Faculty & Resident Preceptor TrainingClinical Curriculum

For Questions Please Contact Rachael Smith at rachael.smith@hsc.utah.edu

ContentsFaculty and Resident Preceptor Training

§ Inclusive Clinical Learning Environment§ Non-Discrimination, Professional Conduct, & Mistreatment Policies § Combating Microaggressions§ Mitigating Implicit Bias in Instruction and Assessment

§ University of Utah School of Medicine Program Objectives§ AAMC Core Entrustable Professional Activities for Entering

Residents (EPAs)§ Clerkship Goals§ Faculty and Resident Preceptor Roles & Responsibilities§ Feedback and Evaluation Forms

§ Mid-Course Formative Feedback§ Preceptor Evaluations

§ Highlighted Policies, Procedures, and Practices§ Clinical Supervision of Medical Students§ Medical Student Clinical Documentation

Non-Discrimination, Professional Conduct, and Mistreatment Policies

Faculty and Resident Preceptor Training

Non-Discrimination Policy§ The University of Utah is committed to providing and fostering an

environment that is safe and free from prohibited discrimination.§ https://regulations.utah.edu/general/1-012.php

Professional Conduct and Mistreatment Policies§ The University of Utah School of Medicine is committed to providing an

educational environment of mutual respect between medical school teachers (faculty, fellows, residents, and staff) and medical student learners.

§ Professional conduct policies for faculty, residents, staff, and students published in multiple locations:§ Faculty: https://regulations.utah.edu/academics/6-316.php§ Residents: https://medicine.utah.edu/gme/files/professional-conduct-policy.pdf§ Staff: https://regulations.utah.edu/human-resources/5-205.php§ Students Handbook: https://medicine.utah.edu/students/current-

students/files/som-student-handbook.pdf

MistreatmentFaculty and Resident Preceptor Training

Standards of conduct between the teacher and the learner that evoke an environment of mutual trust and understanding contribute to developing an environment that supports the learning process.

Mistreatment occurs when negative behaviors adversely impact the learning environment and learner-teacher relationship.

Combating MicroaggressionsFaculty and Resident Preceptor Training

§ Read this short piece on Combating Microaggressions in the workplace: https://www.acepnow.com/article/simple-strategies-for-combating-microaggressions-in-the-workplace/

Mitigating Bias in AssessmentFaculty and Resident Preceptor Training

§ Complete the Addressing Bias in Learner Assessment module from Northwestern University Feinberg School of Medicine: https://www.feinberg.northwestern.edu/md-education/learning-environment/index.html

§ Recommendations for narrative assessment§ Use observations not inference. Give specific examples of

behaviors based on direct observation of the student.§ Do not mention age, race/ethnicity, marital status, children,

physical characteristics, or other personal attributes.

§ Further reading§ Rojek, A.E., Khanna, R., Yim, J.W.L. et al. Differences in Narrative Language in Evaluations of

Medical Students by Gender and Under-represented Minority Status. J GEN INTERN MED 34, 684–691 (2019). https://doi.org/10.1007/s11606-019-04889-9

§ Ross DA, Boatright D, Nunez-Smith M, Jordan A, Chekroud A, Moore EZ (2017) Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations. PLoS ONE 12(8): e0181659. https:// doi.org/10.1371/journal.pone.0181659

UUSOM Program ObjectivesFaculty and Resident Preceptor Training

§ Adapted from the Physician Competency Reference Set

§ Regularly Reviewed and Approved by the Curriculum Committee

§ Located at: https://medicine.utah.edu/students/programs/md/curriculum/program-objectives.php

AAMC Core Entrustable Professional Activities For Entering Residents (EPAs)

Faculty and Resident Preceptor Training

§ The Core Clinical Curriculum of the UUSOM has adopted the AAMC EPAs as the primary basis for its patient care course goals.

§ Regularly Reviewed and Approved by the Phase 3 and 4 Subcommittees with oversight from the Curriculum Committee

§ Detailed Information: https://www.aamc.org/initiatives/coreepas

AAMC EPAsFaculty and Resident Preceptor Training

1. Gather a history and perform a physical examination.2. Develop a prioritized differential diagnosis and select a working diagnosis following a

patient encounter3. Recommend and interpret common diagnostic and screening tests4. Enter and discuss patient orders/prescriptions5. Provide documentation of a clinical encounter in written or electronic format6. Provide an oral presentation/summary of a patient encounter7. Form clinical questions and retrieve evidence to advance patient care8. Give or receive a patient handover to transition care responsibility to another health

care provider or team9. Participate as a contributing and integrated member of an interprofessional team10. Recognize a patient requiring urgent or emergent care, initiate evaluation and

treatment, and seek help11. Obtain informed consent for tests and/or procedures that the day 1 intern is expected

to perform or order without supervision12. Perform general procedures of a physician13. Identify system failures and contribute to a culture of safety and improvement

Course GoalsFaculty and Resident Preceptor Training

§ Clerkship Core Common Goals aligned to EPAs 1a, 1b, 2, 3, 5, 6, 9 § Include detailed developmental benchmarks for

clerkships§ Aligned with core clerkship activities and

assessments§ Core Common Goals aligned to Program

Objectives§ Additional Course Specific Goals

§ Course Specific Syllabi Distributed by Individual Courses

Preceptor Roles & ResponsibilitiesFaculty and Resident Preceptor Training

§ Understand the expected clinical skills developmental benchmarks for medical students

