“Over the four decades of my practice, I have loved meeting students from all backgrounds, many of whom brought their own life lessons and perspectives,” states pediatrician Cynthia Mann, MD '76, a long-time preceptor for Yale School of Medicine (YSM) students and residents. Mann, who completed her undergraduate and graduate medical training at YSM, says community physicians were important to her own education and so she enjoys giving back. After finishing her training, Mann went into practice at Community Health Care Plan, an independent HMO (it has since closed).
Over the years, Mann has engaged with students in different ways. For her first 15 years in practice, she was a guest attending each week, first in the pediatric endocrinology clinic and then in the pediatric primary care center. This provided her the opportunity to spend a substantial amount of time mentoring medical students and residents. Simultaneously, she began hosting them in her office—medical students would spend several weeks with her on rotations, while residents typically were with her for a few days. When Yale transitioned to having a full-time faculty precept at the primary care center, she stopped being a guest attending, but continued precepting at her practice.
At this phase of her career, Mann is working three days a week and coordinates with colleagues to precept students. She adds that COVID-19 unfortunately made it more difficult to precept, because there is little space in the office for social distancing, and telehealth does not work well with pediatrics. Moreover, pediatrics is very relational, and masks hide facial expressions, making connections more difficult.
When students are doing rotations in her office, Mann ideally has them meet with the patient first, with the patient’s permission, and she asks the students if they are comfortable presenting in front of the patient. While she does most of the required documentation, she asks students to write up their own summary of each appointment as a learning tool.
For Mann, it also is important that students experience the entire office during a rotation, which consists of five doctors, two nurse practitioners, five to six nurses, five receptionists, an office manager, and an employee who cleans the office. She has students sit in the waiting room and in the nursing station, both to observe the experience from the point of view of the patient and to help students learn about the different roles in the office, for example, their gaining an appreciation for the volume of calls that nurses handle.
Additionally, Mann says, learning during rotations “always has been a two-way street, with students doing research on specific patient illnesses and bringing back their newfound knowledge to share with patients and families.”
One reason Mann is drawn to precepting is her belief that in the office setting primary care doctors have a different perspective, which often is missing in the primary care experience Yale students have at the hospital. “We often are seeing three or sometimes four generations of patients in the same family, which provides a valuable opportunity for students to enjoy the many long-term relationships we have with patients.” She adds, “Students can see the complexities of many families and get a deeper understanding of bridges and barriers to effective patient care. Each family comes with challenges and strengths that are important to understand.”
Mann thinks a lot about how the life experiences of medical students and residents might impact their interactions with families. For example, she says, “What are our prejudices and preconceptions about patients that might impact our care? How do we broach topics that might seem more important to us than to the family? How do we share something of our own lives without breaching the boundaries?”
In the early years of her practice, Mann says, “my own experiences of parenting informed much of my teaching. I learned that there are two sides of every story: the patient and the parent. While our ‘client’ might be the child or adolescent, the parent perspective is critically important.” Mann explains that learning how to negotiate with both sides without violating the privacy of either is a skill that requires a lot of work. She says it sometimes is more natural for students to ally with the patient, who often is close in age (Mann’s practice sees patients from birth to 22), but students have to learn to see things from a parent’s point of view as well.
Mann devotes a significant amount of time to nonprofit work with children and adolescents through the organization LEAP, which has taught her a lot about the economics and politics affecting the patients she serves. She has enjoyed encouraging students and residents to get involved in this volunteer work, providing them opportunities to see the "whole picture" of kids' lives and to mentor kids who need academic help or are looking for role models. She says, “Many kids do not imagine themselves as doctors and so it is meaningful for them to meet residents and students with similar backgrounds.”