Dr. Cindy Duke is a board-certified OBGYN and a reproductive endocrinologist based out of Nevada. Reproductive endocrinology is a specialization that focuses on the first twelve weeks of pregnancy and complications in that time frame. It is also an OBGYN specialty that works with both male and female patients. It allows medical students and physicians to see a patient base they would usually not see in a core medical clerkship such as those wishing to freeze eggs and sperm or about to undergo gender reassignment surgery. 

She precepts a wide variety of clinical students from MD/DO students to nursing students. Medical students rotating through will often have problem-based learning (PBL) coursework that helps to supplement their clinical training and problem-solving skills. 

She believes strongly that a preceptor should be a clinical educator with a passion for the training they will be implementing. Those that are obligated to precept may lack this intrinsic motivation and the clinical rotation may suffer for all parties involved. It can be a very rewarding experience and the preceptor may learn as much as the student. Also, setting aside time at the end of each day to go over student questions and discuss complicated patients is a great benefit to the learning environment. This offers students a “safe space” to ask questions without judgment. 

For physician and patient safety, it is important to let the medical student know what to expect in a medical specialty learning environment. Explaining the unique precautions to that clinic or prohibited actions ahead of time is a proactive measure for everyone’s safety. Lastly, facilitating the opportunity for medical students to experience those tasks that are allowed create a safe medical and learning environment. 

Cindy recommends that medical students rotating in any OBGYN rotation or specialty become very familiar with female reproductive cycles. Knowing the menstrual cycle, hormonal fluctuations, and how to influence or alter these cycles is a keystone of reproductive endocrinology. Prior to clinical rotations, she encourages medical students to think of three questions or topics they are interested in regarding the clerkship. This allows a preceptor to be aware of this opportunity if it arises and share it with the student. 

When asking for Letters of Recommendation, a medical student that is enthusiastic when asking is going to have much greater success. Cindy points out that a student may want to use a script. Stating, “here are some things I really liked about my rotation with you” will give the preceptor information on which to base their LoR. You do not need to feign interest in the specialty if you do not plan to go into that specialty. You can also ask a preceptor to write a general letter at any point. Then, when a medical student decides on a specialty, contact the preceptor and ask if it can be tailored to that career path. 

Dr. Duke is also the host of the GriPSSI Podcast! Catch new episodes to get into the mind of a fertility clinic physician.

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Residency program director, author, entrepreneur, and family medicine physician, Ted O’Connell, joins us today to discuss precepting of both medical students and residents in a variety of medical settings. He has many years as both a clinical educator as well as authoring educational review textbooks for students. His free question bank allows students to study medically relevant topics without the burden of extra expenses. 

Ted acknowledges that a preceptor must have a strong desire and interest in teaching. Without this drive, it can be very difficult to adequately assess students and convey knowledge to their current level of comprehension. Keeping up with Faculty Development materials available within and outside of your institution can help keep updated on educational processes. He also believes that is it vitally important for students and preceptors to discuss their expectations for a clinical rotation in advance to provide a foundation for the medical experience. 

A student that is proactive in their clinical education will gain the most benefit from their time. This can even begin BEFORE the clinical rotation begins by reaching out to the Rotation Coordinator for advice and researching potential residents and attendings one might have. Doing a little research on their interest can open up the conversation later on and provide an avenue for closer bonds to be formed. 

Being proactive with patient care is also a student's strength that can increase the preceptor’s view of the student’s competency level. Reading the patient history and other records ahead of time allows students to demonstrate more ownership of their patients. This not only can save the preceptor valuable time, but you may catch a routine lab draw or vaccination that could have otherwise been missed. 

Students can prepare for clinical rotations by pretending they are on an isolated island and only they can save the patient. This may allow for more independent thinking and less reliance on residents or attendings for answers. They can also think aloud and explain their thought process as well, which allows for more exact feedback from their clinical preceptor. Independence in clinical tasks, being proactive, and following up on patients you have seen are things preceptor’s look for when a student asks for a Letter of Recommendation as well. 

Read more of Dr. O’Connells work on his blog, including: Ten Actions to Ace Your Outpatient Rotations and How To Ask For A Great Letter Of Recommendation. 

Ted is also the co-founder of the FREE content at Exam Circle and the CCO of InsideTheBoards. Try the All Audio Q-Bank for iOS to study on the go!

