Strategies for Efficient Office Precepting

For the Office-based Teacher of Family Medicine

William Huang, MD
Feature Editor

Editors Note: In this months column, Alison Dobbie, MD; James Tysinger, PhD; and Joshua Freeman,
MD, give practical tips to help the office-based preceptor efficiently teach students during busy patient
care sessions. Drs Dobbie and Freeman are faculty members of the University of Kansas School of
Medicine and Dr Tysinger is a faculty member of the University of Texas Health Science Center at San
Antonio.
I welcome your comments about this feature, which is also published on the STFM Web site at
www.stfm.org. I also encourage all predoctoral directors to make copies of this feature and distribute it
to their preceptors (with the appropriate Family Medicine citation). Send your submissions to
[e-mail]. William Huang, MD, Baylor College of Medicine, Department of Family and
Community Medicine, 3701 Kirby, Suite 600, Houston, TX 77098-3915. 713-798-6271. Fax: 713-798-
7789. Submissions should be no longer than 3.4 double-spaced pages. References can be used but
are not required. Count each table or figure as one page of text.

Strategies for Efficient Office Precepting
Alison E. Dobbie, MD; James W. Tysinger, PhD; Joshua Freeman, MD

http://www.stfm.org/fmhub/fm2005/April/Alison239.pdf

Many family physicians teach because
they enjoy the personal satisfaction
of working with students
and want to share their enthusiasm
for family medicine while contributing
to the education of the next
generation of physicians.1,2 However,
most office-based teachers are
unpaid volunteers,3 and evidence
indicates that time spent teaching
can lengthen the preceptors working
day3-5 and/or decrease their
clinical productivity.3 Fortunately,
preceptors can use several strategies
to minimize the added tasks of
teaching while optimizing students
educational experience. Preceptors

(Fam Med 2005;37(4):239-41.)

  Many family <ファミリー> physicians <内科医[s]> teach because they enjoy the personal <個人的>
satisfaction <満足> of working with students and want to share < � �> their enthusiasm for 

family<ファミリー> medicine <薬／医学> while contributing <与える／捧げる[ing]> to the

education<教育> of the next generation <世代(産生)> of physicians <内科医[s]&gt.1,2 



However, most office<職� �&gt-based <基づく> teachers are unpaid < 未払いの> volunteers 

<ボランティア[s]>,3 and　evidence <証� > indicates <表す[s]> that time spent teaching can 

lengthen the preceptors working day3-5 and/or decrease <減少（する）> their clinical 

  <臨床的> productivity <生産性&gt.3 

Fortunately,preceptors can use several strategies <戦略[s]> to minimize <最小化する> the 

added <添� する[d]>tasks <仕事[s]> of teaching while optimizing <至適化する[ing]> students 

educational <教育的>experience <経験&gt.Preceptors



多くの家庭医は、teachingをすることに喜びや満足を感じており、

学生と共に働いたり、家庭医への情熱を共有したりしている。

そして、そのような教育活動に貢献することが、次の世代の家庭医教育へ貢献している。





しかし、多くの外来ベースの教育では、ボランティアで行われており、

上記のような、証� も出ている

teachingすることで、時間を費やし、日勤で3日から5日分の仕事が伸び、、

外来での生産性は落ちる。



幸運なことに、戦略的な手段を使うことで、教育時間の短縮をはかることが出来、

学生の教育的の適正化にも貢献する。  

who use these strategies have reported
practicing more efficiently
with a student than without one.6 In
this article, we summarize some
practical strategies for efficient office-
based teaching that are likely
to be highly valued by preceptors
and students.

  who use these strategies <戦略[s]> have reported < � �告（する）／憶測[d]> practicing 

<実行するing>more efficiently <効率的に> with a student than without one.6 

In this article, we summarize <要約する> some practical <実際的> strategies <戦略[s]>

for efficient <効率的> office <職� �&gt-
based <基づく> teaching that are likely to be highly <高度に> valued <価値の> by preceptors 

and students.  

precepterがこのような戦略的手段を使うことで、preceptingの効率上がったという報告がある。


Planning and Preparing
Agree on Daily Goals

The vast amount of potential
learning material in each session
can overwhelm both teacher and
student. To better manage this learning
material, spend 1 or 2 minutes
before each session agreeing on
mini-learning goals that relate to the
clerkship objectives and are achievable
that day. For example, it may
be too time-consuming to observe
a student conduct a complete physical
exam, but it is practical to observe
and give feedback on two abdominal
exams in one session and

