There are many preceptorships available nationwide. This paper is only a partial list and a draft at that. It is intended for comparison and comment. Article in Rural and Remote Medicine, the International Electronic Journal of Rural Health outlines the benefits of preceptorships and a break even point at 4 months for students, with increasing value beyond this point. It outlines the need for more global measures of the interventions such as preceptorships rather than simple measures of preceptor time.
Appalachian Preceptorship http://qcom.etsu.edu/srelect/family.htm
RPAP in Minnesota RUOP Washington, WWAMI
For Rural Preceptors interested in graduating more and better rural physicians
Nebraska Rural Family Practice Preceptorship Rated Best by Students
UNMC Celebrates 50th Year of Preceptorship
More on Preceptorships, especially history
Mercer - reaching out to rural regions, networks http://www.mercer.edu/publications/Medicine/fall99/pg6.html
Rural Training in Family Medicine highlights the value of rural training at the graduate level
STFM Document about Preceptorships http://stfm.org/fmhub/Fullpdf/jan99/ftobtofm.pdf
New Florida State University Model http://www.fsu.edu/~medicine/pdf/summaries.pdf
The Rural Alabama Health Alliance
UNMC Students Same the Rural Family Practice Preceptorship the Best 3rd Year Rotation
THE WISCONSIN PRECEPTORSHIP, 1926, 8 wks, required
Target: 4th year Medical Students in Wisconsin
Support: Fund extra costs to students (housing, travel)
Goals: Pragmatic judgment Emphasis on H & P Skills
Responsibility Self-directed learning
Handle stress Handle criticism
Accept supervision Practice management
Physician's homelife Physician's role in community
Knowledge of limits Assist in career definition
Professional conduct toward True primary care experience patients, peers, staff
NEBRASKA Rural Preceptorship, started 1949, required as Family Medicine rotation since 1971, 8 wks, revised 1989, moved from M4 to M3 yr 1995
Contact: Paul Paulman, M.D. [email protected]
Target: Nebraska medical school students
Support: Room, Board, Stipend
Goals: Primary care experience, roles of other health professionals, Community health exposure, Patient management skills, Preventive, mental, chronic illness experience
Clinical skills, Primary care problem-solving, Emergency room experience, Use of lab and diagnostic tests, Office management, Routine Procedures - IV, Catheters, Casts
Interpersonal Skills
This was the top rated rotation (by students) in the M4 year and continues to receive top honors in the M3 year.
Oklahoma Preceptorship, 1949, 6 wk -> 4 wk, required?
Contact: Sonya Crandall, Ph.D.
Target: Oklahoma Medical Students
Support:
Goals: Rural practice experience
TEXAS STATEWIDE PRECEPTORSHIPS, 1980's, 4 - 6 wks, elective
Contact: Jack Haley, M.D.
Target: Medical students in Texas, all yrs, 150/yr, 3000 total
Support: TAFP, rural doctors, $400 for 1 month
Goals: Primary care or rural practice experience
Special Preceptorships
APPALACHIAN PRECEPTORSHIP, 1983, 5 - 6 wks, elective, 12-15 students
Contact: Forrest Lang, M.D. APPALACHIAN PRECEPTORSHIP
Target: Any year medical students nationwide but usually senior students, 12/yr, 77 total, usually in summer except by special arrangement
Support: Stipend for 5 - 6 wks, 1 wk training then 4 wks 1 on 1 with rural doc often in Community Health Center in TN, VA, or NC
Goals: Rural experience, Effect of culture on health beliefs, Group support for primary care decision, Role of rural physician in the community
Has been good feeder program for ETSU residency programs
Contact: Your State Health Department or state medical school or the National Health Service Corps
Target: 1st and 2nd year medical, PA, and NP students nationwide, other students at some sites, NHSC scholars encouraged to apply
Support: varies by state
Goals: Experiences in primary care, serving the medically served, hands-on experiences, understanding the roleof the Public Health Service
Note: Not always in a rural or clinical situation
University of MN Duluth Family Practice Preceptorship Program, 1972, required
Contact: James Boulger, Ph.D.
