Preceptorships

Resources for your Preceptorship

Textbooks and Consult Sites

  1. Advanced Health Assessment & Clinical Diagnosis in Primary Care, current edition
  2. Current Diagnosis & Treatment in Family Medicine, current edition
  3. Bates’ Guide to Physical Examination and History Taking, current edition
  4. Ferri’s Clinical Advisor, current edition
  5. Differential Diagnosis in Primary Care, Collins, current edition
  6. UpToDate clinical database

Patient Education Literature

You should be able to provide patient education and training for your patients on a variety of topics, as authorized and in close coordination with your preceptor. Please peruse the patient education resources so that you are aware of the type of information available for your patients.

Oral Case Presentation

The oral case presentation is an integral part of clinical training and provides you with an opportunity to critically analyze the key elements of each patient case. Additionally, it helps the preceptor to know if you are adequately synthesizing the classroom and clinical information you are learning. If your preceptor does not directly ask it of you, it is highly recommended that you request to provide periodic oral presentations of cases you observe or participate in during your rotation. We suggest presenting at least two cases per rotation. Following are guidelines for what to include in an excellent case presentation.

  1. Chief complaint

    1. Brief identifying statement that includes the patient’s age and complaint

  2. History of present illness

    1. Chronologically organized
    2. Tells a clear story
    3. Includes pertinent positives and negatives that help distinguish among possible diagnoses
    4. Includes elements of past history (such as medications, family history, social history) that specifically contribute to the present illness

  3. Physical examination

    1. Includes vital signs and general appearance
    2. Includes abnormal findings and pertinent elements of physical examination

  4. Laboratory data

    1. Includes pertinent and/or significant laboratory results/studies

  5. Summary statement

    1. Synthesizes the critical elements of the case into one sentence
    2. Includes epidemiology (age, gender, ethnicity, race, predisposing conditions)
    3. Includes key features (symptoms, physical examination findings, laboratory data)
    4. Uses semantic qualifiers (acute vs. chronic, mild vs. profuse, diffuse vs. localized)

  6. Assessment

    1. Includes prioritized problem list
    2. Includes pertinent differential diagnosis for each problem
    3. Identifies most likely diagnosis (and why)
    4. Includes less likely diagnoses (and why)

  7. Plan (if your preceptor requests this of you)

    1. Organized by problem list
    2. Includes diagnostic plans
    3. Includes therapeutic plans

Example Case Presentation (given orally):

A 6-year-old girl who had her appendix removed one week earlier presents with chief complaints of fever and abdominal pain for the past 24 hours. She is also vomiting and having diarrhea, which her brother is also experiencing. There is also decreased urine output. Her physical exam is remarkable for a pulse of 110, dry mucous membranes, temperature of 102.3, an acutely ill appearance, and diffuse abdominal tenderness. Her stool is guaiac negative and her creatine is mildly elevated. To summarize, we have a 6-year-old caucasian girl, status post recent appendectomy, now with acute onset of profuse vomiting and diarrhea associated with diffuse abdominal pain and complicated by severe dehydration. At this point I am considering Clostridium difficile infection due to her recent hospitalization, as well as gastroenteritis considering her brother’s similar symptoms. Our plan could include stool culture to determine the type of infection, or empiric antibiotic therapy with concomitant probiotics, as well as fluid replacement to prevent further dehydration.

The Four Golden Rules of Effective Menteeship

Authors: Vineet Chopra, Mary Dixon Woods, Sanjay Saint

Publication date: August 15, 2016: BMJ Careers
Read The Four Golden Rules of Effective Menteeship

Student Tips for a Successful Preceptorship

The following tips and advice come from other students who have made the most of their preceptorships.

Since I’m only a first year, I don’t have much to contribute, but I carry a small notebook during preceptorships to jot down cases, questions, and things to look back on later. I’ve found that while it’s easy to ask questions during preceptorships in primary care (especially with NDs), it’s a lot harder to know when it’s appropriate in other specialties (like in emergency med where it’s constantly busy and the attending has a lot on their plate). Taking notes on things to ask later is helpful.

Something I’d encourage is to suggest that students engage with other staff in the office and not just preceptors. Oftentimes the mid-level staff do a lot of work that preceptors overlook and have different perspectives to patient care; we tend to miss them as students.

From my experience I’ve found taking the initiative and asking my preceptor if I can do the history and physical on a particular patient has served me well. My first preceptor was doing a lot of primary care women’s health, so I asked her if I could do as much of the physical exam as I felt comfortable doing. This term I’m with an ob/gyn and he calls me when someone is in labor and lets me do exams in the office. All of this because I told them what we’ve been learning in CPD and that I want to have a primary care practice focusing on women’s health.

What I’d suggest is taking the initiative, ask questions, and show your preceptor you are capable of doing things in the clinic and you’ll get a much better experience than simply following the preceptor around.

Something I have found to be an absolutely essential component of a great preceptorship experience was having a sit-down meeting with your preceptor to clarify goals/expectations for the quarter at the very beginning.

Don’t hesitate to ask questions no matter how busy your preceptor seems. They agreed to take you on and you are there to learn so ask away, that’s the whole point.

If you feel like you are overwhelmed by the pace of things take a moment, find a computer, log into the library, and bring up a consult website (like UpToDate, or whatever) and read. There is nothing wrong with learning at your own pace.

Push yourself. The only way to learn medicine is to get your hands dirty, so don’t be afraid to ask seemingly redundant or superficial questions. No one is born with the deductive powers of a skilled preceptor.