FacultyExperienceandEngagementinaLongitudinal

IntegratedClerkshipSarahC.Snow,MDJenniferGong,PHD

JenniferE.Adams,MD

DenverHealthLongitudinalIntegratedClerkship(DH-LIC)

UniversityofColorado

Struggletorecruit&retainambulatorypreceptorsformedicalstudents

• Cliniciansfacepressuretoincreaseproductivityandrevenue

• MedicalschoolsacrosstheUSreportdifficultywithidentifyingandretainingambulatorytrainingsites

• Resourcestoincentivizefacultyarelimited• AllianceforClinicalEducation:“TheCommunityPreceptorCrisis”

1.RecruitingandMaintainingU.S.ClinicalTrainingSites.JointReportofthe2013Multi-DisciplineClerkship/ClinicalTrainingSiteSurvey.2014.2.CoxM,IrbyDM.AmericanMedicalEducation100YearsaftertheFlexnerReport.TheNewEnglandJournalofMedicine.2006.3.Christner JG,Dallaghan GB,BriscoeG,etal.TheCommunityPreceptorCrisis:RecruitingandRetainingCommunity-BasedFacultytoTeachMedicalStudents-ASharedPerspectiveFromtheAllianceforClinicalEducation.Teachingandlearninginmedicine.2016:1-8.

CananLICtipthebalance?

• Schoolsattempttorecruitandretainfacultywithmonetarycompensationandnon-monetarybenefits

• ManypreceptorsatDHhaveleftTraditionalBlockRotations(TBR)teachingroles

• LICpreceptorsreporthighasenseofrewardinworking withstudents

1.DentonGD,GriffinR,Cazabon P,MonksSR,Deichmann R.Recruitingprimarycarephysicianstoteachmedicalstudentsintheambulatorysetting:amodelofprotectedtime,allocatedmoney,andfacultydevelopment.Acad Med.2015;90(11):1532-1535.2.Ogur B,HirshD,Krupat E,Bor D.TheHarvardMedicalSchool-Cambridgeintegratedclerkship:aninnovativemodelofclinicaleducation.Acad Med.2007;82(4):397-404.3.Teherani A,O'BrienBC,MastersDE,Poncelet AN,RobertsonPA,Hauer KE.Burden,responsibility,andreward:preceptorexperienceswiththecontinuityofteachinginalongitudinalintegratedclerkship.Acad Med.2009;84(10Suppl):S50-53.

StudyDesign• 38itemsurvey• AdministeredbeforeandaftertheinauguralyearoftheDH-LIC.

• Topics:experiencesteachingmedicalstudents,motivationforandapproachestoteaching,andperceptionsofobstaclesandchallenges

• OpportunitytocontrastexperienceteachinginTBRvs.LICenvironments(internalcontrols)

• StudyAims:• PerceptionofrewardsandchallengesofteachinginanLIC

• CompareLICandTBRteachingexperiences• Understandimplicationsforrecruitmentandretention

StudySetting• DH-LICestablishedin2014with8students• IncludedvolunteerfacultypreceptorswithregularcontactwithanLICstudentoverthedurationoftheDH-LICprogram• Fortyfacultymembersinsixspecialties• familymedicine,internalmedicine,pediatrics,psychiatry,obstetricsandgynecology,andemergencymedicine

TeachingSatisfactionandRetention

RetentionYear1à 2:85.7%

Rewards

Rewards

PerceptionsofBarrierstoTeaching• Ratedtheimportanceofvariouschallengesinteachingstudentsatbaseline(TBR)andend-of-year(LIC)

• Scaleof1(notaburden)to4(reasonnottoteach)

• Atbothtimepoints,thegreatestbarriercitedwashavingahighclinicalload• 71.4%(n=20)feltthiswasamajorchallengeorreasonnottoteachatbaseline(mean2.78)

• 59.2%(n=16)feltthiswayattheendofyear.(mean2.67)

• Differencenotsignificant(p=0.48)• Novariabilitybetweenspecialties.

PerceptionsofBarrierstoTeaching• Concernsaboutbeingunabletotruststudent

skillsorabouthavingproblematicstudentsbecamesignificantlylessimportantintheLIC

• Importanceofotherbarriersdidnotchangeduringtheyear:• Decreasedefficiency• Can’tmeetteachingrequirements• Noprotectedtimeforteaching• Toomanystudents• Teachingnotvalued

Conclusions

• Withnoadditionalmonetaryormaterialincentives,theDH-LICretainedthemajorityoffaculty.

• ExaminingpreceptorperceptionsafterfirstyearoftheDH-LICprovidedtheopportunitytocompareexperiencesofthesameindividualsinTBRsandtheDH-LIC.

• Limitations:smallsamplesize,singleinstitution,engagedfacultyatbaseline

Conclusions• IntheLICenvironment,facultydescribed:• Increasedjobsatisfaction• Minimalobstaclesrelativetorewards• Meaningfulrelationshipswithstudents• Improvedabilitytoprovidetailoredandconstructive

feedback• Higherqualityofinstruction:practicewithclinical

reasoningandaskingquestionstopromotecriticalthinking.

Conclusions• Thereisanongoingcrisisinrecruitingandretainingcommunity-basedpreceptorsformedicalstudenteducationacrossspecialties

• LICprogramsmaybeanattractivealternativeforfacultyandprovidemedicalschoolswithasustainablemodeltomaintainteachersinambulatorysettingswhoareinvestedinstudentdevelopmentandeffectiveteaching.

Christner JG,etal.2016.TheCommunityPreceptorCrisis:RecruitingandRetainingCommunity-BasedFacultytoTeachMedicalStudents-ASharedPerspectiveFromtheAllianceforClinicalEducation.Teachingandlearninginmedicine.Apr19:1-8.Epub 2016/04/20.

Acknowledgments• Dr.GretchenGuiton andtheEvaluationOfficeatUniversityofColoradoSchoolofMedicine

• Drs.DavidHirshandDougJonesfortheirthoughtfuledits

• UniversityofColoradoSchoolofMedicineandDenverHealthandHospitalAuthorityfortheirfinancialsupportoftheDH-LICcurriculum.