Renewing Primary Care : The Power of Residents as Teachers Steven Lin, Erika Schillinger, and Grace Yu O’Connor Family Medicine Residency Program Stanford University School of Medicine

LEARNING OBJECTIVES 1. To identify the top barriers to primary care encountered by medical students 2. To demonstrate the importance of exposure to family medicine residents as teachers in influencing the selection of primary care specialties by medical students 3. To present the design and implementation of a resident-as-teacher program and its effects on student interest in primary care

LEARNING OBJECTIVES 4. To brainstorm strategies for harnessing the power of residents as teachers in renewing primary care at the medical school level DISCLOSURES No conflicts of interest

Background Question 1 Question 2 Question 3 Discussion

Background Question 1 Question 2 Question 3 Discussion

Background Question 1 Question 2 Question 3 Discussion How important is exposure to FM resident role models in influencing student selection of a PC specialty?

Background Question 1 Question 2 Question 3 Discussion 2012 California Family Medicine Resident-as-Teacher Survey 96% of California’s family medicine leaders “strongly agree” or “agree” that medical student interest in primary care and family medicine is influenced by exposure to family medicine RESIDENTS as teachers during medical school

Background Question 1 Question 2 Question 3 Discussion

Background Question 1 Question 2 Question 3 Discussion How much exposure do medical students have to family medicine residents as teachers in California?

Background Question 1 Question 2 Question 3 Discussion SERT : Student Exposure to Residents as Teachers Score  Each residency assigned a score of 0-3  Medical schools ranked based on total SERT scores of affiliated FM programs SERT ScoreResidency Characteristics +1 pointAffiliated with a medical school +1 pointTeaching medical students part of residents’ responsibilities +1 pointOffers formal track, pathway, or area of concentration in medical education, leadership, or faculty development for residents

Background Question 1 Question 2 Question 3 Discussion

Background Question 1 Question 2 Question 3 Discussion

Background Question 1 Question 2 Question 3 Discussion RankSchoolResidenciesSERT Score 1UCLA9* (-1 in 2012) 19 2UC Davis613 3UC Irvine6* (-1 in 2012) 11 4UCSF410 5Loma Linda48 6USC35 7UCSD2* (+1 in 2012) 4 8Stanford12

Background Question 1 Question 2 Question 3 Discussion Does exposure to FM residents as teachers in medical school lead to higher match rates into PC or FM?

Background Question 1 Question 2 Question 3 Discussion

Background Question 1 Question 2 Question 3 Discussion

Background Question 1 Question 2 Question 3 Discussion

Background Question 1 Question 2 Question 3 Discussion

Background Question 1 Question 2 Question 3 Discussion 2012 California Family Medicine Resident-as-Teacher Survey 83% of California’s family medicine leaders “strongly agree” or “agree” that increasing medical student exposure to FM residents as teachers during medical school will INCREASE interest in primary care and family medicine

Background Question 1 Question 2 Question 3 Discussion CONCLUSIONS 1. Lack of access to role models in medical school is one of the top barriers to primary care. 2. Family medicine residents are a major influence on the selection of primary care specialties.

Background Question 1 Question 2 Question 3 Discussion 3.Increasing student exposure to FM role models during medical school is associated with higher match rates into a primary care field, especially family medicine. 4.Programs that increase medical student exposure to FM resident teachers may be used as a direct strategy to combat the national shortage of primary care doctors.

Background Question 1 Question 2 Question 3 Discussion Strengths:  First study of its kind Limitations:  Two-thirds (66%) survey response rate  SERT score needs validation as a tool  Associations do not prove causality Future directions:  Match data from other regions  Use lessons learned to improve OSLER

Background Question 1 Question 2 Question 3 Discussion Started in 2010 OSLER residents complete the basic elements of a faculty development fellowship by the end of residency  Up to 6 months of teaching/project time  Mentored teaching rotations at Stanford Goals:  Train leaders and innovators in medical education  Renew primary care by addressing role model gap 1 in 3 residents are active in OSLER  First class of OSLER residents to graduate in 2013

Background Question 1 Question 2 Question 3 Discussion Curriculum1 st Year2 nd Year3 rd Year Participate in longitudinal educational curriculum XXX Work with master teachers at O’Connor and Stanford XXX Teach medical students in FQHC/community hospital XXX Precept medical students in Practice of Medicine course XX Design new curricular offerings in the Family Medicine Core Clerkship XX Lead standardized patient exams and the Mini-CPX XX Produce rigorous scholarly projects in med education Plan project Work on project Complete project Attend national meetings (e.g. STFM, AAFP) XXX Develop and maintain an educational portfolio XXX

Background Question 1 Question 2 Question 3 Discussion The Five PillarsKey QuestionsBest Practices O bjectives  Are the objectives measurable and the teaching methods appropriate? The KAS Objectives: 1)Knowledge (cognitive) 2)Attitudes (affective) 3)Skills (psychomotor) S etting and learning climate  Is the session organized and efficient, and is it safe for learners to address their own limitations? The SMART Climate: 1)Safe 2)Motivational 3)Accountable 4)Reflective 5)Timely L earner- centered teaching  Does the teaching meet the learners’ needs and involve them actively in their own learning? The Simplified One Minute Preceptor: 1)Get a commitment 2)Probe for evidence 3)Teach a pearl E valuation and feedback  Was the feedback specific, timely, all- directional, non- judgmental, and digestible? The Ask-Tell-Ask Feedback Sandwich: 1)Get self-assessment 2)Agree or disagree 3)Ask how to improve R eflection  Is there time for self reflection, and are teacher and trainee working as allies with common goals? Reflective Questioning: 1)Pose a reflective question 2)Observe reactions 3)Go deeper

Background Question 1 Question 2 Question 3 Discussion

How do we harness the power of residents as teachers to renew interest in primary care?

LEARNING OBJECTIVES 1. To identify the top barriers to primary care encountered by medical students 2. To demonstrate the importance of exposure to family medicine residents as teachers in influencing the selection of primary care specialties by medical students 3. To present the design and implementation of a resident-as-teacher program and its effects on student interest in primary care

LEARNING OBJECTIVES 4. To brainstorm strategies for harnessing the power of residents as teachers in renewing primary care at the medical school level REFERENCES Association of American Medical Colleges (AAMC) National Resident Matching Program (NRMP) American Medical Association’s Report of the Council on Medical Education (2008)

Renewing Primary Care : The Power of Residents as Teachers Questions? Steven Lin, MD Thank You!