1. Elizabeth Natal, MD Alice Fornari, Ed.D, RD Albert Einstein College of Medicine of Yeshiva University Department of Family & Social Medicine 2009 Annual STFM

2. Today’s Discussion Today’s Discussion Goals Introduction to core planning elements of a 2 week preceptorship Introduction to core planning elements of a 2 week preceptorship Share successes & challenges faced during preceptorship Share successes & challenges faced during preceptorship Introduction to the Nominal Group technique Introduction to the Nominal Group technique Identify essential steps to plan, implement & evaluate a 2 week preceptorship Identify essential steps to plan, implement & evaluate a 2 week preceptorship Describe one qualitative research technique for program evaluation Identify methods to ensure success & overcome challenges Identify methods to ensure success & overcome challenges Objectives

3. Goals Provide students with early exposure to Family Medicine Introduce students to various aspects of Family Medicine; general primary care & specialty areas of practice Identify students who would benefit from ongoing mentoring with a Family Physician early on Preceptorship Goals

4. Introduction: Primary Care Physician Need Aging & culturally diverse population  requires increased primary care work force to meet medical needs of such communities Bronx county:  Greater proportion of Hispanics and African-Americans compared to U.S. as a whole (48.4% Hispanics & 31.2% African-Americans)  Poverty rate 2.5 times that of U.S. average  poverty and lack of access to health care are indicators for poorer health outcomes Medical education must train students to provide health care to all types of communities, but there is certainly a great need for focusing primary care efforts in underserved communities

5. Why a Preceptorship in Family Medicine? Why Family Medicine?  unique position to service primary care needs of multi generational patient populations  unique training makes us prime candidates to work in underserved areas  well documented that many family physicians choose to work in underserved areas, greater need to generate more Family Physicians What increases student interest in Family Medicine?  strong clinical training in family medicine & exposure to good clinicians support larger numbers of students selecting family medicine residencies How can we take advantage of what we know?  medical education institutions should promote activities to increase student awareness and interest in primary care fields, like family medicine (early preceptorships, longitudinal ambulatory clerkships, primary care research, etc….)

6. Preceptorship Opportunity Medical students who just completed 1 st year were invited to participate in a two-week summer preceptorship to learn more about Family Medicine as a primary care specialty

7. Methods Where: setting Who: participants How: transportation, administrative support, faculty leadership What: Curriculum What happened: evaluation

8. Setting Ambulatory Clinics Nursing Home / Hospice Family Medicine Inpatient – Team & Hospitalist Family Medicine Residency  Various ambulatory Clinics: MMG Family Health Center, MMG Wiilliamsbridge Family Practice, Soundview Health Center, MMG Fordham Family Practice, etc…  Montefiore Medical Center: Moses Wound Care & Liver Clinic, Family Medicine Inpatient Ward, Women’s Center  Residency Program in Social Medicine  Others: Methodist Nursing Home, Melrose 9, Compassionate Care Hospice

9. Participants AECOM (Albert Einstein College of Medicine of Yeshiva University) medical students who completed 1 st Year Montefiore Family Physicians & non-Montefiore Family Physicians Patients from various sites Program leadership: Elizabeth Natal, MD (Program Director) Alice Fornari, Ed.D, RD (Medical Educator)

10. Recruitment Students Class-wide emails describing Preceptorship Stipends provided by Department Chair Students selected by review committee: Dept Chair & 2 Faculty Criteria: Quality of essay expressing interest in Family Medicine Prior work/volunteer experience in primary care a plus Preceptors Family Physicians practicing in local clinics recruited via email 35 Primary Care Physicians, 1 Family Medicine Hospitalist (N=36)

11. Other Institution: school and department approval & support important to success Transportation: Must consider transportation issues  logistics/costs/funding (Taxi service provided by AECOM, Approved by Deans office) Stipend funding: Plan ahead in Department budget submission for following year Scheduling  Faculty Coordinator created & updated calendar schedules  Students preferences guided schedule: diversity of physician’s clinical roles Administrative  Faculty coordinator provided core leadership, served as primary contact for all issues & prepared/distributed all materials  Medical Educator assisting in planning of preceptorship, creation and revision of materials and & conducted Focus Group Evaluation

12. Curriculum Expose students to….  Family Medicine as a primary care field  Family Medicine Inpatient (difference in hospital approach to acute illness)  Diverse roles of Family Medicine Specialty: (P-care/Hospice, Women’s Reproductive Health, Maternal & Child Health, Substance abuse, etc) Structure….  Students worked 5 days per week for two weeks  Each provider worked with students 1 to 2 half days  Six students divided into 2- two-week blocks (June & August)

