Many physicians worry they don't have time to precept. Yet preceptorship holds value in enhancing patient care, supporting lifelong learning, and helping medical students grow into confident, competent osteopathic physicians.

In this first episode of DO.fm: Precepting Edition, Bruce Williams, DO, FACOFP dist., associate dean of clinical education at Kansas City University and past ACOFP president, shares how he integrates students into his practice in ways that don’t add to his stress — and in some cases even help with workflow.

Dr. Williams shares:

• Ways to integrate students into real patient care so they contribute meaningfully without slowing clinic flow;
• Simple habits to stay organized, keep charts and paperwork current, and prevent stress from piling up;
• How precepting refines students’ clinical skills, keeps his own knowledge sharp, and pays off when learners match into residency;
• And more

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Juliana Parisi 0:05

Bruce Williams 1:03

Juliana Parisi 2:12

All right. And so, how would you describe your teaching style?

Bruce Williams 2:16

Well, with the students, I would ask them. I mean, I would have a student working with me. I usually ask the students to go in and see the patient, evaluate the patient, come out and discuss with me, and then the student and I would go in and see the patient together. Then after we got done seeing the patient, I'd ask the student to spend the time they needed writing their note, and then usually at the end of the day, after we got done seeing patients altogether, we'd kind of go over the notes and the patients that we saw that day. And then usually I'd have some didactic material for them. So myself, I used the Blueprints of Family Medicine textbook, and it's fairly straightforward reading. You know, it gave them some good information. Generally, throughout the course of the month they were with me, we would read pretty much the whole book. We didn't go through the geriatric part. We didn't go through the pediatric part. We didn't go through the women's health part because they'd be getting that in other clerkships. But the overall family medicine material we pretty much covered during the time that we were together. And then also, while they would work with me, particularly the last few years, I wouldn't be there, I'd be on campus half the time. So they would work with my partner. They'd also work with my nurse practitioner, but they'd work with medical assistants. They'd work with our radiology tech. They'd work with our phlebotomists. They even worked in our front office with the patient service representatives and our practice manager, so they really got to see what everybody in the practice did. Of course, they were supervised by everybody doing that. But it gave them an opportunity to see what everybody's role in the practice was and what they did and helped them to develop their skills. So they got a lot of experience giving injections, drawing blood, doing some basic procedures, EKGs. When they worked with me, I involved them in some of the minor procedures, so joint injections and skin lesion removals, and incision and drainages, and sewing up lacerations and that kind of thing that you'd see in the practice on a day-to-day basis. They'd also do OMT and that kind of thing. So, you know, I tried to involve them as much as possible and give them an opportunity to learn some procedures. But a lot of it was developing their clinical skills in seeing patients directly.

Juliana Parisi 4:41

And so, how did this approach evolve, or how did you come to solidifying an approach in precepting?

Bruce Williams 4:48

I think it was. I started out being a preceptor pretty much when I started in practice, so I think my approach was a lot of what my preceptors did with me when I was a student. So, you know, just kind of what they would have me do when I was a student, I kind of carried through with my students as they started working with me.

Juliana Parisi 5:08

And then how have you managed stress through all of this as being a doctor, a preceptor, being an associate dean, being a past president of ACOFP? How do you find yourself managing these challenges?

Bruce Williams 5:26

Well, I guess as best I can, I try to keep myself organized. So, you know, just responding to emails, trying to make sure that my charting got done, trying to make sure that student evaluations were completed timely, just not having a lot in my inbox. You know, just trying to keep everything pretty much caught up. I think for me, stress is just having a lot of things outstanding and having to do things at the last minute. So I try not to do that. I try to do things sooner than later and then get that stuff off my plate. There's always going to be things that come up that I don't have any control over, and I just have to accept that. But where I can control things, I try to address them fairly regularly. Doctors are famous for hating to do paperwork, but it's part of the job, so I tried to keep my charts caught up and tried to get forms completed as they came along and all that kind of thing. So, you know, as far as being a preceptor, a lot of that was the student evaluations. So I'd get student evaluations, and I would try to do those. I tried to complete those with the students still there, usually on the last day of the clerkship, so I knew they were getting completed, and the student was aware of how they performed on the clerkship.

Juliana Parisi 6:50

Was there any moment either before you started doing so many things at once or during that, did you ever question if you were taking on too much?

