Transition to Clerkship for Standardized Preceptors

Table of Contents

Thank you for serving as a preceptor for our Transition to Clerkship!

You will be working with our second-year medical students, who will soon be transitioning to their third year (where their learning will be primarily in the clinical space during our Longitudinal Integrated Clerkship).

Transition to Clerkship overview video

~7 minutes

Acronyms used in our program

CBL: Case-Based Learning
EMR: Electronic Medical Record
LIC: Longitudinal Integrated Clerkship
LG: Large Group
SP: Standardized Patient
TTC: Transition to Clerkship
VCC: Virtual Clinical Center
WBA: Workplace-Based Assessment

Introduction videos for standardized preceptors

Curriculum information: ~5 minutes

Assessment information: ~5 minutes

Please do

Quick details for standardized preceptors

The Virtual Clinical Center (VCC)

The Virtual Clinical Center is the central point for all simulation-based training at the at the Elson S. Floyd College of Medicine. The center boasts 10 clinical exam rooms, two high-fidelity simulation suites, a classroom for skills-based instruction, a conference room to support video debriefing, and lab space for the creation of low-cost tissue models in-house.

The curriculum supported by the VCC encompasses all aspects and modalities of health care simulation. These include partial-task trainers for teaching basic physical exam or clinical procedural skills, manikin-based simulators to allow learners to experience the pressures of caring for a patient in an acute-care setting, and RQI system and computer-based virtual reality simulations for the purposes of exploring emergent technologies and their application in educating the physicians of tomorrow.

Standardized Patients

The Elson S. Floyd College of Medicine also uses Standardized Patient Simulation, which involves individuals playing the role of a patient. These standardized patient encounters assist in the development and assessment of humanistic and clinical reasoning skills.

Standardized patient simulation involves the use of individuals trained to portray the roles of patients, family members or others. A Standardized Patient (SP) is an individual who is carefully recruited and trained to portray or simulate all aspects of a real patient as part of a case scenario in order to provide an opportunity for a student to learn or be evaluated on their clinical skills in a simulated environment. SP’s learn all aspects of a patient portrayal and are carefully trained to not only simulate a real patient scenario but also provides feedback to the students, especially in regard to their communication and interpersonal skills.

Working with a standardized patient (sp)

Please take a few minutes to introduce yourself to the standardized patient (SP), your partner in this educational experience. Please share with the SP about your precepting style. Do you like to correct student actions as they occur, or do you prefer to wait until the debrief? This will make staying in character easier for the SP. When the student arrives, you will each play your standardized part in the encounter.

You may know your standardized patient. Please do not divulge this information to your students! We try very hard to ensure that our students treat our patient actors no differently than they would a patient in the clinical setting.

Our patients are highly trained to provide feedback surrounding the encounter from the patient’s perspective such as eye contact, clarity in asking questions, jargon, empathy, and rapport building. They are instructed to only provide feedback in this area.

Please bring any standardized patient or VCC concerns to the director of Simulation Based Training, Chris Martin.

How the sessions will work

(Each encounter: 45 minutes total)

  • Students will work in pairs (when there is an absence, you may have one student), with a ‘preceptor’ (you) in the room, to evaluate the patient in their CBL case.
  • Prior to entering the room, students will decide which student will take the history and which one will perform the physical (and which one will provide the counseling on May 14, 2024); each student should ask you for specific feedback on something they are working on. Please prompt them if they do not ask you anything.
  • One student will begin the interview with the Standardized Patient (SP). The second student will perform the physical exam. It is fine if students participate in each other’s tasks if time allows.
  • At the end of the encounter, if time allows, you may want to demonstrate some of the skills that might need improvement in the students.
  • Students record their findings to take back to the next CBL session.
  • Practice asking the preceptor before entering the room for feedback on practicing history-taking skills, physical exam skills, or patient-counseling skills.
  • Practice the clinical skills (patient care, professionalism, interpersonal, and communication) developed since the beginning of medical school.
  • Pay attention to good time management.
  • One student will take the history, and the other will perform the physical exam. On May 14, 2024, one student will provide contraceptive counseling to the patient.

 

We expect students to:

    1.  Come prepared! Students are instructed to arrive at the VCC with a structured plan for the H&P.
    2. Arrive in the VCC 10 minutes before their assigned time with the SP.
    3. Decide who will “go first” with the interview and who will “go first” with the exam.
    4. Conduct the appropriate history and physical exam anticipating feedback from you.
    5. (On May 28 and June 4, 2024) Ask you, the preceptor, for direct observation and feedback on their interview skills or physical exam skills using our workplace-based assessment forms.
    6. Incorporate your feedback into a learning plan to support improved skill demonstration over the 6 weeks.
  • Watch, listen, take notes as needed (simulate a preceptor in the clerkship).
  • Provide specific feedback on missed history information and review physical examination techniques before you transition out of the exam room.
  • Invite the standardized patient to provide feedback in the final five minutes before you leave the room.

 

At the end of the encounter (after ~45 minutes):

  • Transition to a designated feedback room where you provide feedback directly to the students for the final 10 minutes.
  • Fill out the WBA if volunteering on May 28 or June 4, 2024.

Background on the patients

Below are five of the Transition to Clerkship’s patients. Tap on each of them to see the preceptor summary (PDF ). (The PDF will also be included in your Outlook invitation.)

