the program will start promptly at 1:30 pm

The program will start promptly at 1:30 PM

For technical assistance please contact Tech Support at 404-969-0387 or email at [email protected]

For technical assistance please contact Tech Support at 404-969-0387 or email at [email protected]

Teaching Medical, PA, or NP Students in

Community Practices

What Community Practitioners Need to Know

Teaching Medical, PA, or NP Students in

Community Practices

What Community Practitioners Need to Know

Presentation Objectives

By the end of this presentation, attendees will:By the end of this presentation, attendees will:

– Understand some of the issues related the physician Understand some of the issues related the physician shortage in Georgia.shortage in Georgia.

– Know why community practices are well-suited for Know why community practices are well-suited for the training of medical, NP and PA students.the training of medical, NP and PA students.

– Appreciate the key role that Georgia’s AHECs play in Appreciate the key role that Georgia’s AHECs play in facilitating health sciences education in the state.facilitating health sciences education in the state.

– Be able to decide if their clinical practice is suitable Be able to decide if their clinical practice is suitable for teaching medical, NP and PA students. for teaching medical, NP and PA students.

– Realize that they can be excellent preceptors with Realize that they can be excellent preceptors with minimal amount of additional training.minimal amount of additional training.

If you have any technical issues, please contact 404-969-0387 or email [email protected]

mailto:[email protected]

Georgia Has a Physician Shortage

Georgia ranks 9Georgia ranks 9thth in population, in population, but 39but 39thth in total physician supply in total physician supply per 100,000 populationper 100,000 population

Georgia ranks 34Georgia ranks 34thth among the 46 among the 46 states that have medical states that have medical schools in the number of schools in the number of medical students per 100,000 medical students per 100,000 populationpopulation



Where Do Med Students End Up Practicing?

Medical students practicing in Georgia:Medical students practicing in Georgia:– MCG: 52.9%MCG: 52.9%– Emory: 38.1%Emory: 38.1%– Mercer: 57%Mercer: 57%– Morehouse: 47%Morehouse: 47%– All Georgia medical schools: 47.5%All Georgia medical schools: 47.5%

National average in states with medical schools: National average in states with medical schools: 39% retention rate39% retention rate



Addressing Physician Shortages in Georgia

Additional efforts are being made to increase Additional efforts are being made to increase the number of physicians in Georgia by the number of physicians in Georgia by increasing medical school class size:increasing medical school class size:

MCG: MCG: – Increasing class size (190-200)Increasing class size (190-200)– Developing new regional campus in Athens Developing new regional campus in Athens

(40 students entering in 2010).(40 students entering in 2010). Mercer => Savannah: 30 students per year Mercer => Savannah: 30 students per year

(began 2008)(began 2008)



Causes for Physician Shortages in Georgia

Distribution Distribution





Decreasing attractiveness of primary care Decreasing attractiveness of primary care compared with specialties with higher salaries compared with specialties with higher salaries or “controllable lifestyles.”or “controllable lifestyles.”



Educational Debt of Graduating Medical Students in GA’s Medical Schools

National Debt Level of Medical Students:National Debt Level of Medical Students:• 50% with ≥$80,00050% with ≥$80,000

• Median debt nationally: $115,000 (pub. schools); $150,000 (priv. schools)Median debt nationally: $115,000 (pub. schools); $150,000 (priv. schools)





Decreasing attractiveness of primary care Decreasing attractiveness of primary care compared with specialties with higher salaries compared with specialties with higher salaries or “controllable lifestyles.”or “controllable lifestyles.”

Physician demographics & work preferences:Physician demographics & work preferences:

– Younger generation: preference for working Younger generation: preference for working shorter hours, greater emphasis on family & shorter hours, greater emphasis on family & quality of life issuesquality of life issues

– Increasing numbers of female physiciansIncreasing numbers of female physicians



Because of the current and projected unequal distribution of primary care physicians, there is an increased need to train PA’s and NP’s to help meet the health care needs of the citizens of Georgia . . . . .

Medical School: The Big Picture



StudentsStudents

PhysiciansPhysiciansTransformationTransformation




StudentsStudents

PhysiciansPhysiciansTransformationTransformation


How Does It How Does It Happen?Happen?



