BIOM593: Role of the Preceptor

The BIOM 593 (Primary Care Preceptorhip) is a required course for first year medical students at the John A Burns School of Medicine, University of Hawaii. If you have any questions about this program please contact, Dr. Kenton J. Kramer, PhD. Phone (808) 692-0934, FAX (808) 692-1252, email: kramer@hawaii.edu. The following information is for current and prospective preceptors.

JABSOM's Primary Care Preceptorship Course (BIOM593) is designed for first year medical students (MS1) to experience primary care first hand. The program is for 6-weeks (June 25 - August 3, 2007). During this time, the student will be shadowing you for 2-half days a week. A 3 week selective period from August 6-August 24, 2007 may be used to continue the primary care experience or to explore other specialties or health care systems.

It is the student's responsibility to arrange the preceptorship. The preceptor should agree to provide clinical experience and guidance to a student during the 6-week clerkship. Preceptors are responsible for coordinating the student's experiences and for evaluating the student.

Before the preceptorship begins, the preceptor and the student should agree on what is to be learned, how it will be learned and how the student will be evaluated. The student will go over with you a Learning Agenda which will outline the areas the student wants to learn. The basic components of the Learning Agenda should include: 1) clinical skills development, 2) building of a basic science and clinical database, 3) exploring community resources and 4) exploring the balance between a professional and personal life. The Learning Agenda is not a static document, the student should continually revise his/her Learning Agenda based on your feedback and evaluations during the 6 week period.

Student learning, under a Problem Based Learning curriculum, requires continual and effective feedback by the preceptor. Therefore, it is important that the student and the preceptor clearly understand what is to be learned. This is the purpose of the Learning Agenda. In addition, there must be a solid commitment by the preceptor and the student to achieve the objectives outlined in the Learning Agenda. And finally there must be an evaluation process, based on informal and formal mechanisms, which measures the student's progress in achieving the objectives.

1. Clinical Skills. MS1s have been taught to perform a basic history and physical examination. These skills have been taught in the classroom, with simulated patients and with patients selected by their clinical skills preceptor. Under your guidance the student will continue to develop these skills using appropriate and preselected patients. The physician should review the student's H&P write-ups and give feedback to the student. A minimum of 6 write-ups is recommended. The student should document his/her time with you using a Patient Log (sample log). Please initial the log at the end of the day.

2. Applying Basic Science Knowledge to Clinical Medicine. MS1s have been using "paper" cases to probe and expand their understanding of basic science and clinical knowledge. Your student should continue to learn and expand this knowledge base by identifying basic science and clinical learning issues from actual patient problems. Areas which might be covered are basic sciences (biochemistry, physiology, pathology, mechanisms, pharmacology), clinical medicine (diagnosis, treatment, management, prevention, patient education) behavioral (psychology, patient communication), populational (epidemiology). After research the subject area, the student will be discussing these learning issues with you.

3. Learning About Community Resources. MS1s have been exploring community resources for their "paper" cases. The preceptorship is an opportunity for them to appreciate the value of these resource in patient care. The student should research and discuss possible community resources for the patient he/she examines in your practice.

4. Learning to Balance a Professional and Personal Life. The students have been asked to discuss with you how you balance patient care with family time. This discussion will be used as the basis for an essay.

5. The above four objectives should be outlined in the student's learning agenda. This agenda is a dynamic document and should be up-dated periodically throughout the preceptorship. You will be asked to sign the initial Learning Agenda. To view a sample Learning Agenda, click here.

The Preceptor as a Facilitator. The preceptor facilitates the student's accomplishment as outlined in the student's Learning Agenda. The Learning Agenda should be a joint agreement between the preceptor and the student. The preceptor makes available selected patients to the student for interview, examination, clinical decision-making, and self-directed independent study of issues involved in the care of the patient. The preceptor introduces the student to the office staff, the lab facilities and procedures, the medical records system, fee schedules, etc. The student should learn the function of each section within the preceptor's practice.

The Preceptor as a Role Model. The preceptor should provide the student opportunities to experience first-hand the realities of being a physician in the community, the impact on one's life and the integration of a busy practice with family life and social endeavors. The student should be involved in the full range of activities related to the running of a medical practice, including inpatient and outpatient experiences, business, hospital, medical and community meetings.

The Preceptor as an Evaluator. The preceptor is responsible for evaluating the student's performance and is asked to give continual feedback to the student on his/her performance throughout the clerkship. Some examples where feedback is important:

- History taking, physical examination, interpersonal and interviewing skills;
- Hypothesis formulation;
- Verbal and written presentation of appropriate patients;
- Learning Agenda & learning issues;
- Specific concerns that may have arisen during the week.

The following is one format preceptors may find useful for monitoring and giving feedback to the student on his/her clinical performance.

1. The preceptor introduces the student to the patient and explains the student's role to the patient;

2. The student performs a medical work-up, history and/or physical examination, which may be observed by the preceptor;

3. The student organizes an oral presentation including a problem list and plan for patient care;

4. The student orally presents the patient to his/her preceptor followed by a brief discussion and feedback from the preceptor;

5. The preceptor and student see the patient together. The preceptor reviews pertinent history and physical examination to clarify problems and confirm the accuracy of the student's findings;

6. The preceptor and student decide on the appropriate initial diagnosis, treatment and educational plan for the patient. The student is involved in the follow-up of the patient after plans have been implemented;

7. The student completes a write-up of the patient. Inclusion of the write-up into the medical chart is at the preceptor's discretion;

8. The student identifies learning issues related to the hypotheses and clinical problem. After an appropriate amount of study time, the student should discuss the patient with the preceptor in view of the student's learning, results of any lab or imaging studies and the patient's progress.

The preceptor should periodically evaluate the student's performance. The sample evaluation form listed below can serve as a guide.

At the end of the preceptorship the preceptor will be asked to formally evaluate the student using the evaluation form provided in the cover letter from OME or by visiting our Community Health website at (Evaluation forms). This formal evaluation is due August 3, 2007 and serves as the basis for the student's grade for the course.