ACA Preceptor

Ambulatory Care Apprenticeship Program Information

As part of the UCSD Integrated Scientific Curriculum (ISC) – the first complete overhaul of the teaching program since the school’s inception in the late 1960s- the ACA has been expanded to include first year medical students who will begin their ACA experience in early October shortly after they start school. All of their history and physical examination skill training will be accelerated to facilitate this earlier participation. This change is entirely consistent with the consensus of national educational recommendations to include meaningful clinical experiences as early as possible in the course of training. With the ACA operating now throughout the first and second years- students have the potential of having a real longitudinal learning partnership with their community preceptor.

While it will take time to grow and evolve the ACA in its new two-year format, we expect that your students will be able to play an even more active role in assisting you in your practices. We intend to teach them skills that will be of value to your practices as you work to manage your chronically ill patients to the new standards of “patient centered medical homes” and the “pay-for-performance” world we all live in now. We are also in the process of developing an ACA website to support both you and your student in your participation in the ACA Program and in the care of your patients.

How it operates on the ground:

In case you are wondering how this would work in your office- here’s how we think it should go:

  1. Pure observation for the first session or two~ time to get to know each other a bit and for students to familiarize themselves with your practice, support staff, office flow, etc.
  1. After these intro sessions- and as you both get familiar with each other- the goal is for students to see 1-2 patients per session on their own for a limited amount of time while you are seeing someone else. The student can do a focused Hx +/- physical examination and then present their information to you while you are walking to the exam room (i.e. briefly). Then the student observes your Hx (confirming their own history) and then examines the patient with you; when you can confirm their PE findings (should take only a few additional moments).
  1. For the rest of your patients- the student would accompany you into the exam room- observe you taking the history and then examine the patient WITH you. You could also try letting the student ask some history questions while you are in the room- say for one of the patient’s chronic problems or for the social or family Hx.
  1. The hope is that by doing things in small bites the student gains- often while actually being observed- hands-on experience while your trains keep running on time.
  1. Toward the latter sessions it would be GREAT if the student could actually see a healthy person or two for a complete H & P (without pelvic/genital exam) possibly with you watching or at least rechecking the whole thing with the student presenting to you in the exam room.
  1. We also ask that students write one SOAP during each session that you could review and then give them some feedback on, and if the student does an H & P, s/he should write it up and we’d appreciate you reading it over and giving them feedback on these, too.
  1. Finally it’s important to chat with your student a bit- when you take a look at the schedule before the session starts and pick which patients might be good for the student to see by themselves; and at the end of the session to process what you saw and discuss any issues that came up- and even select some questions to investigate on their own. This is a good opportunity to have the student help you look up some topics on some of the patients that might be helpful on the next visit.

SO the ACA Program is basically about having a student “attached” to you and your practice- allowing them to do parts of the visit while you observe them OR to do these parts by themselves with a brief presentation and checking by you as you would normally do when seeing the patient on your own- and chatting with them a bit about the experience as it goes along.

Hope this didn’t sound too complicated. It’s only a session every other week across 8 months- with a sizeable break for the holidays! We expect that you’ll get to know each other well and have some mutual fun.

First Years or Second Years???

With the expansion of the program in to the first year- you have the choice of taking a second year or a first year student. We need preceptors for both years!!! As their schedules alternate it is possible to take one of each- a first year and a second year. That way you will have an opportunity to experience the longitudinal continuity relationship with your student over two years.  This is a very rich mentoring experience that is relaxed and fun- as there is minimal pressure on any one sessions to “get everything done”- because they’ll be back in 2 weeks for more!

As we evolve the program we will suggest ways that your students might actually help you manage some of your challenging patients with chronic illnesses. We will prepare the students with skill training in smoking cessation, home visitation and other useful skills that can perhaps add to your ability to help patients who need a lot of coaching to improve their health behaviors.  We’ll take this slow- but it has great potential to help you as much as you are helping them learn the practice of medicine.

So we hope you will join up and take a student or two. These mentoring relationships have the potential of developing into enduring friendships. Many of our students ask their ACA preceptors to hood them at graduation- a truly proud moment for both of you.

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