In 2001, I took a position as the assistant dean for faculty development at the newly formed Florida State University College of Medicine (FSUCOM) in Tallahassee. I came to FSUCOM with 22 years of faculty development experience, the bulk of that with the Ohio University College of Osteopathic Medicine.
For 16 years I travelled throughout Ohio giving teaching skills workshops for community preceptors. It was during the late 1980s through the 1990s, when the landscape of medicine was changing and preceptors had less time to teach and to participate in faculty development activities. I often thought about pushing for a faculty development requirement but knew there would be push back from preceptors and the administration.
I arrived at FSUCOM as the inaugural class of 30 students was completing year 1. The plan was to gradually increase the class size to 120 and after completion of year 2 on central campus, students would be assigned to one of six community-based regional campuses located throughout Florida. Students were to be taught their required clerkships by community-based preceptors with 80% of that training to occur in ambulatory settings and 20% in hospital settings.
This was a major departure from the norm of most third- and fourth-year training occurring in the hospital setting. The community-based preceptors were to be paid $500 per week and would be called “clinical clerkship faculty” with assistant, associate, and full clinical professor designations. They also were to receive free access to the FSUCOM electronic library, signage for their offices to let patients know of their status, and free CME for attendance at faculty development events.
As the inaugural class progressed through their second year, we needed to start training the preceptors (clinical clerkship faculty). Given the circumstances of being a new medical school, and the fact that we were providing more benefits to preceptors than anyone else, it was my belief that faculty development focused on clinical teaching skills should be required for year 3 and 4 preceptors. Most clinical faculty on central campus were opposed to this suggestion, and the three regional campus deans were neutral. However, one person did agree with me—the dean. He told me to create the details of the requirement, and he would make it happen.
The faculty development requirement was front loaded and stated that preceptors had to participate in 6 hours (three 2-hour workshops) of faculty development before taking a student. The initial 6-hour requirement served as an organizational development function as well as a faculty development function. The first 2-hour session includes topics such as: an overview of the curriculum, FSUCOM mission and vision, regional campus structure, preceptor benefits such as e-Library access, and preceptor responsibilities. The second 2-hour session focuses on basic clinical teaching skills such as orienting the student and providing feedback. The third session focuses on principles and details of evaluating the student.
Preceptors were also required during the first 2 years of being a preceptor to participate in 4 additional hours of training. Thereafter, they were required to participate in faculty development activities for 2 hours each year. Those hours could be attained via live workshops or completion of online modules.
Ten years and hundreds of well-attended workshops later, meeting the faculty development requirement became the norm. Some preceptors have been meeting the requirement for more than 10 years, and the regional deans are suggesting that after a certain length of time preceptors should not have to continue to meet the requirement. This is very understandable. Perhaps after 10 years of meeting the requirement, a preceptor’s participation should be voluntary.
With more than 35 years of faculty development behind me, I feel fortunate to still be associated with a medical school that believes good clinical teaching by preceptors is so important that their engagement in faculty development training is required. I believe that many medical school faculty and administrators do not think required faculty development is possible partly because it is not in the scope of their past experiences.
Believing that required faculty development for preceptors is possible requires a paradigm shift in how we think about preceptors and clinical training. Steven Covey said that most “break throughs are actually break withs.” Many new medical schools are now in start-up mode and I am hopeful that some will “break with” the past and follow the FSUCOM model for helping ensure that students will have high-quality clinical learning experiences with preceptors who have participated in required faculty development to enhance their clinical teaching skills.
Thank you for sharing this information. How is this funded? What is the total budget for paying community preceptors?
Dear Amy, I cannot give you an exact total but I can tell you that the $500 per week is paid to preceptors for years 3 and 4 (includes required clerkships and electives within the FSUCOM system) while they have a student. The money comes from the operating budget. Year 1 and 2 students spend a half day per week with a primary care preceptor during the second semester of the year 1 and a half day per week with the preceptor during the first semester of year 2. Those preceptors are paid a pro-rated amount based on the $500 per week. FSUCOM has a class size of 120. The original decision to pay the $500 per week is based partially on research indicating that when a preceptor has a student he/she is slowed down and either works a longer day (e.g. 30 minutes to 1 hour longer) or sees 1 to 2 less patients. I believe I am correct in saying this research was done in ambulatory settings. One could make the argument that these findings might not apply in hospital settings. However, FSUCOM is a community based education program that focuses on training in the ambulatory setting so FSUCOM students spend about 70 to 75% of their time learning in ambulatory settings.
Interesting model with lots of potential applications; I agree that we aren’t born to teach; training specific skills, especially around setting goals and providing feedback–are crucial!