To Pay or Not to Pay Community Preceptors? That Is a Question …

Motivators and barriers for rural community preceptors in teaching: A qualitative study

PURPOSE

Increasing challenges in recruiting and retaining community-based teaching physicians (e.g., community preceptors) call for a better understanding of motivators and barriers community preceptors perceive in their teaching role. Given the importance of medical school partnerships with community-based sites for student training, it is essential to understand the perspectives of community preceptors as teaching physicians in a context away from the medical school, such as rural, and the factors affecting their career choice to engage in teaching while practising medicine.

METHODS

We conducted semi-structured interviews with rural community preceptors and used open coding to conceptualise data and axial coding to connect codes into categories. We used the socio-cognitive career theory framework to organise categories into themes.

RESULTS

Eleven rural community preceptors from two medical schools participated. Specialties included family medicine, internal medicine and paediatrics; clinical practice and teaching experience ranged from 3-36 and 2-29 years, respectively. Readiness for teaching ('self-efficacy') was pivotal in community preceptors' decision to teach and derived largely from vicarious learning from teaching attendings in medical school or residency; social persuasion and encouragement from clinical partners; and their accomplishments as practising physicians. However, limited faculty development, incomplete knowledge of expectations, disengagement from the medical school and lack of current mentors hindered their self-confidence. Teaching fulfilled their aspirations ('outcome expectations') to give back to the profession, but they felt undervalued and disconnected from other clinician educators. Teaching increased job satisfaction, but clinical workload, and financial impact impeded their goals for achieving excellence ('performance').

CONCLUSIONS

Self-efficacy was a pivotal motivator in rural community preceptors' decision to teach. Role models from early training inspired them to teach. Internal awards sustained teaching efforts. Future research should explore structural barriers influencing rural community preceptors' teaching experiences to better support their career choice to become medical educators.

Applying self-determination theory to stem medical schools' clinical teacher sustainability crisis

THE PROBLEM

Medical schools require highly skilled and committed clinical faculty to teach, assess, supervise and mentor students' clinical care. Medical education is facing a crisis in recruiting and sustaining these clinical teachers. Faced with multiple demands and responsibilities in fast-paced clinical environments, teachers may not have the time, resources or stamina to sustain these critical roles. Medical school leaders must commit to and provide structures and processes to attract, sustain and retain clinical teachers.

CONCEPTUAL FRAMEWORK

The authors use the lens of self-determination theory to frame approaches to support teacher sustainability. Self-determination theory describes sources of human motivation. The theory and its evidence base characterise three human psychological needs: autonomy, competence, and relatedness. This theory can bridge individual psychological and institutional leadership perspectives to help medical school leaders anticipate and respond to their clinical teachers' needs. The authors propose three practical steps: practices to advance employee-centredness, processes to align individual and institutional values, and restructuring education to support clinical teachers' needs alongside student and patient needs. The authors describe limitations to this relational approach that focuses on leadership actions and consider individual agency as another key factor for sustainability.

DISCUSSION

Medical school leaders can develop and apply theory-driven approaches to advance sustainability. Sustainability now and in the future requires careful attention to the needs of clinical teachers and to their relationships with and within medical schools.

Maximizing clinical rotation placements for US medical students: exploring an optimization model

BACKGROUND

For years, US medical schools have relied on community-based, private clinicians to educate medical students. There has been a steady decline in the number of physicians willing to take on medical students in their clinical practices. Recent issues related to the pandemic raise questions about how many patients students should see to have a meaningful clinical experience.

METHODS

As part of a 16-week longitudinal clinical experience, medical students spend 2 days each week in a family medicine or internal medicine clinic. As repetition enhances learning, maximizing the number of patients students see is important. Using a mixed integer linear program, we sought to determine the optimal schedule that maximizes the number of patients whom students see during a rotation. Patient visits were collected from January to April 2018 for clinics used by the medical school. By maximizing the minimum number of patients per learner over all non-empty day-clinic combinations, we deliver equitable rotation plans based on our assumptions.

RESULTS

For this pilot study, multiple experiments were performed with different numbers of students assigned to clinics. Each experiment also generated a weekly rotation plan for a given student. Based on this optimization model, the minimum number of patients per student over 16 weeks was 87 (3 patients per day) and actually increased the number of students who could be assigned to one of the clinics from 1 student per rotation to 8 students.

CONCLUSIONS

The mixed integer linear program assigned more students to clinics that have more total visits in order to achieve the optimal and fairest learning quality. In addition, by conducting various experiments on different numbers of students, we observed that we were able to allocate more students without affecting the number of patients students see.

The effect of a medical student on community preceptor productivity

BACKGROUND

Medical students are increasingly being taught in community-based hospitals and clinics in addition to university-based health systems, and there is sustained interest in the question of whether medical schools should pay healthcare organizations to allow students to precept to compensate for loss of productivity by preceptors. This study aimed to inform this subject by investigating the effect of medical students on preceptor productivity.

METHODS

The authors analysed retrospective data on preceptor productivity and time efficiency from 17 outpatient primary care physicians over 7 months and 38,205 patient visits. Then, the authors surveyed these same physicians to assess how they believe precepting medical students affected their productivity.

RESULTS

The retrospective data analysis found that physicians see slightly more patients per half-day when accompanied by a student. In surveys, these physicians reported the same number of patients seen per half-day with or without a medical student, but more time spent in clinic with a medical student. They also reported that allowing students to document in the medical record often helped reduce/offset the lengthened workday.

CONCLUSIONS

Medical students either increase or do not change the number of patients seen per half-day but can increase preceptor time spent in clinic per day. Generally, physicians accept this increased time for the sake of promoting education and the joy of teaching. These findings can inform medical schools and healthcare organizations when negotiating financial arrangements for preceptorships in community based primary care clinics. Specifically, these findings suggest that medical students precepting do not cost the hospital organization in terms of preceptor productivity.