Bruce Williams 7:02

I don't know if I questioned it. I think other people, my wife in particular, I mean, I think that was always there. And if it got to be too overwhelming, I think I stepped back a little bit. But I enjoyed, particularly working with organizations, working with my local, state, national organizations. It was kind of an outlet for me. I enjoyed doing it, so I never saw it as a burden. Really, the meetings and that kind of thing weren't that overwhelming. Unless you get to be president or on the board, you have more responsibilities then, but for the most part, that wasn't the majority of the time that I was spending. So that part wasn't overwhelming. Being a preceptor wasn't. I hear it from a lot of doctors that I try to reach out to about being a preceptor, that they don't have the time, and I don't know. I didn't see that. I saw having students as being helpful. You know, I could go in and see a patient, and I know if there was a patient that was going to be more demanding of my time than I had, I would make sure and send a student in there because the student can get a lot of the information, and it makes the visit with the patient go faster if you have a lot of that information ahead of time. So the students were very helpful in getting that information. So I tried to add them to my workflow, and it actually overall, I think, cut down on the burdens that I had. So I don't think that was necessarily adding to stress at all. So, you know, I think mostly the stress would just be situations, particular patients that came up. A lot of the administrative work that you do as a physician can be stressful. You know, dealing with regulatory agencies, insurance companies. For a while early in my practice, I had my own practice, so I was not only the physician, but I was the employer, and I had to deal with all the office dynamics and that kind of thing, and that was probably more stressful than anything. When I was acquired by the health system, it actually relieved a lot of that.

Juliana Parisi 9:29

Yeah, that's great to hear that you can manage those stress levels and that you have the confidence to know that you can handle this level of work, even if your wife had some doubts about it first. You mentioned that there are some doctors who say that they don't have time for precepting. What kind of advice do you give them, or would you give to doctors who say that?

Bruce Williams 9:52

Well, a lot of the doctors that say that are doctors that don't understand what their role is as a preceptor. So what they end up doing is they end up having students shadow them. So, I mean, if you're going to walk around behind a physician and just kind of watch what they do all day long, that's not really a good educational experience. So I think it's really learning what a preceptor is. And I think there's a misconception that they're teaching, and they are teachers, but it's more evaluating. It's more evaluating and helping the students develop their clinical skills. A lot of the medical knowledge is already given to them, so they shouldn't be having to do that. It's more directing the student to where to find that knowledge and, like I said, helping the student develop their skills. So, as a physician, as a preceptor, you get continuing medical education for having students work with you, and the reason you get that is because it's adding to your lifelong learning as well. So, you know, if a student asked me a question and I directed them to some resource or to look it up somewhere, both the student and I were learning something. I mean, the students usually, when they came to my office, were getting the most recent information, so I learned more from them than they did from me. So it wasn't really a matter of teaching. It's more, you know, how do you refine your skills in doing an H&P and developing those clinical skills that you need, as opposed to giving them more medical knowledge.

Yeah, that's wonderful to hear that a preceptor not only helps share knowledge but receives it from the students as well. That kind of brings me to my next.

That's one of the benefits of being a preceptor, is that you get that continuing medical education, but it also helps you keep your own skills fresh. So, I mean, you know, the students are going to be a sponge. They're going to soak up everything that you give them. So if you give them wrong information, you have to be aware of your own professionalism. You have to be aware of your own clinical skills, you know, that kind of thing. So they force you to stay on your toes, which I think is another good reason to be a preceptor.

Are there any residents or students or even patients who you had an experience with that made you feel solidified in your choice to be a doctor or be a preceptor? Someone who made you think like, oh, this is why I

do it. Oh, I mean, there's hundreds of patients that made me feel that way. I mean, you know, as a family physician, you become attached to the patients. So, you know, there are lots of experiences I had with patients that really reassured me that I was doing what I was supposed to be doing. Ninety percent of the students as well. I've watched them. There's some of the students that I've had over the years that I've been able to remain in contact with, or follow anyway, and just to see that they've become successful is good. And I've actually had the chance, when I started here at the school, to work with a couple of the students that I had as students. So, I think in my current role, the reason I get out of bed every day is to see the fourth-year students match into the residency programs and watch them walk across the stage. So I think that's kind of the reward that I get.

Yeah, that's great to hear. I love that. That's the reason that you get out of bed. That's really wonderful. And so, kind of the inverse of that. Have you ever had a student or resident who was a little challenging for you to get to, or tried your patience, or was just someone you found to be difficult to work with, and how did you navigate that?

