Same great guests and content, but a brand new name: Rounds to Residency. https://findarotation.com/      

Welcome to the SECOND SEASON! It's been an interesting experience gathering topics for these episodes due to the rapidly changing medical education and social realms. This season of the 1-Minute Preceptor Podcast is going to bring you the same valuable clinical rotations and clerkship advice, but with a much broader view of what it means to succeed in your clinical experiences. If you are looking for advice for specific clerkships, advice for Letters of Recommendation, or resources to succeed in your studies we still got you! In addition, we will touch on topics such as leadership, mentorship, and professionalism in clinical medicine. We will also bring in brave guests to discuss social topics relevant to academic medicine and societal changes that we may all help shape. If you want to find out the best advice for your 3rd and 4th years in medical school, early residency, or improve on your skills as a preceptor you have come to the right place!

Dr. Ryan Neuhofel is a family physician based out of Lawrence, Kansas. He is also the past President of the Direct Primary Care Alliance which advocates for a stronger community and physician-led mentorship through DPC medicine. He likens DPC to the “Costco” of primary care with an emphasis on disease prevention. Dr. Neuhfel states that having his own clinic allows for greater freedom and time to keep updated on education and medical resources. Networking and learning from each other is also a great way to maintain education. This model of clinical practice allows for “true primary care” through regaining physician autonomy and limiting outside interference. More time allows for a greater patient story and to deep think about the patient's experience and healthcare concerns. Jumping into testing is not always the best path. Being outside of a hospital setting also adds additional responsibility, such as when to send a patient to the Emergency Department. DPC physicians have more personal time and patient time. This also translates into better patient experiences, more time for continuing education, and more time for friends and family. Future preceptors interested in DPC also have a strong network and support from others in the community to assist with knowledge acquisition and updating. Current physicians can find DPC physicians in a wide array of social media locations, podcasts, and within the DPC Alliance. DPC is a great transition for medical students and allows them to go from foundational knowledge to clinical diagnosis and medicine. They have more time to discuss the pathophysiology of a current patient with their preceptors. This can be a great, low-stress bridging experience in a learner's medical education. Students can join the DPC Alliance for free and even join their Mentorship Program. Finding a great clinical experience is one of the most important standards a student can set for themselves to progress to the next stage. Ryan suggests that a strong preceptor should talk out loud to their students and explain the thought process. Getting this type of direct insight into the physician's clinical paradigm can add great value and act as a guide for students. And ask questions! There is no better way to get direct feedback then to ask well thought out questions to your preceptor at the right times.   Resources DPC Alliance DPC University DPC Mentorship Program   Connect with Dr. Ryan Neuhofel on Twitter!

Dr. Gerald Diaz joins us today with his vast experiences in clinical medicine and medical education. He began his medical journey in an anesthesiology residency before settling in as an internal medicine physician. He also has a passion for medical education and is a co-founder of GrepMed, an online medical image repository. he has formed a crowdsourced education platform for referencing clinically relevant medical images. Gerald believes that one skill that is very underappreciated in medical education is the ability to read a chest x-ray. Though one of the most common imaging formats a student or physician will find, it is still very easy to overlook non-common findings. Felson's Principles of Chest Roentgenology is a recommended resource for both students and physicians wishing to increase their skills. Students should also be enthusiastic and enjoy the time they have in the clinical setting. This is a time for learning and professionalism, but also a time for fun and building social bonds! Dr. Diaz also recommends practicing your presentation skills as often as possible. Giving a strong presentation to your attending will help a student shine and increase preceptor confidence. Likewise, a poor presentation may make the preceptor second-guessing your ability to move on in your education. Lastly, make sure to ask for a “strong” letter of recommendation. Not specifying this feature may lead to a preceptor writing a mediocre letter. Future preceptors and educators should really have a desire to be there and interact with their colleagues. The day to day activities can be very time-consuming and stressful. Without a passion to learn and teach, these responsibilities can quickly lead to decreased enjoyment. There is definitely a “lifestyle aspect to academic medicine.” Proper goals and expectations can greatly influence the future outcomes of this educational environment. A common complaint Dr. Diaz hears is that preceptors that micromanage are less effective and less appreciated by their students. Keeping up to date on the literature is also a necessity for all clinical instructors. Failing to do so when information is so readily available is unsafe and demonstrates a lack of professionalism or enthusiasm on the part of the preceptor. Failure to set expectations up front as an attending can lead to uncertainty in the clinical environment. Gerald notes that even a brief 1-page summation of expectations can go a long way in clearing up any confusion.