First 2 Years of Medical SchoolBasic Science FoundationBasic Science FoundationClinical SkillsClinical SkillsCommunication SkillsCommunication SkillsProfessionalismProfessionalismCultural CompetenceCultural CompetencePrinciples of Life-long LearningPrinciples of Life-long Learning



3rd Year Clinical Training3rd Year Clinical Training Internal Medicine:Internal Medicine: 8 Weeks8 Weeks Surgery:Surgery: 8 Weeks8 Weeks Neurology:Neurology: 4 Weeks4 Weeks Elective:Elective: 4 Weeks4 Weeks

Pediatrics:Pediatrics: 6 Weeks6 Weeks OB/GYN:OB/GYN: 6 Weeks6 Weeks Family Medicine:Family Medicine: 6 Weeks6 Weeks Psychiatry:Psychiatry: 6 Weeks**6 Weeks**

****4 weeks in 2009, with 2 week Intersession 4 weeks in 2009, with 2 week Intersession



Where Do Medical Students Get Their Clinical Training?

Venues for training learners are changing:Venues for training learners are changing:

– Less inpatient, more ambulatoryLess inpatient, more ambulatory

– Inadequate clinical opportunities near the Inadequate clinical opportunities near the academic medical centeracademic medical center

– Need for more realistic experiences for students, Need for more realistic experiences for students, especially in primary careespecially in primary care

Results:Results:– Community-based learning opportunitiesCommunity-based learning opportunities– Opportunities to interact with other health care Opportunities to interact with other health care

providers => “Real World”providers => “Real World”



Critical Role of Community-Based Teaching Sites in the School of Medicine

Third year core clerkships:Third year core clerkships:– 30% at geographically separated sites distant from 30% at geographically separated sites distant from

MCGMCG– 50% are ambulatory-based50% are ambulatory-based

Community-based sites in:Community-based sites in:– MedicineMedicine SurgerySurgery– Family medicineFamily medicine PediatricsPediatrics– NeurologyNeurology OB/GynOB/Gyn– Emergency MedicineEmergency Medicine PsychiatryPsychiatry



http://www.foothillsahec.org/default.htmhttp://www.foothillsahec.org/default.htm

Role of AHEC in Medical Student Education

On-site coordinator with community preceptors and On-site coordinator with community preceptors and MCGMCG

Housing assistanceHousing assistance Assistance with logistical support for students (when Assistance with logistical support for students (when

needed)needed) Educational support when needed (helping with exams Educational support when needed (helping with exams

in Pediatric Clerkship, for example)in Pediatric Clerkship, for example)



To study the phenomenon To study the phenomenon of disease without books is of disease without books is to sail an uncharted sea, to sail an uncharted sea, while to study books without while to study books without patients is not to go to sea at patients is not to go to sea at all.all.

Medicine is learned by the Medicine is learned by the bedside and not in the bedside and not in the classroom.classroom.

-Sir William Osler, M.D.-Sir William Osler, M.D.



What Really Needs to Be Accomplished in the “Clinical” Years of

Training?

What Really Needs to Be Accomplished in the “Clinical” Years of

Training?



What Really Needs to Be Accomplished in the Clinical Years of Training?

Knowledge: Knowledge: Basic science Basic science knowledge needs to be knowledge needs to be reorganizedreorganized into clinically relevant structureinto clinically relevant structure

– ““Disease-Based” Disease-Based” “Sign or “Sign or Symptom-Based”Symptom-Based”

– Development of clinical Development of clinical associations, applicationsassociations, applications

– Facts Facts Patient-focused Patient-focused

– Knowledge Knowledge Action Action



Goal for Clinical Teaching Encounters

Help the learner develop Help the learner develop his/her clinical knowledge by his/her clinical knowledge by

creating a new link or creating a new link or association from every patientassociation from every patient



What Are the Links or Associations That You Want to Teach?What Are the Links or Associations That You Want to Teach?

KnowledgeKnowledge– Clinical presentation of diseasesClinical presentation of diseases– History-taking questions/contentHistory-taking questions/content– Differential diagnosisDifferential diagnosis– Natural history of diseasesNatural history of diseases– TherapyTherapy– ManagementManagement– Anticipatory guidanceAnticipatory guidance




Knowledge: Knowledge: Basic science knowledge needs to be Basic science knowledge needs to be reorganizedreorganized into clinically relevant structure into clinically relevant structure– ““Disease-Based” Disease-Based” “Sign or Symptom-Based” “Sign or Symptom-Based”– Development of clinical associationsDevelopment of clinical associations– Development of new clinical knowledgeDevelopment of new clinical knowledge

Skills:Skills:– Development of basic clinical skillsDevelopment of basic clinical skills



Clinical Skills Students Need to Learn from Their Preceptors

History-Taking SkillsHistory-Taking Skills

– VerbalVerbal

– Non-verbalNon-verbal

– OrganizationOrganization

Physical Examination SkillsPhysical Examination Skills

Reporting SkillsReporting Skills

– Oral & WrittenOral & Written

Technical SkillsTechnical Skills

– Reading X-RaysReading X-Rays

– Interpreting lab studiesInterpreting lab studies

– Writing prescriptionsWriting prescriptions



Knowledge:Knowledge: Basic science knowledge needs to be Basic science knowledge needs to be reorganizedreorganized into clinically relevant structure into clinically relevant structure– ““Disease-Based” Disease-Based” “Sign or Symptom-Based” “Sign or Symptom-Based”– Development of clinical associationsDevelopment of clinical associations– Development of new clinical knowledgeDevelopment of new clinical knowledge

