The program will start promptly at 1:30 PM
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Teaching Medical, PA, or
NP Students in Community
Practices
What Community Practitioners
Need to Know
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Presentation Objectives
 By the end of this presentation, attendees will:
– Understand some of the issues related the
physician shortage in Georgia.
– Know why community practices are well-suited for
the training of medical, NP and PA students.
– Appreciate the key role that Georgia’s AHECs play
in facilitating health sciences education in the
state.
– Be able to decide if their clinical practice is suitable
for teaching medical, NP and PA students.
– Realize that they can be excellent preceptors with
minimal amount of additional training.
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Georgia Has a Physician
Shortage
 Georgia ranks 9th in population,
but 39th in total physician supply
per 100,000 population
 Georgia ranks 34th among the 46
states that have medical
schools in the number of
medical students per 100,000
population
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Where Do Med Students End Up
Practicing?
 Medical students practicing in Georgia:
– MCG: 52.9%
– Emory: 38.1%
– Mercer: 57%
– Morehouse: 47%
– All Georgia medical schools: 47.5%
 National average in states with medical schools:
39% retention rate
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Addressing Physician Shortages in
Georgia
 Additional efforts are being made to increase
the number of physicians in Georgia by
increasing medical school class size:
 MCG:
– Increasing class size (190-200)
– Developing new regional campus in Athens
(40 students entering in 2010).
 Mercer => Savannah: 30 students per year
(began 2008)
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Causes for Physician Shortages in
Georgia
Distribution
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Causes for Physician Shortages in
Georgia
 Distribution
 Decreasing attractiveness of primary care
compared with specialties with higher salaries
or “controllable lifestyles.”
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Educational Debt of Graduating Medical
Students in GA’s Medical Schools
National Debt Level of Medical Students:
• 50% with ≥$80,000
• Median debt nationally: $115,000 (pub. schools); $150,000 (priv. schools)
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Causes for Physician Shortages in
Georgia
 Distribution
 Decreasing attractiveness of primary care
compared with specialties with higher salaries
or “controllable lifestyles.”
 Physician demographics & work preferences:
– Younger generation: preference for working
shorter hours, greater emphasis on family &
quality of life issues
– Increasing numbers of female physicians
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Because of the current and
projected unequal distribution
of primary care physicians,
there is an increased need to
train PA’s and NP’s to help
meet the health care needs of
the citizens of Georgia . . . . .
Medical School: The Big
Picture
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Medical School: The Big Picture
Transformation
Physicians
Students
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Medical School: The Big Picture
Transformation
Physicians
How Does It
Happen?
Students
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First 2 Years of Medical School
Basic Science Foundation
Clinical Skills
Communication Skills
Professionalism
Cultural Competence
Principles of Life-long Learning
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rd
3
Year  Clinical Training