Dr. Daniel Hochman is a board-certified psychiatrist with a private practice in Austin, TX. He is the creator of a revolutionary online addiction recovery program, selfrecovery.org. Dr. Hochman advocates for using strategies proven through hard science and describes them in ways that are easy to understand and incorporate into one’s life. In this episode, we will discuss how addition and recovery for patients and medical personnel is changing and the resources available to everyone. He believes that good instruction fosters development. Those interested in clinical education must be able to analyze a student's abilities in a non-judgmental manner and reach them on a personal level. Knowing what is going on in an individual's life, including your medical learners, it the best way to truly assess the individual as a person. He believes creating an inviting and enjoyable environment is much more beneficial than a hyper-competitive one. The carrot. Not the stick. In Daniel’s mind, certain actions by a preceptor or student can tell a lot about their personality. Those that lack respect or are abrasive in their interactions are going to struggle in medicine and in life. It signals that they may not have a true interest or calling in the field in front of them. These traits are also much more difficult to alter later on, which can lead to persistent conflicts in the workplace. On the other hand, a student that makes a lot of mistakes but is applying their full effort does not ring as such a problem in his mind. This individual may be lacking some skills now. However, those can be more easily developed than altering one’s personality and outlook on life. Those that try and put in the effort have what it takes to be a successful clinician. Students can also stand out in their psychology clinical rotations by showing up prepared. Know what you want to do, what you know, and where you need to go. Having this plan and sharing it with your preceptor can assure you are both on the same page. Also, when asking for a strong letter of recommendation these skills and personality traits will allow the preceptor to recognize you more and use those experiences in your letter.   For more information on Dr. Hochman’s materials, consider taking his free 6-Day Habit Challenge. You can also receive a 10% discount on his other courses by using the code “oneminute” during your purchase. His other courses include: https://www.selfrecovery.org/addiction-recovery-toolbox/ https://www.selfrecovery.org/enroll https://www.selfrecovery.org/addiction-toolbox-for-providers/ https://www.selfrecovery.org/addiction-toolbox-for-friends-and-family/

Dr. Brian Dooreck is a private practice gastroenterologist in south Florida. He actively produces “Lunch with Dr. Dooreck” educational videos for the LinkedIn community and has 11 years of clinical education experience. Today, he will teach us about the concerns with teaching general education, specialty-related obstacles in education, and simple recommendations for learners and patients to follow for a healthier self. Gastroenterology is an exciting mixture of procedures and follow-ups that gives practitioners and medical students a variable clinical experience. With specialties heavy in procedural tasks, the “see one, do one, teach one” model is still a great educational paradigm to follow. It covers not only the gastrointestinal tract but also many aspects of the hepatobiliary systems as well. Due to the broad coverage, it is a profession that almost everyone can relate to in some manner or another. After all, who hasn’t had an upset stomach or GI distress? In GI, there are many fluids involved in the exams and procedures conducted. Dr. Dooreck emphasizes that the number one rule in safety is using your personal protective gear. Viral transmission of disease is a rare but important transmissible disease to be conscious of in this specialty. However, a preceptor should also focus on the conceptual knowledge of the students under them. The anatomy and physiology involved in these organ systems can easily be overlooked by students focused on board exam material. Brian also wants to point out that medicine is an interactional dialogue between colleges. Teaching medicine should hold many of the same guidelines. In this way, teachers and students are closer to equals and can foster earnest and collaborative decision making and discussions. Students would benefit greatly from having a genuine interest in the specialty if they desired a clinical experience in GI. Attending the procedures and taking initiative to learn specialty-related materials on one’s own time can allow a student to shine. Going home with a list of questions and topics to explore allows for active engagement in one’s own studies as well. Watch procedures online (such as from JOMI) to learn on your own time. Demonstrating commitment and effort are key requirements to attaining a strong letter of recommendation from your clinical rotations.   You can check out more from Dr. Dooreck via his website or by connecting with him on LinkedIn.

Dr. Jeff Smith is a former residency director and current voluntary faculty member and assistant clinical professor at UCSD. He is an orthopaedic trauma surgeon and surgery coach that uses the 8 PRACTICEs of Highly Successful Surgeons to create a lifestyle-friendly practice. He also focuses on physician and student burnout and advocates for increased education around these topics. Dr. Smith noticed during his education that the old methods of clinical medicine and education are not always as productive as traditionally thought. Instructing to do it one way because that is what the instructor did does not allow for personal development and growth. Updated models of adult education, being a proper role model, and those that do not give answers but assist learners in finding answers likely provide the greatest educational benefit. Some preceptors may not maintain their education as well as others leading to older techniques being performed. Outdated information is not only a potential detriment to the medical student and resident under the preceptor’s guidance, but also may lead to patient care concerns. Staying updated on the medical literature and listening to your medical students – who may be more aware of recent educational trends – can be a great way to keep knowledge validated. Learners may wish to be wary of anecdotal comments of preceptor abilities and online recommendations. These are often heavily biased and provide little relevant data to a medical student. Remember, learning can be overwhelming at times and part of the struggle is to learn your own methodology and clinical approach. Preceptors that are not providing you structured guidance – without giving answers – may be doing you a disservice. Teachers thrive on the fact that you are gaining information and learning during your time with them. Make sure to be active and let to preceptor know what improvements you are noticing in your own studies. In the end, mindful awareness and effort throughout your rotations are key to a successful educational experience. Put in the effort and clarify all expectations with your preceptor. Pave your own way to success.   You can contact Jeff via email and visit SurgeonMasters.com for more information on his 8 PRACTICE Techniques.

