Rewarding Volunteer Educators
How to Keep Community Professionals Involved in Student Training Programs
By Janis P. Bellack and Cynthia P. King

From the June 2000 AAHE Bulletin

 


Community health care providers have generally been willing and even eager to serve as preceptors — on-the-job instructors and guides who provide practical experience and training — to medical, nursing, and other health professions students. Many believe their participation is a professional obligation, and they enjoy the rewards of mentoring future practitioners.

Unfortunately, increasing numbers are finding that such experiences can be burdensome to their practices. Health insurers and managed care organizations, in particular, are pressuring providers to see more patients, for shorter periods of time. Students typically slow down that process. Further, federal and state reimbursement policies and managed care systems provide no allowance for the extra costs associated with teaching students in community-based settings as they do for teaching students in hospitals, thus creating a disincentive for community practitioners to agree to precept students in their practices.

Such forces are challenging health professions schools to create incentives that recognize and reward the contributions of the clinical preceptors who are helping to educate their students. Appropriate incentives and rewards can help sustain effective partnerships with community-based providers and minimize the costs in time and money they incur by accepting students for off-campus learning experiences.

Finding Just — and Desired — Rewards
Our university has been working to address the issue of incentives and rewards for our community-based clinical partners. The Medical University of South Carolina (MUSC) is a freestanding academic health sciences campus that offers programs that prepare students for the professions of dentistry, medicine, nursing, pharmacy, and a variety of allied health disciplines. In 1997, our university adopted a strategic plan that addresses both challenges and needed changes in the education of future health professionals. One area of emphasis is to expand the number of community-based learning experiences in all clinical programs.

We established the Clinical Sites Coordinating Committee (CSCC) to facilitate interdisciplinary planning and coordination of these experiences, and to address the challenges and opportunities inherent in expanding off-campus learning sites. The CSCC includes representatives from the various academic programs, the medical center, the ambulatory care center, the university’s primary care practice partner (Carolina Family Care), the library, information technology, and the rural community outside Charleston, South Carolina.

A key issue that emerged early in the committee’s discussions was the need for coordination at the university level to prevent the various colleges and programs from competing for access to the same preceptors and off-campus clinical placements, which are limited in number. Because of wide variation in the number of placements needed by each program, and differences in the resources available to each program to support off-campus clinical training, the CSCC was committed to ensuring equitable access to and rewards for community- based clinical preceptors across colleges and programs.

While there was a general impression among committee members that community-based preceptors — and their local administrators — were increasingly expecting, and in some cases demanding, reimbursement for their time spent teaching and supervising students, we did not have definitive data to support this supposition. Therefore, the committee decided to survey our community-based clinical preceptors to determine what incentives and rewards they value.

Drawing from the literature and national meetings, we came up with a list of 19 possible "perks" for preceptors, then developed a one-page survey that asked respondents to rate each of the items using a scale of one to five (1=not beneficial/desirable; 5=highly beneficial/desirable). We also invited respondents to comment or add incentives not included in the list.

The six items rated highest by respondents were:

  • Free registration or significant discounts on continuing education (CE) courses for self (4.1)
  • Access to MUSC library databases and electronic journals through the Internet (3.9)
  • Reference materials, e.g., book, journal subscription (3.8)
  • Free registration or significant discounts on CE courses for staff (3.8)
  • MUSC library privileges, including literature searches and document delivery (3.7)
  • Adjunct faculty clinical appointment (3.6)

Surprisingly, the item "direct stipends or payments for preceptors" was not among these top-rated items, instead receiving a rating of 3.0. The following items were rated even lower:

  • Computer on loan for student and preceptor use during clinical rotations (2.8)
  • Education consultant available by beeper or phone for preceptor questions or assistance (2.8)
  • Regular visits/phone calls from educational program directors (2.5)
  • Annual reception at MUSC (2.2)

Items rated highest by specific college or program mirrored those rated highest overall.

The final question on the survey invited respondents to list other "perks" they would find beneficial that were not listed on the survey. Of the 399 responses, 83 (21 percent) offered additional suggestions, ranging from "Perks are not needed — education is a labor of love!" to an amusing request for a "1999 Ferrari F1-355 Spyder." Other suggestions included encouraging students to write personal thank-you notes to the preceptor, MUSC T-shirt, and MUSC Wellness Center membership (for preceptors who live within driving distance of the campus). A half dozen respondents simply wrote, "Thank you for asking!"

Lessons Learned
Findings from our survey challenge the conventional wisdom that community-based clinical preceptors want to be paid directly for their efforts. This is good news for health professions programs and their faculty, who are trying to prepare their students for practice in a health care delivery system that is increasingly ambulatory and community-based, yet are facing mounting pressures to do so with no new resources. We learned that the field-based clinical faculty who have become so necessary to the health professions education enterprise prefer to be recognized or rewarded with perks that are relatively affordable and "do-able."