Skills:Skills:– Development of all basic clinical skillsDevelopment of all basic clinical skills

Prepare for residency trainingPrepare for residency training (Med Students) (Med Students)– Pass USMLE Step 2CK, 2CSPass USMLE Step 2CK, 2CS– Make a career choice Make a career choice prepare for the “Match” prepare for the “Match”


““The natural method of The natural method of teaching the student teaching the student

begins with the patient, begins with the patient, continues with the patient, continues with the patient, and ends his studies with and ends his studies with the patient, using books the patient, using books and lectures as tools, as and lectures as tools, as

means to an end”means to an end”

Sir William Osler, M.D.Sir William Osler, M.D.


Why Are Community Physicians Uniquely

Qualified to Teach Medical, NP and PA Students?

Why Are Community Physicians Uniquely

Qualified to Teach Medical, NP and PA Students?


Community Physicians Are Uniquely Qualified to Teach Medical, NP or PA Students

Provide more opportunities for Provide more opportunities for students to see “real world” patients students to see “real world” patients – History-Taking and Physical Exam SkillsHistory-Taking and Physical Exam Skills– Written records, oral presentationsWritten records, oral presentations– See diseases and conditions they’ve only See diseases and conditions they’ve only

read aboutread about



Provide more opportunities for students to see “real Provide more opportunities for students to see “real world” patients world” patients – History-Taking and Physical Exam SkillsHistory-Taking and Physical Exam Skills– Written records, oral presentationsWritten records, oral presentations– See diseases and conditions they’ve only read See diseases and conditions they’ve only read

aboutabout Provide more opportunities for students to apply Provide more opportunities for students to apply

their clinical knowledge:their clinical knowledge:– Differential diagnosis, evaluationDifferential diagnosis, evaluation– Management/Treatment/Follow-upManagement/Treatment/Follow-up



Provide more opportunities for students to see “real Provide more opportunities for students to see “real world” patients world” patients – History-Taking and Physical Exam SkillsHistory-Taking and Physical Exam Skills– Written records, oral presentationsWritten records, oral presentations– See diseases and conditions they’ve only read See diseases and conditions they’ve only read

aboutabout Provide more opportunities for students to apply Provide more opportunities for students to apply

their clinical knowledge:their clinical knowledge:– Differential diagnosis, evaluationDifferential diagnosis, evaluation– Management/Treatment/Follow-upManagement/Treatment/Follow-up

More clinical opportunities More clinical opportunities more learning more learning



Provide more opportunities for students to see “real Provide more opportunities for students to see “real world” patients world” patients – History-Taking and Physical Exam SkillsHistory-Taking and Physical Exam Skills– Written records, oral presentationsWritten records, oral presentations– See diseases and conditions they’ve only read aboutSee diseases and conditions they’ve only read about

Provide more opportunities for students to apply their Provide more opportunities for students to apply their clinical knowledge:clinical knowledge:

– Differential diagnosis, evaluationDifferential diagnosis, evaluation

– Management/Treatment/Follow-upManagement/Treatment/Follow-up

More clinical opportunities More clinical opportunities more learning more learning

Serve as role modelsServe as role models


““It is much more It is much more important to know what important to know what sort of a patient has a sort of a patient has a

disease than what sort of disease than what sort of a disease a patient has.” a disease a patient has.”

-Sir William Osler, MD-Sir William Osler, MD


What is Needed to Teach Students in a

Community-Based Practice?

What is Needed to Teach Students in a

Community-Based Practice?


What is Needed to Teach Students in a Community-Based Practice?

PatientsPatients

Space:Space:

– An exam room where he/she can work at a slower An exam room where he/she can work at a slower pace and not slow you downpace and not slow you down

Internet connection at the officeInternet connection at the office

Excellent clinical and office staffExcellent clinical and office staff

A willingness to teach what you already know . . . . .A willingness to teach what you already know . . . . .

