The Community Physician’s 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
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 school’s
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).
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
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
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
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 student’s 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.
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.
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 (course’s) expectations
– attendance
– behaviors
– challenges
determine the student’s needs
LINK TO STUDENT ORIENTATION
Ten Steps You Can Take To Maximize
the Student-Preceptor Experience
When the student arrives
# 3 Orient and set expectations
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
Ten Steps You Can Take To Maximize
the Student-Preceptor Experience
Daily interactions
# 5 Incorporate students into
patient flow
Wave scheduling
8:00-8:20
Student sees patient 1; preceptor sees patient 2
8:20-8:40
Student and preceptor see patient 1 together
8:40-9:00
Student charts on patient 1; preceptor sees patient 3
Non-patient activities
LINK TO
PATIENT
FLOW
SUMMARY
Ten Steps You Can Take To Maximize
the Student-Preceptor Experience
Daily interactions
# 5 Incorporate students into patient
flow
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
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
Teaching versus Evaluation
…the differences
A teacher’s role:
An evaluator’s role:
…collegial
…detached
…generous
…rigorous
…student advocate
…impartial
…individualized
…based on criteria
…formative
…summative
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
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
Ten Steps You Can Take To Maximize
the Student-Preceptor Experience
Evaluation and Feedback
# 9 Provide Effective Feedback
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 John’s performance as well.”
“Mary is below average. I can recall several examples
and I discussed them with her.”
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.”
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 Mary’s test performance is going to be good.”
“He always wore a nice tie.”
Avoid emphasizing issues outside of the
student’s 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.”
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
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 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
The Community Physician’s 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 Galveston, TX
Link to Program
Evaluation Form
Link to Post-Test and
CME Credit Request Form
Portions adapted from the North Carolina AHEC’s Expert Preceptor Interactive Curriculum (EPIC)
Credits
Video Segments Courtesy of Jack Scott, EdD
Virginia Niebuhr, PhD
Video performances by:
Constance Baldwin, PhD
Toi Shelton
Karen Szauter, MD
Karen Szauter, MD
Jack Scott, EdD
Lindsay Szauter
Pamela Hentschel, MS
Judy Thornton, MS
Michael Ainsworth, MD
Associate Dean for Regional Medical Education
301 University Blvd
Galveston TX, 77555-0410
(409) 772-6928 mainswor@utmb.edu
www.meded.utmb.edu/orme
The Community Physician’s Role
in Medical Student Education
Sources of inspiration for this module include
Society of Teachers of Family Medicine. Preceptor Education Project:
workshop leader’s 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.
The Community Physician’s 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/precept/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