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Jason Mizell a colorectal surgeon and clerkship director from the University of Arkansas and has been running a Business of Medicine course for several years. Like many students, Jason started off with a desire for one specialty (pediatrics) and ended up discovering that another option was much more enjoyable for him. He emphasizes that this is very normal so students should keep an open mind and accept all challenges and opportunities that arise. 

Preceptor’s understanding of their student's future goals and expectations can greatly influence the student-preceptor dynamic during clinical rotations. For instance, Jason realizes that only a small percentage of students will be going into a surgical specialty and as such he focuses his teaching content on more general needs. He also points out that there are significant differences in pre-clinical and clinical medicine which students need to be transitioned into (i.e.: colleague consults). 

When discussing medical topics with medical and healthcare students, preceptors that think-aloud give the student insights into the thought process of clinical medical professionals. They can help students during their medical externships by pointing out the nuances that may otherwise be missed. Proper assessment of student competence and oversight are also extremely important not only for the educational environment but also for patient care. 

A medical preceptor that sets their expectations for the students early is vital for an efficient learning system. In fact, UAMS created its own internal app that allows for constant access to learning objectives and expectations for each medical service which is easily accessible and updated. Also, letting the student take the driver seat during their clinical rotations is a great way to guide them while allowing open-ended reciprocity of ideas. 

Medical and clinical students preparing for surgical rotations should prepare by researching the particular surgery and being aware of the patient history beforehand. Thinking about the situation as if the preceptor is not there, making decisions, and preparing for potential complications is a great way to stimulate one’s thought process pre-op. Lack of effort or interest is easily noticeable by the preceptor and will likely lead to a poor experience for all parties involved. Your activity and interest, as well as personal interactions with patients and preceptors, will greatly influence your Letter of Recommendation as well. 

You can gain more insights into Jason Mizell’s Business of Medicine topics on The White Coat Investor Blog and Podcast as well as Doctor Money Matters and Doctor’s Unbound. For research on financial education in medicine, please read Jason’s article, Money matters: a resident curriculum for financial management.

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Rural family medicine and primary care hold many unique abilities for physicians and students. In fact, Dr. Errin Weisman is able to complete not only the normal primary care activities through her clinic, but some procedures that might otherwise be relegated to microbiology, histopathology, dermatology, surgery, or OBGYN practice. This has given her a unique perspective on modern medicine in different geographic and demographic environments. 

Current and future preceptors in these community centers have much to be cautious of. Imposter syndrome and burnout can impede on, especially when there is less professional support to fall back on. Self-care and being mindful of one’s current moods and thoughts are undeniably beneficial to physicians in these instances. When more help is needed, virtual meetups and life coaching can step in to add the desired support structure (which Errin provides for physicians and students). 

When teaching, giving students the opportunity to learn with guided mentorship can be mutually beneficial. It saves the preceptor’s time by decreased hand-holding, but it also allows the student to work through a problem on their own. They can develop creative thinking skills as they relate to the clinic. However, the “blame and shame” model of education is antiquated and often provides little benefit. It is usually best to avoid this type of negative preceptor-student interaction. 

Errin recommends that students that would like to engage in rural medicine networks and opportunities should consider reaching out on social media. Those active on social media or in education circles are more likely to accept students and interact with them. Students must be truly interested in learning but also keep an open mind as there is no such thing as perfection. In the end, the student and preceptor are a team working within the healthcare system, so an unengaged student is not going to excel in a rotation in her clinic. 

When interacting with patients, sometimes jumping in headfirst is very helpful. This decreases the workload on preceptors needing to explain everything and gives the student a greater feeling of autonomy. However, a poor patient presentation can make a student’s work worthless. Do work to improve your presentation skills and ask for advice when needed. 

You can reach Dr. Errin Weisman on LinkedIn. Do check out her website, TruethRxs, and her podcast, Doctor Me First!

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In Part 2 with Dr. Neel Desai, he advocates for students to continue to learn how to learn. The material, the science, and the medicine will continue to evolve and change. It is more important that you learn how to absorb materials better, faster, and for longer periods of time than to know everything there is to know right at this moment. He also wants students to focus on being Happier, Healthier, Wealthier, and Wiser. This is a theme that you will also hear via his contributions to the Happy Doc Podcast. Medical students should focus on developing other aspects of their life as well during their clinical rotations. 