A little bit of extra timeA little bit of extra time


What About the Quality of the Training by Community-Based Preceptors

Academic Medical Center vs. Community Sites Academic Medical Center vs. Community Sites

– Students comparable in 1Students comparable in 1stst 2 years of medical school 2 years of medical school

Students at community sites:Students at community sites:

– Performed same on NBME subject testPerformed same on NBME subject test

– Performed better on in-house written examPerformed better on in-house written exam

– Received higher clinical grades (assigned by faculty)Received higher clinical grades (assigned by faculty)

– Saw more than twice as many patientsSaw more than twice as many patients

Pediatric Clerkship 1997-2002Pediatric Clerkship 1997-2002


Common QuestionsCommon Questions


Common Questions What am I supposed to teach? Is there a curriculum?What am I supposed to teach? Is there a curriculum?

– The students receive an orientation to the clerkship The students receive an orientation to the clerkship at MCG before going to their community practice.at MCG before going to their community practice.

– They are provided a curriculum and other learning They are provided a curriculum and other learning resources by their clerkship director or MCG-based resources by their clerkship director or MCG-based instructor instructor

– Lectures (if part of the training) are typically Lectures (if part of the training) are typically videotaped and provided as CD’s or streaming video.videotaped and provided as CD’s or streaming video.

– You will be given all the resources and information You will be given all the resources and information you need to be a successful preceptor.you need to be a successful preceptor.


Common Questions

I’ve never done this before. How do I get the skills I’ve never done this before. How do I get the skills needed to teach a student in the office?needed to teach a student in the office?

– The Clerkship Director or experienced educators The Clerkship Director or experienced educators at MCG will provide you with training. It’s actually at MCG will provide you with training. It’s actually very simple – taking less than an hour or so to get very simple – taking less than an hour or so to get started.started.

– Patients are the best teachersPatients are the best teachers – your role is find – your role is find common teaching points or “links” for the student common teaching points or “links” for the student to remember from the patients they see.to remember from the patients they see.


Common Questions

What about evaluations? How do I grade the student?What about evaluations? How do I grade the student?– The Clerkship Director or course instructor will The Clerkship Director or course instructor will

provide you information and instructions about provide you information and instructions about grading your student. There is a specific form that grading your student. There is a specific form that is used, and usually it is done on the Internet.is used, and usually it is done on the Internet.

– The course director will provide you with feedback The course director will provide you with feedback on how your student(s) performed annually, and on how your student(s) performed annually, and how they compared with other students on that how they compared with other students on that course or clerkship assigned to other sites.course or clerkship assigned to other sites.


Common Questions What requirements are necessary for me to What requirements are necessary for me to

perform in order to be a preceptor?perform in order to be a preceptor?– A Faculty Appointment at MCGA Faculty Appointment at MCG: You need to : You need to

fill out an application form for a faculty fill out an application form for a faculty appointment. It’s not too bad – much less appointment. It’s not too bad – much less onerous than applying (or reapplying) for onerous than applying (or reapplying) for credentials.credentials.


Common Questions

Are there any benefits for teaching students?Are there any benefits for teaching students?

– A Faculty Appointment at MCGA Faculty Appointment at MCG– Library privileges at the Greenblatt Library (includes Library privileges at the Greenblatt Library (includes

Internet access to OVID, and full-text journals).Internet access to OVID, and full-text journals).– Access to outreach librarian for technical assistanceAccess to outreach librarian for technical assistance– Reduced CME at MCG-sponsored CME activitiesReduced CME at MCG-sponsored CME activities– Annual faculty development trainingAnnual faculty development training


Observations from MCG Community Preceptors

Teaching takes timeTeaching takes time Physicians feel “energized” by studentsPhysicians feel “energized” by students A chance to “give back”A chance to “give back” Feel “good” about teaching and seeing students Feel “good” about teaching and seeing students

grow in their clinical skillsgrow in their clinical skills Teaching is enjoyable and fulfillingTeaching is enjoyable and fulfilling– Few drop outFew drop out


Benefits for MCG Different type of educational experienceDifferent type of educational experience– Community-based practice – “Real World”Community-based practice – “Real World”– Ambulatory settingsAmbulatory settings– Primary care emphasisPrimary care emphasis

Broadened patient baseBroadened patient base– Meets the educational need for more ambulatory Meets the educational need for more ambulatory

experienceexperience

Closer connection with communityCloser connection with community

Help meet physician shortages?Help meet physician shortages?


““I desire no other epitaph than I desire no other epitaph than the statement that I taught the statement that I taught medical students in the wards, as medical students in the wards, as I regard this by far the most I regard this by far the most useful and important work I have useful and important work I have been called to do.” been called to do.”

Sir William Osler, MDSir William Osler, MD


Contact InformationContact Information

Chris White, MDChris White, MDAssociate Dean for Faculty Development Associate Dean for Faculty Development

& Educational Achievement& Educational AchievementMedical College of GeorgiaMedical College of Georgia

[email protected]@mcg.edu(706) 721-3529(706) 721-3529


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