Thursday, March 3, 2016

Why I'm a rural preceptor - Rick Whitlow, M.D.

It takes a community to raise a doctor. 

I began precepting with the University of Kansas in 1992 after leaving active duty in the U.S. Army. My love for education didn’t just start then, but rather back in elementary school with the example of Gladys Waldach, my 5/6th grade teacher. My science teacher, Gary Sandlin, fostered my desire to ask questions and “discover” answers. Dr. Marvin Wilson, a vascular surgeon in Topeka, regularly mentored me, taking me on rounds, to operating rooms, to his clinic to see patients. Dr. Leland Keller at Pittsburg State University challenged me to constantly strive to be better.

I taught in the residency program at Fort Hood, Texas, while on active duty in the Army. The people in my life have led and guided me on this path to be an educator and rural preceptor. I aspire to be that person, the influencer, the mentor and the force of positive improvement in these students’ lives.

Abraham Flexner published a landmark critique of American medical education in 1910 (Duffy, 2011) and started the monumental fragmentation of medical care delivery. However, consolidation of medical education in universities notably improved the quality and standardization of medical education, but also started the specialization and super-specialization frenzy we see today as anathema to the “primary care” model.

Now, 105 years later, our country ranks 37th in the world for quality of care (Murray, 2010) and meets quality metrics only about half the time (McGlynn, 2003). Across America, we are woefully understaffed with primary care physicians and our access to care in America is embarrassing.

We talk of Medical Homes and the Affordable Care Act as the saviors of health care, but it’s bigger than that. We need to emphasize and train more primary care physicians to meet the needs of our patients. We need to get back to basics! Our medical community, our profession, needs to admit this and fix the system from within before society or the government does it for us.

Precepting gets back to the basics. Just like Hilary Clinton has said, “it takes a village to raise a child.” It takes a community to raise a doctor. Thirty years ago when I was in medical school, the requirement was two months in rural Kansas. Sixty years ago in Wisconsin the requirement was three months (Kindschi, 1959).

We are called to precept because it is the right thing to do (Hippocratic Oath “to teach them this art if they should wish to learn it, without fee or stipulation, and that by precept, lecture and every other mode of instruction.”). Our fathers were right about precepting because it connects the pieces of medicine.

In a rural community, the learner connects the social, economic and psychological facets of behavior and illness, the power of relationships and the connections between acute and chronic illnesses. Rural preceptors meet the six domains of ACGME competencies: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice (Carraccio, 2013). Learners also discover that the private physician, the rural provider, functions on a high plane of science in delivering care to patients.

Adult learners, our medical students, want and need a different education than rote learning based on repetition for memorization along with reading. They want synergy between what they learn and practicing medicine. They want to know about our profession, where it’s going, how we got here and what they can do to change things. They want experiential learning.

Experiential learning graphic
(Yardley, 2012)

In experiential learning (Yardley, 2012), the learner expects the conditions to exist to support learning: patients are present, rooms are available, time is available, the electricity is on, there is a library. The process of learning involves practicing and participating, seeing patients independently and learners are given more responsibility as their skills improve. They rehearse over and over and contribute to care. The outcome of learning is competency demonstrated to the preceptor through presentations and connecting the pieces of the patient’s lives with a treatment plan and intervention.

Why do I precept? Many reasons actually. I feel all doctors adhering to our Hippocratic Oath, are called to teach, be that a science class in the elementary school to foster questioning behavior, mentoring high school students to experiment with our profession, or to participate formally through precepting students.

Precepting is at risk in our country because of economics, time and productivity demands on physicians. The unfortunate truth is that our education students to the benefits of primary care in rural areas will fail without precepting. Our profession will succumb to political and social pressures to change in ways we really might not like. 


After receiving so much in my life, precepting is a way to give back to my profession and my community. It is intellectually stimulating, challenging, fun and enjoyable. It is a way to mentor student attitudes for the unselfish benefit of mankind.   

Hopefully, someday, precepting earlier in the medical school educational process will grow interest in primary care residencies and begin to “right the ship” of American health care.


Photo of Rick WhitlowRick Whitlow, M.D., internal medicine

Whitlow has practiced in the Leavenworth/Lansing area for the past 20+ years. He is also a clinical instructor for KU School of Medicine and UMKC School of Medicine. He is a KU School of Medicine graduate and Army veteran.

 

 

Are you interested in becoming a preceptor?


The KU Office of Rural Medical Education is looking for more preceptors. Visit their website to or contact their office at 913-588-8221 to learn more about becoming a preceptor.

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