December 19, 2018 — For the past 2 years, STFM has been leading an interprofessional, interdisiciplinary initiative to address the shortage of high-quality clinical training sites for students. The goals are to:

• Decrease the percentage of primary care clerkship directors who report difficulty finding clinical preceptor sites.
• Increase the percentage of students completing clerkships at high-functioning sites.

Following is an update on the work of each tactic team.

Tactic 1: Work with CMS to revise student documentation guidelines
This team’s task was to explore ways to revise the student documentation guidelines to help relieve unnecessary administrative burdens on preceptors and increase the active learning of students.

Status: On February 2, 2018, CMS released a revised transmittal, Pub 100-04 Medicare Claims Processing Manual (updated May 31), that “allows the teaching physician to verify in the medical record any student documentation of components of E/M services, rather than redocumenting the work."

The team continues to advocate for making the guidelines more inclusive of physician assistants and nurse practitioners.

Tactic 2: Integrate interprofessional/interdisciplinary education into ambulatory primary care settings through integrated clinical clerkships
This tactic explores a means to increase the number of learners at a given site without putting more pressure on the clinician’s shoulders. This means transforming education, in conjunction with the practice, away from the 1:1 preceptor/student model.

Status: The team has identified a comprehensive list of opportunities where students could be integrated in useful ways into clinical practice workflows. The list/workflows highlight areas and processes that could accommodate multiple and/or interprofessional students. The workflows will be vetted with preceptors and then translated into implementation tools.

This project is being led by the Physician Assistant Education Association (PAEA). 

Tactic 3: Develop standardized onboarding process for students and preceptors & integrate students into the work of ambulatory primary care settings in useful and authentic ways

The team is developing student onboarding resources and processes that will include:

• A student passport that captures a student's training, screenings, clerkship background, objectives for the current clerkship, and basic information about the student
• Education for students on how to hit the ground running at their clerkship site
• Three online training modules for students: "How to Create a High-Quality and Billable Note in the Medical Record," "How to Perform Medication Reconciliations," and "Motivational Interviewing.”
• Promotion of curriculum to meet goals and objectives outlined in the appendix of the AAMC’s Recommendations for Preclerkship Clinical Skills Education for Undergraduate Medical Education

The team is developing preceptor onboarding and processes that will include:

• Use of the AAMC Uniform Clinical Training Affiliation Agreement with preceptors
• A faculty appointment onboarding process where administrative personnel at the institution assist new preceptors in developing and formatting CVs during a phone interview
• An online STFM course on Giving Feedback

Status: These resources and processes will be piloted as part of Tactic 4. The pilot begins in early 2019. 

Tactic 4: Develop educational collaboratives across departments, specialties, professions, and institutions to improve administrative efficiencies

This team will manage a multi-year pilot, funded by the American Board of Family Medicine, called Building Better Clinical Training Experiences: A Learning Collaborative. During the pilot, family medicine departments will participate in one of three projects to implement, evaluate, and disseminate innovative approaches to standardize the onboarding of students and to engage community preceptors.

Five family medicine departments will be selected for each of the three projects through a competitive application process. Preference will be given to departments collaborating with two or more other specialties/departments/professions. Over the next two years, departments and their collaborators will test the materials and processes being developed as part of Tactic 3, as well as recognition and incentive programs being developed as part of Tactic 5. The teams will participate in online and in-person learning communities to share/learn about intervention approaches; conduct standardized pre/post measurement; and disseminate their findings.

Status: Funding has been secured, and the Graham Center has agreed to evaluate the projects. The tactic team is finalizing the application criteria, the project expectations, and the timeline. A call for applications for the pilot will open in January 2019.

Tactic 5: Promote productivity incentive plans that include teaching and developing a culture of teaching in clinical settings
The unifying theme of the tactics under this umbrella is creating the incentives and culture needed to expand the pool of preceptors. A key target audience for these efforts is the health systems that employ community preceptors.

Status: On April 2, 2018 the Society of Teachers of Family Medicine and the American Board of Family Medicine kicked off a pilot program that offers Performance Improvement continuing certification credit (previously MOC Part IV) to ABFM diplomates who provide personal instruction, training, and supervision to a medical student or resident and who participate in a teaching improvement activity. The pilot ends on December 30, 2018. The program will be tweaked, based on lessons learned in the pilot, and rolled out broadly. Results of the pilot will be shared during several sessions at the 2019 Conference on Medical Student Education.

Competencies and incentives for community faculty have been developed in collaboration with the STFM Faculty Development Collaborative, and will be piloted through the Tactic 4 project.

Several articles/manuscripts have been published and information has been disseminated through presentations. This work is ongoing. 

This initiative stemmed from Family Medicine for America’s Health’s Workforce Education and Development Core Team’s task to identify, develop, and disseminate resources for community preceptors. The work is being funded by the Society of Teachers of Family Medicine, the American Board of Family Medicine Foundation, and the Physician Assistant Education Association.