COMMITTEE TACKLES COMMUNITY PRECEPTOR SHORTAGE

Annie Rutter; Mary Theobald

doi:10.1370/afm.2129

Primary care clerkships are struggling to obtain and retain quality clinical training sites. Clinical training at these sites gives medical, nurse practitioner, and physician assistant students hands-on opportunities with patients in real-world settings. A joint survey conducted by the American Association of Colleges of Nursing (AACN), the American Association of Colleges of Osteopathic Medicine (AACOM), the Association of American Medical Colleges (AAMC), and the Physician Assistant Education Association (PAEA), found that all 4 disciplines are experiencing increasing difficulty obtaining clinical training sites.¹

At least 80% of respondents in each discipline felt concern regarding the adequacy of the number of clinical training sites
More than 70% of respondents in each discipline felt that developing new sites was more difficult in 2013 than it had been 2 years before
The key factors influencing the ability to develop new sites were security and legal requirements and training and orientation of preceptors
Despite observed growth in schools/programs and enrollment over the last decade, the majority of respondents indicated that the number of available sites and competition for sites have an impact on enrollment capacity in their programs.”¹

To begin to address this threat to the sustainability of America’s medical education system, the Society of Teachers of Family Medicine (STFM) conducted a Summit in August 2016 to identify the most significant reasons for the shortage of community preceptors and to shape the priorities, leadership, and investments needed to ensure the ongoing education of the primary care workforce.

The Summit was funded by the American Board of Family Medicine Foundation and STFM. The 52 Summit participants included health system leaders, organizational representatives, policy experts, clerkship directors, community preceptors, physicians who do not precept, students, etc.

Summit participants were asked to propose solutions to achieve the following aims:

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

Before proposing solutions, participants looked briefly at potential causes of the shortage:

Increase in the number of students
Not enough high-functioning (comprehensive/advanced-practice) sites
Administrative burden of teaching (complicated paperwork/systems, etc)
Competing clinical/productivity demands leaving inadequate time to teach
Lack of adequate incentives (financial)
Lack of adequate incentives (nonfinancial)
Loss of professionalism among clinicians with less desire to give back

Participants identified the following as the key causes of the preceptor shortage:

Administrative burden of teaching (complicated paperwork/systems, etc.)
Competing clinical/productivity demands leaving inadequate time to teach

Prioritizing Solutions

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.

Mobilizing for Action

STFM staff and the Summit chair vetted the solutions identified at the Summit with the STFM Board of Directors, a group of academic deans, and other primary care organizations. They used feedback from those groups and existing literature on the shortage to develop an Action Plan to implement these tactics:

Work with CMS to revise student documentation guidelines
Integrate interprofessional/interdisciplinary education into ambulatory primary care settings through integrated clinical clerkships
Integrate students into the work of ambulatory primary care settings (clinical clerkship sites) in useful and authentic ways
Develop standardized onboarding process for students
Develop educational collaboratives across departments, specialties, and institutions to improve administrative efficiencies
Promote productivity incentive plans that include teaching (matching financial incentives to lost RVUs)
Develop metrics to define and support high-quality teaching practices
Develop a culture of teaching in clinical settings
Incentivize teaching through Continuing Certification (MOC) incentive

Through a call for applications, 5 tactic team leaders were selected to direct the implementation of these tactics. These tactic team leaders are part of a larger, interdisciplinary, interprofessional Oversight Committee (Table 1) that is charged with:

Ensuring that work is progressing
Ensuring that plans align with the project goals and don’t duplicate or interfere with the work of others involved in the plan implementation
Developing solutions to any barriers

View this table:

Table 1

Oversight Committee

June 26, 2017 Oversight Committee Meeting

Project team leaders have been meeting via conference call since early 2017. At a June meeting of the Oversight Committee, each tactic team leader briefly presented his or her draft implementation plan, which had been submitted in advance for review.

The goals of the meeting were to: refine individual tactic plans; set a clear vision; and identify next steps for implementation of each tactic.

Based on feedback from the Oversight Committee, team leaders and project managers are now fleshing out the details of their implementation plans and identifying team members who can provide expertise and also participate in the actual implementation. They’re also developing timelines and setting tactic-specific metrics for success. Simultaneously, staff is seeking funding to support the work.

References

↵
Association of American Medical Colleges et al. Recruiting and maintaining U.S. clinical training sites: joint report of the 2013 multi-discipline clerkship/clinical training site survey. https://members.aamc.org/eweb/upload/13-225%20wc%20report%202%20update.pdf. Accessed Jul 3, 2017.