Non-physician and physician preceptors in Landscapes of Practice: a mixed-methods study exploring learning for 1^st-year medical students in clinical experiences

ABSTRACT

Medical education has traditionally relied on physician educators. With expanding Health Systems Science competencies, non-physician healthcare providers are required. To investigate preceptor-role types, communication frequency, and importance of preceptors in value-added patient navigator roles (PN) and clinical preceptorships (CP). Using a mixed-methods approach, medical students participating in PN and CP during the first year of medical school (n=191) identified individuals with whom they communicated and communication frequency (1=never, 7=frequently), and importance of preceptors to work/education (1=not important, 7=extremely important; open-ended responses). Quantitative data were analyzed via repeated measures using a mixed-effects model and McNemar’s test; effect size was calculated via Cohen’s d or Cohen’s h; qualitative data was analyzed using thematic analysis. Comparing ratings for non-physicians to physician healthcare professionals in PN, communication frequency (5.54 vs 3.65; p<0.001, d=1.18), importance to work (5.77 vs 4.28, p<0.001, d=0.89) and education (5.02 vs 4.12, p<0.001; d=0.49) were higher for non-physician educators. Comparing ratings for non-physicians to physician healthcare professionals in CP, communication frequency (4.93 vs. 6.48, p<0.001, d=1.33), importance to work (5.12 vs 6.61 vs, p<0.001, d=1.29) and education (4.32 vs 6.55, p<0.001, d=1.89) were higher for physician educators. Qualitative analysis indicated that non-physician healthcare providers in PN focused on Health Systems Science concepts, including social determinants of health and healthcare delivery. In PN, students observed collaboration from the perspective of multiple providers. In CP, healthcare providers, mainly physicians, focused on physician-centric clinical skills and interprofessional collaboration from the physician’s perspective. Educational benefits of non-physician healthcare professionals related to Health Systems Science in work-based clinical settings – or Landscapes of Practice – can help students understand systems-based concepts such as social determinants of health, healthcare delivery systems, and interprofessional collaboration. Differences in the educational value of non-physician healthcare educators perceived by students should be further explored.

KEYWORDS:

• Communities of Practice
• Health Systems Science
• Landscapes of Practice
• mixed-methods
• precepting
• qualitative methods
• social determinants of health
• systems-based practice
• undergraduate medical education

Acknowledgements

The authors would like to thank all preceptors working with medical students in both the clinical preceptorships and patient navigation roles.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The Systems Navigation Curriculum at the Penn State College of Medicine was developed with financial support from the American Medical Association (AMA) as part of the Accelerating Change in Medical Education Initiative, and the Josiah Macy Jr. Foundation.