Preceptorship Student Manual

Table of Contents


Introduction

While clinical preceptorship is a required component of your naturopathic education, it will also provide some of the most rewarding experiences of your medical school training. The ND Preceptorship program provides the opportunity to be mentored by a variety of preceptors in diverse clinical settings. You will be expected to integrate the basic and clinical sciences you learn at school with real world clinical scenarios.

Your preceptor may engage you in all manner of supervised clinical activities, ranging from observation of the preceptor’s patient interactions to participation in patient interviewing, physical and diagnostic examination, and therapeutic interventions. The level of your participation in patient care is dependent upon your preceptor’s licensure as well as their wisdom and discretion.

Preceptorship provides students with a supervised opportunity to:

  • Observe varied clinical pathologies and development of differential diagnoses
  • Develop and/or observe communication skills during the medical interview
  • Perform and/or observe physical examinations and diagnostic evaluations
  • Develop and/or observe methods for fostering patient rapport and improving patient compliance
  • Develop and practice oral case presentation skills
  • Observe how a healthcare provider handles difficult patient encounters
  • Deliver and/or observe therapeutic interventions and assess their effectiveness
  • Observe business strategies for creating a viable practice

Outcomes and Competencies

Outcome – Medical Knowledge

Competencies:

  • Observe or elicit the taking of a complete and accurate medical and biopsychosocial history.
  • Observe or perform complete and appropriate physical examinations.
  • Demonstrate increasing proficiency in case presentation skills.
  • Observe the creation of or demonstrate the ability to write progress notes in a standard format with pertinent content.
  • Recognize the appearance of varied clinical pathologies and formulate differential diagnoses.

Outcome – Patient Management

Competencies:

  • Provide evidence-informed ideas in discussion of treatment protocols that are consistent with naturopathic principles.
  • Observe and participate in the formulation of therapeutic interventions, and assess their effectiveness.

Outcome – Communication and Collaboration

Competencies:

  • Demonstrate the ability to function as part of a patient care team.
  • Demonstrate the ability to establish patient rapport.
  • Recognize strategies for dealing with difficult encounters, increasing patient compliance, and encouraging return visits as appropriate.
  • Demonstrate or observe the delivery of diagnostic findings and diagnoses, and provision of patient education around those findings.

Outcome – Practice-Based Learning and Improvement

Competencies:

  • Demonstrate a commitment to independent learning.
  • Demonstrate acceptance of critical feedback.
  • Demonstrate integration of basic science and clinical knowledge.
  • Demonstrate ability to accept uncertainty.
  • Demonstrate clinical curiosity.

Outcome – Ethics and Professionalism

Competencies:

  • Demonstrate respect, compassion and integrity in patient and professional interactions.
  • Demonstrate a commitment to ethical principles of medicine.
  • Adhere to NUNM clinic and preceptor handbook requirements of professional conduct and attire.
  • Demonstrate sensitivity to patients with a variety of cultural, ethnic, and financial backgrounds.

Outcome – Practice Management and Business Skills

Competency:

  • Observe business strategies for the creation of a fiscally viable practice.

Outcome – Systems-Based Practice

Competency:

  • Observe and develop an understanding of the process for patient referrals and consultation with other healthcare providers as required.

Student Requirements

Prerequisites

Students must meet the following requirements to earn preceptorship credit beginning the spring term of their first year:

  • Successfully complete the first term of year one ND coursework.
  • Attend a preceptorship program orientation (offered during winter term of first year).

Required Hours

  • 216 total hours are required (240 hours for students who matriculated prior to fall 2015).
  • At least 145 hours must be completed with an approved naturopathic physician.
  • The remaining 71 hours (or 95 if the student matriculated prior to fall 2015) MAY be completed with other approved healthcare providers as listed below:
    • MD (Medical Doctor)
    • DO (Osteopathic Doctor)
    • DC (Chiropractic Doctor)
    • DPM (Podiatric Doctor)
    • PA (Physician Assistant)
    • NP, CNM (Nurse Practitioner, Certified Nurse Midwife)
    • DPT, PT (Doctor of Physical Therapy, Physical Therapist)
    • PsyD, PhD, LCSW, LPC, MFT (Clinical Psychologists only)
  • Students holding another medical degree (e.g., MD, DO, DC) are required to complete only 145 ND hours.
  • Typically, you may spend no less than nine hours and no more than 50 hours with the same preceptor. In rare circumstances, you may have a very short rotation of eight or fewer than eight hours. You are allowed no more than four rotations of eight or fewer hours. Students may choose to work more than 50 hours with the same preceptor, but will not receive credit for the extra hours unless a “Petition to Deviate” has been approved prior to working over 50 hours. Deviation petitions are normally only approved if the student has worked with at least four other preceptors and is in their final year of school. CURRENT HOUR EXCEPTION: until further notice, students may receive credit for up to 75 hours per preceptor without filing a Petition to Deviate. 
  • While preceptorship hours may be scheduled any time after orientation in the winter term of first year, students are formally registered for preceptorship hours in their required summer (five credits) and in spring of their final year (four credits) (five credits for students who matriculated prior to fall 2015).

