June 19, 2019—You’ve likely received a smattering of emails from STFM over the past few months about ongoing efforts to address the shortage of clinical training sites for students. Here’s a quick (relatively speaking) recap, in case you missed an email or two:
Student Documentation in EHRs
- On April 26, CMS issued a new transmittal, R4283CP, clarifying that more than one student can be involved in patient care and documentation, and allowing nurses and residents, in addition to teaching physicians, to document the teaching physician's participation in visits.
- On May 15, STFM proposed several scenarios that would provide clearer interpretation of the guidelines, specifically around “physical presence” and resident involvement. We also encouraged CMS to change its policy regarding the inclusion of Advanced Practice Nurses (NPs) and Physician Assistants (PAs).
- The Council on Graduate Medical Education will be sending a letter to CMS asking for changes to:
- Support the use of NP and PA student notes in the medical record.
- Allow teaching NP and PA preceptors to use student notes without redocumentation, as with teaching physicians.
- Clarify the role of medical residents in the use of student documentation.
- Allow the use of the student note as part of the primary care exception when the teaching physician is not attesting to physical presence.
- STFM will be submitting similar recommendations to CMS through their open call for ideas to reduce administrative burden.
- Senators John Barrasso and Tina Smith sent a letter to CMS asking that the policies be revised to include NPs and PAs.
Quality of Clinical Training
Over the past few months, STFM and collaborators have launched the following in an effort to increase the pool of community-based preceptors and the quality of training at ambulatory sites:
- A pilot project to test standardized student onboarding and/or standardized preceptor onboarding and engagement.
- A new Community Preceptor Self-Assessment tool on TeachingPhysician.org
- Free clerkship onboarding modules, passports, and tips for students
- Master Preceptor Award and a Practice Recognition Award for Teaching Excellence
- ABFM Precepting Performance Improvement Program and a Precepting Performance Improvement Toolkit
- Online Giving Feedback course