13. Modes of Evaluation Students….. Pre & Post program survey Self-reflection narrative Preceptor evaluations of students Nominal Group Technique ** High student participation rate Preceptors….. Student Evaluation Overall Program Evaluation Not requested until after 2 nd block rotation Poor response Need to request feedback early on

14. Evaluation Students & Preceptors completed evaluations of each other Students completed pre/post program evaluation Preceptors asked to give feedback about program (2 nd block) Student prepared 1-2 page Self- Reflection paper Nominal Group Technique Evaluation (Identify common themes) Challenges Completion by preceptor of individual evaluation of students  used “FED” model; recommend using Likert scale evaluation Completion of preceptor evaluation of program  use Likert scale evaluation (Survey monkey) What to do with this?  submit for publication; med school newsletter vs. “Pulse” vs. portfolio Requires independent evaluator, no data for statistical significance, getting full student participation  make required part of successful completion to receive stipend Evaluation

15. Student Program Evaluation Student Program Evaluation

16. Focus Group Results Focus Group Results Describe Nominal Group Technique Results Strengths….  Well organized, good communication with faculty leader  Physician contact, camaraderie, & enthusiasm  Variety of physician practices & “hands-on” teaching and learning  Patient diversity (multigenerational, cultural, etc…)  Family Medicine Hospitalist experience Areas for improvement….  Add orientation day & lengthen preceptorship  Provide background descriptive clinic information (i.e.; methadone clinic, etc…)  Observation of FM faculty precepting residents, as a solo activity

17. "Program Evaluation Student Quotes" “I was given guidance and independence allowing me to experience Family Medicine the way I envisioned it” “The program demonstrated the wide range of ways to practice family medicine” (i.e.: general primary care, special practice niches, etc...) “The program demonstrated the wide range of ways to practice family medicine” (i.e.: general primary care, special practice niches, etc...) “Doctors … took care of multi-generational families, and were able to make a human connection with each member” “The inpatient experience was wonderful in that I was able to see disease processes that I had read about … was able to compare primary care in that setting to primary care as an outpatient” “The inpatient experience was wonderful in that I was able to see disease processes that I had read about … was able to compare primary care in that setting to primary care as an outpatient”

18. Student Evaluation of Preceptors 102/108 preceptor evaluations completed by students Of the 102 preceptor evaluations completed by students: all preceptors met or exceeded expectations in the following categories: Medical Knowledge Patient Care Practice-based learning & improvement Interpersonal & communication skills Professionalism

19. Successes & Challenges Successes…..  All 6 students completed preceptorship  Students were satisfied with the experience  Self-reported increased student knowledge of Family Medicine as a primary care field; new knowledge about diverse practice roles  Successful preceptor recruitment: larger institution, teaching institution, considerate of time commitment  1 to 2 half days) Challenges…..  Administrative support  Funding for stipends (request to include in dept. budget well in advance)  Preceptor availability & scheduling (summer)  Competing preceptor assignments with other medical students  Completion of student evaluations by preceptors  Coordinating transportation (one site all day if possible)

20. Conclusions A two-week preceptorship can effectively introduce early 2 nd year medical students to Family Medicine as a primary care field A Family Medicine preceptorship was effective in providing medical students with an introduction to the diverse career roles of Family Physicians Evaluation was an important component of this curriculum:  Formative evaluation provided timely data about modifications to enhance the program  Summative evaluation provided evidence of the benefit of this program in supporting an early introduction to Family Medicine as a primary care field

21. Implications An early preceptorship can increase student awareness about Family Medicine as primary care specialty Mentorship roles with Family Physicians can foster student interest in primary care career choices such as Family Medicine.

22. Next Steps Create new forms: Preceptor Student Evaluation form: Likert Scale Preceptor Program Evaluation: Survey Monkey Identify new funding sources for program Offer program yearly Provide Family Medicine mentors to interested students & Identify method to evaluate effectiveness of mentorship roles Track alumni residency selection

23. Special acknowledgments Department Chair & Medical School Dean for their support (Dr. Peter Selwyn, Dean Kuperman) Secretary, Dean of education: Debbie Mazella (program advertising) Medical Educator, Dr. Alice Fornari: role as a partner & mentor Physician, students and patients who participated

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