Primary Care Clerkship Enhancements Benefit Preceptors, Students, & Patients

In the third-year, students at the School of Medicine and Public Health (SMPH) get a big hands-on introduction to real-life primary care practice: the eight-week Primary Care Clerkship (PCC).

A collaboration between the Department of Family Medicine (DFM), the Department of Medicine's Section of General Internal Medicine, and the Department of Pediatrics, the PCC gives students the opportunity to work closely with primary care physicians in communities throughout Wisconsin.

Throughout the past year, the PCC has implemented several key program enhancements to better support its preceptors, train its students, and ultimately, improve the experiences of future patients.

Training Videos Improve Preceptors' Teaching Skills

The PCC's clinical experiences are guided by more than 350 preceptors throughout Wisconsin. According to PCC Acting Director John Brill, MD, MPH, one of the program's most immediate goals was to help those preceptors become better teachers. "Most of our preceptors are volunteer physicians," he said. "They're trained as doctors first, so we're helping them further develop as educators."

Results from a preceptor survey indicated a strong desire for short, "just-in-time" training, so PCC staff worked with media specialists from the SMPH's Health Sciences Learning Center to develop a series of brief, Web-based training videos.

The first training video shows preceptors how to orient students to the clinic setting. Additional videos will focus on other elements of the preceptor's role, such as teaching physical examination skills or giving feedback. These will be developed and posted throughout the rest of the year.

Extending the EBM Experience

To extend the evidence-based medicine (EBM) training students receive in the first two years of medical school into the clinical setting, the PCC also incorporated an EBM exercise into its curriculum.

In this exercise, students must address and report on at least one clinical situation in what's known as the Patient/Intervention/Comparison/Outcome (PICO) format. This helps students learn how to reframe real-life patient scenarios as answerable clinical questions. From there, they can then find, assess, and apply evidence to support clinical decision making.

Students may submit these reports as part of their electronic portfolio, a collection of work required of all School of Medicine and Public Health (SMPH) students.

Online Forum Encourages Case Discussion

In keeping with its goal of preparing students for real life primary care scenarios, the PCC curriculum also now includes a series of 14 online "cases and questions". Each case presents a topic first introduced in the first and second year, followed by questions designed to encourage thought and reflection.

After viewing the cases, students login to an online forum to share thoughts, resources, advice from preceptors, and other helpful information. The ideas and discussion generated from the forum are available as open resources for students' written and clinical assessment exams.

From Student to "Real Doctor"

Underlying all the PCC's enhancements is the long-term goal of improving the quality of health care… at all levels. The hands-on nature of the PCC teaches students to be better communicators and to deliver patient-centered care-critical skills not only for primary care, but any discipline.

According to Dr. Brill, "The PCC nurtures the 25 to 30 percent of students with a career interest in primary care, but it also trains future specialists on how to best work with primary care physicians."

"If we can train a large cadre of people who understand what primary care physicians can do," he added, "we can improve the patient experience and create better, safer health care."

By students' accounts, the approach is working. In a recent evaluation, one student said, "I think this is one of the most valuable clerkships in the third year. It requires you to put everything you've learned from medicine to psychosocial aspects of care together. This experience most exemplifies what it means to be a "real doctor."