An immersive clinical experience to create sustainable clinical learning opportunities for nurse practitioner students.

ABSTRACT: A significant increase in nurse practitioner program enrollment has resulted in a critical need for committed preceptors willing to offer clinical learning opportunities for students. Academic practice partnerships have been proposed as a strategy to address the preceptorship crisis. This project evaluated the impact of a longitudinal immersive clinical experience designed for nurse practitioner students in collaboration with two federally qualified health centers and an underserved clinic within an academic health center. The study used a pre- and postsurvey method to determine the impact of an immersive clinical experience on preceptor perceptions of benefits and rewards, support, and commitment to the role. A statistically significant increase in preceptor perception of support was noted in three areas. Participants reported increased opportunity to share information with other preceptors, improved support from nursing faculty to help identify students' performance problems, and greater clarity in faculty responsibilities related to the preceptor role. Increases in perceptions of benefits and rewards and commitment to the preceptor role did not reach statistical significance. Immersive clinical experiences have the potential to improve the levels of preceptor support, commitment, and perceived opportunities for benefits and rewards, which may facilitate the development of high-quality, sustainable clinical learning opportunities for nurse practitioner students.

Financial Impact of Universal Precepting in Family Medicine Residency Clinics.

BACKGROUND AND OBJECTIVES: Precepting methods have significant impact on the financial viability of family medicine residency programs. Following an adverse event, four University of Minnesota Family Medicine residency clinics moved from using Medicare's Primary Care Exception (PCE) and licensure precepting (LP) to a "universal precepting" method in which preceptors see every patient face to face. Variation in the implementation of universal precepting created a natural experiment of its financial impact. METHODS: Universal precepting was implemented in October 2013 across four residency programs. Billing codes were measured 1 year before and 2.5 years after implementation by clinic and residency year. RESULTS: There were significant financial differences between clinics based on original precepting method and implementation quality of universal precepting. The clinic moving from PCE to universal precepting with excellent implementation increased higher-level billing (99214) by 8%-10%. Clinics moving from LP demonstrated wide variation ranging from an 18% increase to a 13% decrease, consistent with the implementation quality. CONCLUSIONS: Clinics transitioning from PCE to universal precepting can see a significant increase in 99214 billing. Clinics transitioning from LP to universal precepting are at significant financial risk if poorly implemented, but may see increased 99214 billing with effective implementation. This suggests that both implementation quality and original precepting method impact 99214 billing rates when transitioning to universal precepting.

Establishing nurse practitioner clinical practicums: Addressing fiscal realities.

As demand expands for nurse practitioner clinical practicum sites, the supply of preceptors is decreasing. The traditional model of in-kind clinical training is losing its foothold for a variety of reasons. A looming question is how quickly a "pay to precept" norm will grow and what will be the costs. The pay for precepting movement is discussed including current trends, costs, and emerging compensation models. To adapt to this trend, alternative ways of drawing the precepting value proposition are suggested, particularly decreasing preceptor and site demands while increasing students' readiness to enter clinical practicum and tapping into faculty expertise to add value to the partnership. The authors provide suggestions on building a strategy for rethinking the structure of student precepting arrangements and compensation models.

To Pay or Not to Pay Community Preceptors? That Is a Question .

Phenomenon: Pairing medical students with community-based preceptors has provided unique medical education advantages. However, due to an increase in the number of M.D.-granting medical schools and medical school class sizes, academic medical institutions have struggled to recruit community preceptors to teach their students. This task has been made more difficult due to rising pressures upon institutions and clinicians-for example, increased productivity demands, greater volume and oversight of electronic health record documentation, and competition for community preceptors from both D.O. and non-U.S.-based medical schools. Although academic institutions have historically relied largely on altruistic motives and intrinsic rewards to actively engage and retain community-based preceptors, alternative models have arisen, chiefly those in which community-based preceptors are explicitly compensated for teaching. Approach: To study this phenomenon, representatives of the Alliance for Clinical Education developed and deployed a 31-item survey accompanied with a subset of free text questions to the collective membership of its 8-member constituent organizations. Survey questions explored if community preceptors were compensated indirectly or directly and what types of compensation were provided, if any. There were 188 surveys analyzed, with an estimated response rate of 18.2%. Findings: Twenty-six percent of respondents indicated they compensate community preceptors directly and/or indirectly. Respondents discussed their motivations for payment (or nonpayment), mechanisms for paying, aspirations to pay, and expectations of the recipient. No statistically significant association was found when comparing responses of paid versus not paid by region. Free text responses provided additional insight regarding payment considerations, institutional competition, recruitment/retention, recognition, and education issues. Insights: Increasingly, medical schools are finding it necessary to provide funding for community preceptors in order to retain them. New creative forms of compensation to community preceptors may prove important in the future for this vital aspect of medical student education.

Willingness, concerns, incentives and acceptable remuneration regarding an involvement in teaching undergraduates - a cross-sectional questionnaire survey among German GPs.