Tips for providing feedback in real time in the exam room

  • Sessions with Standardized Patients are 45 minutes long.

    There are 40 minutes allotted for history taking and physical exams. Switch from the history to the physical after 20 minutes. The remaining 5 minutes are reserved for feedback from the standardized patients. A session timer will be displayed in the room to help you stay on time.

  • Remind students you are there to observe and provide feedback to help their developmental preparation for the Longitudinal Integrated Clerkship starting in July.

  • Let students know you may interrupt them.

    It is part of the teaching process!

  • If you notice that students are omitting parts of the history that might be important in the case, you might say:

    “Let me suggest you explore that symptom a bit further.”
    or
    “I noticed the patient mentioned [symptom, such as constipation]. It’s a good idea to explore what the patient means by that.”
    or
    “I noticed the patient seems confused by your question. How might you re-frame it or check for understanding to see if you’ve explored that symptom well enough?”

  • When observing physical examination skills, work with the students together to conduct a thorough exam using proper technique.

    After observing the student who performs the physical examination, feel free to demonstrate to both students physical exam techniques that may need improvement and allow them to practice, as time allows.

  • The standardized patient (SP) will provide feedback to the students before leaving the room (up to 5 minutes).

    Then you will have 10 minutes to provide feedback to the students. When the SP returns to the room, your session is completed; please exit the exam room at this time.

  • Informing the SP about your precepting style prior to the encounter will help the SP stay in character.

    Do you like to correct student actions as they occur, or do you prefer to wait until the debrief?

Framework for simulated encounters

We believe that everyone participating in activites at the Virtual Clinical Center is intelligent, capable, and cares about doing their best and wants to improve.

Simulation is an opportunity for learners to discover and experience interpersonal risk-taking relationships in a safe and harm-reductive strategy/space to empower critical thinking concepts.

We acknowledge the technology we use has limitations. We have done everything in our power to provide a valuable learning experience for you. We ask that you meet us halfway and act as if you were in the clinical environment.

Workplace-Based Assessments (WBAs)

Please review the metrics of the Workplace-Based Assessments so that you are aware of what to look for when assessing students in the VCC on May 28 and June 4, 2024. Copies will be emailed one week in advance with your PIN, and the form will also be accessible on the student’s iPad, which they should provide for you to complete.

Student orientation materials: Welcome to Wesford

This is an introduction to Wesford, our fictional Transition to Clerkship city.

The Setting
Students are part of a clinical team in a Family Medicine practice taking care of a panel of patients. This team rotates responsibilities with other teams to care for new patients wishing to establish care and for patients with urgent care needs for the whole practice. This practice prioritizes characteristics and principles guiding family medicine—comprehensiveness, continuity, coordination, and care provided in the context of family, community, and culture through the biopsychosocial, team-based practice, primary-care-first model. Thus, when your team’s patients present to the Emergency Department or are admitted to the hospital, you remain fully engaged in the care of these patients even if not the primary admitting (e.g., hospitalist) physician.
This practice is in the town of Wesford, Washington, a town of 40,000 people.
Wesford has a critical access hospital (Wesford General Hospital) that is staffed with a team of 4 hospitalists (internal medicine and family medicine physicians) who take primary responsibility for admitted patients in the 20-bed general wards and the 5-bed combined CCU/ICU. Two general surgeons work at this hospital, each with two days of scheduled operative time, and they share urgent and emergency general surgery call.
Wesford General has two operating rooms.
One anesthesiologist and two certified registered nurse anesthetists (CRNAs) support pre-operative, intraoperative, and immediate post-operative care for patients, as well as acute pain consultations. Other specialists work part-time at this hospital (they commute from nearby larger communities). Four nurse midwives work with the Family Medicine physicians to practice obstetrics. The nearest larger medical center and tertiary care hospital is 75 miles away. In this larger medical center, all the specialists and subspecialists in internal medicine, pediatrics, obstetrics, gynecology, psychiatry, and surgery are available for telehealth visits and referrals. 
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  • Family Physicians: Hamad Khan, Stephanie Lambert
  • Internists: Lauren Hall, Eric Chan
  • Hospitalists: Mariana Sanchez (FM), Richard Burnham (FM), Keisha Jones (IM), Dakota Ferguson (IM)
  • EM Physicians: Lilly Krieger, Karl Harrison
  • Radiologist: Eric Ng
  • General Surgeons: Stephen Dieters, Leslie Romero
  • Anesthesiologist: Jeff Flett
  • Nurse Anesthetist: Karen Lee
  • ICU Nurses: Kelly Anne Larsen
  • Pharmacist: Esther Chege
  • Registered Dietitian: Keith Somers
  • Hospital RN Care Manager: Abbie Edwards

 

The following specialists are available for remote consult, occasionally take shifts in Wesford, and will care for transferred patients from Wesford during your rotation:

    • Cardiologist: Sam Watson
    • Interventional Cardiologist: Christine Zhu
    • Pulmonologist: Elizabeth Chaterjee
    • Nephrologist: Adam Ryerson
    • Endocrinologist: An Nguyen
    • Obstetrician/Gynecologist: Amber Sawyer
    • Neurologist: Sofia Rudenko
    • Gastroenterologist: Scott Johnson
    • Pediatrician: Maria Guzman
    • Infectious Disease Specialist: Lee Park
    • Pathologist: Natalie Odenkirk
    • Psychiatrist: Sam Horace