Preceptorship in a Nutshell

BIOM593 is a self-directed learning experience. It is split into two timeframes: 1) the Primary Care Preceptorship portion runs from June 25 - August 3, 2007. During this time you will shadow a primary care physician for 2-halfs days a week coupled with independent study time. The preceptor must be a primary care physician in a JABSOM clinical department. The independent study time is 3-half days a week, during which you should be researching learning issues, researching community resources, completing your "Medicine & Life Essay" and completing 6 H&P write-ups. 2) the Selective Experience portion runs from August 6 - August 24, 2007. During this time you can arrange for additional learning experiences which may include continuing to shadow your primary care preceptor, shadowing a medical specialist, volunteering at a community organization (such as HUGS or Hospice), working full time (40 hours/week) on a research project, domestic travel or a nonclinical international travel experience. The time commitment remains the same: 2-half days a week shadowing or completing your learning objectives and 3-half days of week of independent study.

Introduction

This Primary Care Preceptorship course (BIOM593) offers you the opportunity to shadow a primary care physician after a year of PBL training. This is the time to use your PBL and clinical skills for patient care under the guidance of a practicing primary care physician.

Listed below are some of the basic tenets of PBL which apply to the Primary Care Preceptorship:

1. The movement of learning in tutorial to learning in the clinical setting;
2. Receiving feedback on clinical skills through a one-on-one interaction with a practicing physician;
3. The use of patients and their problems as a springboard for the application of the basic science disciplines to clinical medicine;
4. The opportunity to view medicine from a community perspective;
5. The opportunity to examine, first-hand, the impact of being a physician on one's life and lifestyle; and
6. The opportunity to examine a primary care practice in preparation for deciding on a career specialty.
7. The opportunity to explore other cultures or medical specialties.

Important Dates (Calendar):

February 28, 2007: Last day to submit requests for international travel. Refer to: Travel Guidelines
May 4, 2007: BIOM593 Designation Forms and Travel Documents are due in OME
June 8, 2007: End of Unit 3
June 11 - June 22, 2007: Unit 3 Break
June 25 - August 3, 2007: BIOM593: Primary Care Preceptorship
August 3, 2007: BIOM593 Evaluation forms and assignments are due in OME
August 6 - August 24, 2007: BIOM593: Selective Educational Experience
August 27, 2007: Unit 4 begins
August 31, 2007: Selective Educational Experience assignments are due in OME.

BIOM 594 (Student Research Project) runs concurrently from June 25 - August 24, 2007.

The Role of the Student

BIOM593 will begin to alert you to the realities of clinical practice and to help you to begin to acquire an understanding of the community in which the preceptor's patients lives, works and plays. This experience will allow you to exam how a physician integrates his/her personal life with the professional demands of a clinical practice as well as the physician's position as a member of the community. You should begin to identify the determinants of health and well-being in the physician's community.

Because of the realities inherent in the preceptorship (the site is away from the Medical School, there is limited contact with faculty and peers, facing new and different challenges, and functioning in a very individual setting), you will need to develop a self-assessment plan to evaluate your progress. For example and for self-assessment only, set aside time during week 3 to go over your learning agenda and the preceptorship evaluation form with your preceptor.

The expectations of the student during the Preceptorship (June 25 - August 3, 2007) are as follows:

1. Idenitfy a primary care precetor (unofficial list). This physician should be a JABSOM faculty member in a primary care speciality. The preceptorship should be completed in Hawaii.
2. To generate, update and fulfill your learning agenda (sample learning agenda),
3. To complete at least one complete H&P per week with feedback from the preceptor,
4. To use the patient's problem(s) as an in-depth study of the underlying basic science issues,
5. To document the your work in a "Patient Log" (sample patient log),
6. To spend a minimum of 2 half-days per week over the 6 week period (June 25 - August 3, 2007) in the preceptor's office. Spend 12 hours/week on independent study of identified learning issues, H&P write-ups and research community resources,
7. To discuss with the preceptor the community organizations used to help his/her patients,
8. To discuss with the preceptor how he/she balances his/her professional and personal life, and
9. To turn in to OME all evaluation forms and assignments on time.

The Satisfactory Completion of BIOM 593 Will Be Met by Completing the Following Objectives:

4. Learning issues are derived from the patient encounters as a springboard to the study of basic and clinical sciences. You are expected to identify and research biological, clinical, behavioral and populational learning issues generated from each of their patient's problems. You should discuss the learning issues with the preceptor. Record your Learning Issue on your Patient Log.
Assessment: Evaluation of the Student by the Preceptor. Submission of your Patient Log.(checklist)

Frequently Asked Questions

1. What is the time requirement for BIOM593? The faculty members who designed BIOM593 envisioned students working closely with a primary care physician over an extended period of time. The major objective of this course is to identify and study learning issues developed from patients while continuing to practice and develop your clinical skills. The time frame is two half-days a week in the MD's office and researching the identified LIs for 3-half days per week over a 6 week period. This time frame allows for adequate study time as well as time to reflect on the numerous aspects of patient care.

