WHY ON EARTH WOULD I WANT TO BE A PRECEPTOR? AND IF I AM A PRECEPTOR HOW DO I MAINTAIN MY SANITY?

KATHERINE FISHER DO WESTERN UNIVERSITY OF HEALTH , COMP-NW LEARNING OBJECTIVES

• UNDERSTAND IMPORTANCE OF TRAINING OUR FUTURE PHYSICIANS

• LEARN A MORE OBJECTIVE AND EFFECTIVE EVALUATION PROCESS

• MAINTAIN EFFICIENCY AND SANITY IN OFFICE OR HOSPITAL BASED PRACTICE WHILE TEACHING STUDENTS PHYSICIAN SHORTAGE/GME SHORTAGE

• ACA • INCREASED NUMBER OF MEDICAL SCHOOLS WITHOUT SUBSTANTIAL INCREASE IN SLOTS OR STUDENT ROTATION SLOTS. • DO ENROLLEES INCREASED FROM 6,892 IN 1990, TO 21,743 IN 2012 • FIRST YEAR ENROLLEES, DO, 2,968 IN 2002 TO 5,804 IN 2012 • 1910 FLEXNER REPORT -- DÉJÀ VU ALL OVER AGAIN? • 2002 – 125 MEDICAL SCHOOLS, 2012 – 141 MEDICAL SCHOOLS

COMMUNITY VS. INSTITUTIONAL TRAINING

• TREND OF PAST TWENTY YEARS • AS MORE OUTPATIENT CARE EVOLVED TO OUTPATIENT, SO DID TRAINING • MORE STUDENTS, FEWER UNIVERSITY HOSPITAL SITES • CARNEGIE FOUNDATION REPORT, 2010 • STANDARDIZATION AND INDIVIDUALIZATION • INTEGRATION • HABITS OF INQUIRY AND IMPROVEMENT • PROFESSIONAL FORMATION COMP-NW CURRICULUM

• FIRST TWO YEARS: BASIC THEN SYSTEMS BASED COURSES, OTHER CLASSES • THIRD YEAR: ROTATIONS IN 4 WEEK BLOCKS:

• 12 WEEKS MEDICINE, 4 WEEKS EACH OF FAMILY MED, SURGERY, OB-GYN, OMM, PSYCH, PEDS, 8 WEEKS OF ELECTIVE

• DIDACTIC WEEKS AFTER EVERY THIRD ROTATION • FOURTH YEAR: • 4 WEEKS EM, 4 WEEKS EACH OF SUB- IN MEDICINE AND SURGERY, AUDITIONS ROTATIONS AND ELECTIVES

WHAT CAN PRECEPTORS TEACH STUDENTS?

• NOT THE FACTS -- PRECEPTOR’S BRAIN VS COMPUTER, PHONE AND TABLET • STUDY OF MEDICINE VS. THE ART OF PRACTICING MEDICINE: • NOT THE PHARMACOLOGY OF A MED BUT WHY YOU ARE CHOOSING ONE VS ANOTHER • NOT THE PATHOLOGY OF THE PROCESS BUT WHY YOU ARE CHOOSING TO ORDER AN ULTRASOUND VS CT SCAN (COST, RENAL FAILURE, SE, ETC) • TUMOR BOARD, M&M CONFERENCE, GRAND ROUNDS, ETC. • PARTICIPATION, NOT SHADOWING • KIDS THESE DAYS --- WHAT CAN STUDENTS LEARN FROM YOU?

• PROFESSIONALISM • WORK/LIFE BALANCE • HOW/WHEN TO ASK FOR HELP (CONSULTS/REFERRALS) • LEARNING IS A LIFELONG PROCESS • HOW TO CHOOSE A SPECIALTY • IMPORTANCE OF CASE PRESENTATIONS • CRITICAL THINKING CASE PRESENTATIONS – WHAT’S THE BIG DEAL?

• MAIN FORM OF MEDICAL COMMUNICATION FOR REST OF THEIR CAREER • WRITTEN VS ORAL • INCREASE EFFICIENCY IN THEIR FUTURE • AUDITION ROTATIONS AND RESIDENCIES • TAKING THE STEP FROM PRE-CLINICAL THINKING TO CLINICAL THINKING

ONE MINUTE PRECEPTOR

• FIVE STEP MICROSKILLS MODEL • GET A COMMITMENT -- DX • PROBE FOR SUPPORTING EVIDENCE • REINFORCE WHAT WAS DONE RIGHT • GET ANOTHER COMMITMENT -- TX • TEACH GENERAL RULES • CORRECT MISTAKES EFFECTIVENESS OF THE ONE MINUTE PRECEPTOR (FIVE STEP MICROSKILLS MODEL)

• TEACHER’S ABILITY TO CORRECTLY DIAGNOSE THE PATIENT’S PROBLEM FROM THE STUDENT PRESENTATION • TEACHER’S CONFIDENCE IN EVALUATING THE LEARNER • TEACHER’S ABILITY TO ENCOURAGE LEARNER TO DO INDEPENDENT LEARNING/OUTSIDE READING • QUALITY OF FEEDBACK THAT TEACHERS GIVE TO LEARNERS • FREQUENCY WITH WHICH TEACHER GIVES FEEDBACK TO LEARNERS LIMITATIONS OF ONE MINUTE PRECEPTOR (FIVE STEP MICROSKILLS MODEL)

