Family Medicine Vital Signs

I love teaching. Preceptors (and teachers in general) might give different reasons for why they teach, but common themes are:

• Making a difference in a student’s life
• Deriving joy from watching a student “get it”
• “Paying it forward,” and emulate a great teacher/ mentor that they had
• Enjoying life-long learning and staying sharp; it is a “professional development journey”
• Empowering students to reach their full potential, watching them grow, and in the process, growing oneself.

In addition to these reasons, I enjoy teaching students and residents because it helps me be a better clinician. Whether in class or in clinic, teaching students helps me improve my ability to explain complex concepts to patients, improve time management, and enhance my communication skills. I also find that I master material and procedural skills when I am coaching someone else. In addition, one solution to burnout is finding meaning in one’s career, and teaching definitely grants me meaning as it confirms my reason for going into medicine in the first place. The one downside to my job is the difficulty in finding others to help me teach.

Our Family Medicine clerkship is not alone in its challenge to find more preceptors. Around the USA, many health professional (MD, DO, NP, PA, PT, etc.) schools are facing a preceptor shortage. It is difficult to recruit and retain preceptors who are both able and willing to teach our students. Common barriers are lack of time, especially with increased administrative burdens, new EMRs, meetings, etc., and perhaps a lack of confidence. While I cannot fix many of the barriers (though that is a dream of mine!), I can help preceptors overcome the barrier of lack of confidence, and maybe even address some of the time and administrative aspects. I also want to help them realize how valuable they are to the future of medicine and our community at large. Students can also add value to clinic and may even help the preceptor be more efficient and effective. Plus, patients usually love students!

Most of the time medical schools and residencies do not prepare us to become good teachers. Students instead learn from their teachers, or on their own, about how best to explain diagnoses and treatment plans to patients. Although I was not formally taught how to be a good preceptor or teacher, I have been blessed with wonderful mentors and role models, and I have done research on the topic. I would like to share what I have learned so that we can recruit, develop, and retain preceptors, as well as help my colleagues experience the joy of teaching and help prevent burnout.

First, I wanted to understand the qualities of a good preceptor. Most of the following traits are self-evident, but here they are:

• Be a good role-model
• Spend extra time with your students
• Emphasize the importance of the doctor-patient relationship
• Highlight the psychosocial aspects of patient care
• Give in-depth feedback (using various models)
• Explain concepts in non-threatening style; show student where/ how to look up EBM, articles
• Simply try to remember what it was like being in their shoes

Second, I wondered how I could effectively teach students when I already am very busy in clinic. After asking colleagues, researching articles on the topic, and experiencing it for myself, I came up with the following list:

1. Plan ahead: Meet with student about 10-15 minutes prior to your clinic start time and decide which patients they should see, what key things need to be addressed in the visit – you could combine this with your “team huddle” with your medical assistant (MA)
2. Choose patients that would be appropriate (and would enable you to stay on time):
   1. New pts are great since usually have extra time
   2. Patients you know well since you know much of the history and needs
3. Do not have your students see the first patient; this could put you behind for the rest of the day
4. Have student see a patient while you see another patient. Have them present to you when ready
5. Allow the student to scribe or YOU can scribe while they are conducting the visit.
6. Break it up: have the student get only the history, then do the exam together and come up with the plan with the patient (when appropriate).
7. Have the student present in front of the patient: patients often like this since they feel more involved in their care, correct history if needed, and feel like they are part of the teaching team
8. Have the student do some patient education or motivational interviewing while you are seeing other patients
9. Assign the student to work with MA to room the patient, update the history or medication list, pre-chart, etc.
10. Let the student make telephone calls or look over patient messages: this can decrease your after-clinic work and also helps expose students to other aspects of patient care

Finally, I find that one of the best ways to recruit and retain preceptors is to let them know how valued and appreciated they are. I have heard countless stories of how preceptors inspired students to go into Family Medicine, or at least helped them better understand the field and develop skills they will use in other specialties. Students report how their preceptors touched their lives, helped them develop a skill they did not know they had, or modeled for them what kind of physician they wanted to be one day. Every human being has something to teach others and can influence another’s life in a positive way. Physician teachers are in a unique position to improve the future of healthcare by inspiring the next generation of physicians, patient advocates, political activists, and leaders. I am grateful for you and all you to do to inspire and mentor students, and I hope you love teaching like I do!

Marlana Li, MD is a Board-Certified Family Medicine physician who received her medical degree from Loyola University Chicago Stritch School of Medicine, and completed her residency at St. Anthony North Family Medicine Residency in Westminster, Colorado. As a full-spectrum Family Medicine doctor, Dr. Li delivers pediatric, maternity, and adult care, with special interests in chronic disease management, preventive medicine, and patient education. She enjoys teaching and mentoring medical students and residents.

 

References/ Resources:

Medical Students’ and Residents’ preferred site characteristics and preceptor behaviors for learning in the ambulatory setting: a cross-sectional survey.” Schultz, K. et al. BMC Med Educ. 2004; 4: 12.)

https://www.teachingphysician.org/become-a-preceptor/How-Students-Can-Add-Value-to-Your-Office