1. ©2014 MFMER | slide-1 Sara Oberhelman, MD Marcia O’Brien, MD; Kurt Angstman, MD Department of Family Medicine, Mayo Clinic, Rochester MN STFM April 27, 2015 Patients as Teachers Student Clinic The Scheduling Logistics and Preceptors’ Experiences with a Novel Approach to the Family Medicine Outpatient Clerkship

2. ©2014 MFMER | slide-2 Disclosures No financial/off-label disclosures. I am one of the PAT preceptors and completed the survey myself.

3. ©2014 MFMER | slide-3 Objectives 1. Review the Patients as Teachers Student Clinic model for an outpatient medical student clerkship. 2. Discuss preceptor feedback and lessons learned from the first year of utilizing this student clinic model. 3. Identify barriers and solutions to incorporating a student clinic into a busy clinic setting and consider adopting a similar model at their own clinics.

4. ©2014 MFMER | slide-4 Background: Our Medical School ~ 50 medical students per class ~3-8 students per block FM clerkship is 3 weeks (14 days) Schedule includes morning didactics All faculty are possible preceptors Located at 4 different primary care sites Also have option of FL or AZ campus

5. ©2014 MFMER | slide-5 Background: The Traditional Approach Shadowing “Go get a history” Direct observation Student involvement at expense of patient/nurse satisfaction and timeliness Any blocked time for teaching?

6. ©2014 MFMER | slide-6 Background: Idea We can do better! How can we mimic the time allowances and ownership students are able to have in free clinics and/or inpatient settings? And how can we do that while meeting the needs of our preceptors, nursing/desk staff and patients?

7. ©2014 MFMER | slide-7 Background: Idea Patient as Teachers (PAT) Student Clinic Schedule 3 students & 1 preceptor assigned per day 3 patient appointments per 75 minute block Acute/sub-acute appointments Nursing support Patient Appointment Coordinators Offered this as same-day appointment option Revealed that student would participate and appointment could be longer Promoted the patient’s role as educator Continued one-on-one preceptor

8. ©2014 MFMER | slide-8 Making it “Neutral” 10 a.m. – 5 p.m. 10-11:45 + 1:15-4:45 15 min NVC = 5.25 hr direct patient care Each student has 30 min “education time” per half day 60 min x 3 students = 3 hrs = 2.25 hrs left of direct patient care Appointment slots 15-30 min 9 PAT appts x 30 min = 4.5 hrs direct pt care 9 PAT appts x 15 min = 2.25 hrs direct pt care

9. ©2014 MFMER | slide-9 Original Objectives Improve the students’ clerkship experience More time/opportunity to independently interview and examine patients More autonomy in patient care Expectation to formulate assessment and plan Improve the ability for preceptors to function as teachers Remain neutral in terms of patient and nursing/support staff satisfaction

10. ©2014 MFMER | slide-10 Timeline Fall-Winter 2013: Planning, baseline data February-June 2014: Pilot July 2014 – June 2015: First academic year of new curriculum

11. ©2014 MFMER | slide-11 Early Challenges How to stagger appointments Unpredictability of acute appointment needs Best ratio of time between PAT clinic and one- on-one preceptor Student expectations Non-visit care time for preceptor

12. ©2014 MFMER | slide-12 Results Snapshot of Preceptor Views after One Year

13. ©2014 MFMER | slide-13 Methods/Data Collection Anonymous, online survey (SurveyMonkey) Spring 2015 Data analysis PAT Preceptors compared their experiences with PAT clinic vs traditional precepting PAT Preceptors compared to Traditional Preceptors Statistics Mann-Whitney U for Likert Scale Chi 2 – Positive/negative ? Neutral responses

14. ©2014 MFMER | slide-14 Results: Response Rate PAT Clinic Preceptors N=7 Response Rate 87.5% Traditional Preceptors N=12 Response Rate 63%

15. ©2014 MFMER | slide-15 Results: Educational Quality No Statistical Significance

16. ©2014 MFMER | slide-16 Results: Impact on Care/Time P<0.05 PAT vs 1:1 Better vs Worse No Statistical Significance

17. ©2014 MFMER | slide-17 Results: Satisfaction P<0.05 by Mann-Whitney and Chi 2 with Neutral Negative

18. ©2014 MFMER | slide-18 Conclusions Creative scheduling can offer new educational opportunities Both (all?) models of precepting offer challenges for preceptor timeliness PAT Clinic preceptors had better perceptions of PAT clinic than traditional preceptors

19. ©2014 MFMER | slide-19 Continued Work/Next Steps Plan to expand preceptor pool Plan to expand to additional clinic sites Continue to work on distribution of time during a very short clerkship

20. ©2014 MFMER | slide-20 Many, Many Thanks Preceptors – Greg Anderson, MD; Greg Bartel, MD; Andy Bock, MD; Teresea Jensen, MD; Jay Mitchell, MD; Marcia O’Brien, MD; Liz Westby, MD Chair of Education – Kurt Angstman, MD Clerkship Director – Bob Sheeler, MD Clinic Director – Greg Bartel, MD Chair of Undergraduate Education – Lori Bates, MD Clinic Operations Manager – Rob Bender Nursing Supervisor – Julie Sanger, RN & Susan Daniels, RN Assistant Supervision of Clinic Operations – Renea Schouweiler Clerkship Secretaries – Sharon Krier, Shelly Clark Patient Appointment Coordinators – Chris Bachman, Teresa Fenske, Lisa Hanson, Amber Hookey, Wendy Mienar Neissen Clinic Nursing Staff Hundreds of Patients who became the teachers

21. ©2014 MFMER | slide-21 Questions & Discussion oberhelman.sara@mayo.edu