Transcript Document

“I Don’t Have Time For Students”
Showing Preceptors How to Be more
Efficient with Students
Oregon Health & Science University
Frances Biagioli, M.D., [email protected]
Associate Professor, OHSU Family Medicine
Claire E. Hull, MHS, PA-C – Clinical Coordinator
OHSU Physician Assistant Program
Objectives
Identify the most common causes of
running behind with students.
Identify concrete solutions to those
causes.
Create tools for clinical preceptors so they
can become more efficient teachers.
Create scripts and to use when recruiting
clinical preceptors to respond to the
comment: “I don’t have time for a student.”
Barriers to the Recruitment and
Retention of Clinical Preceptors
Preceptor Perceptions
– Patient population not accepting of students
– Lack of teaching experience
– Decreased productivity
– Not enough time to teach
When a preceptor has a student , what are
the barriers to running on time and thus
maintaining productivity?
We are here to discuss solutions
Remind Preceptors of the Benefits
Show them how others succeed
Provide preceptors with resources to help
them succeed.
Benefits for Clinical Preceptors
Increased enjoyment of clinical practice
Sense of giving back to the profession
Decreased sense of professional isolation
Satisfaction in being a role model for
students
Adjunct or volunteer faculty appointments
CME for teaching
Teaching improves own skills
“I’m Too Busy to Take a Student”
Classic teaching method used is an
inefficient and ineffective way of teaching
an learning
It is possible for preceptors to be effective
educators while maintaining high clinical
productivity
OHSU Faculty Teaching Hours vs.
Productivity RVU/clinic
Clinical Teaching Hours
RVU/clinic
600
500
400
300
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20
100
10
0
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G
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K
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Strategies Used*
Orient students to the practice setting
Clarify expectations to students
Schedule patients in such a way that maximizes
teaching and productivity
Provide frequent and immediate constructive
feedback to students
Share students with other practice partners
*Seim HC and Johnson OG. Clinical Preceptors: Tips for Effective
Teaching with Minimal Downtime. Fam Med1999; 31(8):538-9.
Practice Tips from Productive
OHSU Clinical Preceptors
See one, Do One, Teach One
Faculty is busy while student is – while
student is in one room faculty is seeing
one, two, or three other patients.
Don’t repeat student questions – rather,
summarize and clarify history.
Student is Value Added Team Member:
patient education, vitals, assist with getting
patient ancillary services
SMALL GROUP
Discussion Questions
Do you have clinical preceptors that seem
to have an endless capacity for students?
– What types of things do those preceptors do
differently?
What educational materials or methods
exist to help preceptors be more efficient?
Discussion Key Points
Good communication is critical!
– Orient student to the practice on first day
– Set clear goals and expectations; refine and update
goals as rotation progresses
– Provide feedback that is immediate and constructive
Quality not Quantity
– The quality of the patient encounter (having the
student follow one patient thoroughly, look something
up, and order their labs) and the teaching point is
more important than the number of patients the
student is seeing. If the student is seeing nearly every
patient with you – that is too much.
Discussion Key Points
Observation is important!
– Observe H&Ps and other skills over time with multiple
patients – don’t observe an entire physical all the
time.
– Don’t need to observe from start to finish all the time.
Choose which components of the patient encounter to
observe based on patient’s medical problem and
student’s skill level
– Have student keep track of what skills have been
observed (HPI, P.E., procedures, patient education,
etc). Communicate with student about what skills still
need to be observed and plan accordingly.
Discussion Key Points
Mix up the type of teaching you do.
– The classic teaching method of having the student
see the pt, come out and present the case, then the
two of you going back in can be very inefficient.
– Sometimes you can go in and observe the student “I
am going to be a fly on the wall” (and write your notes
while they do everything).
– Sometimes go in after they do the history.
– Sometimes you do the history and they do the
physical (you repeat what is needed).
– Sometimes just have them observe you.
Time Management
Begin clinic on time!
Double book patients such that the student can see one
patient and the preceptor sees the other patient;
maintains productivity
Set time deadlines for students: (“You have 10 minutes
to see this patient”)
Teamwork: As the student is obtaining the history or
performing the exam, the preceptor can enter the
information into the electronic medical record (or visa
versa)
Not necessary to repeat the entire HPI and PE obtained
by the student, just summarize with the patient what you
heard and add any clarifying statements.