Program Requirements

The following items must be completed in the CORE Clinical Tracker to receive full credit for a preceptorship. Video tutorials can be found on the CORE home page, with any questions directed to preceptorship@nunm.edu. Note that no credit will be given if all documentation is not completed by the deadline or if the preceptor was not approved prior to the start of the rotation.

Action itemDue DateResponsibility
Communicate with potential preceptor and secure their agreement to work with them before submitting anything in COREBefore starting any preceptorshipStudent and Preceptor
Site Prospector Submission and receipt of approval notificationBefore starting any preceptorshipStudent
Preceptorship Hours Form (includes submission of Hours Tracking Template, and self-evaluation)As soon as possible following completion of preceptorship, and NO LATER THAN Friday, week two of the term following the term in which the rotation is completed.Student (NUNM and preceptor approval required)
Preceptor EvaluationAs soon as possible after receipt of student’s submission of their hoursPreceptor

1. Find a Potential Preceptor

Utilizing the Research Center in the CORE Clinical Tracker, identify a potential preceptor. You are also welcome to identify potential preceptors who are not in the Research Center, and request that they apply to become approved NUNM preceptors. Read preceptorship listings carefully and find a good fit for your goals. Contact the practitioner and discuss their availability for a preceptorship that will fit your and their schedule. Decide on your learning goals together and THEN complete and submit for pre-approval. When preceptors are part of this planning process, you have a much higher probability of a successful placement. Blind submissions of these forms almost never work and are off-putting to preceptors.

2. Site Prospector submission for pre-approval

Your preceptorship may not begin until you have submitted and received approval notification. Following the instructional tutorials in CORE, complete the Site Prospector submission, which includes listing your specific learning goals for the rotation. Once you receive notification of approval, you may begin working with your preceptor via the schedule that the two of you agreed to. The approval email comes with a link to an Hours Tracking Template. Download this form, and add the hours you work to it each day. 

3. Preceptorship Hours Form Submission

Within 1 week of finishing your preceptorship, go to Field Encounters and make a Preceptorship Hours Form Submission, which includes your completed Hours Tracking Template, and a self evaluation of your experience. Instructional videos for this are located on your CORE home page. It is recommended that you maintain your tracking log as you go through your rotation, and not leave it until the conclusion. List every date you worked in your preceptor’s office, the number of hours, and the number of patients with whom you had contact. 

Your preceptor will receive a copy of your submission, and must then approve your submission as well as evaluate your performance. The Evaluation from your preceptor is not a grade, but rather is formative feedback designed to provide you with information about where you are doing well and what areas require more study. Ideally, your preceptor has provided you with feedback along the way, prior to completing your evaluation. Help your preceptor by reminding them to complete this document by the due date so that you can receive credit for the rotation. You will be able to view the evaluation in your CORE Clinical Tracker.

Professionalism

It is expected that you will adhere to the NUNM Code of Conduct as delineated in the NUNM student handbook while participating in your preceptorship rotations. Students must demonstrate respect, compassion and integrity in all patient and professional interactions. It is your responsibility to contact the preceptor prior to the beginning of your preceptorship rotation to clarify your preceptor’s expectations.

Participation in Patient Care

You may participate in patient care at the discretion of your preceptor if they hold a valid license in their state of practice and are covered by malpractice/professional liability insurance. Otherwise, a student may only observe the preceptor in practice, and may not participate in patient care in any way, including the provision of medical or nutritional advice. If you do not maintain this standard, you will not be covered by NUNM’s professional liability (malpractice) insurance and your ability to practice medicine in the future might be jeopardized.

