Work with CMS to revise student documentation guidelines
The rules regarding the use of student notes for billing purposes limited the student documentation role to review of systems and/or past family/social history and prohibited teaching physicians from referring to a student’s documentation of other parts of the history, physical exam findings, or decision-making. This team’s task was to explore ways to revise the student documentation guidelines to help relieve unnecessary administrative burdens on preceptors and increase the active learning of students.
Status
On February 2, 2018, CMS released a revised transmittal, Pub 100-04 Medicare Claims Processing Manual (updated May 31), that “allows the teaching physician to verify in the medical record any student documentation of components of E/M services, rather than redocumenting the work."
The team continues to advocate for making the guidelines more inclusive of physician assistants and nurse practitioners.
Resources for Implementation of New Guidelines
Integrate interprofessional/interdisciplinary education into ambulatory primary care settings through integrated clinical clerkships
This tactic explores a means to increase the number of learners at a given site without putting more pressure on the clinician’s shoulders. This means transforming education, in conjunction with the practice, away from the 1:1 preceptor/student model or a model favoring any one profession's education requirements. The team is developing effective, simple workflow models that target everyone along the learning spectrum from students to preceptors. The workflow models will be distributed at national and regional levels in professional development settings with a train-the-trainer model, and the dissemination plan will develop champions that can teach it at the local level.
Develop standardized onboarding process for students and preceptors & Integrate students into the work of ambulatory primary care settings in useful and authentic ways
This tactic team is developing resources to:
- Ease the administrative burden on community faculty at ambulatory clinical sites by standardizing documentation
- Help preceptors integrate the student more easily into the practice
- Increase student value to the practice
- Aid teaching programs in administering clinical clerkship (rotation) experiences
Status
The team is developing student onboarding resources and processes that will include:
- A student passport that captures a student's training, screenings, clerkship background, objectives for the current clerkship, and basic information about the student
- Education for students on how to hit the ground running at their clerkship site
- Three online training modules for students: "How to Create a High-Quality and Billable Note in the Medical Record," "How to Perform Medication Reconciliations," and "Motivational Interviewing.”
- Promotion of curriculum to meet goals and objectives outlined in the appendix of the AAMC’s Recommendations for Preclerkship Clinical Skills Education for Undergraduate Medical Education
The team is developing preceptor onboarding and processes that will include:
- Use of the AAMC Uniform Clinical Training Affiliation Agreement with preceptors
- A faculty appointment onboarding process where administrative personnel at the institution assist new preceptors in developing and formatting CVs during a phone interview
- An online STFM course on Giving Feedback
These resources and processes will be piloted as part of Tactic 4.
Develop educational collaboratives across departments, specialties, professions, and institutions to improve administrative efficiencies
This tactic team will conduct three national projects to pilot, evaluate, and disseminate innovative approaches to standardize the onboarding of students and to engage community preceptors. Selected family medicine departments, ideally in collaboration with other specialties and professions, will test the materials and processes being developed as part of Tactic 3, as well as recognition and incentive programs being developed as part of Tactic 5.
Status
A call for applications for the pilot is now open. Learn more and apply.
This pilot project is funded by the American Board of Family Medicine Foundation.
Promote productivity incentive plans that include teaching & develop a culture of teaching in clinical settings
The unifying theme of the tactics under this umbrella is creating the incentives and culture needed to expand the pool of preceptors. The target audience for these efforts is the health systems that employ community preceptors. Foundational to this work is defining the characteristics of high-quality ambulatory primary care clinical training sites and recognizing high-quality teachers and practices.
Status
On April 2, the Society of Teachers of Family Medicine and the American Board of Family Medicine kicked off a pilot program that offers Performance Improvement continuing certification credit (previously MOC Part IV) to ABFM diplomates who provide personal instruction, training, and supervision to a medical student or resident and who participate in a teaching improvement activity. Learn more.
Several articles/manuscripts have been published and information has been disseminated through presentations. See the full list.
Competencies for community faculty have been developed and will be piloted through the Tactic 4 pilot.
