1. Family Medicine Preceptorships for First Year Medical Students: Looking Back While Moving Forward James G. Boulger, Ph.D. Emily Onello, M.D. University of Minnesota Medical School Duluth Campus Department of Family Medicine and Community Health

2. Objectives: To Describe Benefits of early Family Medicine office-based clinical instruction Difficulties inherent in moving instruction from the medical school to the community in today’s practice environment Some opportunities in using “real world” context for application of basic science How one successful and long-standing program has accomplished its educational goals for students Changes in the interest & perceptions of medical students and community-based preceptors of early introduction programs

3. Background Since 1972, the medical students in Duluth have participated in a required clinical Family Medicine Preceptorship One critical element in a comprehensive, continuing thread throughout a curriculum designed to promote and continue interest in Family Medicine as a career Resoundingly successful – 48% entering Family Medicine residencies since 1976 (N = 837 of 1749 graduates)

4. Many Changes in Practice and Medical Education in Past 20 Years... Transition from private practice model to health systems model of health care Changes within the practice environment (e.g. EMR) Variations/declines in reimbursements Affordable Care Act Decrements in physician practice autonomy

5. Effects on the Educational Model Difficulties with increasing paperwork, HIPAA, background checks, student certification, etc. Time demand changes on practitioners Increasing pressures from ALL health sciences training programs to utilize practitioners in office settings Need to better support our clinical, non-University practicing faculty

6. The Family Medicine Preceptorship Program Early exposure – seven half-days through the first year of medical school Preceptors located within 25 mile radius of Duluth Beginning list of possible preceptors: All practicing family physicians in the area unless they have specifically requested NOT to be contacted (very few). Initial solicitation with dates of sessions for the year; follow-up by mail or phone after three weeks. No stipends for preceptors

7. The Family Medicine Preceptorship Program At conclusion of year, students rate preceptors on the following variables using a 5-point Likert scale –Interest & Enthusiasm –Graduated responsibility –Realistic Practice View –Timing & Arrangements –Clinical Teacher

8. Table 1: Mean and Modal Ratings of Family Medicine Preceptors: 1992 and 2012

10. 199220012012 Affirmative83.61%70.97%61.22% Negative16.39%24.73%14.29% No Answer0.00%4.30%24.49% Responses To Solicitation of Community Practitioners for Mentoring

12. Do the student ratings, which are remarkably consistent over the years, mirror the preceptor’s practice satisfaction or are these two characteristics unrelated? Does the decrement in positive responding to the call to serve as preceptors reflect o Personal practice dissatisfaction o Organizational anomié and/or resistance o Negative experiences with prior students o A more limited set of practices and skills o More competition for the practitioners’ teaching time … OR o All of the above and more?

13. Conclusions Interest & enthusiasm among students remains high Preceptors are responsive to many pressures – including our requests for teaching Benefits to students from early patient exposure are motivating and reinforcing of interest in Family Medicine

14. Disclosures None Questions?