1. Clinical Sites – Established Programs
Program Directors 101
Clinical Sites – Established Programs
Patrick Auth
Sandra Banas

2. Instructional Objectives
Identify and discuss the factors that affect securing clinical sites
Develop strategies to recruit and retain clinical sites
Develop a model for credit hour workload distribution for members of the clinical year team
Identify ways to meet the specific clinical education needs of your program

3. What’s in a name? PROGRAM
The Clinical Team
The Clinical Team
PROGRAM
Clinical Coordinator or Director of Clinical Education
Clinical Administrator
Clinical Staff
Principal Faculty
CLINICAL SITE
Credentialing administrator
On-Site Coordinator
Scheduler/gatekeeper
Primary Preceptor
ARC Standard board certified physician or PA supervised by board certified physician
Other clinical faculty
Anyone missing? Review traditional roles/responsibilities of each member of the team

4. What Works? Has knowledge of PA profession, education, role
In the traditional model, the CC:
Has knowledge of PA profession, education, role
Knows how to navigate the clinical and political climate in the area
Has the ability to effectively communicate with other PA educators and clinicians
Ask the group to list: What are the qualifications/qualities of an effective Clinical Coordinator?

5. CC can oversee/intervene CC performs curriculum and student evaluation
What Works ?
CC can oversee/intervene
CC performs curriculum and student evaluation
CC provides preceptor training
Ask the group to list: What are the qualifications/qualities of an effective Clinical Coordinator?

6. CC doing basic administrative tasks
What Doesn’t Work?
CC doing basic administrative tasks
When something goes wrong, everyone points to the CC to solve it
CC often seen as “on call” 24/7 to deal with rotation issues
Something goes wrong = last minute rotation changes, student issues

7. CC is point of contact for entire 2nd year class
What Doesn’t Work?
CC is point of contact for entire 2nd year class
The stress of limited clinical sites and the “silo effect” causes burnout in CC positions
Something goes wrong = last minute rotation changes, student issues

8. Non-Traditional Models
Non-clinical staff doing a range of work
Communication, follow-up, recruitment and retention
Elevate the role of the CC
CC responsible for the integrity of the curriculum and quality of the teaching

9. Non-Traditional Models
All faculty participate in recruitment of sites/preceptors
Faculty advisors responsible for overseeing experience of 2nd year students
On-site CCs in large academic medical centers or networks
Others?

10. External and Internal Challenges
You know this…..
What are the external challenges
to recruiting and retaining quality
clinical experiences for your students?
What are the internal challenges to
recruiting and retaining quality clinical
experiences for your students?
External: Changing demands of health care (fewer resources), competition from other programs, payment by other programs (PA and others), supervisors/gatekeepers protests (money, productivity, safety, lack of adequate staff, transition to EMR/PCMH/etc.)
Internal: competition from other programs (medical school, NP program), resources for rewarding sites/preceptors, resources for securing and maintaining sites, increasing class size, novice faculty, faculty recruitment

11. What are the opportunities?
Building two-way relationships
What is our value to the clinical site/preceptor
Innovative approaches to clinical training
Preceptor development
Improve teaching skills and maintain productivity
Regional approach
Recruitment and placement
Innovative approaches pairing students (collaborative learning), presentation in room with patient, tailor rotation to meet needs of site, others?

12. Characteristics of an Effective Preceptor - Student Perspective
Hands-on experience
Welcomes students
Remembers being a student
Patient, supportive, and encouraging
Knowledgeable, confident, and enthusiastic
Welcoming = friendly, professional, prepared and ready to precept.
Knowledgeable, confident about continuing their own knowledge

13. Characteristics of an Effective Preceptor - Student Perspective
Models best-practices
High student expectations
Integrity and respect for all people
Demonstrates professional ethics
Welcoming = friendly, professional, prepared and ready to precept.
Knowledgeable, confident about continuing their own knowledge

14. Characteristics of an Effective Preceptor - PA Program Perspective
Demonstrates broad knowledge
Effectively communicates clear objectives and expectations
Open to conflicting ideas and opinions
Accurately assesses learner’s knowledge, attitudes  and skills
Provides effective feedback to the student

15. Characteristics of an Effective Preceptor - PA Program Perspective
Fair and thoughtful evaluations
Balances clinical and teaching responsibilities
Good role modeling
Enjoyment and enthusiasm for patient care and teaching
Supportive relationship with the student

16. Barriers to the Recruitment and Retention of Clinical Preceptors
Preceptor Perceptions
Patient population not accepting of students
Lack of teaching experience
Decreased productivity
Not enough time to teach
Increased student burden
PA Program not paying
the clinical preceptor

17. Benefits for Clinical Preceptors
Increased enjoyment of clinical practice
Sense of giving back to the profession
Decreased sense of professional isolation
Satisfaction in being a role model for students
Faculty appointments
CME for teaching
Teaching improves own skills

18. The One-Minute Preceptor
A strategy for instruction in the health care setting that consists of the following steps:
Get a commitment from the student
Probe for supporting evidence
Reinforce what was done well – be specific
Give guidance about errors and omissions
Teach a general principle
Conclusion
Neher, J. O., Gordon K. C. et al. (1992). A five-step "microskills“ model of clinical teaching Journal of the American Board of Family Practice, 5,

19. PAEA Resources
Preceptor Orientation Handbook: Tips, Tools, and Guidance for Physician Assistant Preceptors – developed by PEAA Committee on Clinical Education
Clinical Educator Handbook – developed to provide guidance for faculty and staff in coordination of the clinical phase of education

20. PAEA Resources End of Rotation Exams
Cover the 7 core supervised clinical practice experiences of PA education
Emergency Medicine
Family Medicine
General Surgery
Internal Medicine
Pediatrics
Psychiatry and Behavioral Health
Women’s Health

21. Discussion
Models for credit hour workload distribution for members of the clinical year team

22. List 3-5 takeaways from your session
Snowball fight here? Write down one thing you’re going to do with what you learned today.

23. Acknowledgements
Special thanks to the following colleague for her contributions to this presentation:
Lisa Walker MPAS, PA-C