Family physicians who precept students -- or who are thinking about doing so -- will be interested in an Alabama-based study in which researchers utilized literature reviews, physician focus groups and one-on-one interviews with rural physicians to understand the kind of support rural preceptors need to confidently teach medical students in a proposed eight-month longitudinal rural curriculum.
Their findings were published in the October issue of Southern Medical Journal in an article(sma.org) titled "Teaching Medical Students in the Rural Setting Long Term: Physicians' Attitudes and Perceptions."
Lead author John Wheat, M.D., M.P.H., is a professor of family, internal and rural medicine at the University of Alabama College of Community Health Sciences in Tuscaloosa. He also founded the college's Rural Health Leaders Pipeline(cchs.ua.edu) in 1993 to address the shortage of primary care physicians in Alabama's rural communities.
The college serves as a regional campus of the University of Alabama School of Medicine in Birmingham.
- Alabama-based researchers sought to understand the kind of support rural preceptors need to teach medical students in a proposed eight-month longitudinal rural curriculum.
- Study authors identified four key themes that collectively captured physicians' attitudes and perceptions.
- The four themes discussed in the study -- preceptor characteristics, student characteristics, community support and institutional support -- were identified primarily from physician focus groups and interviews.
Wheat told AAFP News he was born and raised in rural Alabama and is board-certified in both internal and preventive medicine. His career focus has long been to improve health care in the rural Deep South by producing physicians to provide that care.
"This is an optimal time for these findings to circulate," said Wheat, who clarified that his comments represent his personal views and not those of the university or any agency with which he is affiliated.
"The country is far behind -- even negligent, in my opinion -- in its attention to producing rural physicians, and it is important in the midst of the current heightened awareness to make solid advancements in that area. We know good preceptors -- as well as the experiences young medical students have in rural communities -- are major influences in their career decisions.
"But that's not enough; students need to understand the reality of rural practice so that when they begin their careers, they feel secure and confident in their ability to handle medical situations for which they've been trained," said Wheat.
A total of 21 rural alumni of the Alabama pipeline program agreed to participate in the study.
Of those, 19 were family physicians, one was an internist and one did not specify a specialty. The length of their practice experience ranged from one year to 11 years. Fifteen of the participants were engaged in private practice; the rest were employed by hospitals, community health centers or rural clinics.
Researchers inquired about physicians' personal experiences with role modeling and teaching students, and tossed these questions out for discussion:
- How would you describe your satisfactions and dissatisfactions with your teaching experiences?
- What does the medical school need to know to help support you as a clinical teacher or preceptor?
- How should your role as a preceptor be evaluated?
- How can your community support you in your role as a preceptor for the Alabama pipeline program?
Participants were also asked to provide specifics of the kind of information about themselves, their practices and communities that could be communicated to students seeking a rural site for medical training.
Authors chose four themes that collectively captured physicians' perceptions as to what they needed to conduct successful long-term preceptorships.
Preceptor characteristics: Preceptors should have a desire to teach and be committed to learning preceptor teaching skills. They also should have a facility and panel of patients amenable to teaching the required curriculum.
Student characteristics: Students should be enthusiastic learners, engage with the practice and the community, and have characteristics such as a rural background and primary care interests "that make them candidates to be recruited into rural practice," declared the researchers.
Community support: Communities should help provide student housing and get students actively involved in community activities by inviting them to events.
Institutional support: Academic institutions should offer preceptor development, mindfully match preceptors and students, use structured curriculum and evaluations, provide regular communications, and offer "benefits that make the preceptor role feasible," wrote the authors.
Study authors also provided some actual physician responses from which those four basic themes were derived.
For instance, one participant wrote, "I had one student who told me she did not think that she wanted to be a family physician, but she was going to keep all options open. She said she was going to do her best to learn as much as she could. She was always on time and was always asking questions. She was one of the hardest workers I have come across, and that made it a joy to teach her."
Another physician wrote, "Some students show up to the site expecting to have all the latest technology, and this is just not the case for many of us."
Regarding preceptor evaluations, one physician said, "If I knew there were certain things that the student needed to know, then I could make sure that the student was getting exposure to these cases or readings."
Lastly, on community support, a physician reflected that, "Finding a way to get the student involved in local sporting events or church events seems important. Maybe the student could work with the high school team physician on some Friday nights."
Additional Author Comments
During his conversation with AAFP News, Wheat provided additional thoughts about his work to expand the rural workforce. The following Q&A captures some of those ideas.
Q. Why should this topic be of interest to family physicians?
A. Long-term preceptorships are becoming more popular because they better suit the overall needs of rural trainees. The physicians who participated in this study were all trained in a less-than-coordinated system of rural medical education. What improvements do they think need to be made? What would it take for them to be happy and satisfied participants in a well-constructed preceptorship program integral to a rural medical education program?
Q. Were you surprised by any of the findings?
A. I was modestly surprised -- knowing how busy these physicians are -- at the amount of attention they want medical schools and communities to give to the precepting role. Our study participants said medical schools should engage in preceptorship-based education with the same vigor that's applied to medical school education.
Preceptors felt like there was not a commitment from the medical school and were not sure the students assigned to them were given the same structure and support as students training at the medical school. Nor did they think that, as preceptors, they were given the same attention, structure and guidance that medical school faculty received.
Q. What's the most important takeaway for readers?
A. Physicians really were concerned that precepting be valued as a high-quality experience, with all of the components formalized, to ensure that medical education delivered during a precepting experience is just as pristine as one would find at the medical school.
Q. How should these research findings be used?
A. These findings can help physicians get involved in the conversation so they can begin to have an influence on how preceptorship programs are structured. I think that in itself is an empowering process that will further physicians' commitment into making it happen in their local towns.
Related AAFP News Coverage
Leader Voices Blog; Mentoring Is Key to Expanding Primary Care Pipeline