Dr. Thomas has a teaching agreement with OHSU School of Medicine and welcomes first- and second-year medical students for a 10-week clinical preceptorship — ten half-day visits, one per week. Students from other accredited medical schools are also welcome to apply.
The following is adapted from the orientation letter sent to incoming students.
About This Practice
This is a subspecialty practice — laryngology, a subspecialty of otolaryngology. I see only problems related to the larynx and do not perform general otolaryngology at all. My new patient exams are about an hour long. Typically you will use about 10 minutes to collect a history and present your findings.
To orient yourself before arriving, review this site — particularly the sections on diagnosis and how voice works. Two resources that are especially useful: the Secrets of Listening handout, which describes a very important and different aspect of my practice — the ability to hear a problem rather than just look for one — and the neurolaryngology booklet. At a minimum, familiarity with laryngeal anatomy including the names of the cartilages, muscles, and nerves is a helpful baseline. I also have instructional lectures on YouTube at youtube.com/@docvox.
What You Will Learn
Medical students observe a great deal, but there are real hands-on opportunities for the prepared student. You will experience looking into the ears and nose, though there is seldom general ENT pathology here. If you can learn to coordinate using a headlight with a speculum and see into the openings of the ears, nose, and mouth, you will be ahead of the bulk of your colleagues.
If you can learn a little about the manipulation of an endoscope — and more importantly, what incredible detail can be seen with a scope when used appropriately — I will feel satisfied with your training. Many physicians possess excellent tools; many use them incompletely.
You will also be able to generalize your learning to other subspecialty practices, and compare this model to general internal medicine or family practice — incredible detail about one area versus the beauty of the panorama but unable to know everything well. This should also alert you to how difficult it is to know what you don’t know.
You will also see how a private solo practice runs with a tolerable overhead where a physician is one’s own boss. We can discuss finances, procedure coding, and practical items applicable to all practices.
Hands-On Opportunities
Most students perform an endoscopy. You are welcome to coordinate having another student visit late in the afternoon — you may use the endoscope on each other and record your own vocal cords. You are welcome to a copy of the recording. There will likely be one or two patients during the term who are appropriate for you to run the endoscope on, if you are observant and prepared after having watched a number of laryngoscopies. You will likely also be able to perform some trans-tracheal injections.
If you feel you are ready to take on more of the intake history and ENT exam, please speak up and we will arrange it. Surgery is mostly in the mornings — if you would like to observe, make any arrangement you like with my front office staff.
The Weekly Reflection Email
This is the most important part of getting value from your time here. After each visit, please write a concise, insightful paragraph to me by email elaborating on what you observed and how any reading you did relates to what you saw in the office. Concentrate especially on how what you observed impacts your perception of the practice of medicine.
Students who do this shortly after their day in the office have found it rewarding. Students who wait until an hour before their next visit have found it tedious — and I have found their time management skills wanting. There are no limitations on this writing; be creative. You may draw on the medical literature if appropriate, or equally from your own personal experience.
Practical Notes
Dress: I do not wear a lab coat — since COVID-19 I wear scrubs full time in the office. You may dress in a way that feels comfortable, but probably not jeans casual.
Patient conduct: The patient is king/queen here. Whenever a patient is in the office, all conversation and activity should be for the patient’s benefit. You cannot be too deferential. Use the patient’s last name with the appropriate title — Mr. Smith, Dr. Jones — even if I am using a first name due to a longstanding relationship.
Transgender patients: I work almost daily with transgender individuals. You will have the opportunity to interact with people of various gender orientations, and pronouns are respected here as they are at OHSU.
Phones and notes: Taking notes is a great idea and helps you formulate your weekly emails. If you use your phone for notes, please avoid social media while in the exam room.
Time management in the exam room: If you are assigned to interview a patient and I have allotted an hour total, you have about 5–7 minutes to gather as much information as you can, then summarize it into 3–5 sentences as a presentation. Communication in medicine is both gathering information and distilling it to its essence. We will work on this together.
Staff: Get to know Jacquelyn and Jonica. They have a wealth of experience dealing with patients and running a small office, and you can learn as much from them as from me.
How to Apply
OHSU students should arrange the preceptorship through the school’s standard preceptorship process. Students from other accredited schools are welcome — contact the office directly via the contact form or email thomas@voicedoctor.net. Include your school, year, and the term you are hoping to attend.