Target: All 48 students
Support: All expenses paid by local physicians
Goals: One on one contact with physicians
10 visits in year 1, 3 days in year 2
Results: 60% of Duluth students locate in towns < 50,000 (12% is national average)
Intermediate term preceptorships
NEW MEXICO PCC - PRIMARY CARE CURRICULUM, 1979, 3 months rural, track Revised since this was prepared
Contact: Stewart Mennin, Ph.D.
Target: 1st year Medical Students in New Mexico, 20/yr, 147 total
Support: Extra costs covered while in 3 months of rural at end of M1 year
Goals: Primary care curriculum, Self-direction, Expose to primary care, Learn to collect data, Interpersonal skills Impact of family on health
Community health environment, Support each other (students), Understand health care costs
Note: This is a problem-based track as well
Long Term Preceptorships
RMED - RURAL MEDICAL ASSOCIATE PROGRAM, 1989, 9 months, track http://www.upstate.edu:80/fmed/rmed/
For Outcomes data on RMED try http://www.upstate.edu:80/fmed/rmed/outcomes.shtml
Director: Tom Wolff, M.D.
Target: 4th year Medical Students in Syracuse, NY, 4/yr, 8 total
Support: Stipend by community and hospital
Goals: Broaden knowledge Clinical skills, Continuous, comprehensive care Sensitivity to patients, Independent learning Common office procedures
Patient education skills Health promotion skills, Clinical problem-solving/patient management, Family dysfunction, substance abuse
Knowledge of limits, need for referral, Learn community resources, Learn problem-oriented medical records
RMED students, like RPAP students below, perform at a level far beyond traditional students in family medicine residency programs - key is doing evaluations in more than just testing, do behavioral, procedural, and cognitive, expand to management also.
RPAP - RURAL PHYSICIAN ASSOCIATE PROGRAM, 1971, 9 months, track
Director: Wally Swentko, M.D.
Target: 3rd year Medical Students in Minnesota, 20 - 40 students a year, over 800 graduates
Support: Stipend $9,000 state; $3,000 rural docs
Goals: H & P proficiency, Procedural skills, Sensitivity to psychosocial, Interpersonal skills, Learn when to admit, refer, Practice management
Roles of other professionals, Computers for information, Independent, life-long learner, Experience comprehensive care, Increase responsibility for patients and
increase confidence, and competence, Balance personal life, Learn cost-effective medicine
RPAP students below, perform at a level far beyond traditional students in family medicine residency programs
REALIZING THE POTENTIAL OF PRECEPTORSHIPS When used as the major method of educating students in their clinical years, much as was done a century ago, the data is remarkable. The Rural Physician Associate Program began in 1971. Students in RPAP spend 9 - 12 months of their first clinical year with a rural preceptor. They see patients and learn about their diseases as opposed to seeing diseases and occasionally meeting the patient. They work closely with their preceptor, but also pursue study of the doctor-patient relationship, ACLS, basic trauma support, and substance abuse. Faculty travel to the site to ensure that education is the top priority for the students. Students in RPAP choose family practice, primary care, and rural practice locations. When students are admitted for rural background and primary care interest (Duluth) and then attend long term preceptorships such as RPAP, over 80 % enter family practice and
In twenty-three measurements RPAP students outperform non-RPAP students in 19. RPAP students are preferred by residency directors. Students on preceptorships explore the community, other health disciplines, practice management, public health issues, and more. They relate with mature people and become more mature. This is a stark contrast with academic medicine where students relate only to each other and individuals who are chasing personal goals.
Syracuse developed its own RPAP program with the help of John Verby. They implemented their program in the 4th year. Their results are similar.
In memory of....
HPDP - AMSA's Health Promotion and Disease Prevention Program, 1984, 1 - 2 months, folded into SEARCH Program thru NHSC very effective in primary care and underserved, however it was terminated,
Target: 1st and 2nd year Medical Students Nationwide, 120/yr., 667 total
Support: Stipend of $900 - 1000/month for 4 - 8 Weeks
Goals: Early socialization to medically underserved areas, Introduction to primary care role models, Opportunities for community service, HPDP skills
Objectives: Orientation to Community Health Centers and rural towns, Observation of health care delivery, Life planning/career development
HPDP Project completed