Dr. Tom Biernacki is a Residency Director in podiatric medicine. Similar to MD (allopathic physician) and DO (osteopathic physician) degrees, the DPM degree requires four years of medical school. They also have a mandated three-year residency, which is similar to many specialties in MD/DO pathways. It holds the most overlap with the medical specialty of orthopedics. However, podiatry handles many chronic diseases of the foot and ankle without the emergency and trauma care scenarios that an orthopedic surgeon may.   He states that preceptors that are patient and understanding with their students provide a greater support structure and more clinical education benefit. Those that are frequently angry, hurried, and condemning of their students are still in existence, and it may be difficult for a student to navigate these educational environments. Retention of information from these poor preceptors will likely be hampered by this negative learning avenue. Compassion for your students ultimately leads to better education and often better patient care.   He cautions residents and new preceptors not to move too fast in their clinical practice. It is easy to see the seasoned and experienced physicians moving efficiently and swiftly and wishing to do the same. Much of this comes with experience and it’s more important that every clinical educator and physician moves at their own pace. Speed can lead to patient safety concerns and other mistakes. It’s alright for physicians to admit when they need to gather their thoughts, when they need a break, and when they need help.   Dr. Biernacki also recommends that students show humility to their preceptors, other students, and the staff. No one appreciates a student that shows off and attempts to demonstrate superior knowledge to other staff members. This attitude and work ethic reflects more poorly on the student than poor grades or weak exam scores. Being open to learning is the key to being a great student, as is supporting your team and colleagues. People skills and professionalism are increasing in importance during residency selection process as well. And, as always, remember that “perfection” is not the goal. Enjoy your clinical experiences and you will derive much greater total benefit from the time spent.   Students are there to learn, but Dr. Biernacki warns that some students may incorrectly think that asking many questions counts as academic engagement. This can become problematic and interrupt the day's routines. It is important to not become a burden to your preceptor or others around you. When you make your preceptor's job easier that allows them more time to focus on your education and guidance as well. If listeners and readers were to take one thing away from this interview it would probably be this: “be a pleasant person to be around.” This can go very far in displaying a positive work ethic and forming a support system with your colleagues.   Resources www.michiganfootdoctors.com

Dr. Kenneth Fisher practiced as a nephrologist for 31 years, is the author of multiple books related to healthcare including most recently Understanding Healthcare: A Historical Perspective, and is Co-Founder Michigan Free Market Medical Association. Kenneth believes in a medical system without the middleman and with greater price transparency. Medical expenses would be paid by cash and healthcare accounts as opposed to medical insurance. In clinical education for nephrology, the main focus is on patient care in a hospital setting. This can be through private practice or as an employee for the hospital. A preceptor interested in this specialty should be concerned with the quality of their ability and desire to teach the medical student. Understanding the thinking patterns of the student’s thought process is a key skill to develop. A preceptor must also be careful in double-checking all student work and assessments. Pharmacology and pathophysiology of kidney disease is a complicated mesh and overlooked data can lead to disaster. Preceptors teaching in contemporary medical education need to make the learning environment conducive to deep thought. Inspiring students to come up with great questions is beneficial to both the student and more engaging for the preceptor. Electronic health records are a great impediment to the time allotted for student education. Encouraging more discussion about the student thinking process can build the knowledge base for the student and alert the preceptor into knowledge gaps. Students learning in contemporary clinical medicine need to be aware of the complexities of modern medicine. With the system as is, time constraints that may be involved, and dedicated time needed for data entry students may have less time to learn. For nephrology, it is important to have a firm grasp of pathophysiology. Being aware that the learning environment may not be conducive to learning all clinical skills and techniques can also help students early in their education. This can lead to better communication about expectations between the student and the preceptor. When considering asking a preceptor for a letter of recommendation, Dr. Fisher states that your performance is the number one indicator to consider. If you have performed well throughout your rotation, consider asking for a LoR from your preceptor.   For more information, feel free to contact Dr. Fisher via Twitter and download his free E-book. You can also find more on the Michigan Chapter, Free Market Medicine Assoc and find Kenneth’s books on his Amazon page or FreedomInHealthcare.org.   Our HOLIDAY SALE is still going on for a few more weeks! Get your discounted copy of Read This Before Medical School now! It is a great gift for peers, family, and students!

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.

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!

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.

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!

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).

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!

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.

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

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.

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!