When I was in practice and as a preceptor, there were probably only like three students that I can remember in the entire 30 years that I took students that were, in my opinion, more challenging, and for different reasons. You know, one student, and this was really early on, just wasn't really engaged. He'd get there, he'd get to the office late, leave early, didn't really spend a lot of time becoming prepared and that kind of thing. And, you know, I met with him and expressed my concerns about what he was doing. And in the end, he didn't end up getting probably the best grade. He didn't fail, but he didn't end up getting the best grade. Then there was another student that just had some issues with professionalism. You know, we always told a student that you're not the doctor yet. So if a patient asks you a question, your response is that I'll discuss it with Dr. Williams and we'll come back in and talk about it. He could never get that message. I mean, you know, he'd always be giving patients medical advice ahead of me going in there, and I'd have to spend 10 more minutes explaining why what he said wasn't necessarily wrong, but it wasn't consistent with what I was thinking about. And sometimes what he was thinking was right and mine was wrong, but we still needed to discuss it before we went in and saw the patient so the patient wasn't getting confused by the messaging they were getting. So he finally got the message, but it came with a threat that if he didn't cut it out, he was going to sit in my office and read textbooks for the rest of the clerkship. And then the other one was just a student that, you know, I tell them that they're adults, and if there's something that comes up and they can't be at the office on time or that day or whatever, understand that everybody's car breaks down or somebody gets sick or situations happen, but just that they let me know about it. And he did, but the first week of the rotation, it was an excuse every day why he couldn't be there on time or couldn't be there at all. And he eventually got to the point where he just didn't show up at all. So I went to the dean and I said, you know, I can't give him credit for this clerkship. He hasn't been here. So I didn't fail him, but I said he's basically going to get an incomplete from me. So the school handled it from there. But those are really the only students I had over the years that I really struggled with. Most of them were great students. Now, in my role as associate dean, there's a lot more, and that's just, you know, I always tell them, I said, if I know you by your first name, that's not a good thing. So I have to keep telling myself, of the five or 10 students I have to deal with regularly, there are 420 that are rock stars and do great.

Yeah. And so how has your approach to helping students kind of shifted as you change roles from a preceptor dealing with people in clinical settings to then being a dean?

Well, I think I was dealing more with the student and trying to help them develop their clinical skills when I was a preceptor. In the dean role, it's more aligning expectations and trying to get them to understand that when they get to their third year, it's a lot of focus on identifying yourself as a physician in training at this point and not a student. So, you know, the expectations of you are that you're going to be on time, that you're going to be engaged. You need to stay off your phone, pay attention, and work to develop your clinical skills. So, you know, they have to take some standardized exams, and we try to get them to focus on that because now they're at the stage where they're applying for residencies, and their performance on those exams directly relates to their competitiveness to get into a residency. So it's not going to be good enough to just pass your exams. You actually have to do well and perform well. But also, you have to really focus on doing well on your clerkships. You just can't show up and be present and expect to get everything that you need out of that program. I always tell them, every preceptor and every patient is looking at you and asking themselves the same question: Would I send a member of my family to you? And if that answer is no, then we've got a problem. So I think that's kind of the messaging that we try to give to the students, that you're going to be a physician and your success is going to be dependent on how well you develop your skills and your professional identity as well.

So over these different roles that you've had, preceptor and dean, which has, I mean, I'm sure they both have their pros and cons, but which one have you preferred so far?

Well, I don't know if there's a preference. I've enjoyed them all. You know, I enjoyed being a family physician. It's what I always wanted to do. When I started in practice, one of the first things I did was ask the school how I got a medical student, and I really saw that as an expectation of me. I never really thought about, well, this is an option about whether you take a student or not. It's, you know, there was somebody there that allowed me to come and learn from them, so I need to take on that role as well. So I think it came with the territory. At least that's how I saw it. And so I enjoyed having the students with me, and my patients enjoyed having them. You know, if I didn't have a student for whatever reason during a month, the patients would always ask me where the students were. So I think they saw that as an asset. I enjoyed that. When I changed roles, I had an administrative role when I was in practice as well. I was what we called a facility lead, so I was kind of involved in the leadership role for my practice and for the health system. But I was looking for kind of an off-ramp as I approached retirement, and so that's how I kind of steered toward the role that I'm in now. And I've enjoyed working for the school that I graduated from. I come in every day, and people enjoy their jobs, enjoy working with the students, so it's not like I have to drag myself to work every day. I started during the pandemic and worked from home for the first year. That was not fun. But otherwise, I've enjoyed coming to campus and engaging with everybody here. I can't say that I've really had a preferred role. I've enjoyed the transition to each role that I've had, and it hasn't been difficult. It hasn't been an effort.

Thank you so much for joining us today, Dr. Williams. We truly appreciate your time, insights, and valuable contributions to this discussion. To our listeners, thank you for tuning in. We hope you found today's episode of DO.fm Precepting Edition both engaging and informative. DO.fm is a production of the American College of Osteopathic Family Physicians. To learn more about ACOFP, please visit www.acofp.org.