Balancing Preceptorship with Clinical Practice: A Guide for Physician Preceptors

This blog is part one of a six-part series on the art of preceptorship. Learn more about becoming a preceptor.

Balancing the demands of clinical practice while guiding 3rd- and 4th-year medical students can be both challenging and rewarding for any physician preceptor. Effective preceptorship not only enriches students' educational experiences but also sharpens the preceptor’s own clinical and teaching skills. A structured approach, clear communication, and strategies to integrate students into clinical workflows can help preceptors maintain high standards of patient care without compromising the quality of their teaching. Below, we’ll explore practical strategies to maximize student learning, make precepting manageable, and integrate teaching into even the busiest of clinical settings.

STRUCTURING AN EFFECTIVE ORIENTATION 

A well-planned orientation is essential for setting the stage for a successful preceptorship. A brief yet thorough introduction can help students understand their roles, expectations, and boundaries within the clinic, allowing the preceptor to focus on patient care. The best part? You don’t have to do it all yourself. Delegating orientation to your office manager or a trusted staff member can save time while still setting students up for success. Here are some key points to include.

• Clinical Workflow: Outline your clinic’s routine, patient load, and interactions with healthcare team members. Giving students a sense of the clinic’s pace and dynamics helps them integrate more smoothly.
• Learning Objectives: Communicate the skills and knowledge students should aim to acquire, from interview techniques and physical exams to clinical reasoning. I also enjoyed sharing areas of practice where I felt particularly skilled, and if I had a student with a special interest, I’d focus on related cases when possible. Being a family doc certainly helps with variety!
• Documentation Guidelines: Establish documentation policies early. Let students know what they’re allowed to document and how to flag notes for your review, addressing any legal and ethical considerations.
• Patient Interaction Protocols: Review ways for students to introduce themselves professionally and empathetically as student doctors. I usually had students shadow me for a few patients to learn the flow of the office and how I interacted with my patients before turning them loose to start seeing patients first on their own.

This orientation helps students engage confidently and reduces the chance of misunderstandings. Writing a handout can also make orientation smoother and ensures that no key information is missed.

FOCUSING ON REAL-WORLD APPLICATION, NOT COMPREHENSIVE TEACHING

The preceptor’s role is to bring academic knowledge to life, not to teach every nuance of their specialty. Medical schools cover the didactics; our job is to show how that knowledge applies to real patients and guide students in bridging the gap between theory and practice. Clinical experience teaches students the nuances of patient interaction, clinical judgment, and adaptability—things a textbook can’t replicate.

As you work with students, focus on demonstrating how foundational knowledge informs decision-making and patient care. By emphasizing real-world application, you help students see the relevance of their studies and prepare them for independent practice.

ASSESSING STUDENT READINESS AND TAILORING TEACHING

Every student comes in with different levels of knowledge, confidence, and skill, and adjusting your teaching style to meet them where they are is key. One way to gauge a student’s readiness is by listening to their questions:

• In-Depth Questions: Students who ask deep questions about pathophysiology or differential diagnoses may be ready for advanced discussions.
• Practical Questions: Hands-on learners often ask about specific procedures or clinic navigation and may benefit from shadowing other team members or focusing on practical skills.
• Clarification Questions: If students are curious about your decision-making, walk them through your thought process. These students often need help understanding the “why” behind clinical choices.

Paying attention to the type of questions students ask allows you to personalize their experience. For confident students, consider assigning complex cases or allowing more independence. For those who need extra guidance, focus on providing foundational instruction, structured feedback, and closer observation.

ENCOURAGING DOCUMENTATION IN THE MEDICAL RECORD

Documentation is a hands-on way for students to practice clinical reasoning and improve their ability to articulate findings. Some students may be ready to document right away, while others may need coaching first. Regardless, you must review all entries, making any necessary edits before signing off.

• Supervision and Feedback: Constructive feedback on student documentation ensures compliance with standards while helping students refine clarity, style, and clinical relevance.
• Incremental Responsibility: Start with small tasks (e.g., subjective and objective sections) and gradually move to assessments and plans as students gain confidence.

Reviewing documentation with students helps reinforce accurate record-keeping, clinical decision-making, and attention to detail—essential skills for any future physician.

