The Community Physicians Role in Medical Student Education

1
The Community Physicians Role in Medical Student
Education

• An orientation module developed by the
• Office of Regional Medical Education
• The University of Texas Medical Branch
• School of Medicine

The University of Texas Medical Branch at
Galveston (UTMB) is accredited by the
Accreditation Council for Continuing Medical
Education to provide continuing medical education
to physicians. The University of Texas Medical
Branch at Galveston designates this educational
activity for a maximum of two (2) AMA PRA
Category 1 CreditsTM. Physicians should only
claim credit commensurate with extent of their
participation in the activity.
Estimated Study Time 2 hours Medium Used CD
and web-based access
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Version 1.4 Original Release Date July 1,
2007 Expiration Date July 1, 2010
2
Speaker

• Dr. Ainsworth is Associate Professor in the
  Department of Internal Medicine, and Associate
  Dean for Regional Medical Education at the UTMB
  School of Medicine. He is responsible for
  coordinating community-based education in the
  School of Medicine.

He also serves as Director of Clinical
Assessment and Professional Development in the
School of Medicine. In this role, his
responsibilities for student development include
direction of the Integrated Curriculum Evaluation
Exercise, which is the schools Year 4
interdisciplinary summative clinical skills
examination, and coordination of the school's
Professionalism Project, which emphasizes student
development in professional behavior skills.
In accordance with the Accreditation Council for
Continuing Medical Education (ACCME) standards
and the policy of the University of Texas Medical
Branch at Galveston, presenters are asked to
indicate if they have any relationship which, in
the context of their presentation, could be
perceived as a real or apparent conflict of
interest, (for example, ownership of stock,
honoraria, or consulting fees). Any such
relationship will be disclosed to the audience
and consideration will be given to possible
influences of their presentations. Dr. Michael
Ainsworth has no relevant financial relationships
with any commercial interest to the provider
(UTMB).
3
Objectives

• Describe and conduct the steps needed for
  effective precepting of medical students in your
  practice, including

• Preparation before the student arrives at your
  office
• Orienting the student on the first day
• Establishing your daily interactions with the
  student
• - Providing effective evaluation and feedback

4
Applying These Principles

• While many of the scenarios described in this
  module involve students in an office or clinic
  setting, most of these principles will apply to
• Inpatient and outpatient encounters
• University and community-based sites
• General and specialty-based practices
• Learners of all levels

5
Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• Preparation Before the Student Arrives
• When the Student Arrives
• Daily Interactions
• Evaluation and Feedback

6
Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• Before the student arrives
• 1 Know course objectives
• Do you have what you need from the course?
• Determine the range of possible student
  activities
• Think about the students schedule

Hint The evaluation form you will complete on
each student at the end of the rotation can be a
useful tool in planning your time with the
student.
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Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• Before the student arrives
• 2 Prepare your office
• Staff
• Space
• Special concerns

Hint Thinking about these issues before the
student arrives is the best way to make your
orientation of the student upon arrival efficient
and effective.
8
Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• When the student arrives
• 3 Orient and set expectations
• to your staff, facility, and practice
• to your (courses) expectations
• attendance
• behaviors
• challenges
• determine the students needs

LINK TO STUDENT ORIENTATION
9
Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• When the student arrives
• 3 Orient and set expectations

10
Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• Daily interactions
• 4 Tailor to the level of learner
• Pre-clerkship level
• Look to go beyond observation alone
• Year 3 and 4 clerkships/electives
• Expect graded responsibility
• Independent patient evaluations

LINK TO STUDENT EXPECTATIONS
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Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• Daily interactions
• 5 Incorporate students into patient flow
• Wave scheduling
• 800-820
• Student sees patient 1 preceptor sees patient 2
• 820-840
• Student and preceptor see patient 1 together
• 840-900
• Student charts on patient 1 preceptor sees
  patient 3
• Non-patient activities

LINK TO PATIENT FLOW SUMMARY
12
Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• Daily interactions
• 5 Incorporate students into patient flow

13
Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• Daily interactions
• 6 Teachable moments
• Get a commitment
• Probe for supporting evidence
• Teach general rules
• Reinforce what was right
• Correct mistakes

LINK TO ONE MINUTE PRECEPTOR
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Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• Daily interactions
• 7 Asking effective questions
• Lower and higher-level questions
• Cognitive and affective questions
• Closed and open-ended questions
• Leading, asserting or humbling questions
• Effective wait time

LINK TO ASKING EFFECTIVE QUESTIONS
15
Teaching versus Evaluationthe differences

• A teachers role An evaluators role
• collegial detached
• generous rigorous
• student advocate impartial
• individualized based on criteria
• formative summative

16
Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• Evaluation and Feedback
• 8 Judge the level of skills
• FOCUS
• Follow categories on evaluation form
• Observe and measure
• Critically identify problems early
• Use evaluation scale
• Summarize for student

17
Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• Evaluation and Feedback
• 9 Provide Effective Feedback
• Effective feedback is
• S Specific
• O Observational
• R Relevant
• T Timely

18
Ten Steps You Can Take To Maximize the
Student-Preceptor Experience

• Evaluation and Feedback
• 9 Provide Effective Feedback

19
Providing Effective Feedback

• SPECIFIC rather than general
• Avoid statements applicable to all students
• I am sure John will improve further with time
  and practice.
• Avoid unreferenced comparisons
• John is performing about as I expect for a
  second-year student.
• He and Mary are performing at about the same
  level.
• See my evaluation of student X for comments
  applicable to Johns performance as well.
• Mary is below average. I can recall several
  examples and I discussed them with her.

