Transcript Document

What Can We Learn From Our
Successful Clinical Preceptors?
Claire E. Hull, MHS, PA-C - Clinical Coordinator
Frances Biagioli, M.D. - Medical Director
Oregon Health & Science University
Physician Assistant Program
November 19, 2008
Acknowledgements
Faculty Development Institute
Joe Schwenkler, MD
Toya Vigne
Webinar Format
Audience participation
If you have a question…
All questions may not be answered during this
webinar. However, any comments or questions
can be sent to me by e-mail: [email protected]
Education Goals and Objectives
Identify the characteristics of a successful
clinical preceptor
Describe the ways to use the experience
of successful clinical preceptors to
– provide faculty development to new and
established preceptors
– develop recruitment tools to engage new
clinical preceptors
Challenges to the Recruitment and
Retention of Clinical Preceptors
Concerns about productivity
Concerns that patient population will not be
accepting of a student
Good clinician does not equal good teacher
Logistical barriers: housing, EMR, transportation,
lack of space, etc.
Preceptor Burnout
Competition with other programs
Student Perspectives
Top 5 characteristics obtained from a
survey of 119 students1
– Preceptors welcomed student questions
(86%)
– Enthusiastic about having a student (77%)
– Answered questions thoroughly (77%)
– Encouraged more student responsibility as
the rotation progressed (66%)
– Asked questions in a non-threatening manner
(66%)
–
1Zayas
TT. Qualities of Effective Preceptors of Physician Assistant
Students. Perspectives on Physician Assistant Education 1999;10(1):7-11.
Preceptor Perspectives
Top 5 characteristics obtained from a survey of 40
preceptors asking them to rate their own effectiveness
as a preceptor1
– Welcomed questions from students (84%)
– Enthusiastic about having a student (74%)
– Always available for supervision (66%)
– Answered students’ questions thoroughly (61%)
– Gave students clear instructions regarding clinic
schedule (61%)
–
1Zayas
TT. Qualities of Effective Preceptors of Physician Assistant
Students. Perspectives on Physician Assistant Education 1999;10(1):7-11.
Student Perspectives
PA students from OHSU2:
– Students feel welcome in the practice
– Open and frequent communication
– Students are directly observed
– Preceptor takes an active interest in the
student’s learning
–
2Unpublished
data collected from student surveys of clinical preceptors
and rotation sites
“I’m too busy to take a student!”
Vinson and Paden et al
found that the
presence of a learner
adds on average 45
minutes per day
OHSU Faculty Teaching Hours vs. Productivity
600
Pink is productivity per clinic session
Blue is teaching hours per yr
500
400
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200
100
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B
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Z AA
Scheduling Patients
Create a “student schedule”
– Schedule appointments with student
– Review the schedule each day
– Include more spots for walk-in acute problem visits
Share the teaching responsibilities
– Engage other providers to get involved
Double Up!
– Precepting more than one student at a time can be
easier
Integrating the Student
into the Practice
Distribute a plaque or tent card to display
in the office
PHYSICIAN ASSISTANT PROGRAM
CLINICAL ROTATION STUDENTS
This office has been selected as a training site
for Physician Assistant students from Oregon
Health & Science University. This practice has
shown a sincere interest in teaching and has
been carefully selected to provide students with
an excellent experience in patient care. Your
participation is appreciated but purely voluntary.
Thank You.
Integrating the Student
into the Practice
Discuss with the staff how the student will
be introduced to the patients
Regular presence of students in the
practice
Other Activities for Students
Patient Education
– Chronic disease management
– Community health experience
Additional Assignments
– Using EBM to answer a clinical question
– Researching a clinical problem and reporting
back to preceptor
The One Minute Preceptor*
Get a Commitment
Probe for Supporting Evidence
Reinforce What was Done Well
Give Guidance About Errors and
Omissions
Teach a General Principle
Conclusion
*Neher JO, Gordon KC, et al. A five-step “microskills” model of
clinical teaching. J Am Board of Family Practice 1992; 5:419-424.
Being a good clinician
does not necessarily mean
you are a good teacher
% of
preceptors
Huang WY and Monteiro FM who discussed
this issue
Observations made during orientation
Student’s past rotations
Types of patients to be seen
88%
75%
Preceptors goals
Responsibility of student in patient care
75%
63%
Student’s goals
Time to spend with each patient
63%
50%
How preceptor liked to teach
What did student wish to learn
Specific learning objectives
50%
38%
38%
Negotiation and prioritization of goals
0%
Observations made during teaching
encounters with patients
Huang WY and Monteiro FM
% of
preceptors
who
discussed
this issue
Student saw patient independently
74%
Student wrote or dictated note
Discussed patient after student assessment
66%
64%
Focused on 1 or 2 teaching points
56%
Taught how to do part of physical
38%
Gave general feedback to student
9%
Gave positive feedback to student
9%
Gave negative feedback to student
0%
Issues discussed in the final evaluation
session at end of clerkship rotation
Huang WY and Monteiro FM
% of
preceptors
who
discussed
this issue
Student’s clinical skills
75%
Specific aspects of student performance
75%
Preceptor allowed student to assess rotation
50%
Preceptor allowed student to assess preceptor
25%
Discussed goal that were achieved
0%
Why Evaluations Are Important
Evaluating learners is a basic expectation
of teaching
Assist programs in making decisions
regarding advancement.
