Welcome back! Today I’ll wrap up our discussion of Standard B3.06. In my previous blogs, we discussed the ARC-PA Commission stringency regarding using board-certified preceptors in the SCPE’s specific learning area. When that isn’t possible for your program, far more intricate vetting is required.

The vetting process

If you have determined that non-board-certified preceptors are your only option in a certain SCPE area, then you must establish proof to the Commission of your chosen preceptor’s ability to meet the Standard’s requirements. Here are my recommendations.

1. Review the preceptor’s current CV along with their preceptor application components to ensure that they are qualified through academic preparation and experience to oversee the SCPE for which they are assigned and will enable students to meet program-defined learning outcomes (Standard A2.13).  The Program considers, for example:

   1. How many years the provider has been in practice

   2. Expired board certifications

   3. Experience precepting

   4. How many patients the provider sees

   5. The distribution of patients seen

   6. Any other locations and sites the preceptor practices within

   7. Previous background in teaching

   8. Educational credentials

   9. Additional members of the preceptor teams (if applicable)

2. Placements will only occur after a site assessment which includes the following:

   1. Indication that the physicians or physician/PA teams are qualified to precept in the area of instruction, and

   2. Indication that students will be able to meet program-defined learning outcomes for the SCPE in question. 

   3. A review of the physician’s certification status (including expired certifications or other certifications outside the area of instruction), curriculum vitae, years of experience in practice, years of experience in precepting, and experiences with the necessary patient populations to ensure appropriate level of expertise and exposure. 

3. In the event a student is placed on the clinical site with a physician preceptor who is not board-certified in the area of instruction or is not practicing in the area of instruction (i.e., a board-certified family medicine physician precepting the women’s health SCPE), the site assessment process will include the following, within particular SPCEs after students have completed the SCPE in question:

   1. Comparing student evaluations of the nontraditional clinical sites (with preceptors who are not board-certified in the area of instruction or practicing in their area of instruction) and the traditional sites (with board-certified preceptors who are certified and practicing in the area of instruction). I recommend providing three years of data.

   2. Comparing the student evaluations of preceptors at nontraditional clinical sites with preceptors at traditional sites.

   3. Comparing the preceptor evaluations of students in nontraditional sites and the traditional sites in the SCPE.

   4. Comparing the student end-of-rotation (EOR) performance for those in the nontraditional clinical sites with the EOR performance of students in the traditional clinical sites.

   5. Comparing the PANCE performance for those in the nontraditional clinical sites with the PANCE performance of students in the traditional clinical sites. 

   6. Documenting evidence that students have met learning outcomes at these nontraditional sites. 

   7. Logging of encounters ensures exposure but does not constitute competency in the eyes of the Commission. Be aware of this change. Before 2018, logging was considered relatively acceptable as evidence, but this is no longer true. Logging is quality assurance to ensure your students get appropriate amounts of exposure to the appropriate kinds of patients. But it’s not going to demonstrate competence to the commission. You have to use the other modalities we discussed.

   8. Have a defined process and procedure for orienting preceptors to the program's policies, procedures, and learning outcomes. Develop a standard operating procedure to ensure preceptors understand required learning outcomes and what’s expected of them. Confirmation can be in the form of attestations.

As you’ve already deduced, vetting preceptors is a great deal of work. The amount of proof you must provide to satisfy the Commission is considerable.

This is why it is wise (and honestly, far more simple in many instances) for programs to begin the shift from using board-certified physicians as preceptors, replacing them NCCPA-certified PAs whenever and wherever possible. 

Summary and Conclusions

I hope that this review of Standard B3.06 has been useful to you. Let’s summarize the main points as we finish.

• Standard B3.06a has become a virtual absolute and should be read as “must” rather than “should.”

• Programs with integrated and blended rotations must modify to ensure students have a pure learning experience and achieve learning outcomes. I see programs coming up on their first validation being blindsided by this, but there are preemptive measures that can potentially prevent problems. Don’t wait until the last minute!

• The best option is to replace all board-certified physicians with PAs whenever possible. This seems to solve many problems across the board under this Standard.

• If eliminating non-board-certified providers in specific areas of instruction is not possible, implement a detailed vetting process to demonstrate through data evidence that the learning experience is equivalent and the outcomes do not demonstrate a significant difference.

Thank you, as always, for joining me. I’ll see you next week!