Professional Conduct

  • You should refrain from asking questions in the presence of a patient. Questions may be asked respectfully at a time when you are alone with the preceptor.
  • Students are not to give medical advice, comment on treatment in front of a patient, or offer unsolicited suggestions in the presence of patients unless explicitly instructed to do so.
  • Please refrain from taking notes in the presence of patients unless it for the expressed purpose of medical charting or otherwise approved by your preceptor in advance.
  • If you have “downtime” during your rotation, ask your preceptor how you can assist around the office, or if they have a research project they can assign you.
  • Never ask the preceptor for medical advice in regard to you, your family or friends.
  • Turn off your cell phone, and do not utilize it or any other personal devices without approval from your preceptor. If permission is granted, it should only be used for clinical purposes related to your rotation.

Attendance

Attendance is mandatory. Students should be at their sites on the dates and at the times as scheduled or assigned. Contact your preceptor if you are running late or if there is an unexpected absence. You should consider that this is your private practice. For example, your responsibility to your patients does not stop because there is an upcoming test. If you fail to notify the preceptor’s office within a timely manner, absences will be considered unexcused and you may be required to complete up to 10 additional preceptorship hours.

Dress Code

A professional appearance is required of all students. While on a preceptor shift, you should wear a clean, white, ironed clinic jacket with your student ID badge. Students are expected to adhere to NUNM Health Centers dress code and fragrance-free policy unless otherwise requested by your preceptor.


Scheduling Your Preceptorship Rotations

Preceptorship rotations must be completed only with healthcare providers who have been previously approved by NUNM. It is your responsibility to ascertain if a provider has been approved prior to beginning your rotation. All practitioners with an active, non-expired preceptorship listing in the CORE Research Center have been approved for preceptorships. If the provider has not been previously approved, you will not receive credit for the rotation. There are two ways to find a preceptor with whom to work:

  1. Find your own preceptor
  2. Utilize the CORE Clinic Tracker Research Center

Option 1: Find Your Own Preceptor

If you know a healthcare provider with whom you would like to work, first ascertain if they are already in the CORE Research Center of approved preceptors.  If not, the healthcare provider must then apply and be approved―at least two weeks prior to the date you wish to begin your rotation.

Who to Contact/Who to Consider?

Tips for Approaching a Potential Preceptor

Before you contact any healthcare providers, make sure you know what you want to say to them by using the Elevator Pitch worksheet for your preceptorship “Unique Self Presentation” (USP). Do you research ahead of time – check their website so that you are aware of their practice and their background. Be sure their type of practice is a good fit for you. 

Determine if it is best to visit in person, call or email. Be sure to let them know you will follow up using another form of communication if you have not had a response in a week.

If you visit a potential site in person:

  • Introduce yourself to the office personnel (office manager), and if possible, the healthcare provider. If you can only get in touch with the office manager, ask if they can provide you with the email address of the provider.
  • Ask if they would be interested in serving as a clinical preceptor and if you can schedule a time to discuss this possibility and what they would be looking for in a student learner.
  • Have a copy of your resume or CV with you to show them. Explain how many hours you need (a minimum of eight and maximum of 50 hours). The clinical days should be determined by the site/preceptor needs and availability.
  • You can direct them to further information for preceptors found on the ND preceptorship website, including eligibility criteria and student evaluation standards.
  • Follow up with them in a few days (this can be done by phone).
  • If the provider agrees to precept, please ask them to fill our the Preceptor Application. If they are approved and a CORE account is created, follow the instructions found in the video tutorial entitled “How to Search the Preceptor Database & Get Approval,” found on your CORE home page. Your submission will show as ‘pending’ initially, and then be reviewed by the Registrar’s office.
  • Students can begin preceptorship hours once they receive email approval from the Registrar’s office.

Contacting a potential preceptor by phone or email:

  • Let them know if a particular person has referred you to them and tell them why you are interested in working with them.
  • If you are unable to speak with the potential preceptor, leave a message using the “Elevator Pitch” worksheet.
  • Do not give up or take it personally if they do not respond right away (or at all).
  • Tell the office manager your USP and ask them if you can leave a message or have the provider’s email address. Office managers are often “gate keepers” and can help you in your efforts.
  • If the provider you contact is not interested or not available, try asking them if they know of any provider who might be interested (always ask for referrals).

