An Out-call Service for Service Senior Medical Students

There has been established at the University of Nebraska College of Medicine since 1913 an out-call service for senior medical students. This has developed into one of the most desirable and most instructive services of the senior year, and it might be of interest to other schools to learn the details of this work and the points which seem most important to its organization…. … There are two essential features in the success of this work, first its limitation to senior medical students and, second, responsible supervision…. The senior class of about sixty students is divided into quarter sections for clinic assignments, and one section is assigned in rotation to out-call service for two months. These students are not assigned to hospital clinical clerk or dispensary service during this time as extra hours usually are required to attend properly to the necessary home visits each day. The calls are received at the dispensary where a book is kept recording the patient's name, address, leading symptoms, student assigned, diagnosis and treatment. The calls this year have averaged between five and ten per day. The minimum number assigned per month to individual students is ten. The assignment often exceeds this number as some students take this work during the summer and reduce the number in the class sections. Also, some students are more ambitious than others or possess a car which enables them to make more calls. In addition, follow-up visits must be made on many cases and at the end of the service the daily calls of each student will average three to five, sometimes more. Preliminary to this out-call service assignment the entire section of ten to fifteen senior students is met and a period spent in explanation of the responsibility incurred, various procedures to follow and precautions to take. This instruction is given by the medical director of the dispensary who is responsible for the organization of the work. The following printed brief of the most important points is given to each student: INSTRUCTIONS TO SENIOR STUDENTS OF OUT-CALL Students assigned to outcall are to report to the dispensary, or telephone twice daily, between 11 and 12 a.m. and after 2 p.m. An out-call book is kept recording name, address and symptoms of patient. The condition found and diagnosis must be reported back the same day the call is made, or at the latest, early the following morning. Keep accurate records of each case on out patient history cards, and do not neglect to make urinalyses, blood counts, and throat cultures whenever indicated. A urinalysis, leutocyte count and differential count should be made on every suspected acute abdominal infection, and throat culture for diphtheria from every sore throat…. … SUPPLIES AND MEDICINE. Dressings, gloves, bandages, etc., are furnished at the dispensary office. Prescriptions will be honored at drug stores if written on University blanks. Sign your own name, but not as “M.D.” You cannot prescribe narcotics. Do not prescribe expensive or unnecessary medicine which the patient is unable to get. MEDICAL SOCIAL WORK. Observe the social condition of the family as poverty, ignorance, housing, sanitation, vice, etc. Encourage the family to tell their problems and difficulties, and learn how to give help to make the medical treatments more effective…. … SURGICAL PROCEDURES are not permitted without direct supervision…. … Students usually work in pairs, one of whom possesses a car, thereby saving much time. The two together, through conference, are less liable to meet a situation entirely unprepared, and are able to talk over the diagnosis and treatment. A record is required to be kept and is filed at the dispensary when the case is discharged…. … The work has a great practical value and a common remark by students is that they learn more practical medicine from this service than from any other course in medical school. It approaches the experience of actual practice and teaches self-reliance and initiative.

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