Preceptor Workshop:
Teaching Medical Students and Working with Underserved Populations, Part 2:
Teaching Strategies in Challenging Situations
February 16, 2005

This workshop built on the efforts of the first workshop by concentration on the specific challenges that preceptors commonly face in teaching and working with underserved populations. The workshop focused on four areas:

• Time Management
• Orientation Strategies
• Working with Interpreters
• Tableside Teaching: Assessment of Student Centered Level of Learning

The topics were introduced by skits and scenarios which are frequently encountered in community clinics. Each participant was assigned to a small group which was tasked with examining one of the four topics. Preceptors shared their own experiences in this area, and strategized on ways to address these challenges. Participants then reconvened to discuss their findings with the group at large. Several common themes emerged and are listed below for your review.

1. Cultural Competence and Understanding the Patient in Context
2. Setting Expectations and Goals
3. Pre-Selecting Patients and Previewing the Chart
4. Time Constraints
5. Orientation to the Mission

1. Cultural Competence and Understanding the Patient in Context

Providers working with disadvantaged communities have a unique opportunity to teach students to appreciate patients in the context of their cultural belief systems and social support conditions. This responsibility to understand patients is critical given that many of the patients we serve have limited English proficiency, low functional health literacy and often are unable to advocate for themselves.

Students need to be taught both to respect the values of other ethnic traditions and to seek understanding of other cultures and minority groups. If these principles are not instilled in future physicians, then poor functional health literacy and lack of cultural insight will ultimately conspire to adversely affect the health of our patients.

2. Setting Expectations and Goals

Delineating student goals and preceptor/course expectations at the outset of the clerkship is important in setting the ground rules of any clinical rotation. Scheduled, ongoing feedback either at the end of each session or after a mutually agreed upon time period ensures that students learn and progress more quickly while also allowing the preceptor to structure optimally the learning experience. Explicit communication of course objectives serves to circumvent any unanticipated evaluations at the end of the clerkship.

3. Pre-Selecting Patients and Previewing the Chart

Pre-selecting patients and previewing the charts with the students helps to clarify the agenda for patient, student and preceptor alike. It allows the preceptor to assess the student level of learning, frame the patient visit for the student and simultaneously manage time more efficiently.

4. Time Constraints

Lack of time remains a significant challenge to teaching effectively. Some participants expressed concerns over students being exposed to negative primary care experiences as a result of preceptor time constraints. Other participants felt strongly that students should understand fully the challenges of working with vulnerable populations and experience the “real world.”

5. Orientation to the Mission

Teaching and working with vulnerable populations, unlike working in other venues serves a dual purpose:

• it allows preceptors to experience the joys of teaching
• it helps fulfill their sense of mission to train future physicians to care for the underserved

Orientation of the student to the clinic should therefore include a discussion of the mission and not just the mechanics of the clinic.

Ironically, preceptors live and breathe their mission everyday such that it eventually becomes background noise. They often fail to express to students their personal value system and why they choose to work in the communities and with the populations that they do.

Preceptors need to point out and verbalize their sense of mission, the joys and rewards they receive from working with the underserved in a way that brings it to life, humanizes and models it for students.

To the participants of this workshop we thank you for your insights and thoughtful remarks. We hope preceptors find this summary helpful and trust we will see many of you at the next OCBE teaching workshop.