Option 2: Utilize the CORE Research Center

The preceptorship program maintains a database of approved preceptors that students may contact directly in the CORE Research Center. This database contains information about the preceptor including where they are located and areas of practice focus. These preceptors have agreed to receive direct communication from students in regard to scheduling rotations. Do not submit a preceptorship in CORE (via Site Prospector) until you have already communicated with the preceptor, and they have agreed to have you work with them.

The same guidelines as noted in Option 1 above can be used for contacting already approved preceptors. Do not assume that they will always be available at the times you require, and be courteous if a preceptor is unable to accommodate you and your schedule. Always be ready with your USP and your resume or CV when contacting a preceptor directly.


What to Expect

Know that every preceptor’s office is run differently, so your experience will vary from rotation to rotation. Start by always having an open mind to different types of practices and a variety of learning experiences.

Please call or email your preceptor’s office a day or so before you are scheduled to begin your rotation. Introduce yourself to the staff if you haven’t done so already and remind them of the day and time that you are scheduled with them. Make sure there are no last minute changes from the preceptor.

Orientation to the Office

  1. You should be introduced to the office staff upon your arrival.
  2. Learn how the office operates―where should you park; which door you should use; what are the hours of operation on the days you come?
  3. Dress code―check with your preceptor regarding any additional or special stipulations in addition to the NUNM student dress code (i.e., whether or not your preceptor requires you to wear a white coat).
  4. Review confidentiality and HIPAA information with your preceptor or their designee.
  5. Learn how the office functions, e.g., how medical records are maintained, where the charts are kept if paper charting is used. What is each staff members’ role in record keeping? How are the charts maintained? Ask the preceptor if they have ideas about how you might contribute to the functioning of the office. You should also observe and come up with your own ideas, asking permission before initiating anything.
  6. Receive an introduction to the medical records system, and obtain any needed access passwords. Discuss what your role will be in charting and record-keeping.
  7. Listen and learn how phone calls are handled, how telephone and office advice are given and how appointments are made. What happens at check-in and check-out? Observe patient flow. How do patients pay? Which insurances are accepted at your office? What is the average co-pay? Do they pay cash or use charge cards or debit cards?

Orientation to the Student-Preceptor Relationship

  1. Learn about your preceptor―hobbies, family, education, hometown, and practice focus.
  2. Share information about yourself with your preceptor―hobbies, family, education, and hometown. Let s/he know what type of practice or career you desire.
  3. Before your rotation beings, you should have shared your learning goals with your preceptor. Learn what the clinical expectations will be for your rotation. To which patients will you be assigned? Will you “room” patients and take their vital signs and check their medication lists and allergies? Will you assist in taking patient histories and physical exams? Will you assist with providing lab results to patients or patient education or referral for preventive services?
  4. Please note that if the preceptor is not practicing in a licensed state, or is not covered by malpractice/professional liability insurance, you may only observe, and not have any active participation in patient care.
  5. You should give oral case presentations for patients with whom you interact or observe (ideally at least two per rotation). How and when does your preceptor want you to orally present cases? See page 16 for guidelines on presenting cases.

Orientation to the Student-Preceptor Relationship

  1. Learn about your preceptor―hobbies, family, education, hometown, and practice focus.
  2. Share information about yourself with your preceptor―hobbies, family, education, and hometown. Let s/he know what type of practice or career you desire.
  3. Before your rotation beings, you should have shared your learning goals with your preceptor. Learn what the clinical expectations will be for your rotation. To which patients will you be assigned? Will you “room” patients and take their vital signs and check their medication lists and allergies? Will you assist in taking patient histories and physical exams? Will you assist with providing lab results to patients or patient education or referral for preventive services?
  4. Please note that if the preceptor is not practicing in a licensed state, or is not covered by malpractice/professional liability insurance, you may only observe, and not have any active participation in patient care.
  5. You should give oral case presentations for patients with whom you interact or observe (ideally at least two per rotation). How and when does your preceptor want you to orally present cases? See page 16 for guidelines on presenting cases.

