Doctors combine patient care, teaching to prepare future workforce
WILLMAR — Another school year has started and Dr. Emily McDevitt is mentoring another third-year student from the osteopathic medical program at Des Moines University in Iowa.
Her student will learn and gain new skills over the next several months but so will McDevitt.
“It’s always fun, even watching them change over the first week,” said McDevitt, a family practice doctor at Affiliated Community Medical Centers.
And working with students keeps her on her toes with her own practice, she said.
“It’s humbling. It reminds you how much you don’t know.”
Local doctors have long combined patient care with educating and preparing the next generation of physicians. Those who precept say it’s an opportunity to share their own knowledge while building hands-on skills among medical students undergoing clinical rotations as part of their training.
“I wanted to do this because someone took the time to teach me when I was in medical school,” said Dr. Michael Nicklawsky, an ACMC family practice physician who has spent 10 years precepting third-year medical students in the University of Minnesota’s Rural Physician Associate Program.
What’s especially rewarding is seeing his students develop skill and confidence, he said. “By the end, they know a lot. They know what to do and that’s pretty powerful.”
But more than knowledge and technical skills, preceptors like McDevitt, Nicklawsky and other physician educators help their students learn lessons that only a seasoned mentor can teach.
The art of communicating with patients and seeing them as individuals is “not in a textbook,” Nicklawsky said. “They’re not numbers and they’re not illnesses. They’re all people who have a story to tell.”
Preceptors are critical in training not only future doctors but other health professionals as well, said Wendy Foley, executive director of the Southern Minnesota Area Health Education Center.
“They are the mentor for the student. They are the role model,” she said. “They’re the gateway not only to the health care system but also to their community.”
Her region, 21 counties in southwestern Minnesota, has preceptors in fields ranging from medicine to dentistry to pharmacy. Some have students working alongside them for a few weeks; others, for eight or nine months.
What they have in common is a strong sense of how they can contribute to developing the future health care workforce, Foley said. “They see the win-win. They see the rewards.”
They share a high level of competency in their practice, she said. “They have a skill set that follows best practices. They raise the bar.”
Julayne Mayer, who coordinates student clinical rotations at ACMC, uses words such as “focused,” “caring” and “interested.”
“They’re great listeners. They’re confident and yet adaptable,” she said. “They know what worked well for them as students and they know what wasn’t so great. Fortunately, they’ve been able to hang onto what was good.”
Dr. Richard Wehseler trained at ACMC in New London with the U of M’s Rural Physician Associate Program and came back to practice family medicine. He’s now a preceptor who often has a student working alongside him.
His own training taught him the value of getting students directly involved, he said. “Following somebody is useful for about three hours. You have to get students in the room, thinking on their own so they start developing those skills. … Early on, you try to help them learn how to talk to people. You try to help them learn how to treat patients and how to care for patients. There’s a difference.”
Students learn a lot from the hands-on experience of working up and presenting individual patient cases, said Dr. Daniel Fuglestad, another ACMC family practice physician who is a preceptor in Willmar for the Rural Physician Associate Program.
“We’ll come out and we’ll talk about the assessment. We’ll talk about the plan and the student will go back and implement that,” he said. “It’s like an apprenticeship. … If somebody spends enough time with me, they will see just about everything they need to see.”
Health care preceptors don’t necessarily have formal training as educators but teaching tends to come naturally to them. “As family physicians, we are teachers,” Fuglestad observed. “We are teaching and counseling our patients all the time.”
When patients have a physician who’s also a preceptor, they become part of the educational process as well — a role that Nicklawsky hopes his patients can value. “They actually are helping play a role in shaping this person,” he said. “They’re contributing.”
For many preceptors, the greatest challenge is juggling their dual role as physician and educator. “It’s not for everybody,” Foley said. “They need to feel supported. It can be lonely sometimes, especially when you’re working long days.”
When she’s with a student, McDevitt feels “like I’m usually a little bit behind. I have people who stand in the doorway, wondering where we are.”
Preceptors sometimes must work harder to stay ahead of students full of fresh knowledge, Wehseler said. “That doesn’t always work. You learn together.”
Foley works constantly to develop a regional cadre of health care professionals willing to be preceptors. Clinical rotations are often a bottleneck in the education process, and this worsens when sites and preceptors for hands-on training are in short supply, she said.
It’s especially critical for rural health care, Foley said. “For us to help cultivate the next generation of health care providers, they really have to see and experience the rural area. We have to have wonderful preceptors to pass on the understanding of how rural health works.”
The number of students in the health professions completing clinical rotations in west central Minnesota has grown significantly in recent years. Rice Memorial Hospital in Willmar alone had 487 students last year, undergoing clinical training in disciplines ranging from nursing to dental hygiene to laboratory technology.
“We’re very, very thankful for the preceptors who have the pay-it-forward philosophy and are willing to share their time,” Foley said.
During Fuglestad’s first year as a preceptor, he and his student used to review microbial tests together. Years later, that student now specializes in infectious diseases. “He says that experience changed his life,” Fuglestad said. “That’s really rewarding.”