Internal Medicine:
Surgery:
Neurology:
Elective:
8 Weeks
8 Weeks
4 Weeks
4 Weeks




Pediatrics:
OB/GYN:
Family Medicine:
Psychiatry:
6 Weeks
6 Weeks
6 Weeks
6 Weeks**
**4 weeks in 2009, with 2 week Intersession
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Where Do Medical Students Get
Their Clinical Training?
 Venues for training learners are changing:
– Less inpatient, more ambulatory
– Inadequate clinical opportunities near the
academic medical center
– Need for more realistic experiences for students,
especially in primary care
 Results:
– Community-based learning opportunities
– Opportunities to interact with other health care
providers => “Real World”
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Critical Role of Community-Based
Teaching Sites in the School of Medicine
 Third year core clerkships:
– 30% at geographically separated sites distant from
MCG
– 50% are ambulatory-based
 Community-based sites in:
– Medicine
Surgery
– Family medicine
Pediatrics
– Neurology
OB/Gyn
– Emergency Medicine
Psychiatry
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http://www.foothillsahec.org/default.htm
Role of AHEC in Medical Student
Education
 On-site coordinator with community preceptors and
MCG
 Housing assistance
 Assistance with logistical support for students (when
needed)
 Educational support when needed (helping with
exams in Pediatric Clerkship, for example)
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To study the phenomenon
of disease without books is
to sail an uncharted sea,
while to study books without
patients is not to go to sea at
all.
Medicine is learned by the
bedside and not in the
classroom.
-Sir William Osler, M.D.
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What Really Needs to Be
Accomplished in the
“Clinical” Years of
Training?
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Accomplished in the Clinical Years of
Training?
 Knowledge: Basic science
knowledge needs to be reorganized
into clinically relevant structure
– “Disease-Based”  “Sign or
Symptom-Based”
– Development of clinical
associations, applications
– Facts  Patient-focused
– Knowledge  Action
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Goal for Clinical Teaching Encounters
Help the learner develop
his/her clinical knowledge by
creating a new link or
association from every patient
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What Are the Links or Associations That
You Want to Teach?
 Knowledge
– Clinical presentation of diseases
– History-taking questions/content
– Differential diagnosis
– Natural history of diseases
– Therapy
– Management
– Anticipatory guidance
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What Really Needs to Be Accomplished
in the Clinical Years of Training?
 Knowledge: Basic science knowledge needs to be
reorganized into clinically relevant structure
– “Disease-Based”  “Sign or Symptom-Based”
– Development of clinical associations
– Development of new clinical knowledge
 Skills:
– Development of basic clinical skills
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Clinical Skills Students Need to Learn
from
Their Preceptors
 History-Taking
Skills
– Verbal
– Non-verbal
– Organization
 Physical Examination Skills
 Reporting Skills
– Oral & Written
 Technical Skills
– Reading X-Rays
– Interpreting lab studies
– Writing prescriptions
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What Really Needs to Be Accomplished
in the Clinical Years of Training?
 Knowledge: Basic science knowledge needs to be
reorganized into clinically relevant structure
– “Disease-Based”  “Sign or Symptom-Based”
– Development of clinical associations
– Development of new clinical knowledge
 Skills:
– Development of all basic clinical skills
 Prepare for residency training (Med Students)
– Pass USMLE Step 2CK, 2CS
– Make a career choice  prepare for the “Match”
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“The natural method of
teaching the student
begins with the patient,
continues with the patient,
and ends his studies with
the patient, using books
and lectures as tools, as
means to an end”
Sir William Osler, M.D.
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Why Are Community
Physicians Uniquely
Qualified to Teach Medical,
NP and PA Students?
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Community Physicians Are Uniquely Qualified
to Teach Medical, NP or PA Students
Provide more opportunities for
students to see “real world” patients
– History-Taking and Physical Exam Skills
– Written records, oral presentations
– See diseases and conditions they’ve only
read about
If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org
Community Physicians Are Uniquely Qualified
to Teach Medical, NP or PA Students
 Provide more opportunities for students to see “real
world” patients
– History-Taking and Physical Exam Skills
– Written records, oral presentations
– See diseases and conditions they’ve only read
about
 Provide more opportunities for students to apply
their clinical knowledge:
– Differential diagnosis, evaluation
– Management/Treatment/Follow-up
If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org
Community Physicians Are Uniquely Qualified
to Teach Medical, NP or PA Students
 Provide more opportunities for students to see “real
world” patients
– History-Taking and Physical Exam Skills
– Written records, oral presentations
– See diseases and conditions they’ve only read
about
 Provide more opportunities for students to apply
their clinical knowledge:
– Differential diagnosis, evaluation
– Management/Treatment/Follow-up
 More clinical opportunities  more learning
If you have any technical issues, please contact 404-969-0387 or email support@healthtecdl.org
Community Physicians Are Uniquely Qualified
to Teach Medical, NP or PA Students
 Provide more opportunities for students to see “real
world” patients
– History-Taking and Physical Exam Skills
– Written records, oral presentations
– See diseases and conditions they’ve only read about
 Provide more opportunities for students to apply their
clinical knowledge:
– Differential diagnosis, evaluation
– Management/Treatment/Follow-up
 More clinical opportunities  more learning
 Serve as role models
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“It is much more
important to know
what sort of a patient
has a disease than
what sort of a disease
a patient has.”
-Sir William Osler, MD
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What is Needed to Teach
Students in a
Community-Based
Practice?
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What is Needed to Teach Students
in a Community-Based Practice?
 Patients
 Space:
– An exam room where he/she can work at a slower
pace and not slow you down
 Internet connection at the office
 Excellent clinical and office staff
 A willingness to teach what you already know . . . . .
 A little bit of extra time
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What About the Quality of the Training
by Community-Based Preceptors
Pediatric Clerkship 1997-2002
 Academic Medical Center vs. Community Sites
– Students comparable in 1st 2 years of medical school
 Students at community sites:
– Performed same on NBME subject test
– Performed better on in-house written exam
– Received higher clinical grades (assigned by faculty)
– Saw more than twice as many patients
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Common Questions
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Common Questions
 What am I supposed to teach? Is there a curriculum?
– The students receive an orientation to the clerkship
at MCG before going to their community practice.
– They are provided a curriculum and other learning
resources by their clerkship director or MCG-based
instructor
– Lectures (if part of the training) are typically
videotaped and provided as CD’s or streaming video.
– You will be given all the resources and information
you need to be a successful preceptor.
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Common Questions
 I’ve never done this before. How do I get the skills
needed to teach a student in the office?
– The Clerkship Director or experienced educators
at MCG will provide you with training. It’s actually
very simple – taking less than an hour or so to get
started.
– Patients are the best teachers – your role is find
common teaching points or “links” for the student
to remember from the patients they see.
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Common Questions
 What about evaluations? How do I grade the student?
– The Clerkship Director or course instructor will
provide you information and instructions about
grading your student. There is a specific form that
is used, and usually it is done on the Internet.
– The course director will provide you with feedback
on how your student(s) performed annually, and
how they compared with other students on that
course or clerkship assigned to other sites.
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Common Questions
 What requirements are necessary for me to
perform in order to be a preceptor?
– A Faculty Appointment at MCG: You need to
fill out an application form for a faculty
appointment. It’s not too bad – much less
onerous than applying (or reapplying) for
credentials.
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Common Questions
 Are there any benefits for teaching students?
– A Faculty Appointment at MCG
– Library privileges at the Greenblatt Library (includes
Internet access to OVID, and full-text journals).
– Access to outreach librarian for technical assistance
– Reduced CME at MCG-sponsored CME activities
– Annual faculty development training
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Observations from MCG
Community Preceptors




Teaching takes time
Physicians feel “energized” by students
A chance to “give back”
Feel “good” about teaching and seeing students
grow in their clinical skills
 Teaching is enjoyable and fulfilling
– Few drop out
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Benefits for MCG
 Different type of educational experience
– Community-based practice – “Real World”
– Ambulatory settings
– Primary care emphasis
 Broadened patient base
– Meets the educational need for more ambulatory
experience
 Closer connection with community
 Help meet physician shortages?
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“I desire no other epitaph than
the statement that I taught
medical students in the wards, as
I regard this by far the most
useful and important work I have
been called to do.”
Sir William Osler, MD
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Contact Information
Chris White, MD
Associate Dean for Faculty Development
& Educational Achievement
Medical College of Georgia
cwhite@mcg.edu
(706) 721-3529
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Q&A
Please type your questions in the
chat box provided.
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Thank you for attending our program!
For more information on becoming a Preceptor,
please contact your local Area Health Education Center:
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