Preceptors help determine whether
students have the knowledge, attitude and
skills to be future health care providers
Effective and ongoing evaluation can
enhance the rotation experience
Evaluations
Evaluations should be scheduled
Formal session
Ideally done at regular intervals
Based on objective data and personal
observation
Evaluation vs Feedback
FEEDBACK
EVALUATION
Timing
Timely
Formal
Setting
Informal
Formal
Basis
Observation
Observation
Content
Objective
Objective
Scope
Specific Actions Global Performance
Purpose Improvement
Grading & Improvement
The G-R-A-D-E Strategy for
Evaluation
G:
R:
A:
D:
E:
Get Ready
Review Expectations with Learner
Assess
Discuss Assessment at Midpoint
End with a “Grade”
Langlois JP and Thach S. Evaluation using the GRADE strategy.
Fam Med 2001; 33(3):158-60.
Strategies to keep current preceptors engaged and
interested in teaching PA students?
Show appreciation by giving gifts, banquets in their
honor, lunches, awards, certificates of
appreciation, etc.
Provide CME presentations (on CD-ROM, webinar
or online format)
Provide materials related to teaching
Strategies to keep current preceptors engaged and
interested in teaching PA students?
Cherry-pick students for preceptors – send strong
students to preceptors who may be burning out
Offer adjunct/affiliate faculty appointments
Write a program newsletter to keep preceptors in
the loop; highlight a preceptor or site in
newsletters to give them some recognition
Provide student evaluations to preceptors;
highlight positive
Case Scenario
Dr. XY has been a clinical preceptor for several
years and usually precepts several students a
year in his pediatric office. Student evaluations
of this preceptor are mediocre. Students
indicate that he does not provide them with
much feedback, and that “he seems too busy to
teach”. Student comments also include
statements such as “I spent a lot of time
observing because he didn’t want to get too far
behind.”
Possible Strategies
Encourage students and preceptors to discuss
individual learning and teaching styles at the
outset.
Emphasize importance of students seeking out
additional learning opportunities
Encourage sharing responsibilities of teaching
with other providers
Discuss ways to create a “student schedule”;
student does not need to see every patient
Involve office manager with logistics
Case Scenario
You have been successful in scheduling a
meeting with a family practice group who
have expressed an interest in precepting
PA students from your program. Although
they would like to help out, they are
concerned that they are too busy to have a
student
Possible Strategies
Bring to the meeting a preceptor handbook, do a formal
presentation on the program, highlight benefits of
precepting, learning objectives for rotation, evaluation
forms.
Outline expectations and goals of both the PA program
and the preceptors/site.
Gauge their intent: how committed are they to teaching?
What are their expectations in terms student working
hours?
What is the practice make-up? Who would be
responsible for precepting students?
What is the administrative process for placing a student
at the site? (EMR training, hospital privileges, etc)
Possible Strategies
Potential concerns to address:
– Make sure they understand the PA role, scope of
practice
– Student doesn’t need to see every patient
– Discuss/reference other successful preceptors
– Emphasize importance of sharing responsibility
among preceptors; suggest rotating preceptors each
month
– Suggest a “trial run” – not locked in to precepting (and
send a great student!)
– Explain the skill level of the student and clearly define
expectations
– Strong communication between PA program and
preceptors
Summary Key Characteristics
of Effective Preceptors
Provide an adequate orientation to the practice setting
Make students feel welcome
Clarify expectations and goals
Schedule patients to maximize teaching and productivity
Provide frequent and immediate constructive feedback
Maintain a system of frequent and open communication
with the student as well as the program
Remind Them of the Benefits of
Precepting Students
Increased enjoyment of clinical practice
Sense of giving back to the profession
Satisfaction in being a professional role
model
Decreased sense of professional isolation
Adjunct or volunteer faculty appointments
CME for teaching
Teaching improves own skills
Nobody’s Perfect
Please e-mail me
your questions or
comments:
[email protected]
Resources
Society for Teachers in Family Medicine:
http://stfm.org
http://www.oucom.ohio.edu/fd/monographs
http://www.med.unc.edu/epic/
A faculty development curriculum in clinical teaching for community
practitioners who serve as preceptors to health professions students
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. MacDonald PJ and Bass MJ. Characteristics of Highly Rated
Family Practice Preceptors. J Med Educ 1983; 58:882-893.
4. 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.
References
5. 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.
6. Skeff KM, Stratos GA, et al. Clinical teaching improvement: past
and future for faculty development. Fam Med 1997;29(4):252-7.
7. York NL, DaRosa DA, et al. Patients’ attitudes toward the
involvement of medical students in their care. Am J Surg
1995;169:421-3.
8. 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.
References
9. 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.
10. Simon SR, Peters AS, et al. Effect of medical student teaching
on patient satisfaction in a managed care setting. J Gen Intern Med
2000; 15:547-561.
11. Neher JO, Gordon KC, et al. A five-step “microskills” model of
clinical teaching. J Am Board of Family Practice 1992; 5:419-424.
12. 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
References
13. Huang WY and Monteiro FM. Teaching behaviors used by
community –based preceptors for a family and community medicine
clerkship. Fam Med 2000;32(10):678-80.
14. Lyons P. Get out of my office. Fam Med 2000;32(10): 675-7.
15. Langlois JP and Thach S. Evaluation using the GRADE
strategy. Fam Med 2001; 33(3):158-60.