Your Clinical Role

If your preceptor is licensed and is covered by malpractice insurance, you may participate in patient care at your preceptor’s discretion. If your preceptor is practicing in an unlicensed state or is not covered by malpractice insurance, you may only observe and not participate in a patient care, including even activities such as taking vital signs. Examples of activities that you might engage in if your preceptor is licensed and is covered by malpractice insurance are:

  • Greet patients and take vital signs
  • “Room” patients (collect the chief complaint/basic history, med and allergy update, etc.)
  • Assist in medical charting (with your preceptor’s signature)
  • Run CLIA-waived/in-office tests such as urine dipsticks, hem occult, urine HCG, influenza, monospot
  • Perform phlebotomy
  • Deliver basic lab results by phone or in person, explain treatment plans, or provide patient education on designated topics

Your level of participation in patient care may also be dependent upon other factors, including the patient population and their individual desires. If permissible, you should begin to take histories and practice examining patients as your skills and confidence allow, and at the wisdom, discretion and readiness of the preceptor.

You will get out of the preceptorship experience what you invest in it.


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.


Syllabus

Doctor of Naturopathic Medicine

Course Syllabus

ND Preceptorship ― Experiential Learning

Instructor name
Kelly Baltazar, ND, DC, MS (program oversight)
Preceptors vary according to site
Email & Phone
kbaltazar@nunm.edu
503.552.1860
Office hours & location
Drop-in or by appointment
Administrative building

Course Schedule and Location

This course is year-round and is located at the respective preceptor’s office, clinic or hospital.

Course Description

Students participate in external clinical rotations (“preceptorships”) throughout the duration of their education under the mentorship of licensed preceptors outside NUNM. Students will observe and may participate in medical interviewing, physical examination, diagnostic techniques and analysis, and application of therapeutic modalities. Students will also observe routine clinic policies and procedures, doctor/patient communications, coding and billing practices, and referral management.

Definitions

  • “Preceptor” means the licensed and NUNM-approved healthcare provider with whom the student will work or observe in the community.
  • “Rotation” means the total number of hours a student works with a preceptor during one quarter.
  • “Shift” means one single day of a rotation.

Credit Hours

Nine credits (five credits are given in the required summer term, and four in the student’s final spring term prior to graduation)

Course Prerequisites

  • Passing grade in all first-term ND coursework
  • Attendance at ND preceptorship orientation (winter term of first year)

Course Competencies

Upon successful completion of this course, students will be able to achieve the following:

Medical Knowledge Competencies

  • Observe or elicit the taking of a complete and accurate medical and biopsychosocial history.
  • Observe or perform complete and appropriate physical examinations.
  • Demonstrate increasing proficiency in case presentation skills.
  • Observe the creation of, or demonstrate the ability to write, progress notes in a standard format with pertinent content.
  • Recognize the appearance of varied clinical pathologies and formulate differential diagnoses.

Patient Management Competencies

  • Provide evidence-informed ideas in discussion of treatment protocols that are consistent with naturopathic principles.
  • Observe or participate in the formulation of therapeutic interventions, and assess their effectiveness.

Communication and Collaboration Competencies

  • Demonstrate the ability to function as part of a patient care team.
  • Demonstrate the ability to establish patient rapport.
  • Recognize strategies for dealing with difficult encounters, increasing patient compliance, and encouraging return visits as appropriate.
  • Demonstrate or observe the delivery of diagnostic findings and diagnoses, and provision of patient education around those findings.

Practice-Based Learning and Improvement Competencies

  • Demonstrate a commitment to independent learning.
  • Demonstrate acceptance of critical feedback.
  • Demonstrate integration of basic science and clinical knowledge.
  • Demonstrate ability to accept uncertainty.
  • Demonstrate clinical curiosity.

Ethics and Professionalism Competencies

  • Demonstrate respect, compassion and integrity in patient and professional interactions.
  • Demonstrate a commitment to ethical principles of medicine.
  • Adhere to NUNM clinic and preceptor handbook requirements of professional conduct and attire.
  • Demonstrate sensitivity to patients with a variety of cultural, ethnic, and financial backgrounds.

Practice Management and Business Skills Competency

  • Observe business strategies for the creation of a fiscally viable practice.

Systems-Based Practice Competency

  • Observe and develop an understanding of the process for patient referrals and consultation with other healthcare providers as required.

