Frequently Asked Questions
- How will my patients react to my having a student in my office?
- Will having a student in my office take extra time?
- How do I introduce the student to my patients?
- Whom do I call if I have a problem with a student in my office?
- How much can I let a student do in my office?
- Does the student have to spend all of his or her time with me?
- I'll be gone for 3 days while my student is in my practice. Can the student work with someone else?
- How do I know what I am supposed to teach the student?
- I'm not sure I know how to teach; how can I prepare?
- How do I handle student-related problems?
- Problem Prevention
- Problem Assessment
1) How will my patients react to my having a student in my office?
Physicians typically find that serving as a preceptor increases their own credibility and enhances the prestige of their practice in the eyes of patients. Patients usually enjoy being interviewed by and interacting with students - provided they understand that by doing so they're contributing to the student's education. Older patients are often especially appreciative of the opportunity to interact with a young person. Many physicians display plaques in their waiting areas indicating that the practice serves as a precepting site for the OU-COM/CORE System. They also post announcements and/or pictures of students who are working in their office. It is a good idea to announce the commitment of the practice to teaching medical students in any descriptive brochures or materials. Patients should not be surprised by the presence of a student - many front office staffs routinely inform patients who make appointments of the presence of a student who may be involved in the patient's care. There are of course exceptions to these generalizations, and "discretion is the better part of valor". The preceptor may find it advisable to avoid student involvement with patients who strongly resist change, who are querulous or contentious, or those who will need to undergo a sensitive or painful examination.
2) Will having a student in my office take extra time?
Anecdotal comments, as well as reports in the medical education literature, suggest that the preceptor's day is lengthened by 20 to 60 minutes when a student is present in their practice. As the preceptor becomes more experienced in working with students this time differential is reduced, but does not seem to be entirely eliminated. Evidence reported in the literature suggests that the preceptor's income is not affected by a student's presence.
3) How do I introduce the student to my patients?
The student should be treated as a professional by hospital and office personnel at all times. In the clinical setting, when being paged and introduced to patients and their family members, refer to the student as "Student Doctor" followed by the last name so he/she in not misrepresented as a licensed physician.
4) Who do I call if I have a problem with a student in my office?
If a serious problem develops with a student who has been assigned to your office immediately call the CORE Office. It is also a good idea to call whenever you have a question or just feel the need for guidance. Call sooner rather than later! No question is stupid or out of place.
5) How much can I let a student do in my office?
Base your decisions about the scope of your student's role on 1) their level of training, 2) your assessment of their clinical experience (gained during your orientation discussion), and 3) your observations of the student during his or her first few days in your practice. Pre-clinical students are medical novices and probably will not be able to make a physical diagnosis nor recommend medications. They can, however, be very effective in interviewing patients and taking a complete history. They will also gain a great deal by interacting with patients and staff, learning how your practice operates, and bringing their enthusiasm to your practice environment. Third or fourth year students will be much more capable clinically, and should be given a much wider role, probably akin to that of a capable nurse. Both kinds of students need to be supervised and observed; their roles should be quickly adjusted whenever they - or you - are well outside of your comfort zones. Remember that medical students are adults and prefer active approaches to learning; they will quickly lose interest if they are confined to a role of shadowing or observing.
6) Does the student have to spend all of his or her time with me?
Your practice is a very rich learning environment, so feel free to assign your student to other staff members. Check with your student after he or she has been with you for a few days or a week and ask if there are areas of the practice they would like to learn more about. A tutorial with your business manager can provide a valuable perspective on the economics of your practice; working for a half day with your receptionist will help the student understand how patients are checked in and scheduled; working with your nursing staff can teach the student how you utilize these valuable colleagues. Take the teaching burden off yourself by enlisting your colleagues in a team teaching effort; ask for their input on what they think they could teach the student. Also, the student does not have to spend all of his or her time with you since he or she is required to attend a regularly-scheduled didactic program offered by the respective CORE.
7) I'll be gone for 3 days while my student is in my practice. Can the student work with someone else?
As preceptor you are responsible for supervising the student, but this responsibility can be delegated briefly to another physician, even one from another specialty. Be sure that your student and your colleague understand their roles and responsibilities. If your absence will involve attending a professional meeting, consider taking the student along.
8) How do I know what I am supposed to teach the student?
As a preceptor you are responsible for reviewing the rotation/course syllabus. The Year 3/Year 4 Manual and other educational resources are available from the CORE Office.
