Primary care clerkship directors are finding it increasingly difficult to obtain clinical training sites.1
To begin to address this challenge, STFM is implementing new initiatives to:
Decrease the percentage of primary care clerkship directors who report difficulty finding clinical preceptor sites
Increase the percentage of students completing clerkships at high-functioning sites
Quantifying the Quality Issue
In order to determine the quality of current clerkship experiences, STFM developed research questions for a Council of Academic Family Medicine Educational Research Alliance (CERA) survey. The survey asked family medicine clerkship directors:
Using either actual data or your best estimate, what percentage of your students complete their family medicine clerkships at preceptor sites that:
◦ Have patient-centered medical home (PCMH) or similar practice transformation recognition?
◦ Provide comprehensive care, including obstetrical care (OB)? Comprehensive care is defined as inclusion of both acute and chronic care, preventive services, end-of-life care, care at all stages of life, and obstetrics.
◦ Provide comprehensive care, without obstetrical care (OB)? Comprehensive care is defined as inclusion of both acute and chronic care, preventive services, end-of-life care, care at all stages of life, but without obstetrics.
◦ Allow students to access data in the EHR?
◦ Allow students to write patient encounter notes in the EHR?
In your estimation, how often do your students hear negative comments about family medicine at their family medicine clerkship sites?
The results of the survey are being analyzed and will be used as baseline data to track results of improvement efforts over time. A follow-up survey will be conducted in 2020.
Summit to Address the Shortage of High-Quality Primary Care Community Preceptors
In August 2016, STFM brought together multiple stakeholders—health system leaders, organizational representatives, policy experts, clerkship directors, community preceptors, physicians who do not precept, students, etc—for a Summit to Address the Shortage of High Quality Primary Care Community Preceptors.
A summit provided an opportunity to bring together those who understand the problem and have power to make change. The summit was the first step in identifying the most significant reasons for the shortage of community preceptors and shaping the priorities, leadership, and investments needed to implement solutions to ensure the ongoing education of the primary care workforce.
At the beginning of the summit, Beat Steiner, the summit chair, laid out the following measures of success for the 1½ day summit. Participants would:
Move beyond problems and barriers (talk about solutions)
Identify 3 to 5 solutions that are ambitious enough to help resolve this vexing problem
Make significant progress over the next 6 to 12 months to implement solutions
Before discussing solutions, participants reached consensus that key causes of the preceptor shortage are:
Administrative burdens of teaching (complicated paperwork/systems, etc)
Competing clinical/productivity demands leaving inadequate time to teach
Summit participants gave and listened to brief presentations on innovative ideas that are being implemented around the country on:
Improving administrative efficiencies related to teaching
New/better ways of teaching learners in the office
Financial and other incentives
They then broke into small workgroups to discuss if/how those ideas and others could contribute to solutions to the preceptor shortage.
At the end of the second day, participants prioritized solutions, based on feasibility and potential impact; brainstormed next steps; and discussed who could help move the solutions forward.
Prioritized solutions
Integrate Inter-professional education into ambulatory primary care settings
Integrate longitudinal structure into ambulatory primary care settings
Integrate students into the work of ambulatory primary care settings in useful and authentic ways
Develop simplified and standard competencies/objectives and assessment tools for ambulatory primary care settings
Develop a standardized onboarding process for students
Develop educational collaboratives across schools to improve administrative efficiencies (central database of preceptors, centralized scheduling, shared administrative responsibilities)
Work with CMS to revise student documentation guidelines
Measure and adjust relative value units (RVU)s for high quality teaching practices
Develop metrics to define quality teaching and quality clinical care that defines high quality teaching practices
Develop a culture of teaching in clinical settings
STFM is working in collaboration with colleagues to finalize a vision and a detailed action plan that will be executed over the upcoming months and years. The action plan, which will incorporate some or all of the proposed solutions, will identify organizations and individuals who are willing and able to drive change within the health care system.
Additional information about the summit can be found at http://www.stfm.org/Portals/49/Documents/AboutPageDocs/PreceptingSummitExecutiveSummary_9_15_2016.pdf?ver=2016-09-16-102350-693.
The summit was supported, in part, by a grant from the American Board of Family Medicine Foundation. It was held to address Family Medicine for America’s Health’s Workforce Education and Development Core Team’s task of identifying, developing, and disseminating resources for community preceptors.
Other Relevant Work
The preceptor shortage, while escalating, is not new. Over the past few years, STFM has developed several projects/programs for clerkship directors and/or community preceptors:
TeachingPhysician.org: An online resource that streamlines training, answers questions, and communicates regularly with preceptors on behalf of medical schools. A revamped website and revised monthly communications launched in April 2016.
White Paper: Strategies to Ensure that Students Add Value in Outpatient Offices
Position Statement on Student Use of Electronic Health Records
Preceptor Guidelines on Student Use of Electronic Health Records
STFM National Clerkship Curriculum: Core content and competencies, learning objectives, assessment tools, educational strategies, and role definitions for family medicine clerkships
STFM National Clerkship Curriculum Core Score Tool: An online tool to help clerkship directors identify curriculum gaps
Medical Student Educators Development Institute: Yearlong fellowship that offers training, tools, and support for those who aspire to be clerkship directors
Conference on Medical Student Education, with the recent addition of preconference workshops on preceptor recruitment and integrating students into ambulatory primary care settings in useful and authentic ways
A forum for Clerkship directors to collaborative and discuss within the Medical Student Education Collaborative on STFM’s new collaboration platform, STFM CONNECT
Medical Student Education Collaborative project on preceptor recruitment and retention: The group is conducting national focus groups of community physicians who are, or may become, preceptors to identify relevant factors in decisions to precept. They are using lean methodology to rapidly test interventions and innovations to address barriers and create value for community physicians in their role as preceptors.
- © 2016 Annals of Family Medicine, Inc.
References
In this issue
Jump to section
Related Articles
Cited By...
- No citing articles found.