Preceptor+Orientation+for+Specialty+Clinic

To: Resident Specialty Clinic Preceptors From: Joe Chavez Carey, MD, Director of Outpatient Ambulatory Rotations Re: Orientation to precepting residents in your specialty clinic. Ver. 3, 1/31/2014

Hello! First let me start by thanking you for precepting residents in your specialty clinic. As you know, our residents come to CCHS seeking a full-spectrum training experience in Family Medicine. The residency program depends on the teaching of excited and engaged specialists like you to make this a reality. I am sending you this packet to help explain which residents are being sent to your clinic and also what the residency asks of you in your capacity as a preceptor.

First, the residents. The Rotations. The residency lasts three years. During that time, the residents rotate through many different areas of the hospital and clinics, including stints at offsite locations such as Children’s Hospital in Oakland. The rotations vary in length but average about four weeks. The rotations that I coordinate are called Clinics 1 (first year resident), Clinics 2 (second year), Clinics 3 and Med-OP (both third year). You may have residents from just one year or all three visiting your clinic. Attendance. There are two factors that may make resident attendance to your clinic variable and unpredictable. o Vacations: Residents are allowed to take vacations only during certain rotations- and all of the rotations above are eligible. o Resident Family Medicine Clinic: The FMCs of the resident will vary rotation to rotation. Thus, every rotation schedule looks a little bit different (with the exception of the first years). This may mean that you don’t get assigned a resident during a given block __How do I know if I am supposed to have a resident?__ I will send an excel file with the schedule each block. Please search for yourself using the “Ctrl+f” function. Please note that the numbers in parentheses refer to the week of the calendar month. I hope that by being able to predict resident attendance, you can prepare yourself for teaching on a given day.

Second, You! You are a group of dedicated, knowledgeable and generous specialists who have committed their time to the training of future leaders in Family Medicine and primary care.

Thank you so much again for this service.

There are a couple of simple items that the residency requests to ensure the highest quality teaching for our residents.


 * __Evaluation Forms__. It is the residents’ responsibility to present these forms to 2-3 of their preceptors each block for completion. See a blank form below. You can also feel free to complete an evaluation form on your own. Please send completed forms to me via interoffice mail at the Residency Office in Martinez.
 * Suggested readings and Learning objectives. The residents are given a list of learning objectives and selected readings- it can be found at this site. Please review for your specialty and feel free to send me your own preferred readings or possible changes to learning objectives.
 * __Teaching in clinic.__ See below for a section I’ve adapted from the CCRMC Family Medicine Preceptor’s Handbook. These are the teaching methods the residents are accustomed to in Family Medicine clinic. Consider applying them as much as possible in your specialty clinic, though I understand that some of the suggestions are not relevant to that setting.

Again, please know that your efforts to work with and teach our residents are immensely appreciated by all involved in the residency. I hope that this information helps you as you continue to provide this invaluable service. Please do not hesitate to contact me with any questions, comments, concerns or suggestions. I can be reached via email at jcarey@ccfamilymed.com, pager at 925-346-4679 or cell at 925-270-7107. Warm regards, Joe

= What Do Residents Want? = (Adapted from FMC “Preceptors Handbook” version 5, 8/2011 by Tai Roe) We know a fair amount about what residents want from several years of preceptor evaluations. There are areas of clear consensus and areas of differing needs, and we will try to describe these separately.

Residents all want preceptors to:
1. Be on time. Residents perceive tardiness as a lack of enthusiasm for the work of teaching as well as a major inconvenience when they want to present a patient. 2. Be positive. Residents do not want to hear their preceptors complain. Their experience of outpatient family medicine is being shaped by what they hear from you. If you are excited and enthusiastic about the work, they will be too. Cynicism and despair may have their place but it is NOT while you are precepting. 3. Be available. Preceptors who use their precepting time for catching up on their own work or making personal phone calls, or chatting with colleagues, or running errands, do not seem to residents to be available for the work of precepting. 4. Be helpful. Residents often feel overwhelmed in clinic, and lots of times it’s not just clinical questions that overwhelm them. Logistical issues, how to get things done, can be equally daunting. Preceptors who lend a hand by making calls or looking things up, or digging in to do whatever needs to be done for a swamped resident, are universally appreciated. 5. Be sensitive to time constraints. You may have a really marvelous talk on diabetic care all ready to go, but it will rarely find an appreciative audience during a busy FMC. There is a lot to learn, but try to restrict yourself to one or two pertinent teaching points unless the resident indicates that they have plenty of time. Think about jotting down some notes to give them at the end of clinic to cover those things that are important but too time-consuming to explain in the moment. 6. Be respectful. Residents value their relationships with their patients and want you to respect that. Try to distinguish between your way of doing something and the “right way”. Avoid dogmatism unless the evidence for your approach is overwhelming or the patient is being endangered.

Residents differ in how they want preceptors to:
1. Give timely and specific feedback. All residents want to hear more about how they are doing, what they are doing well and what they could do better. They have varying desires about how and when to get that feedback. It is best to inquire.

2. Teach. Residents have different learning styles and often we have only one teaching style. Asking residents what they know about how they learn best, can help us to expand our teaching repertoire. Some learn best by doing, some by reflection, and some by talking about it. Ask.

What Residents Do Not Want
Residents do not expect you to know everything, though this is the biggest fear of new preceptors. They much prefer for you to say you don’t know when you don’t, and then to model for them how you find the answers that you need at the point of care. Seeing us ask questions and look things up is actually reassuring to them in their chronic anxiety about how they will ever “learn it all”.

PO(w)ER Precepting
We recommend the PO(w)ER precepting model, which suggests four parts to the precepting role. 1. PREPARE- Be there early enough to look at the rosters and huddle with residents and staff. It’s a time to identify and prepare together for procedures or challenging patients or unfamiliar territory, as well as any staffing challenges. It’s a good time to identify patients with whom the resident might want you to go in the exam room. 2. ORCHESTRATE- This is an underrated but highly important function for preceptors. Helping residents keep track of patient flow, teaching them “tricks” for keeping things moving, modeling the kinds of behavior that facilitate clinic flow and communication, intervening if there are logjams with staff or patients, these are all things that, when done well, help residents to feel good about their FMC experience, and when not done cause high levels of resident frustration and despair. 3. EDUCATE- We recommend the One-Minute Preceptor Model. Briefly, when residents present their patients: a. Ask for a commitment: “What do you think is going on?” b. Probe for supporting evidence: “What brings you to that conclusion?” c. Reinforce what was done well d. Teach general principles as needed e. Correct mistakes If you are not sure what is going on with the patient after hearing the presentation, it is rarely useful to continue questioning the resident (“Did you ask this? Did you check this?”), but it is a great time to take the resident back in the exam room and ask those questions and check those things yourself. When you come out of the room, it is a good time to explain why those things were important to understanding the patient’s problem. 4. REVIEW- The end of clinic is a good time to huddle again and discuss together what things went well, what problems came up and what you might do differently next time. These sessions can include clinic flow as well as medical and teaching issues. It is also a good time for residents to ask questions they might not have had time for earlier.

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