In addition, there are three sources of information which you can use to give greater focus to the student's learning: 1) information about the preceptorship sent to you by your student's CORE Office; 2) the evaluation form which you will have to complete on the student at the end of the month; and 3) your orientation discussion with the student. By reading these documents - and by talking to your student - you can work out several goals which meet the student's learning needs. Encourage the student to reflect on and inform you about what they think they need to learn. Defining personal learning goals may be a new experience for many of your students; it is a valuable ability for them to develop as they approach residency training. It is very useful to write down the student's personal goals. An example for a third year student might be: "Jane Smith will be able to: 1) recognize depression in patients she interviews and ask them appropriate questions; 2) perform a focused musculo-skeletal examination; and 3) present the patient's history and physical exam findings concisely." Review these goals after the student has been with you for a week or two and set new ones as needed.
Also discuss the goals with the student at the end of the month to see if they have been accomplished. This review of goals can serve as a basis for your evaluation of the student.
9) I'm not sure I know how to teach; how can I prepare?
When a physician decides to become a preceptor he or she usually experiences a feeling of uncertainty and doubt. This reaction is entirely reasonable since the preceptor's role is new and unfamiliar and most physicians have had very little - if any - preparation for teaching. As with any new undertaking these uncertainties quickly resolve with practice. It helps to recall that the Latin root for doctor docere, means to teach, and that as a physician you have a great deal of experience teaching your patients and staff and helping them to acquire new and more productive behaviors. The essence of teaching is to communicate frequently and openly.
For a fuller understanding of how to improve your effectiveness as preceptor, please consider attending one of the Faculty Development Workshops offered by the CORE Office of Educational Research and Faculty Development. Physicians in these workshops examine how to orient medical students to their practice, how to create a productive learning environment, how to give constructive feedback, and how to evaluate the student's performance.
10) How do I handle student-related problems?
In the sense used here, a problem exists whenever the performance of a student in your practice does not meet your expectations. Example: a third year student arrives at the hospital at 7:30 am, even though he's been informed that your patient rounds start at 6:30.
Most serious problems with students will be prevented if you:
- Orient the student, providing clear information and clear expectations.
- Talk frequently with the student and listen carefully to her/his needs and interests.
- Observe and give feedback to your student.
- Communicate frequently with the student.
- Communicate frequently with the student's CORE Office.
Such an approach usually results in small problems and issues staying small. In the case of the tardy student mentioned above, it would be important to check out with him whether you actually did explain that rounds start at 6:30, and if he remembers that time. Such a reminder will usually be sufficient.
If the problem is more complex - if it's not resolved by means of a simple reminder - assess it by asking yourself two questions: 1) Is it real? (or was it just a bad day?) and 2) Is it important? (what would happen if nothing were done?) If you decide the problem is both real and important, look into it further by asking the student about it and by asking colleagues in your office if they perceive the problem as well. As you talk with the student, try to determine if he or she has had this kind of problem in the past.
Define the Cause of the Problem
Based on your assessment and your thinking, decide whether the problem is a
- Learning deficiency problem - in which the student cannot
perform to expectation even if her life depended on it. In such cases the behavior in
question has never been learned, or been learned incompletely or incorrectly.
Example: a third year student who is examining a patient's thyroid places her hands on the wrong part of the patient's neck.
Preceptor's response: Take an educational approach with this student. You can check out her understanding of the location of the thyroid, demonstrate and coach her on how to perform the exam appropriately, and give her clinical exposure to other patients so that she develops appropriate physical examination skills.
- Forgotten knowledge problem - in which acceptable knowledge or
skill has declined with lack of use.
Example: A third year student cannot describe the contraindications of two different anti-depression medications, but remembers that they went over this question in his pharmacology course.
Preceptor's response: Your response is again educational. You can recommend readings, give the student more practice interviewing and recommending medications for depressed patients, and hold a follow-up discussion with him later in the month.
- Knowledge Present Problem - in which the student can perform
appropriately but for some reason does not.
Example: your third year student continues to arrive late to the hospital, even after you've reminded him that rounds begin at 6:30.
Preceptor's response: More education and more reminders from you will probably not solve this problem. Instead, find out whether there are individual or system factors that are interfering with the student's performance and initiate a process that will resolve them. Whatever you find out - whether the problem is personal or systemic - talk it over straightforwardly with the student, enlisting his help in resolving the issue.
(Adapted from: S.T.F.M. Preceptor Education Project, 1993)