Providing access to the university’s established and robust library network of databases and full-text electronic books and journals via the Internet can be readily accomplished for any off-campus clinical preceptor who has access to a local Internet service provider and holds an adjunct faculty title. (The latter is necessary to meet requirements of product site licenses that users must be bona fide faculty members.) Adjunct faculty appointments are relatively easy to accomplish, provided the clinical preceptor meets established qualifications (necessary to comply with state and national regulatory/accreditation requirements). Further, an adjunct faculty appointment was one of the most preferred perks identified by respondents. Literature search and document delivery services through the library were also rated highly, and are available at no charge to all faculty. Fortunately, these perks can be accomplished within existing structures at minimal cost to the university.

The other top-rated items relate to continuing education. The CE directors in each of our health professions schools are exploring how they can accommodate the desire for free or discounted registration for CE for clinical preceptors and their staff. We are considering a structure similar to the airlines’ "frequent flyer" programs, in which clinical preceptors would earn points for supervising students in their field-based practices, based on number of students and level and length of clinical rotations. Points could then be redeemed for free or reduced-cost CE programs, with a limited number of spaces reserved (in each program) for which points could be redeemed. While most of the university’s CE programs are currently offered in the Charleston area, we also deliver programs via digital satellite and compressed video to a number of locations throughout the state, and offer several Web-based programs that are accessible "anytime-anywhere." The availability of such programs will continue to increase, making CE more readily accessible to our clinical preceptors in rural and underserved locations.

Other Options
We are exploring the possibility of giving gift certificates to Web-based resources such as amazon.com or barnesandnoble.com so our clinical preceptors may purchase professional books and journals of their choice. However, a funding source for this preferred "perk" has not yet been identified.

Finally, because some of the early survey returns indicated interest in local newspaper articles, the CSCC worked with the university’s Office of Public Relations to initiate monthly preceptor profiles in the campus newspaper that also are shared with the preceptor’s hometown newspaper. To date, we have profiled clinicians in different regions of the state who have served as preceptors for pharmacy, nursing, and medical students.

Next Steps
We learned how important it is to ask our clinical partners in the field how they prefer to be recognized and rewarded for their professional service to the university, and not assume their preferences (e.g., direct stipends or payments). Our next step is to follow through with creating and offering a menu of "perks" that individual preceptors can select from, according to their particular interests and needs.

The role of the CSCC has been to ensure that the playing field is kept level across the five clinical colleges, whose needs and resources vary considerably. The CSCC is committed to creating a common system of preferred perks to ensure equitable access to high-quality off-campus clinical sites regardless of which college or program a student comes from. Such a system will prevent the possibility of differential rewards being given, for example, for precepting medical students versus physician assistant or nurse practitioner students, and will avoid expensive competition among programs for the same community-based preceptors.

Other academic programs that require field-based practice placements, whether in the health professions, teacher education, business, or the humanities and social sciences, can benefit from the insights we gained from this process. Practice-based academic programs and their community-based preceptors share a stake in preparing the nation’s future workforce, and must work effectively as partners toward this common aim and for mutual benefit.

Janis P. Bellack is associate provost for educational programs, and professor of nursing and health professions at the Medical University of South Carolina. Contact her at bellacjp@musc.edu.

Cynthia P. King is administrator of special projects, Office of Academic Affairs, at the Medical University of South Carolina. Contact her at kingcp@musc.edu.


Healthcare Professionals Education and Service-Learning

AAHE’s 18-volume Series on Service-Learning in the Disciplines includes two volumes on health care education.

Creating Community-Responsive Physicians: Concepts and Models for Service-Learning in Medical Education, edited by Sarena D. Seifer, Kris Hermanns, and Judy Lewis, aims to help the reader understand service-learning, how it differs from traditional clinical medical education, and how, as a form of experiential education, service-learning can have a profound impact on students, faculty, communities, medical schools, and the relationships among these important stakeholders.

Chapters center on three themes: "The Broader Context for Service-Learning in Medical Education," "Designing and Implementing Service-Learning in Medical Education," and "Service-Learning Research and Evaluation." The appendix includes a variety of service-learning resources, including descriptions of programs and organizations and lists of websites and publications.

Also available is Caring and Community: Concepts and Models for Service-Learning in Nursing, edited by Jane S. Norbeck, Charlene Connolly, and JoEllen Koerner. The book addresses questions such as how to create meaningful connections beyond the requirements of patient care, how to coalesce fragmented nursing curricula, and how to develop a central focus on the individual in the context of the community as health care shifts to that setting.

The Nursing volume includes theoretical essays, classroom applications, and samples of syllabi and assignments, as well as an annotated bibliography and a list of practitioners involved in service-learning projects.

Both volumes were published in cooperation with Community-Campus Partnerships for Health, a San Francisco-based nonprofit organization founded in 1996 to foster health-promoting partnerships between communities and educational institutions (see futurehealth.ucsf.edu/ccph.html for more information).

For more information about these volumes or the entire series, contact AAHE’s Publications Coordinator, 202/293-6440 (x780), or order online at www.aahe.org.



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