When It Starts to Come Together: Doctoring in Vermont

Dario Vanegas is a medical student in the UVM Larner College of Medicine Class of 2025.

In the following blog post, Vanegas writes about his experience in the Vermont Integrated Curriculum course – “Doctoring in Vermont.”

“Doctoring in Vermont is a course that spans the first and second year of Foundations. Students spend 8 sessions in the office of a primary care physician within a one-hour drive of Burlington. Students travel to their preceptor’s office, observe direct patient care, and practice interviewing and examination skills.” Learn more about Doctoring in Vermont and the VIC.

UVM Larner College of Medicine Assistant Professor of Medicine Jose Lopez, M.D., and Dario Vanegas.

Initiative and Connection

As I reflect on my first year of medical school, the experiences and lessons have been many, but Doctoring in Vermont (DIV) was certainly the most meaningful activity. This is a course during which we are paired with a primary care physician in the community based on our specialty preferences and given the opportunity to see patients to apply the knowledge we have acquired in our pre-clinical courses. In my case, I selected family medicine as my preferred specialty and was fortunate to be paired with Dr. Jose Lopez who is a primary care physician in the Family Medicine Department at the Central Vermont Medical Center.  

One of the first things Dr. Lopez told me was that he wanted me to have a good experience and that he was comfortable with me being as hands-on as I wanted to be. This gave me the confidence to immerse myself in aspects I felt confident with and to take a step back when I needed to. After seeing our first patient together and observing how Dr. Lopez navigated the visit, I took a step forward and saw the next patient on my own. The patient came to the clinic with their mother due to ongoing anxiety and unexplainably getting sick often. Their concern was palpable and although I had yet to learn about anxiety in our curriculum, I had been taught many other valuable skills such as taking a thorough patient history, listening actively, and being compassionate. This was enough to make both the patient and mother comfortable while gathering all the pertinent details.  

Once I finished the patient interview, I presented the case to Dr. Lopez. We discussed the history of present illness (HPI), social history, differential diagnosis, and formulated a plan. Then, we provided our recommendations to the patient together. As we all came to an agreement and closed the visit, the patient’s mother told Dr. Lopez that I had done a great job and that they were content with the outcome of the visit. That one compliment meant the world to me because it provided me with confirmation that I was on the right track and that the education I have received at the Larner College of Medicine thus far is making a difference so early on. For the remaining visits that day, I alternated between seeing one patient with Dr. Lopez and seeing the next patient on my own. In the blink of an eye, the day came to an end. Driving home, I felt a great sense of satisfaction and gratitude to have the opportunity to help others in a meaningful way.  

The Learning Process and Calibration

Over the next few sessions in DIV, I built on the foundation of the first session, adding layers to my learning process. It was evident that I was having success in key areas such as taking a patient history and connecting with patients, but through reflection and feedback from Dr. Lopez, I realized I needed to improve on elements such as conducting physical exams and being able to summarize a patient visit in a succinct manner. Consequently, I began focusing on doing physical exams on every patient to further develop skills including observing, auscultating, palpating, percussing, and even more specialized exam techniques to test for musculoskeletal and neurological function. I took the same focused approach for presenting cases in a simple manner that encompassed the essence of the patient visit. Gradually, through continued practice and feedback from Dr. Lopez, I began to make progress and feel more comfortable with these components.  

During the final session of DIV of the Spring semester, it was time to put it all together. Throughout the day, we saw patients with a variety of needs ranging from acute cases, chronic care management, annual physical exams, prescription refills, and preoperative visits. Some of the patient visits were more complex than others, but they were all rewarding because we were able to meet their specific needs and enhance their wellbeing. Once the day concluded, Dr. Lopez provided me with my midterm assessment in which he highlighted my motivation, curiosity, and ability to connect with patients while giving me a satisfactory mark on all the criteria assessed. It was the perfect day to round out the first half of DIV and upon leaving the office it was clear that through this experience I had taken the next step in my medical education. 

Mentorship and Lessons

It is important to highlight that one of the cornerstones of my growth during DIV was Dr. Lopez’s mentorship. The trust he showed me from the first day, along with his adaptability to my comfort level, was fundamental for me to fully engage with the experience.

The way he provided feedback was always calm and tactful. For instance, instead of directly telling me that I was struggling with succinctly summarizing patient visits, he would remind me at the end of each patient visit to continue practicing that skill with him. Moreover, whenever I had a question or concern, he took his time to address it.

Thus far, Dr. Lopez has taught me to meet patients where they are at, to be a lifelong learner, and to carry myself in a composed manner through it all. These are lessons I will take with me going forward and I will always be grateful for his guidance.

The experience was a validation of my journey, the daily hard work, and confirmation that primary care is where my true passion lies. As I look ahead, I am excited for the second half of DIV and determined to continue voraciously learning with the goal of becoming the best physician I can be and providing medical care that is second-to-none to my future patients.