1. First-Year Medical Students' Contribution to Office Productivity in Primary Care Preceptorships
Richard W Pretorius, MD, MPH
Denise McGuigan, MSEd
Basma Faris, MS, RD, MS-3
SUNY AT BUFFALO
STFM 34th Annual Predoctoral Education Conference
Portland, Oregon January 25, 2008

2. BACKGROUND Trend towards early clinical exposure
“Shadowing” vs. active participation
First-year medical students possess basic communication skills
Interview skills are taught early

3. BACKGROUND Pros of Precepting: Helps physicians keep current
Increase sense of value in own work
Makes work more enjoyable
Altruism
Cons of Precepting:
Time pressure
Loss of productivity
Loss of income

4. RESEARCH QUESTIONS
1. Can first-year medical students contribute to office productivity upon entering medical school, with minimal instruction? After interview skills training and six preceptor sessions? After 12 sessions?
2. Are there differences in the number of skills performed by students in university affiliated practices vs. community practices?

5. METHOD
N = 144 students enrolled in a Clinical Practice of Medicine course over two semesters during the academic year
Six half days sessions each semester with a primary care preceptor
Students recorded and submitted data on 33 skills (20 interview skills & 13 office skills) at three points in time:
After two sessions
After six sessions (at end of fall semester)
After 12 sessions (at end of spring semester)

6. METHOD Students recorded: number of each skill they completed
of these, number not duplicated by the preceptor or other member of the health care team
N=139 (97%) students completed clinical skills checklists for fall semester
N=135 (94%) submitted data on unduplicated skills
N=99 (69%) submitted data for spring semester
N=92 (64%) submitted data on unduplicated skills

7. All done > 1 skill per student per 4-hour precepting session
RESULTS
Skills Assessed (top 14)
All done > 1 skill per student per 4-hour precepting session
Chief complaint
History of present illness
Agenda
Pain assessment
Past medical history
Blood pressure
Family history
Social history
Review of systems
Update problem list
Update med list
Health risk profile
Put patient in room
Height and weight

8. RESULTS Skills Assessed (bottom 19)
All done < 1 skill per student per 4-hour precepting session
Review intake questionnaire
Sexual/OB/gyn hx
Discuss weight loss
Discuss smoking cessation
Fill out prescription
Obtain temperature
Get lab or x-ray from
Get pt education materials
Get drug sample
Fill out lab or x-ray forms
Calculate ideal body weight
Suicide and homicide screen
Depression screen (SIG E CAPS)
Coping skills (BATHE)
Culture eval (Kleinman’s 8 questions)
Domestic violence (HITS or SAFE)
Use of translator phone
Adolescent interview (HEADS)
Alcohol screen (CAGE)

9. RESULTS (top 14 skills)

10. RESULTS (top 14 skills—summary)
unduplicated
total %
session 2
10.2
19.4
53%
session 6
14.1
21.8
65%
session 12
21.7
31.0
70%
% increase
113%
60%

11. RESULTS (top 5 skills after 12 sessions)
University vs. Community Preceptor
Unduplicated skills 32% (13.6/10.3) more common with university preceptor
Total skills 18% (19.3/16.3) more common with university preceptor

12. LIMITATIONS Recall bias
Five patient write-ups required per semester according to assigned templates
Single institution
Time saving to preceptor not quantitated
Total skills per patient visit—both preceptor and student—not recorded

13. DISCUSSION
First-year students enter medical school with a high level of communication skills.
After only two precepting sessions, students are performing many office and interview skills.

14. DISCUSSION Over the 1st year: # of total skills increased (by 60%).
# of unduplicated skills increased (by over twofold—212%)
% of unduplicated skills increased (by 1/3rd—from 53% to 70%
This implies preceptors are satisfied with data obtained by the student.
Since the preceptor does not repeat every skill done by the student, the preceptor can spend time on other aspects of the patient interaction.

15. DISCUSSION
Both unduplicated and total skills are more common in academic than community preceptors.
Students with academic preceptors have more autonomy and may be better integrated into the healthcare team.