Fall 2010
Preceptors are 'angels on earth'

synapse: University of Nevada, Reno School of Medicine

Pablo Joya

Pablo Joya, M.D., fulfills his desire for teaching by volunteering to train medical students at his internal medicine clinic in Las Vegas. Photo by Edgar Antonio Nunez

A community-based institution, the School of Medicine has long relied on the generous donation of time from community physicians to mentor students and residents.

Online extra: List of volunteer community physicians

Known as preceptors, these volunteer, community-based physicians from across the state open their clinics to students and residents offering patient contact experiences and feedback to enrich their medical education.

“Our preceptors are angels on earth,” said Jamie Anderson, MSN, director of the division of interdisciplinary medical education. “They are giving back to their profession in a meaningful and tangible manner and are a gift to this medical school.”

According to Amy McFarland, education coordinator for the division of interdisciplinary medical education, preceptorships started as a voluntary summer program between the first and second year of medical school.

“In 1987, the school received a grant and the program became mandatory in the summer between the first two years. Another grant followed in 1992 and the preceptorships changed from a summer program to a two-year program called Introduction to Patient Care,” she said.

Students in their first year enter the preceptorship, or IPC I, in their second semester of school and second-year students continue the program in their first semester as IPC II.

The overall goal of IPC I is to provide the student the opportunity to experience care of actual patients in varied clinical settings, giving them the opportunity to increase their oral and written communication skills and refine their general history and physical examinations. The IPC II preceptorship gives students a clinical experience to address patient problems using a patient-centered interview and a biopsychosocial approach and appreciate the importance of the doctor-patient relationship.

In addition to preceptorships in the first two years of medical school, community physicians contribute to third-year clerkships, the required advanced clinical experiences in rural health course to fourth-year students and the second-year family medicine residency requirement for a rural rotation.

“The third- and fourth-year experiences with community physicians help students pull together all they’ve learned and experience what it is like to practice in a rural setting as well as self-assess their own knowledge, skills and abilities to treat people,” Anderson said.

Justin Terry, M.D.’10, believes his preceptor experiences as a medical student strongly influenced his decision to go into internal medicine and were valuable to his overall medical education.

He said the practice of medicine is as much an art as it is a science and while medical students are adept at obtaining the science of medicine through lectures and reading, the art of medicine comes from years of experience.

“This is why preceptors are vital to the education of future physicians. They have learned from years of experience and established their own depiction of the best practice of medicine,” he said. “Learning from a variety of preceptors allows you to absorb their experiences and begin to formulate your own interpretation of the art of medicine, without the pain of making the mistake.”

Carissa Sparrow, M.D.,’10, a first-year resident with the School of Medicine in obstetrics and gynecology, describes her “ah-ha” moment as a student working with a preceptor dealing with a patient dying of cancer who made the decision to go home under hospice.

“I remember Dr. Brad Graves, my attending at the time, deviating from our normal routine and walking into the room and sitting with the family and just making sure all of their questions were answered and that the family felt safe and comfortable taking the patient home,” she said.

Pablo Joya, M.D., an internist in Las Vegas who has precepted for the School of Medicine for more than 25 years, sees several benefits to having medical students in his clinical office setting.

“I have been impressed by these medical students because they fit well into the office and several have spoken Spanish. This is important because many of my patients are from the culinary union,” he said. “These students are polite, respectful, punctual, pleasant to be around, very smart and able to take the time with patients.”

Joya said his dream was to become a teacher, but family pressures as a young man led him to the medical profession. The chance to teach medical students fulfills his passion to teach.

He encourages other physicians to consider becoming a preceptor because of the benefits he has enjoyed over two decades.

“Students stimulate us. I know I read twice as much when they are around,” he said. He feels useful as a senior professional when younger students are nearby and he is able to instruct them and share his experiences with the next generation.

Dennis Brown, M.D., a member of the school’s two-year class of 1975 and an internist practicing in Reno, is also a longtime volunteer preceptor who sees the experience as a win-win for himself and students.

“I’ve learned to slow down when a medical student is with me and listen more intently to the patient. It is getting back to basics,” Brown said. Being self-employed puts additional constraints on his time, which he is better able to overcome when students are with him.

Brown said his patients enjoy seeing the next generation of medical professionals in his office and appreciate being part of their educational experience.

He encourages other physicians to take medical students under their wing and mentor them.
“We learn from these students, too,” Brown added. “Academics change from when I went to school and so I ask students how they would handle a particular medical situation and then learn from them.”

Anderson said more community physicians are needed to volunteer their time to precept, especially those in primary care, since there is such a shortage of these physicians in Nevada.

“We need them as role models and to teach our students about having a positive career in primary care,” she said.

Benefits to those volunteering their time for students and residents include being exposed to the cutting edge of medical education: what is being taught and how it is taught in today’s curriculum, and helping students integrate between the first two classroom years of medical school to real-life clinical medicine.

The preceptor time commitment is one afternoon each week during the semester.

Over the years, student applicants have said they specifically want to come to Nevada because of the early clinical experiences offered by the medical school.

Fourth-year student Andrew Tomlinson sees great value in having the precepting courses early in his medical career.

“It was wonderful because we were exposed to clinical patients so early and were able to be focused and excited about medicine,” he said.

Working alongside a preceptor helped keep his “eye on the ball” about the end goal of treating patients during his first two years, which are traditionally heavy on classroom learning.

“We want our students to have early clinical experiences, one of the things that has attracted good applicants to this school, and volunteer community physicians are vital to that,” Anderson said.

She said medical school leadership sees community physicians as terrific role models for students and residents and added that preceptors are needed to execute fully the school’s curriculum.

“We think they have the clinical skills, abilities and attitude we’d like our students to emulate,” she said.

Anderson said it is difficult for the medical school to thank adequately all its preceptors and their office staffs who also contribute to student and resident learning in the clinical setting.

“There are lots of demands on them, so their time with our students says a lot to us,” she said.

More information: To volunteer time to precept for the University of Nevada School of Medicine, contact Amy McFarland, educational coordinator, at (775) 682-7734.