Summary of Closing Plenary for the 2015 Community Faculty Conference

Summary of Closing Plenary for the 2015 Community Faculty Conference

Panelists:

Joan Haltom, Pharm.D., FKSHP

Laura Hancock-Jones, DMD

Mike Muscarella, PT DPT

James Werkmeister, MD

Moderator: James Norton, PhD

This session was a follow-up to our closing plenary last year. It again featured our four experienced and expert community faculty members representing the colleges of medicine, pharmacy, health sciences and dentistry. We reviewed some of the points that had been raised last year and the panelists and audience members discussed them in light of their experience during the year.

1)The importance of a complete and structured orientation of the student immediately on his/her arrival at the practice site was the first point discussed last year and the inclusion of staff members in this process was seen as of particular value. There was agreement among the panelists and audience members that this remains a critical element of a successful rotation and the panelists shared some improvements they had made in the process since last year. One idea shared was to have students be, ‘patients for a day,’ to understand how the practice works from the patients point of view.

2)Last year, giving students the opportunity to understand the business processes of the practice was described as being highly relevant to the students’ education. There was a lengthy discussion of this point involving audience members and the panel. It was suggested that this be added as an explicit course objective for community rotations. In PT, in fact, it already is and may be in some other courses, but this point will be shared with the coursed directors. In addition, it was suggested that, where appropriate, students learn about this from three sources: the individual responsible for finances (e.g., billing and coding),human resources (e.g., hiring and promotion) and, management (e.g., organizational structure). Clearly, community rotations present a unique opportunity for students to learn about the business aspects of clinical operations and this opportunity should not be missed. Dr. Haltom described having students do drug cost comparisons, so that they fully understand the financial implications for the patient of various medications. This tactic would seem relevant for all students, but particularly for those who will, as professionals, write prescriptions. The point was also made that the WKI experience, immersing students in community practices for an extended period of time, offers a better opportunity for addressing business issues than does the typical four week experience. This is particularly true if the several of the rotations are done in the same group practice.

3)The value in introducing students to community groups such as Rotary, health coalitions and Lions Clubs was mentioned last year and discussed again at this session. Such experiences help students learn about the community generally and the special role health professionals can play as community leaders and advocates. Audience members shared personal experiences in doing this, as did panelists. The point also was made that this can include political advocacy if preceptors are involved in such efforts.

4)The introduction of electronic medical records in practices is a contemporary challenge at many sites. This was discussed last year and revisited this time. One panelist described providing students with a shadow PC on which they can log on as the preceptor, write notes and have a realistic experience in charting. The preceptor then reviews their work with them.

5)Last year, several faculty members advised having students present their finding on the patient to the preceptor with the patient present. This has at least two advantages. First, it gives the patient the opportunity to correct any errors or omissions in the student’s presentation and, second, it saves time. There was a consensus again that this is a good teaching strategy and it had been adopted by many of the preceptors in the audience.

6)One audience member last year described a scheduling innovation that was discussed again this year. This preceptor sees patients on 15 minute intervals, thus seeing four per hour. When a student is in the practice, he schedules one patient per hour for the student, with the student’s patient being the fourth patient on the preceptor’s schedule each hour. He then sees the patient with the student as described in 5) above. He has found this method to be very efficient, minimizing the often described slowing of the practice when a student is present. This methodology was again endorsed by those in attendance. The point again was made that having students frequently is actually better in terms of integrating them into the practice and minimizing productivity loss than is having them only occasionally.

7)Last year, it was noted that more advanced students can positively affect productivity, if the practice is structured to maximize their role. This seems to be truer of some disciplines than others, but Joan Haltom suggested that, over the course of the year, it is reasonable to expect higher productivity from students. That is, preceptors might consider increasing the number of patient encounters expected of the student late in the year, given the fact that they should be improving their performance as they progress through clinical training.

Two new topics arose this year and lead to considerable discussion.

1)In terms of recruiting practitioners to rural communities, one audience member advocated for the creation of a loan repayment program available to solo practitioners and administered by the state.

2)There was considerable discussion of the many changes in practice that will be implemented beginning later this year as part of the roll out of the ACA, the emphasis on accountable care organizations in terms of reimbursement and the adoption of the ICD 10. It will be important for the academic programs to prepare students for these realities before then go on rotations.

Thanks to all who participated in this session.