ensure that the student has mastered
this part of the physical exam.
Achieving such mini goals over several
sessions results in an impressive
amount of clinical observation,
teaching, and feedback.
Limit the Number of Patients
That Your Student Sees
Seeing too many patients often
prevents students from reflecting on
how the clinical experience aids
their learning. Depending on the
number of clerkships completed,
the clerkships goals, and the patients
clinical complexity, thirdyear
students should see between
three and six patients for each 4-
hour session.
Encourage Just
in Time Learning
Between patients, students
should review content related to the
patients they see. For example, after

seeing a child with a sore throat,
students can use their handheld
computers or the Internet to look up
the risk factors for strep throat and
determine the sensitivity and specificity
of the rapid strep test. This
just in time learning, especially
when combined with formulating
clinical questions, encourages students
to seek and use evidencebased
medicine. Such integration of
evidence-based medicine into practice
has been reported as one of the
top three factors students associate
with effective teaching.7

Debrief and Plan
for the Next Session
At the end of each session, it is
efficient to spend a few minutes
debriefing on the teaching session,
reviewing how well the student met
the mini goals, agreeing on any
homework, and planning for the
next session.

Maximizing Learning
Efficiency

Limit Presentation Time
Students must learn to give a focused
23 minute patient presentation
that includes pertinent positive
and negative findings and their assessment
and plan. Students consistently
report the opportunity to formulate
assessments and plans as
one of the top factors associated
with high-quality clinical teaching.8

Use the Five Clinical
Teaching Microskills

Most preceptors are familiar with
the five microskills of clinical
teaching9 but may not use them because
they think that completing all
steps after every patient is too timeconsuming.
However, all five
microskills do not need to be completed
for every patient. For example,
if a patient presents with a
sprained ankle, the preceptor can
use the microskill teach general
rules in discussing and demonstrating
a proper ankle exam and
use the microskills reinforce what
was done right and correct mistakes
in giving the student feedback
about his/her actual exam of
the patients ankle. For other
sprained ankle issues such as understanding
why an X ray was or was
not ordered, the teacher can direct
the student to find the Ottawa ankle
rules as just in time learning between
patients and discuss their
application in more detail later.

Make Feedback Routine

Giving feedback challenges most
preceptors because they see it as
time-consuming and fear it may
upset the student. Yet students report
receiving high-quality feedback
as one of the top two factors
associated with excellent clinical
teaching.8 Feedback that is based on
observation, consistent, fair, routine,
and given in a spirit of unconditional
positive regard will be accepted
and appreciated. For example,
while observing the student
perform an abdominal exam, a preceptor
might say, You correctly
palpated all four quadrants superficially
and deeply, but you forgot to
observe and listen first! Remember:
always observe the abdomen first,
listen to it second, and then palpate
it.

Teaching With Patients
Develop a Cadre
of Teaching Patients

Every physician has patients who
have interesting stories to share. If
these patients have conditions that
add to students learning, both student
and patient usually enjoy
spending extra time together. Such
regular teaching patients can become
familiar with students and
may even learn to evaluate them
and give informal feedback on students
performance. Such patient
feedback is particularly powerful
for students.

Seize Unexpected
Learning Opportunities

Besides planning in advance
which patients the student will see,
one should seize unexpected learning
opportunities. For example,
where a patient has a newly discovered
goiter or heart murmur, the student
may be briefly introduced to
the patient simply to experience the
abnormal sign.

Hear Presentations
in the Exam Room

When all parties are comfortable
and the clinical problem is suitable,
it is efficient and mutually satisfying
to have the student present his/
her findings and for the preceptor
to teach in the patients presence.
Patients can then give immediate
feedback on the accuracy and completeness
of the students presentation.

Using Service Learning
Use the Students for
Administrative Tasks

Many non-clinical tasks can aid
student learning. For example, students
can learn a great deal by performing
administrative tasks under
the preceptors guidance and supervision.
These tasks may include filling
out lab requests, writing referrals,
updating problem lists, and
doing telephone callbacks.

Let Students Write Notes

Writing notes aids students
learning and helps students present
the patients issues to the preceptor
in an efficient and organized manner.
According to Health Care Financing
Administration documentation
guidelines, only a small portion
of a students note is billable,
and the preceptor must still write or
dictate a note and personally document
major aspects of the patient
visit.10 However, preceptors can still
save time by using the students
note as a guide when dictating or
writing their own note. In one study,
students notes saved preceptors 3.3
minutes of charting time per patient.
11

Use Students to Teach Patients

Students learn a great deal by
teaching patients about such topics
as smoking cessation and weight
loss. Teaching patients sharpens
students communication and negotiation
skills and makes them aware
of the many reasons patients dont
comply with medical advice.

Conclusions

Using these simple strategies can
help office-based teachers improve
the teaching experience for themselves
and their students. Devoting
a few minutes each day to these
activities can maximize the teaching
sessions efficiency and minimize
extra work for the preceptor.