Academic Detailing Preceptor Development that Works Scott Moser

Academic Detailing: Preceptor Development that Works Scott Moser, MD John Dorsch, MD Rick Kellerman, MD The University of Kansas School of Medicine-Wichita

Objectives • Identify important advantages and challenges to academic detailing as a means of preceptor development. • Describe techniques useful for academic detailing including methods to address problems that arise with or between students and/or preceptors. • List action steps necessary to implement academic detailing in your own setting.

Rationale • Preceptor development workshops attract a minority of preceptors. • Workshop attendees are often the preceptors who need the least “development. ” • Preceptors rarely utilize Web modules.

New Method Goals • Reach nearly ALL preceptors, urban AND rural. • Address INDIVIDUAL development needs in REAL TIME.

KUSM-W Preceptor Sites

Pre-Intervention • Urban/suburban preceptors: phone contact midway through 6 -week Yr 3 clerkship (+1 hr mid-term student check -in for problems) • Rural preceptors: phone contact midway through 4 -week Yr 4 rotation

Intervention • Title VII grant (1999 -2001) • “Academic Detailing”: faculty travels to preceptor office midway through each rotation • “RAFT” technique

Academic Detailing Literature • • What do pharmaceutical reps do? What is the evidence that it works? What is “academic detailing”? Does it work?

“Commercial Detailing Techniques Used by Pharmaceutical Representatives to Influence Prescribing” Roughead EE, Harvey KJ, Gilbert AL. Aust N Z Med 1998 Jun; 28(3): 306 -10. v Marketing Principles and Results: • Reciprocity: samples, gifts, invitations, etc. , offered at all visits • Friendship/liking: not specifically measured • Commitment/consistency: request or move to agreement to use in 39% • Social validation: peer group reference in 41% • Authority: appeal to specialists, professors in 14% • Scarcity: not observed

“Principles of Educational Outreach (‘Academic Detailing’) to Improve Clinical Decision Making” Soumerai SB, Avorn J. JAMA 1990; 263: 549 -56. v Principles: • • • Define specific problems and objectives Market research: understand underlying motivations Establish credibility: use prestigious references Target “high-potential” physicians Involve “opinion leaders” Two-sided communication: inoculate against counter-arguments Promote active learner involvement Repetition and reinforcement Brief graphic materials Offer practical alternatives Select and train detailers carefully

Academic Detailing Applications • Prescribe less expensive antibiotics, analgesics, antidepressants, lipid-lowering agents • Curtail overuse of antibiotics • Stop unsafe prescribing • Increase early detection of cancer • Promote EBM • Improve compliance with guidelines for asthma care

RAFT • Rapport-building • Assessment • Focused preceptor development • Thanks/trinkets

Agenda • Visit with preceptor and student • Visit with preceptor alone • Visit with student alone

Agenda: Preceptor and Student • Rapport building • Patient encounter log report

Agenda: Preceptor Only • Feedback from preceptor: student progress/concerns, reflection, practice changes • Feedback to preceptor: grade graphic, student feedback/comments • Focused faculty development: “Preceptor Tips” (PDA beaming), Online resources (http: //wichita. kumc. edu/fcm/), curriculum updates, future workshops • Thank you!

Preceptor Grade Distribution Dr. X 90 All Preceptors +/- 1 S. D. 88 70 80 90 Student *Adapted from Frank Domino, UMass 100 Score Student 1 83 Student 2 97 *

Agenda: Student Only • Feedback from student: satisfaction with preceptor, learning goal progress • Feedback to student: preceptor comments, SOAP note review • Action steps

Results • >250 urban/suburban detailing visits • >70 rural detailing visits • Unable to schedule 8%

Costs • Faculty/preceptor/student encounter time: 60 min avg • Faculty travel/waiting time: • Local: 60 min avg • Rural: 2 hr 20 min avg • Incidentals: travel, food, trinkets, handouts = $45/visit

Preceptor Feedback (1) • “I appreciate when you visit to discuss the medical student on rotation with me. I think it shows the Department cares about how and what the students are doing. ” • “I appreciate the teaching tips, such as the card that I was given. ” • “I had attended seminars on teaching before the office visits were initiated so the visits mainly help by giving me personal feedback on my approach. ”

Preceptor Feedback (2) • “I believe the visits are very important as they keep the preceptor comfortable with the med school and on a first name basis with the academic staff. ” • “The contacts help the preceptor’s assessment of the student to be less superficial and more carefully thought out. ”

Preceptor Feedback (3) • “I always appreciate visits from faculty to our rural office as they communicate we are valued by the university. They strengthen my allegiance to the medical school and its students in a way that no plaque or card can. ” • “These visits are valuable opportunities for the preceptor to ventilate problems with a student, schedules, or curriculum. ” • “The visits eliminate the ‘town-gown’ syndrome. ”

Preceptor Feedback (4) • “What visits? We’d love to have you come. ” • “The visits are more convenient and more focused than workshops but there is no interaction with other preceptors. ”

Student Feedback • “I don’t know what you said to him at that visit but I hadn’t gotten to do any pelvics before that and by the end of the clerkship, I’ve done close to a dozen. ” • “My preceptor started putting me on the spot more, making me say what I thought we should do instead of just telling me what to do. ” • “After (faculty rep) left, we sat right down and filled out that feedback form together. ”

Additional Benefits • Adjusted content of preceptor workshops • Refined the preceptor’s evaluation form • More frequent feedback reports • New workshop attendees • New preceptors recruited • Early recognition of EHR issues

Challenges • Cost: faculty time • Scheduling: especially rural sites

Conclusions • • Academic Detailing works RAFT models 1 -Minute Preceptor skills Cost is expensive but favorable Builds ivory bridges, not ivory towers

Future • • Maintain during budget cuts Expand to other clerkships Expand to residency sub-internships New preceptor development ideas