Editor’s Note: Jeffrey A. Stearns, MD, of the Department of Family Medicine at the University of Wisconsin, Milwaukee; and Karla Hemesath, PhD, and Richard A. Londo, MD, of the Department of Family Medicine at the University of Illinois at Rockford, examine a key part of student orientation in this column.

I welcome your comments about this feature, which is also published on the STFM Web site at . I also encourage all predoctoral directors to make copies of this feature and distribute it to their preceptors (with the appropriate Family Medicine citation). Send your submissions to Paul Paulman, MD, University of Nebraska Medical Center, Department of Family Medicine, 983075 Nebraska Medical Center, Omaha, NE 68198-3075. 402-559-6818. Fax: 402-559-6501. E-mail: ppaulman@unmc.edu. Submissions should be no longer than 3–4 double-spaced pages. References can be used but are not required. Count each table or figure as one page of text.

(Fam Med 2000;32(3):161-2.)

As increasing numbers of community physicians participate in office-based clerkships, there are many new areas of knowledge, skills, and attitudes that are important for a successful experience for the students, preceptors, and the family medicine department. A number of these topics deal with orientation of the student. A critical component of orientation is goal setting. This column addresses the elements of goal setting and describes the benefits of it for all participants.

Setting goals is important to assure that the expectations of the participants are explicit, shared, and agreed on. Frequently, unclear expectations on the part of the stakeholders lead to frustration, misunderstanding, and a less-than-optimal experience for all involved. It is important to understand that there are three players involved in the preceptorship: the student, the preceptor, and the department/university. Each has its own goals and expectations, and they are not always the same. For each precepting experience, the sponsoring department or program should provide a set of explicit and accomplishable goals, objectives, and expectations. Prior to the preceptorship, it is important for the student and the preceptor to review these items.

The community physician and the learner must understand what is expected of them and why they are participating in the experience. Vague and global objectives are not helpful and do not maximize the learning opportunity for those involved. The preceptor and the student should work together to develop their own goals and objectives for the experience. These goals should be appropriate for the setting, the preceptor, and the student’s level of learning and prior clinical experience. Mismatches can lead to significant problems and frustration.

After reviewing the preceptorship’s goals, students should reflect on their individual goals for this learning opportunity. What specific objectives do they want to accomplish? Although some goals may be broad, like seeing patients in an office or seeing a variety of common problems, it is important to be as specific as possible. What types of patients would the student like to see? Are there diagnoses he/she has not been exposed to or procedures the student would like to assist with or perform? The more specific the goals, the easier it is for the preceptor to provide the optimal learning experience. Students should reflect on their previous experiences and what unique opportunities this community-based preceptorship offers. Writing down these goals and expectations prior to the preceptorship allows time to reflect and become better prepared to start the experience. Sometimes, a clinical skill checklist or procedure log is a helpful tool for students and preceptors to assess students’ strengths and weaknesses and focus on specific areas to address.

Similarly, preceptors should review the goals of the preceptorship. Often, they have had previous students and can assess their level of skills at the beginning of the experience. Nevertheless, each student is different. If it is available, the preceptor should review the student’s previous rotations and performance. Also to be considered is the timing of the preceptorship in the academic year. Having reviewed this data, preceptors can better formulate their own specific objectives for the experience.

Research in physician-patient communication indicates that a key component of patient satisfaction with the provider and the office visit is the act of “orienting the patient to the visit.”1 A similar technique is also quite useful in orienting students to a preceptorship. Overview discussions, often referred to as “housekeeping,” do a great job of getting all participants on the same page. Things to address in a housekeeping discussion include: Does the office have a usual routine for the day? What does the student do in the practice? It is useful to write these down to communicate at the beginning of the preceptorship.

Some students are adaptable and are quick learners of the house rules. Others need explicit instructions about how things work in this unique setting. Remember that many students have not worked in a busy ambulatory office before. They may be overwhelmed by the pace and business of the practice. A specific list of tasks may be helpful, including some indication of the preceptor’s expectations regarding the roles that the student will take in the office and the various tasks he/she will perform.

Some preceptors place a higher priority on hospital patient involvement, others on generating a differential diagnosis or providing patient education. While these student roles may be general, it is also useful to delineate specific types of patients or skills you would like to see the student experience. Each practice is unique and may provide special opportunities for students or may display special skills of the preceptor or office staff. It is important to point these out so they are not missed.

Finally, it is critical that the student and preceptor schedule time for discussion of the housekeeping items and to review each other’s goals and expectations. This must be done under controlled circumstances so each participant can listen and reflect on the other’s expectations and needs. It is important that both parties agree to a plan for learning at the start of the rotation. As the preceptorship proceeds, these goals may change and need to be adjusted, but if there is a mismatch of expectations at the start, it bodes poorly for achieving optimal learning and teaching.

In summary, it is critical that goal setting takes place before and at the beginning of the experience to achieve the best outcomes for all the stakeholders of community preceptorships. Each party should have clear and accomplishable goals. These goals should be shared, and all parties should agree about the learning plan. Community preceptors have so much to offer to the education of medical students that cannot be learned at the academic medical centers. It is important to maximize this opportunity. Good planning helps assure that this can happen.

Corresponding Author: Address correspondence to Dr Stearns, University of Wisconsin, Milwaukee, Department of Family Medicine, 2801 W Kinnickinnic River Parkway, Suite 155, Milwaukee, WI 53215. 414-649-5636. Fax: 414-649-5324. E-mail: jstearns@fammed.wisc.edu.

Reference 1. Levinson W, Roter D, Mullooly J, Dull V, Frankel R. Physician-patient communication. The relationships with malpractice claims among primary care physicians and surgeons. JAMA 1997;277(7):553-9.