BACKGROUND: Worldwide, many undergraduate general practice curricula include community-based courses at general practitioners' (GPs') offices. Usually the academic general practice departments collaborate with networks of affiliated teaching practices. To successfully master the challenge of network development and extension, more information is needed about GPs' willingness to be involved in different teaching formats, important influencing factors, incentives, barriers, and the need for financial compensation. METHODS: In this cross-sectional study a questionnaire survey was conducted among all GPs working in Leipzig and environs (German postal code area 04). In addition to descriptive statistics, group comparisons and logistic regression were performed to reveal differences between GPs with and without an interest in teaching. RESULTS: Response rate was 45.3% with 339 analyzable questionnaires. The average age was 52.0 years and 58.4% were women. Sixty-two participants stated that they were already involved in teaching undergraduates. Altogether 60.1% of all GPs and 53.5% among those who didn't teach yet were basically interested in being involved in undergraduate education. The interested GPs could imagine devoting on average 6.9 h per month to teaching activities. GPs interested in teaching were on average younger, were more actively involved in continuing education and professional associations, and more frequently had pre-existing teaching experiences. The willingness to teach differed substantially among teaching formats. GPs were more willing to teach at their own practices rather than at university venues and they preferred skills-oriented content. Comprehensive organization on the part of the university including long-term scheduling and available teaching materials was rated as most important to increase the attractiveness of teaching. Time restraints and decreased productivity were rated as the most important barriers. Interested GPs appreciated financial compensation, particularly for teaching at university venues, and demanded amounts of money corresponding to German GPs' hourly income. CONCLUSIONS: The GPs' interest in undergraduate teaching is generally high indicating a substantial pool of potential preceptors. Recruitment strategies should consider the collaboration with institutions involved in residency and continuing education as well as with professional associations. Comprehensive organization by the responsible department should be promoted and time restraints and decreased productivity should be overtly addressed and financially compensated.

Can state-supported interprofessional coalitions cure preceptor shortages?

The shortage of clinical preceptors compromises the current and future supply of healthcare providers and patient access to primary care. This article describes how an interprofessional coalition in South Carolina formed and sought government support to address the preceptor shortage. Some states have legislated preceptor tax credits and/or deductions to support the clinical education of future primary care healthcare providers. As a result of the coalition's work, a bill to establish similar incentives is pending in the South Carolina legislature.

Reframing Nursing Preceptor Development: A Comprehensive Approach to Improve Education, Standardize Processes, and Decrease Costs.

High preceptor turnover and mandates for cost efficiency in a rapidly changing healthcare environment require innovative approaches for developing and supporting nurse preceptors. Responding to new organizational strategic and cost containment initiatives, a quality improvement project was initiated that combined several evidence-based approaches to align traditional processes and programs. The resultant preceptor development program decreased costs and standardized processes. It also showed improved learning and preceptor satisfaction and increased educational, networking, and recognition opportunities.

Do we pay our community preceptors? Results from a CERA clerkship directors' survey.

BACKGROUND AND OBJECTIVES: Family medicine clerkships depend heavily on community-based family physician preceptors to teach medical students. These preceptors have traditionally been unpaid, but in recent years some clerkships have started to pay preceptors. This study determines trends in the number and geographic region of programs that pay their community preceptors, identifies reasons programs pay or do not pay, and investigates perceived advantages and disadvantages of payment. METHODS: We conducted a cross-sectional, electronic survey of 134 family medicine clerkship directors at allopathic US medical schools. RESULTS: The response rate was 62% (83/132 clerkship directors). Nineteen of these (23%) currently pay community preceptors, 11 of whom are located in either New England or the South Atlantic region. Sixty-three percent of programs who pay report that their community preceptors are also paid for teaching other learners, compared to 32% of those programs who do not pay. Paying respondents displayed more positive attitudes toward paying community preceptors, though a majority of non-paying respondents indicated they would pay if they had the financial resources. CONCLUSIONS: The majority of clerkships do not pay their community preceptors to teach medical students, but competition from other learners may drive more medical schools to consider payment to help with preceptor recruitment and retention. Medical schools located in regions where there is competition for community preceptors from other medical and non-medical schools may need to consider paying preceptors as part of recruitment and retention efforts.

Financial, performance, and organizational outcomes of a nurse extern program.

Nurse externships help prepare nursing students for practice, but the organizational costs are high. To decrease costs, nurse educators collaborated to revise their existing nurse extern program. Nursing professional development educators who want to implement a nurse extern program within an organization will benefit by learning about the planning, implementation, and evaluation of a nurse extern program designed to decrease costs while producing well-prepared new graduate nurses.

Medical students on long-term regional and rural placements: what is the financial cost to supervisors?

INTRODUCTION: Medical student education is perceived as utilising significant amounts of preceptors' time, negatively impacting on clinical productivity. Most studies have examined short-term student rotations in urban settings, limiting their generalisability to other settings and educational models. To test Worley and Kitto's hypothetical model which proposed a 'turning point' when students become financially beneficial, this study triangulated practice financial data with the perspectives of clinical supervisors before and after regional/rural longitudinal integrated community-based placements. METHODS: Gross practice financial data were compared before and during the year-long placement. Interview data pre- and post-placement were analysed by two researchers who concurred on emergent themes and categories. METHODS: This study suggested a financial 'turning point' of 1-2 months when the student became beneficial to the practice. Most preceptors (66%) perceived the longitudinal placement as financially neutral or favourable. Nineteen per cent of supervisors reported a negative financial impact, some attributing this to reduced patient throughput, inadequacy of the government teaching subsidy and/or time spent on assessment preparation. Other supervisors were unconcerned about costs, perceiving that minor financial loss was outweighed by personal satisfaction. CONCLUISONS: Senior students learning in long-term clerkships are legitimate members of regional/rural communities of practice. These students can be cost-neutral or have a small positive financial impact on the practice within a few months. Further financial impact research should include consideration of different models of supervisor teaching subsidies. The ultimate financial benefit of a model may lie in the recruitment and retention of much-needed regional and rural practitioners.