20
Providing Effective Feedback

• OBSERVATIONAL behaviors - not judgments
• Avoid drawing excessive conclusions
• John seemed distracted during office sessions
  like he had some personal problems outside of
  class.
• John seemed to have real problems expressing
  himself, but this is due to cultural
  differences.
• Avoid introducing your personal feelings
• Mary was disorganized in her presentations, but
  she was at a disadvantage because the course does
  not emphasize this enough.
• John acted squirrelly at times.
• She has a Mona Lisa smile.

21
Providing Effective Feedback

• RELEVANT rather than off-topic
• Avoid statements not related to evaluation
  categories
• Based on my observation of her skills in the
  office, I suspect Marys test performance is
  going to be good.
• He always wore a nice tie.
• Avoid emphasizing issues outside of the students
  control
• John should have spent more time with me in the
  office being absent on Monday afternoons for
  coursework on campus detracted from the time I
  had to evaluate him.

22
Providing Effective Feedback

• TIMELY rather than delayed
• Late evaluations compromise
• Ability to recall meaningful details accurately
• Credibility of critical comments
• Opportunity for student to change before next
  course

23
10 Things You Can Do To Maximize the
Student-Preceptor Experience

• Before Student Arrives
• 1 Know course objectives
• 2 Prepare your office
• When the Student Arrives
• 3 Orient and set expectations
• Daily Interactions
• 4 Tailor to level of learner
• 5 Incorporate into patient flow
• 6 Teachable moments
• 7 Asking effective questions
• Evaluation and Feedback
• 8 Judge the level of skills
• 9 Providing effective feedback

24
10 Things You Can Do To Maximize the
Student-Preceptor Experience

• Before Student Arrives
• 1 Know course objectives
• 2 Prepare your office
• When the Student Arrives
• 3 Orient and set expectations
• Daily Interactions
• 4 Tailor to level of learner
• 5 Incorporate into patient flow
• 6 Teachable moments
• 7 Asking effective questions
• Evaluation and Feedback
• 8 Judge the level of skills
• 9 Providing effective feedback

10 REMEMBER You are a role model for your
student
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The Community Physicians Role in Medical Student
Education
Link to Program Evaluation Form

• An orientation module developed by the
• Office of Regional Medical Education
• The University of Texas Medical Branch
• School of Medicine Galveston, TX

Link to Post-Test and CME Credit Request Form
Portions adapted from the North Carolina AHECs
Expert Preceptor Interactive Curriculum (EPIC)
Credits Virginia Niebuhr, PhD Constance Baldwin,
PhD Karen Szauter, MD Jack Scott, EdD Pamela
Hentschel, MS
Video Segments Courtesy of Jack Scott, EdD Video
performances by Toi Shelton Karen Szauter,
MD Lindsay Szauter Judy Thornton, MS
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The Community Physicians Role in Medical Student
Education

• Sources of inspiration for this module include
• Society of Teachers of Family Medicine. Preceptor
  Education Project workshop leaders manual.
  Kansas City, MO. Society of Teachers of Family
  Medicine, 1992.
• Baldwin CD, Niebuhr VN. Teaching Skills for
  Preceptors in the Community Setting A
  self-directed continuing education package.
  Developed for the Robert Wood Johnson Generalist
  Physician Initiative at the University of Texas
  Medical Branch. Contributions from Megan Becker,
  PhD, D. Lawrence Camp, PhD, Harold G. Levine, MA,
  Jennifer Peel, PhD, Alice Speer, MD, and Barbara
  Thompson, MD. 1996 re-edited 2004.

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The Community Physicians Role in Medical Student
Education

• Sources of inspiration for this module include
• EPIC (Expert Preceptor Interactive Curriculum).
  http//www.med.unc.edu/epic
• The Office of Educational Development at the
  University of North Carolina School of Medicine
  and the Office of Regional Primary Care
  Education, Mountain AHEC, Asheville, NC.
  Developed with a HRSA Family Medicine Training
  Grant (1D15PE50119001) to the Mountain AHEC
  Office of Regional Primary Care Education,
  Asheville, NC. 1998.
• Preceptor Development Program. University of
  Virginia, Department of Family Medicine. In
  Progress.
• http//med-dev.hscs.virginia.edu/courses/fm/prece
  pt/index.htm.
• HRSA Family Medicine Predoctoral Training Grant
  to the University of Virginia (5D16HP00134-03-00)
  , with the efforts of Lisa. K. Rollins, PhD,
  Karen Maughan, MD (Clerkship Director), John
  Gazewood, MD, MSPH (Predoctoral Director), and
  John Jackson, MS (Medical Education Support).
  2006.

End Show