For students, it is important to get on the same page as your preceptor. Neel likes to know what type of educational medium the student most frequently uses so that he can “speak their language” so he can better tailor the content to the student. He also advises students to reach out to potential mentors, creatives, and thinkers. By developing these networks early on – and possibly creating your own content to begin fostering your online reputation – students can form mutually beneficial cooperatives with those in fields of interest. 

For those interested in a strong Letter of Recommendation for Residency, see this opportunity from the eyes of the preceptor. If, when you leave, a patient praises you to the physician that will leave a lasting positive impressing on the preceptor. The reverse is also true. Finding resources that are useful to you, and personally curating your own curriculum is quickly becoming best practices in medical education as well. 

You can reach Neel via email or @TheHappyDoc on social media. 

Looking for an educational resource for yourself or someone you know? Try my new book, Read This Before Medical School. You can download our free “Essentials of” eBook to see if this material may be a good fit for you! 

For you clinical rotations platform, save FindARotation.com in your Bookmarks and download the FindARotation mobile app for iOS and Android (when it becomes available).

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Dr. Neel Desai is a co-founder of MedFlashGo and a contributor at the Happy Doc Podcast. His training in family medicine has been a unique experience and has helped to shape his views on academic medicine and healthcare. He prefers to be proactive than reactive in his role as a primary care physician and wishes to empower patients with tools and education. He argues that the current model of healthcare is outdated and advocates that we start Teaching, Learning, Creating and Practicing medicine in the century we live in. 

One of the most important keys to take away from Neel’s medical and educational philosophy is to show humility. All too often physicians – and even students – may take on a paternal role or let their ego get in the way of their patient interactions. Cynicism is all too common in healthcare due to the stresses we all endure. Checking one’s ego at the door and truly listening to one another and to our patients is the only way to move to a more patient-centered and be true to our calling in healthcare. 

One last point to remember is that we need to enjoy every aspect we can from each rotation. Even if we do not see ourselves in that specialty or profession in the future, there is valuable information to be gained if we stick with an open and positive mindset. You also never know what curve-balls life may throw at you or a loved one. Absorb all of the information you can while you can. You may not have another opportunity to do so. 

You can reach Neel via email or @TheHappyDoc on social media. 

Looking for an educational resource for yourself or someone you know? Try my new book, Read This Before Medical School. You can download our free “Essentials of” eBook to see if this material may be a good fit for you!

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Dr. James Gomez is board-certified in Obstetrics & Gynecology in the Chicago area and has been a clinical educator for over 10 years. As a community physician, he handles both in-clinic patients and prenatal care as well as hospital deliveries and surgeries. This specialty uniquely borders between primary care, surgery, and other subspecialties depending on each physician’s scope of practice. 

Preceptors in OBGYN (OB/GYN) often have a particularly sensitive population and special care is often needed when preparing students for the patient population. They must also assess their students for their level of knowledge and interest in order to best plan how to approach the individual's clinical education. Proper mentorship is key. Gaining the respect of one’s students is never a bad idea, and being too strict is unnecessary. However, Dr. Gomez cautions that boundaries must be set between the student and preceptor in order to keep a professional and proper learning environment. 

Medical students are required to participate in several weeks of clinical education in OBGYN for their core rotations. They may also choose to gain more experience in OBGYN during their elective rotations. Students that show an interest in the topics and patients likely to present in this clinical setting are likely to more involved and gain the attention of their preceptor. A student is expected to gain basic ultrasound technical skills, read the US monitor, monitor lab and hormone changes, and follow these assessments to a diagnosis and treatment plan. 

Some key takeaways would be: 

It has to make sense. Not all lab results and patient's signs or symptoms add up to the typical case. Atypical presentations are much more common in the clinic than on the boards. 

Develop a preceptor-student bond and get on the same page. The relationship between clinical preceptor and student may be strained and distant or maybe inappropriately close. Make sure to foster a healthy learning environment. 

Be active with your education. Forcing a preceptor to repeat his/herself multiple times may demonstrate a lack of interest by the student and strain the rest of the medical externship.

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Dr. Allison Edwards is the owner of Kansas City Direct Primary Care. Though she works in the community, she still hosts students from the University of Kansas and other locations at her clinic. DPC is a movement as well as a clinical environment that is designed to eliminate the middle-person and reduce costs for patients. Direct Primary Care provides a low-volume yet diverse learning experience and is great for shadowing or students requesting a break between intense rotations. 

