November 22, 2021—In 2019, the Society of Teachers of Family Medicine (STFM) launched a multi-year pilot project called Building Better Clinical Training Experiences: A Learning Collaborative. The project was funded by the American Board of Family Medicine.

During the pilot, family medicine departments – and collaborating specialties and professions – implemented one of three projects to improve administrative efficiencies for community preceptors by:

• Standardizing student onboarding resources and processes
• Standardizing preceptor onboarding and engagement resources
• Standardizing both student onboarding resources and processes plus preceptor onboarding and engagement resources

The pilot began in fall 2019 with an in-person training session for representatives from all 15 family medicine departments. The representatives then returned to their institutions prepared to work with their partners to implement the tools and strategies developed through STFM’s Preceptor Expansion Initiative, including:

• A Student Passport to provide preceptors with basic information about students’ training, screenings, previous clinical rotations, and objectives for current clinical rotations 
• Education for students on “How to Be Awesome in an Ambulatory Clinical Rotation”
• Online Training Modules for Students
• "How to Write a High-Quality Note in the Electronic Medical Record"
• "Motivational Interviewing"
• "How to Perform Medication Reconciliation"
• Faculty Appointment Onboarding Process
• TeachingPhysician.org subscription and Community Faculty Self-Assessment Tool
• Online Module on Giving Feedback
• Master Preceptor Award
• Practice Recognition Award
• ABFM Performance Improvement Credit for Precepting

The sites were also asked to standardize by implementing AAMC’s Recommendations for Preclerkship Clinical Skills Education for Undergraduate Medical Education and the AAMC Uniform Clinical Training Affiliation Agreement

Unfortunately, COVID shifted priorities for participants, and implementation of some of the resources and processes were halted, since students weren’t going to clerkship sites for a portion of the project. Communication about the project within schools and between schools and precepting practices slowed down and became low priority during COVID response. Planned visits from STFM’s project evaluation team were converted to virtual visits.

The student passport and the feedback module for preceptors stood out to clerkship directors, preceptors, and/or students who were interviewed during the project. However, preceptors may not have been aware of many of the resources and opportunities.

Recommendations Based on This Pilot Project

Recommendation 1: The focus of future efforts needs to remain on reducing administrative burdens for preceptors.

• A centralized location for opportunities and resources, such as an institutional website or Blackboard site, is preferred by preceptors over emails with links.
• Clerkships need to take on any extra administrative work required to implement innovative projects. That burden cannot be put onto preceptors.

Recommendation 2: Clerkship coordinators need to be part of implementation strategies, from the start.

• Including clerkship coordinators, clinic administrators, and other administrative staff in an “orientation” to projects, resources, and opportunities can be an effective strategy in ensuring follow through and in engaging preceptors and students.

  Recommendation 3: Timing of distribution of tools is important

• Having an orientation day for students with dedicated time to go over student onboarding resources is essential.
• Institutions should have a targeted approach to distributing opportunities for faculty development. Faculty development offerings are especially helpful for newer preceptors, however faculty development opportunities tied to continuing certification are likely of use to preceptors in all stages of their careers.
• The student passport is most effective when distributed and filled out at the beginning of clinical rotations (for most schools the beginning of third year) and maintained throughout the clinical years.

Pilot Project Participating Sites:

• Advent Health Medical Group Family Medicine
• North Carolina Area Health Education Centers
• University of North Texas Health Science Center
• Ohio State University
• Ohio University Heritage College of Osteopathic Medicine
• University of Washington School of Medicine
• Hackensack Meridian School of Medicine
• Keck School of Medicine at USC
• Louisiana State University-New Orleans
• Morehouse School of Medicine
• Rush Medical College
• Stanford University
• University of Alabama
• University of Illinois-Peoria
• University of Minnesota

Current and Next Steps:

In January of 2021 STFM began a new phase of the Preceptor Expansion Initiative with goals still 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

Current work is focused on dissemination of results and resources developed since the Initiative launched in 2017, and outreach to family physicians to encourage them to precept. Tactics have included:

• Presentations and exhibits at AAFP chapter meetings
• A panel presentation for AAFP chapter executives about the initiative and its resources
• An update of STFM's list of precepting incentives
• One-page tips for chapters to share with preceptors in their publications and/or on their websites
• Print and social media ads for chapter publications
• A panel presentation on tax incentives for preceptors 
• An article in FPM about how medical students can add value to clinical practices
• An article in Modern Healthcare on how medical student precepting is crucial for a robust primary-care workforce

As the preceptor shortage is still critical, the work of this initiative is ongoing. A new plan and tactics will be developed in early 2022.