FOSTERING INTERDISCIPLINARY LEARNING

Students benefit immensely from exposure to the multidisciplinary nature of healthcare. Collaborating with midlevel providers, like nurse practitioners or physician assistants, helps students broaden their perspectives on patient care, while shadowing ancillary staff, such as phlebotomists or medical assistants, shows how every role contributes to patient outcomes.

• Midlevel Collaboration: Pair students with midlevel providers for a broader view of patient management and multidisciplinary care.
• Learning from Ancillary Staff: Observing and assisting with the work of phlebotomists, radiology techs, and other team members helps students appreciate the continuum of care.
• Team Discussions: Facilitate open communication between students, midlevel providers, and ancillary staff to reinforce the importance of each role in healthcare delivery.

This interdisciplinary exposure fosters respect for all team members and prepares students for collaborative practice.

PAIRING STUDENTS FOR PEER LEARNING AND HEALTHY COMPETITION

Supervising two students can be beneficial, allowing them to learn from each other’s questions and approaches. A little friendly competition can also motivate them to strive for excellence.

• Case-Based Learning: Assign cases to each student and encourage them to ask questions and provide feedback on one another’s findings. This fosters critical thinking and collaboration.
• Skill Competitions: Create mini-challenges, such as physical exams or case presentations, to keep students engaged.
• Encouraging Reflection: After patient encounters, ask students to reflect on what they learned from each other’s approach, adding another layer of learning.

These activities foster a supportive, interactive environment and help students grow by challenging each other.

INTEGRATING PRECEPTORSHIP INTO A BUSY CLINICAL PRACTICE

Balancing teaching responsibilities with a packed clinical schedule requires a bit of planning and creativity. Here are some strategies for incorporating preceptorship seamlessly into your workflow:

• Routine Check-In Points: Schedule quick check-ins, such as a morning huddle or midday debrief, for ongoing feedback that doesn’t disrupt patient care.
• Utilizing Downtime: If a patient declines student involvement or there’s a break in the schedule, give students productive “homework,” like practice questions from their schools assignments or researching a recent case. This keeps students engaged, ensuring they make the most of their time.
• Real-Time Feedback: Offer quick, constructive feedback immediately after patient encounters, focusing on key learning points to maintain clinical momentum.
• Delegating Teaching to Midlevel Providers and Staff: Midlevel providers and ancillary staff can contribute to student training, which enriches their experience and distributes the teaching load.
• Leveraging Documentation: Assign students to help with preliminary documentation, allowing you to focus on patient care while giving them valuable practice. Feedback on documentation sharpens their clinical reasoning and attention to detail.
• Incorporating Teaching into Patient Encounters: Narrating your clinical reasoning during patient visits lets students see the decision-making process firsthand. Patients often enjoy knowing they’re helping shape future doctors, too.

With these strategies, preceptors can integrate student teaching into their clinical day without disrupting workflow. Patients, students, and preceptors alike benefit from this balanced approach to preceptorship.

CONCLUDING THOUGHTS

Balancing preceptorship with clinical practice demands structure, flexibility, and thoughtful planning. With structured orientations, focused real-world teaching, documentation practices, interdisciplinary learning, peer support, and time management, preceptors can create a meaningful and educational experience for students without compromising patient care or clinic efficiency. This approach not only prepares students for future practice but also enhances the preceptor’s own professional growth and satisfaction.

Embracing the role of a preceptor means shaping the next generation of osteopathic family physicians, a role filled with both responsibility and reward. By using these strategies, you can create a lasting impact on your students and the future of patient care.

REFERENCES

1. Love, L. M., & Love, R. J. (2019). Peer-assisted learning in clinical education: Student perspectives on the effectiveness of peer teaching. Medical Education, 53(2), 143-152. doi:10.1111/medu.13767.
2. Taylor, D. C. M., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11), e1561-e1572. doi:10.3109/0142159X.2013.828153.
3. Silverberg, M., & Moses, S. M. (2021). Optimizing the clinical learning environment: Perspectives from medical students and faculty. Journal of Graduate Medical Education, 13(3), 389-396. doi:10.4300/JGME-D-20-00316.