Program Outcomes Met by this Course

  • Medical Knowledge
  • Patient Management
  • Communication & Collaboration
  • Practice-Based Learning & Improvement
  • Ethics & Professionalism
  • Practice Management & Business Skills
  • Systems-Based Practice

Required Textbooks, Articles and Other Information Resources

ND Preceptorship Student Manual

Recommended Textbooks, Articles and Other Information Resources

  1. Bates’ Guide to Physical Examination and History Taking, current edition
  2. Ferri’s Clinical Advisor, current edition
  3. Differential Diagnosis in Primary Care, Collins, current edition
  4. UpToDate clinical database

Assignments

  1. Experiential Learning Objectives Overview
    1. Completed once by the student―a brief, but thoughtful big picture assessment of short- and long-term goals, required before they begin the course. Must be submitted on MyCareer.
  2. Learning Goals/Placement Form
    1. Completed by the student in collaboration with the prospective preceptor. The preceptor may optionally add their own goals for student learning. Approved through MyCareer by NUNM and by the preceptor, prior to or on the first shift of each rotation.
    2. Student is responsible for form completion and submission on MyCareer.
  3. Student Evaluation and Hours/Patient Tracking Log
    1. Evaluation is completed by the preceptor for all rotations of greater than eight total hours. The preceptor confirms the hours completed during the rotation and submits an evaluation of your performance through a link to a MyCareer form.
    2. It is helpful if the student reminds the preceptor to complete the evaluation, as credit for the hours completed is dependent upon submission of this form to the Clinical Education office.
    3. The student maintains a tracking log of all shift dates, times, and patient contact numbers. This log is approved by the preceptor at the completion of the rotation.
  4. Self-Reflection/Goals Assessment and Preceptorship Program Evaluation Forms
    1. Student is responsible for completion and submission to the Director of Career Services through MyCareer following the end of each rotation.

All forms must be completed and submitted through MyCareer to the Director of Career Services no later than Friday of week two of the quarter following the completed rotation. For example, if you complete your rotation anytime in fall quarter, submitted forms would be due by week two in the winter quarter of that same academic year. These online forms are required for each preceptorship rotation that a student completes. Note:

  • If your rotation with a single preceptor proceeds continuously throughout more than one quarter, you need only to submit the required forms one time at the end of the rotation.
  • If you work with a single preceptor more than once, but not continuously (you skip six or more weeks), this would be considered two (or more) separate rotations, and documentation must be submitted for each rotation.
  • Credit will only be given for rotations with approved preceptors. It is the student’s responsibility to ascertain if the preceptor is approved by completing one or more of the following steps:
    1. Check the MyCareer database.
    2. Email Emma Britton at ebritton@nunm.edu to determine if the preceptor is approved.

    Retroactive credit will not be given if the preceptor was approved after the student began working with the preceptor

Late Documentation Policy

Credit will not be given for documentation that is submitted after the due date.

Scheduling your Preceptorship Rotations

ND preceptorship rotations must be completed only with healthcare providers who have been previously approved by the program. It is your responsibility to ascertain if a provider has been approved prior to beginning your rotation. If the student is listed on the MyCareer website with a preceptorship job listing, they are approved. This does not guarantee availability! If the provider has not been previously approved, you will not receive credit for hours completed in a rotation.

There are three ways to schedule a preceptorship:

  1. Utilize the MyCareer Preceptor Database or contact the Director of Career Services to find an approved preceptor.
  2. Create your own preceptorship (preceptors must always be approved in advance of beginning your rotation or credit will not be awarded).
  3. Complete the online Lottery Request form. (for students in their final year only).

Specific instructions for each scheduling method can be found in the ND Preceptorship Student manual beginning on page 11.

Remediation Policy

Students receiving low final evaluation scores of 1 or 2 (out of 5) will have additional preceptorship hours assigned as determined by the number of hours in the rotation.

Attendance Requirements

All preceptorship shifts must be attended as scheduled with the individual practitioner. Tardiness and absences without notification are unprofessional and are detrimental to both your own reputation as a student clinician and to the program as whole. Absences with no or late notification, or chronic tardiness will result in assignment of up to 10 additional hours and/or a referral to the Honor Council.

Requirements for Passing this Course

There is no grade given for this course. Student matriculating in fall 2015 or after are required to complete 216 preceptorship hours (240 hours for students who matriculated prior to fall 2015), 145 of which must be with an ND, and the remainder of which can be with any of the following licensed practitioners: ND (Naturopathic Doctor), MD (Medical Doctor), DO (Osteopathic Doctor), DC (Chiropractor), DPM (Podiatrist), NP or CNM (Nurse Practitioner or Certified Nurse Midwife), PA (Physician Assistant), DPT/PT (Doctor of Physical Therapy, Physical Therapist), or Clinical Psychologist (LCSW, MFT or PsyD). All documentation must be completed and submitted on time in order to receive credit for the course.

