1. Join the conversation! Our Twitter hashtag is MSE12 The Satisfaction, Motivation, and Future of Community Preceptors: One State’s Experience Revisited Robyn Latessa, MD Mountain AHEC FMRP & UNC School of Medicine Asheville Gaye Colvin, MLIS Mountain AHEC, Office of Regional Primary Care Education Norma Beaty, MS MAEd, UNC School of Medicine Asheville Beat Steiner, MD, MPH UNC School of Medicine Chapel Hill

2. Community preceptor based education Important component of medical education NC AHEC system has affiliations with most health science schools in NC Offices of Regional Primary Care Education (ORPCEs) provide support for preceptors Assist with faculty appointments Provide CME events Access to online library resources Financial Setting:

3. Join the conversation! Our Twitter hashtag is MSE12 Setting: University Medical Centers 1. Wake Forest University 2. UNC at Chapel Hill 3. Duke University -- Each AHEC has ORPCE 4. East Carolina University

4. 2005: surveyed 2,061 preceptors in NC AHEC system to measure satisfaction, motivation, and future plans for teaching students Disciplines served: medicine, pharmacy, advanced practice nurse, physician assistant Original intention to repeat in 5 years Setting:

5. The 2005 survey found high levels of: Satisfaction with teaching Self-reported intention to continue Satisfaction with professional lives & incentives/rewards Since 2005, anecdotal feedback from all disciplines indicates: Difficult economic climate More learners (↑ enrollment & programs) ↑ practice demands & new practice models Setting:

6. Are costs to preceptors beginning to outweigh benefits/motivation for teaching? Are we approaching the point where traditional models of community-based medical education need to be re-evaluated and possibly redesigned? What might be implications for future innovative curriculum changes especially regarding MS3 training? Questions:

7. Hypotheses: Given increased challenges, we anticipated: Lower overall satisfaction with Teaching role Incentives received Professional life Greater importance on Extrinsic rewards (money, access to online library resources, CME, etc.)

8. Methods: Supported by NC AHEC, UNC SOM, and Mountain AHEC Sent survey by email and mail to 2,359 primary care preceptors in the NC AHEC program (Jul 2009 – Dec 2010) Same survey items as 2005: Overall satisfaction with precepting Anticipated likelihood of continuing (next 5 years) Reasons for teaching students Satisfaction with/value placed on tangible incentives Satisfaction with professional life

9. Results: Overall response rate to survey 2005 – 69% 2011 – 54% 2011 Highlights: Half were physicians - 50% Medical specialties represented: FM - 50% IM - 22% PED - 20% OBGYN - 8%

10. Results: MDsAll Characteristic 2005 (n=813) 2011 (n=633) 2005 (n=1428) 2011 (n=1278) Gender, % Male 73.168.653.946.9 Female 26.931.446.153.1 Race, % Caucasian 81.077.186.084.8 Non-Caucasian 19.022.914.015.2 Practice location, % Urban 26.123.928.928.3 Suburban 35.739.033.736.3 Rural 38.237.137.435.4

11. Results: MDsAll Characteristic 2005 (n=813) 2011 (n=633) 2005 (n=1428) 2011 (n=1278) Nbr yrs precept – median10 8 Nbr yrs precept – median10 8 Wks/yr precept – median881012.0 Hrs worked/wk – median50 4545.1 Age, years, % ≤ 40 years27243230 41-60 years59625659 > 60 years14 1211 Years in practice, % ≤ 15 years53445851 16-25312925 > 25 years16271724

12. Results: Still high degree of satisfaction: Still high likelihood of intention to continue: Satisfied/ Very Satisfied 20052011 ∆ from 2005/2011 MDAllMDAll 93% ND*91%92%ND Probably/ Definitely 20052011 ∆ from 2005/2011 MDAllMDAll 91% ND89% ND *ND = No difference between MDs & All

13. Intrinsic reasons for precepting still important: Results: Great/Very Great 20052011 ∆ from 2005/2011 MDAllMDAll Give back 98% ND98%99%ND Enjoy teaching 98% ND98% ND Role model 95%96%ND96%97%p=.006ND Intellectual stim 98% ND98% ND Demo community practice 99%98%ND98% ND PA – 99%, APN – 99%, PHARM – 99%

14. Results: Overall satisfaction with current incentives received: Satisfied/ Very Satisfied 20052011 ∆ from 2005/2011 MDAllMDAll 55%57%ND47%49%ND MDs: p=.002 All: p=<.001

15. Results: Physicians placed significantly less value on the following rewards: Great/Very Great 20052011 MDAllMDAll CE for teaching 84%82%p=<.00182%86%p=<.001 Academic Appt 66%64%ND68%66%ND AHEC Digital library 62%70%p=<.00161%72%p=<.001 CME programs 61%72%p=<.00160%73% p=<.001 Financial reimb. 53%60%p=<.00153%62%p=<.001

16. Results: Value of financial compensation the same Greater interest in higher financial compensation Satisfied/ Very Satisfied 20052011 ∆ from 2005/2011 MDAllMDAll $100-$15056%65%p=<.00126%31%p=<.001 >$15041%34%p=<.00153%43%p=<.001

17. Results: Satisfaction with professional life – physicians rated slightly lower: Great/Very Great 20052011 MDAllMDAll Overall professional life 92%94%p=.00290%94%p=<.001

18. Conclusions: Overall satisfaction with precepting & professional life remains very high Intrinsic motivators are still important (even higher in 2011 than 2005) Extrinsic rewards may be increasing in value (CE credit, academic appt., CME, on-line library resources, monetary compensation)

19. Conclusions: Use of community preceptors in medical education is still a viable model in NC Beginning to see trends in preceptor satisfaction that may suggest need for redesign of teaching models for physicians

20. Questions: Are physicians a unique preceptor group? New teaching models needed? Funding issues? – Specialized teaching practices? – Longitudinal curriculum? Should practices be encouraged to allow preceptors to receive financial rewards directly? Other questions or thoughts?