your practicum, avoid becoming part of a clique. Depending on how long you’re there, you may start to feel comfortable with the staff and feel as if you belong. Belonging is a good feeling but there’s a difference between fitting in and being part of a clique. Fitting in simply means that you work well with the staff and you are viewed as cooperative. Your personality may blend well with the personalities of the employees, but being part of a clique can work against you. Cliques stick together and don’t associate with the rest of the staff. They’re exclusionary and they impede teamwork. Employees in cliques are typically less productive because they spend too much time socializing and gossiping.