§ Ensure appropriate opportunities for students to participate directly in patient care§ Directly supervise and observe students in the clinical setting§ Orient students to the specific clinical practice and student role§ Provide students with timely formative performance feedback on:

§ history taking § physical examination skills § clinical reasoning § clinical testing § clinical documentation§ oral presentations§ integration into the health care team

§ Provide final written evaluation of student performance§ Participate in faculty and resident development activities to develop clinical teaching

skills such as:§ Annual training updates on UUSOM Clinical Curriculum practices§ Efficiently incorporating students into busy clinical practices§ Providing useful performance feedback§ Creating and delivering effective didactic instruction

Mid-Course Formative FeedbackFaculty and Resident Preceptor Training

§ Well-conducted mid-course formative feedback sessions ensure that all students receive timely, low-stakes feedback with sufficient time to continue to improve adequate performance or correct sub-standard performance.

§ Students with performance below expectation in one or more areas must be referred to the course director immediately!

§ Aligned with Course Goals and Preceptor Evaluation Form§ Includes Observable and Relevant Medical Student Clinical Skills§ Includes Student Self-Assessment§ Only 7 Items to Rate§ Only 1 Comment Boxes

§ Mid-Course Formative Feedback FAQs: https://uofu.box.com/s/t5nt7vq822mw8ds2pmultgrubfuw1yrk

Preceptor EvaluationsFaculty and Resident Preceptor Training

§ Workplace Based Assessment§ Provide Observations and Assessments from the Authentic

Clinical Setting§ One component of the Overall Clerkship Grade

§ Preceptor Evaluations§ Shelf Exams (NBME Clinical Subject Exams and CLIPP Exam)§ OSCEs§ Other Clerkship Assessments

§ Structure§ Aligned with Clerkship Goals§ Includes Observable and Relevant Medical Student Clinical

Skills§ Only 7 Items§ Only 2 Comment Boxes

Evaluation Best PracticesFaculty and Resident Preceptor Training

§ Complete the evaluation immediately upon completion of preceptor experience

§ Mark the highest sustained performance observed§ Compared the student performance to the descriptors for each performance domain§ Select the rating that most closely matches the students highest sustained performance.§ Do not rely on your own constructs of the Honors vs. Passing student; the preceptor evaluation represents only

one component of the student’s overall grade.

§ Only rate items you directly observed§ Marking the Not Observed choice neither increases nor decreases the overall

score.§ Complete individual evaluations individually; complete team

evaluations as a team.

§ Notify the clerkship director immediately of students with low-lying performance!

§ Preceptor Evaluation FAQs: https://uofu.box.com/s/0mg1ncm6k7dop5z35qwi9up8yh1jan2s

Clinical Supervision of Medical StudentsFaculty and Resident Preceptor Training

Practice§ Students of the University of Utah School of Medicine must be appropriately supervised when

participating in required or elective clinical activities. Level of Supervision§ Students may be supervised at one of two broad levels as determined by the supervisor: § Direct Supervision ***: The supervisor is present with the student and the patient. § Immediately available Indirect Supervision: The supervisor, while not in the presence of the student

and/or patient, is immediately available to the learner and/or at the site of care to provide direct supervision.

***Students may not perform procedures without direct supervision.

Supervisor Requirements and Responsibilities§ Supervisors must either hold a faculty appointment or be supervised in their teaching and

assessment role by an individual who has a faculty appointment. Supervisors may include physicians, residents, fellows, and other licensed health professional supervising an activity within the scope of their license, expertise, and practice.

§ Except as noted for procedures, determination of appropriate level of supervision is made by the supervisor and based on consideration of:§ Level of training of the student § Previous experience and skill of the student with the clinical activity and setting § Familiarity of the supervisor with the abilities of the student§ Acuity of activity and level of risk to patient

Clinical Documentation by Medical StudentsFaculty and Resident Preceptor Training

§ Medical students receive training on how to effectively use the medical record § They should receive feedback from their supervisors on their documentation, order

entry, and information management. § Medical students should document their clinical encounters in the medical record,

enter patient orders, and retrieve clinical information. § Medical student documentation should be identifiable as such but should not be

hidden or removed from the medical record. § Clinical faculty and residents who supervise medical students should receive training

on how and where students may document their clinical encounters, how student documentation may be used or referenced in the clinical care of patients, and how to provide feedback to students on their documentation.

§ Attending physicians should submit documentation for billing that accurately reflects their own services performed or those services that can be appropriately referenced according to CMS guidelines. Attending physicians should receive training on the strengths and limitations of the various methods for creating billable documentation (e.g. dictation, transcription, scribes, referencing or attestation of resident or student documentation, copy and edit functions, templates, preprinted forms, questionnaires, medical record macros or check lists)

§ All students and providers will use their own individual logon names and passwords for clinical documentation and order entry.

Thank YouFaculty and Resident Preceptor Training

§ Thank you for your commitment to medical student clinical education; we appreciate all you do to mentor and train our future physicians!