Grading Scale

There is no grade given for this course, however you will be evaluated on the following 1–5 scale and receive feedback from your preceptors.

1
Unacceptable performance
2
Below expected level of performance
3
Expected level of performance
4
Performing above expectations
5
Superior performance
NA
Not Assessed/Not applicable

Students receiving low final evaluation scores of 1 or 2 (out of 5) will have additional hours assigned as determined by the number of hours in the rotation.

Instructional Philosophy

It is our sincere belief that you will take away from ND preceptorships and experiential learning opportunities what you invest in them. The process of creating your learning goals at the beginning of your rotation is your opportunity to tell the preceptor what you can do and specifically what you would like to obtain from this experience. Reflection on your experience is an integral part of the learning process, and the reflection and goals assessment is your opportunity to consider how and if you achieved your goals.

Study Strategies and Classroom Participation Guidelines

The amount of engagement you have in this experience is related to two main factors, but there are a myriad of ways to get the most out of your preceptorship rotations:

  1. If your preceptor is practicing in an unlicensed state or does not have malpractice insurance coverage, your only option is to observe that preceptor with their patients. However, you should challenge yourself to engage in active discussion with your preceptor about all aspects of cases.
    1. Challenge yourself to summarize the pertinent aspects of the case for your preceptor.
    2. Challenge yourself to provide differential diagnoses for the case and your ideas for evaluation and management.
    3. Do literature searches on interesting presentations, diagnoses, or treatment options.
  2. If your preceptor is licensed and is covered by malpractice insurance, your preceptor has the option to include you in patient care at their discretion. Let them know that this is possible, and volunteer to help when you feel ready and comfortable to do so.
    1. Ask if it is appropriate for you to “room” patients (take their vital signs, basic chief complaint, meds and allergies). If your preceptor is comfortable with it, ask to take the history (established patients or patients with acute concerns might be good candidates for this).
    2. Ask if you can perform or repeat a physical exam.
    3. Ask if you can perform in-office tests like urinalyses, wet preps, or rapid strep tests.
    4. Ask if you can provide patient education around certain topics that you are comfortable with (tobacco cessation, therapeutic diets, child safety).
    5. Ask if you can help with documentation to help you become familiar with different electronic records systems.
    6. Ask to give an oral case presentation on an interesting patient you have seen.

Academic Integrity

All students are required to be familiar with and adhere to the academic integrity policy. For further information on cheating, plagiarism, misconduct, etc., please refer to the “Student, Clinic and Preceptor Handbooks” found at https://studentservices.nunm.edu/.

Citation Requirements

When referring to other sources of work, students are required to cite their sources. NUNM uses the American Medical Association (AMA) standard.

Academic & Student Resources – Quick Guide

Library Resources

Most of the required and many of the recommended textbooks for courses are available in the NUNM library for checkout. Required texts are typically on reserve and may be checked out for six hours. Recommended texts may be available for longer checkout periods. Library staff are also available to assist with research assignments and locating course and assignment resources.

Tutoring

Tutors are available for students who are seeking additional help in any subject. Please see the Associate Dean of Academic Progress to request tutoring.

Excused Absences

For NUNM’s excused absence policy, please see the current student handbook.

Technical Help

For assistance with email, please contact the IT department: 503.552.1585 or ITSupport@nunm.edu. For assistance with Moodle, please click the link for Moodle Support Page.

Students with Disabilities

Students with documented disabilities are encouraged to work with the Office of Student Life to access academic accommodations.

NUNM Commitment to a Healthy Learning Environment

NUNM is committed to providing a healthy learning and work environment free of all forms of discrimination and sexual harassment, including sexual assault, sexual harassment, domestic and dating violence, and gender-based stalking. All NUNM employees are required reporters unless, at the time of your report, you are being seen in a counseling session or at a patient visit at our clinic.

Additional local, regional and national resources can be found on the NUNM Sexual Assault and Interpersonal Violence page.

For more information about services available to students, please visit the NUNM Student Services.