Time Management
Plan ahead: Look at your schedule and preselect the patients the student will see… some
patients you know will take forever.
Utilize the student fully:
– Don’t repeat unnecessary items that you know
student does well, just clarify.
– Have students look up questions that the patients
have and after they discuss it with you call patients
back.
– Have students call patients with results after you
discuss them with the student.
– Have the student call specialists and help facilitate
care with ancillary services.
Time Management
Share the teaching responsibilities:
– Share teaching with practice partners
– Utilize nurses, medical assistants, lab
assistants to teach students in how to give
injections, perform lab tests, obtain an EKG,
practice blood draws, etc.
– The office manager, billing specialist,
scheduler, can teach the student about the
business side of clinical practice
– If you have more than one student they can
teach each other
Time Management
Use a Step-Wise Approach to Teaching
– Have student focus on one aspect of a patient
encounter rather than a comprehensive approach
with each patient.
– Example: For patient “A” who complains of shortness
of breath, the student should focus on the HPI only.
For patient “B” with asthma, the student should focus
on patient education. For patient “C” who developed
a new rash, the student should focus on the physical
exam.
– Example: Instead of allowing the student to perform
an entire procedure have him/her perform the digital
block/lidocaine injection the first time, and the next
time remove the toenail.
– Emphasize key teaching points only; lengthy
discussions usually not necessary.
Create the Right Environment
Patients are more accepting of students if they
are incorporated into the practice setting on a
regular basis
The preceptor’s passion for teaching will have a
positive effect on the students, staff, and
patients
Do students need training to access the EMR
system? How/when will this be done?
Consider the physical aspect of the clinic:
– Is there a place for the student to work?
– Are there enough exam rooms?
Resources
The One-Minute Preceptor
A strategy for instruction in the health care
setting that consists of the following steps:
– Get a commitment from the student
– Probe for supporting evidence
– Reinforce what was done well – be specific
– Give guidance about errors and omissions
– Teach a general principle
– Conclusion
Neher, J. O., Gordon K. C. et al. (1992). A five-step "microskills“ model of clinical
teaching Journal of the American Board of Family Practice, 5, 419-424
Resources
Preceptor Education Project
Sheets K and Garret E., Co-directors.
Preceptor Education Project: Facilitator’s
Guide, 2nd edition. Society of Teachers of
Family Medicine. 1999. Available to order
at http://stfm.org/bookstore
References
1. Zayas TT. Qualities of Effective Preceptors pf Physician Assistant
Students. Perspective on Physician Assistant Education 1999;10(1):7-11.
2. Seim HC and Johnson OG. Clinical Preceptors: Tips for Effective
Teaching with Minimal Downtime. Fam Med1999; 31(8):538-9.
3. McKee MD, Steiner-Grossman P, et al. Quality of student learning and
preceptors productivity in urban community health centers. Family Medicine
1998;30(2):108-12.
4. Salerno SM, O’Malley PG et al. Faculty development seminars based on
the one-minute preceptor improve feedback in the ambulatory setting. J
Gen Intern Med 2002; 17:779-787.
5. Skeff KM, Stratos GA, et al. Clinical teaching improvement: past and
future for faculty development. Fam Med 1997;29(4):252-7.
6. York NL, DaRosa DA, et al. Patients’ attitudes toward the involvement of
medical students in their care. Am J Surg 1995;169:421-3.
References
7. O’Malley PG, Omori DM et al. A prospective study to assess the effect of
ambulatory teaching on patient satisfaction. Acad Med 1997; 72:1015-7.
8. Gress TW, Flynn JA et al. Effect of student involvement on patient
perceptions of ambulatory care visits. J Gen Intern Med 2002; 17: 420-427.
9. Simon SR, Peters AS, et al. Effect of medical student teaching on patient
satisfaction in a managed care setting. J Gen Intern Med 2000; 15:547561.
10. Neher JO, Gordon KC, et al. A five-step “micro skills” model of clinical
teaching. J Am Board of Family Practice 1992; 5:419-424.
11. Sheets K and Garret E., Co-directors. Preceptor Education Project:
Facilitator’s Guide, 2nd edition. Society of Teachers of Family Medicine.
1999. Available to order at http://stfm.org/bookstore
http://www.oucom.ohio.edu/fd/monographs
http://stfm.org