DPC preceptors are unique in that they are entrepreneur-physicians to a greater degree than hospitalists. As small business owners, they navigate the two complex worlds of medicine and business. DPC physicians are also free from the hospital and administrative constraints other physicians are regulated by. This potentially allows preceptors and students to run more tests and provide in-house support that a hospital setting may pass off to a tech. There is a great focus on learning how to learn now so that students can use these critical thinking and technical skills more effectively later. 

Students interested in a Direct Primary Care clinical rotation must be concerned with time-constraints and customer service. Though there is generally lower volume at DPC clinics, patient time expectations (more so than hospital time restrictions) are of paramount concern. Customer satisfaction is an important consideration in all small businesses. 

Students should prepare for their externships by being open-minded and energetic. They should plan for downtime and have a general plan for self-directed studies. Showing passion and being proactive are great ways to assure a student's Letter of Recommendation will display their strengths and ambitions. Also, students that remain humble and understand they are still learning will benefit more from their clinical experience than those that are abrasive or overstep their boundaries. The preceptor-student relationship is that of a dynamic team. Understanding each person’s level in the hierarchy and personal limitations provide a smooth transition of knowledge from one individual to another. 

Most links related to DPC: 

DPC Alliance 

DPC Frontier (map of local DPC clinics) 

Atlas.md & Bagel.md (EHRs that serve DPC) 

D4PC Foundation (host of the Nuts & Bolts Conference) 

AAFP’s DPC Toolkit 

HintHealth DPC Software

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Dr. Bruce Morgenstern is the Vice Dean of Academic and Clinical Affairs at Roseman University College of Medicine and President for the Alliance for Clinical Education (ACE). His medical history as a board-certified pediatric nephrologist led him on his path to becoming the Clerkship Director for Pediatrics at Mayo, working with The Council on Medical Student Education in Pediatrics (COMSEP), and he eventually became the President of ACE which collaborates with numerous medical education associations. 

Preceptors: Dr. Morgenstern believes in medical education and the importance of precepting for healthcare students. Physicians should be encouraged to seek out faculty development training if available to them if they wish to continue to progress in their mentorship roles. However, the most important aspect of any student-teacher relationship is setting clear expectations early on. He also confirms the importance of a basic education model, such as the one-minute preceptor model, in medical education. Though many preceptors may not be aware of the exact model, they often implement a similar structure into their educational environment. 

Students: Dr. Morgenstern feels students should also express their level of education to preceptors early on. This helps to facilitate material being disseminated in a manner appropriate for each individual’s level of education. Students that lay out their hopes for the rotation or that discuss topics they would like to learn more about are more likely to receive specific training. Those that don’t may fall the wayside. 

When asking for a Letter of Recommendation (LoR), it is best to ask a preceptor that knows the “unwritten code” of a strong letter. Many physicians may have good intentions, but do not always know what current residency directors are looking for. Also, do not ask “will you write me an” LoR, but instead specify that you are looking for a “strong” LoR. This can make all the difference in the preceptor's interpretation of your desire for that field and the letter. 

Keep updated with education meetings via the ACE Calendar. 

For more education information, check out the Medical Mnemonist Podcast or other shows in the network via the InsideTheBoards (ITB) website. For those earlier in their education, we recommend our book, Read This Before Medical School. For board-review and q-bank questions, iOS users can download the freemium ITB Audio Q-bank or join the conversation via the ITB Slack Community! 

*Please note my mistake in calling it the Alliance for Clinical EducatORS in the audio when, in fact, it is the Alliance for Clinical EducatION.

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Brought to you by the co-author of Read This Before Medical School: How to Study Smarter and Live Better While Excelling in Class and on your USMLE or COMLEX Board Exams, this show will bring you interviews from medical educators in the clinical sciences. 

Wondering how to ask for Letters of Recommendation or how to best prepare for an upcoming clinical experience? This show will prepare you for your upcoming clinical rotations and make sure your externship experiences are fulfilling. Following the 1-Minute Preceptor Model, we explore how different preceptors in different clinical scenarios approach students and their education. 

Stay tuned for the many great physicians we have interviewed and be sure to share this with your friends and Subscribe!

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