• IF ONLY TEACHING TECHNIQUES USED, MAY BE OVER SIMPLISTIC • ASSUMPTION IS MADE THAT STUDENT CAN GATHER GOOD QUALITY DATA IN THEIR HISTORY, PHYSICAL AND DATA COLLECTING

BIG PICTURE FEEDBACK

• FORMATIVE ASSESSMENT (MONITOR THE LEARNING) --LOW STAKES • DAILY/ IN THE MOMENT • OBSERVATION CARDS • WEEKLY • SUMMATIVE ASSESSMENT (EVALUATE THE LEARNING) --HIGH STAKES • MID ROTATION • FINAL EVALUATION (NEW INNOVATIONS) • RIME HTTPS://WWW.MED.ILLINOIS.EDU/FACULTYDEV/EVALUATION/RIME/RIMEEVALMODEL.PDF RIME

• REPORTER • INTERVIEWS, PE, WRITTEN AND ORAL CASE PRESENTATIONS, RELIABILITY, RESPONSIBILITY • INTERPRETER • PROBLEM LISTS (NOT SYMPTOM LISTS), DDX, INTERPRETS BASIC LABS AND TESTS, SOME ADVANCED TESTS • MANAGER • DX AND TX PLANS, RISK/BENEFIT DECISION MAKING, PROCEDURES, INCORPORATE PATIENT VALUES • EDUCATOR • REFLECTIVE SELF DIRECTED LEARNING, CRITICAL READING SKILLS, PRACTICE BASED LEARNING

NEW INNOVATIONS

• ELECTRONIC • MSPE COMMENTS • OTHER COMMENTS • PRECEPTOR GRADE + COMAT EXAM + OSCE EXAM = ROTATION GRADE

MAINTAINING EFFICIENCY IN THE OFFICE

• ONE MINUTE PRECEPTOR • WORKFLOW • TWO PATIENTS IN FIRST SLOT OF MORNING AND AFTER LUNCH • WHEN IS A SCRIBE NOT A SCRIBE • STUDENT CAN UPDATE CHARTS REGARDING PMHX, PSHX, FAMHX, ETC • STUDENT PRESENTS CASE TO YOU IN ROOM WITH PATIENT MAINTAINING EFFICIENCY IN HOSPITAL SETTING

• REMIND STUDENT TO DO THEIR OWN PRE-ROUNDS BEFORE ATTENDING ROUNDS • STUDENT NOTES SHOULD BE DONE BEFORE ATTENDING ARRIVES • HAVE STUDENT SPEND TIME WITH RADIOLOGY, LAB, OTHER DIAGNOSTIC AREAS • STUDENTS SHOULD ATTEND TUMOR BOARDS, M&M CONFERENCE, OTHER CONFERENCES WHERE THEY CAN LEARN THE GIVE AND TAKE OF PHYSICIAN TEAM DECISION MAKING

TANGIBLE BENEFITS OF BEING A PRECEPTOR FOR WESTERN UNIVERSITY OF HEALTH SCIENCES (COMP-NW) STUDENTS

• TEACHINGPHYSICIAN.ORG • EDUCATION SCHOLAR: HTTP://WWW.EDUCATIONSCHOLAR.ORG/INDEX.HTM • ELECTRONIC RESOURCES: HTTP://WWW.WESTERNU.EDU/LIBRARY/LIBRARY-ELECTRONIC- RESOURCES/ • ACCESS MEDICINE • PUBMED • AUDIO DIGEST • BATES’ VISUAL GUIDE TO PHYSICAL EXAMINATION HTTP://BATESVISUALGUIDE.COM.PROXY.WESTERNU.EDU/MULTIMEDIA.ASPX?CATEGORYID=21787#21768 • FIVE MINUTE CONSULT: HTTP://WWW.5MINUTECONSULT.COM.PROXY.WESTERNU.EDU/HOME

BIBLIOGRAPHY

• EVIDENCE-BASED OFFICE TEACHING – THE FIVE STEP MICROSKILLS MODEL OF CLINICAL TEACHING

• EVALUATION OF CLINICAL COMPETENCE, HOLMBOE, ERIC S., HAWKINS, RICHARD E.,

• TEACHING IN YOUR OFFICE, A GUIDE TO INSTRUCTING MEDICAL STUDENTS AND RESIDENTS, ALGUIRE, PATRICK, AMERICAN COLLEGE OF PHYSICIANS • TEACHING IN THE HOSPITAL • CARNEGIE MELLON: HTTP://WWW.CMU.EDU/TEACHING/ASSESSMENT/BASICS/FORMATIVE- SUMMATIVE.HTML • HTTPS://WWW.MED.ILLINOIS.EDU/FACULTYDEV/EVALUATION/RIME/RIMEEVALMODEL.PDF