2. Can I complete BIOM593 in less time? Some physicians will suggest that students need to spend more than two half days a week on the preceptorship. These physicians feel that viewing the entire spectrum of patient care is better experienced this way. Please explain to these physicians that the objectives of this course are both an out-patient and independent study experience.

3. Can I shadow more than one primary care physician during the 6 weeks? The selective educational experience portion of BIOM593 can include 3 weeks of shadowing another physician.

4. I'm traveling to a foreign country, do I need to complete the entire 6-weeks of BIOM593? Yes. You need to complete the entire 6 weeks between June 25 and August 3, 2007. August 4 - August 26, 2007 can be used for the selective educational experience.

5. I was awarded a research fellowship for the summer, how can I complete BIOM593? Students awarded research grants or fellowships, in which their primary responsibility is research, will need to discuss their plans with Dean of Student Affairs and the BIOM593 course director to develop a plan to meet BIOM593's requirements.

6. Can I use part of the 6-weeks for a vacation? Your summer vacation is scheduled for June 11 through June 22, 2007. Alternate plans need prior approval from the BIOM593 course director.

7. My preceptorship starts June 11 and ends August 3, 2007. When can I take my vacation? This situation usually arises for students participating in the Quentin Burdick Rural Health Training Program. Discuss alternative plans with the course director before committing to the QB program.

8. Can I change primary care preceptors once the course has started? Yes, with prior approval from the BIOM593 course director and the Dean of Student Affairs.

9. Can I shadow a physician who is not in primary care? BIOM593 is designed to be a primary care experience and every attempt should be made to shadow a primary care physician in family practice, geriatrics, internal medicine, pediatrics, or ob/gyn. Alternate arrangements may include shadowing a primary care physician with a subspecialty or shadowing both a primary care physician and a specialist. The intent of BIOM593 is for you to continue to develop your clinical skills, basic science knowledge base and interpersonal skills in preparation for your 3rd and 4th years of medical school. At this point in your education, you may be severely limiting your learning opportunities by shadowing a specialist. The selective educational experience can be used to shadow a specialist for 3 weeks.

10. My preceptor wants to know what his/her responsibilities are? Physicians who have not been a preceptor before need to be educated about our PBL curriculum and the early introduction of clinical skills. Physicians not familiar with JABSOM's program should call the course director (Dr. Kramer at 808 692-0934) for more information or visit our website at http://www.hawaii.edu/cm.

Summary of duties: The primary care physician serves as a mentor to the student on examining and working-up a patient. The preceptor should directly observe the your performance. A typical patient encounter might look like this: the physician introduces you to the patient. You conduct a focused history and physical examination. You presents the patient to the physician. You reenter the room with the physician and observe as the physician examines the patient. After the patient has left, you should receive feedback from the physician and agree upon learning issues to be research before your next visit. At the next visit, the learning issue(s) are discussed. In addition, you will be asking the MD about the community organizations commonly used by the physician and how the physician balances his/her personal and professional life.

11. How many H&P write-ups should I do? At least one per week for a total of 6.. Feedback on the write-ups should be given by the preceptor. Students should also practice writing progress notes. Part of the preceptor's assessment of you is his/her comments about your H&P write-ups and progess notes.

12. Does the medical school have malpractice insurance for MS1s? Students are not licensed to practice medicine and can not be sued for malpractice.. However, JABSOM has a liability insurance policy for full-time students enrolled in BIOM593 who are sued in a United State court. A letter will be sent to your preceptor explaining this insurance policy.

13. What if my preceptor is not a JABSOM faculty member? JABSOM's liability insurance does not cover physicians who are not faculty members. Such individuals need to apply for Adjunct Faculty status in the JABSOM clinical department of their specialty. This can be a difficult process and it takes time to complete.

14. What if I cannot meet the deadlines? Contact the instructor for BIOM593 as soon as possible. Extensions are possible but there must be a good reason. Failure to meet any of the deadlines will result in an Incomplete for the course. (contact information: Kenton J. Kramer, PhD, phone: 692-0934, fax: 692-1252, email: kramer@hawaii.edu).

14. Are there procedures I cannot do during the preceptorship? The preceptor is legally and morally responsible for any procedure you perform in his/her office or practice. This is especially important if you are not licensed or trained to perform that procedure. Always check with your preceptor before proceeding.

15. Are there travel funds available? Some international programs in the selective program may have travel funds available, however, you should plan on paying your own way (airfare and living expenses).