Community Preceptor and Entity Recruitment and Retention Michael Nduati, MD Andrew Alexander, MD UC Riverside School of Medicine April 27, 2015 *with contributions from Dr. Kendrick Davis, Dr. Paul Lyons and Dijon Gatewood

Introduction to Contributors Michael Nduati, MD, MBA, MPH –Associate Dean, Clinical Affairs –LACE Co-Director –2014 STFM New Faculty Scholar & MSEDI Fellow Andrew Alexander, MD –Clerkship Director –Former Mayor Kendrick Davis, PhD : Director of Medical Education; LACE Co-Director Paul Lyons, MD : Sr. Associate Dean of Education; Chair of Family Medicine Dijon Gatewood : UCR SOM Intern; UCR Pre-med undergraduate student

Disclosures We have nothing to disclose other than we are excited to present to you in beautiful Orlando today about our work!

Outline Background on LACE & CILC Brief literature review Our Hypotheses Survey Results Preceptor Feedback Future directions

What do you think? Let’s do a quick exercise to get your mental wheels churning: What do you think are the top 3 reasons community preceptors participate in teaching medical students? What do you think are the top 3 reasons healthcare entities want their physicians involved in medical education?

UCR SOM Educational Environment Mostly HMO-based physician partnerships (e.g. Kaiser), IPAs and County physicians Relatively educational-naïve medical community No monetary provision for community preceptors (CPs) teaching in a clinical setting

LACE Longitudinal Ambulatory Care Experience 3-year outpatient primary care experience that begins in the 1 st month of medical school Goals –Link classroom to the clinic –Provide longitudinal experience with substantial mentor- mentee relationship –Introduce population-based principles and practice into the clinical setting

Clerkship Model: CILC Clinically Integrated Longitudinal Clerkships Innovative longitudinal structure throughout 24 week blocks to encourage interdisciplinary learning and improved formative feedback Interweaves: –Family Medicine, Pediatrics & OB/GYN –Internal Medicine & Surgical specialties –Psychiatry, Neurology & Emergency Medicine integrated throughout entire 3 rd year

CILC Schedule

Brief Review of the Literature on Community-Based Teaching CPs want 1 : –To be recognized (i.e. faculty appointments) –Access to resources (e.g. SOM library & CME) Many CPs lack confidence in being teachers & want training 2 –Poor effective teaching skills → observational approach to learning (educationally inferior) 1 Baldor, et al. (2001) 2 Bowen, Irby (2002)

Brief Review of the Literature on Community-Based Teaching (cont.) Major benefits of participating were 3 : –Increased enjoyment in practice of medicine –Increased reading of medical literature and review of the basics of clinical medicine –Only 33% of CPs noted decreased productivity CPs teach for 4 : –Personal satisfaction and appreciation from students and peers –Allows them to give back to the medical community 3 Grayson, et al. (1998) 4 Kumar, Allen and Mathew (2002)

Our Hypotheses Physicians would want to participate as CPs if we offered more extrinsic, tangible benefits (e.g. faculty appointments) Entities would want to participate in SOM educational programs as an employment pipeline

Actual Preceptor Survey Directions: The following section contains items which require you to think about potential organizational benefits that may currently motivate you to participate in the LACE program. Please rate the importance of each item below. Not at all important Minimally Important Somewhat Important Moderately Important Very Important Extremely Important 1. The LACE program is personally important to me in providing an employment pipeline for my organization The LACE program is personally important to me for providing practice improvement at my clinical site The LACE program is important in providing an employment pipeline for my organization as a whole The LACE program is important in providing practice improvement for my organization as a whole Comments (Please provide your thoughts on other potential benefits to your organization): LACE Motivation Scale – Preceptor (Modified from Baldor, Blair, Warfield, & Shea; 2001) Instructions: For the following questions, please respond regarding the importance of each to your experience with LACE. Indicate how important each item is from your perspective Using the following response scale: Section A: Potential current benefits to organization

Preceptor Survey Results

Analysis of Results: Preceptors (n=57) The 4 lowest rated items centered on appreciation & recognition (from peers being less important than from medical students) Getting CME credit [ 3.24 ] and providing practice improvement [ 3.27 ] were also low The highest rated item [ 5.29 ] was “getting personal satisfaction from giving back to the medical profession” The other high scores centered on things that provided intrinsic value to the CPs

Analysis of Results: Entities Entities participate for the employment pipeline opportunity [ 4.75 ] and don’t think significant practice improvement will occur [ 2.75 ] Entities believe their physicians participate for the University faculty appointment [ 5.5 ] and recognition (from both students [ 4.75 ] and peers [ 5.0 ]) Entities undervalued the importance of intrinsic factors to their physicians

Preceptor Feedback Benefits to organization: –“My group is aging – we love the concept of ‘growing our own’ replacements.” –“Influencing students with Inland Empire connection is an opportunity.” Benefits for them: –“Having the opportunity to see students develop into physicians gives me tremendous pleasure. Keeps me relevant.”

Preceptor Feedback (cont.) Benefits for them (cont.): –“It takes time and effort to teach, but I enjoy teaching and it is a rewarding experience.” –“I get some satisfaction from teaching and from ‘paying back’ to the system of physician education.” Potential future motivators: –“Having access to the SOM library and doing more faculty development.”

Entity Feedback Benefits to organization: –“Succession planning – increase recruiting success rate of PCPs.” Benefits to their physicians: –“They want to give back to the medical profession.” –“Provides variety in the work day. Opportunity to mentor others.” Potential future motivators: –“Having LACE students for all 4 years.” –“Would love to have access to weekly ‘Grand Rounds’.”

The Bottom Line CPs highly value developing a true “teaching identity” 5 Intrinsic rewards were much more significant to the participating CPs than extrinsic rewards were Entities didn’t truly understand why their physicians want to participate, but the organizations value the employment pipeline 5 Starr, et al. (2003)

Future Directions Provide more faculty development and training to solidify the “teaching identity” Provide more non-monetary extrinsic rewards for our CPs Examine the differences in responses between practice types (i.e. County vs. IPA vs. large/small physician partnership) Examine the differences (if any exist) in motivating factors between LACE and CILC physicians

References 1.Baldor, Robert A., W. Blair Brooks, Marji Erickson Warfield, and Kathleen O‘Shea. "A Survey of Primary Care Physicians' Perceptions and Needs regarding the Precepting of Medical Students in Their Offices." Medical Education (2001): Bowen, Judith L., and David M. Irby. "Assessing Quality and Costs of Education in the Ambulatory Setting." Academic Medicine 77.7 (2002): Grayson, Martha S., Martin Klein, Javier Lugo, and Paul Visintainer. "Benefits and Costs to Community-based Physicians Teaching Primary Care to Medical Students." Journal of General Internal Medicine 13.7 (1998): Kumar, Ashir, David J. Kallen, and Thomas Mathew. "Volunteer Faculty: What Rewards or Incentives Do They Prefer?" Teaching and Learning in Medicine 14.2 (2002): Starr, Susan, Warren Ferguson, Heather-Lyn Haley, and Mark Quirk. "Community Preceptors’ Views of Their Identities as Teachers." Academic Medicine 78.8 (2003): 820-5

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