A primary care preceptorship for first-year medical students coordinated by an Area Health Education Center program: a six-year review.

In 1991, the University of Florida College of Medicine established a required primary care preceptorship coordinated by the Area Health Education Center (AHEC) Program for all students in the first semester of medical school. Six years' experience with this course, which is entirely community-based and taught by community physicians, provides evidence of the success of the preceptorship. Over the first six years, 97% of students and 92% of preceptors felt strongly that this was an appropriate and valuable experience for students in the first semester of medical school. All believed that the students were capable of interacting with patients in a meaningful fashion and that the course allowed students to gain confidence as health care providers. The course also reinforced the importance of the basic science curriculum and initiated the process of professional development by affirming students' decisions to pursue a career in medicine. The use of content analysis to further evaluate attitudes and behaviors indicated that the students were highly satisfied with their experience and were active participants in the preceptors' practices. Students' approach to patients as people, rather than cases, was positive, and increased from the first to the last day of the preceptorship. After six years, this preceptorship has been demonstrated to have a positive and meaningful impact on medical student education and development.

Moving a graveyard: how one school prepared the way for continuous curriculum renewal.

From 1991 to 1996, the faculty at the University of Florida College of Medicine initiated several significant changes in its curriculum. These changes, included the introduction of early clinical experience in primary care settings; the enhancement of active learning experiences in small-group settings; production and use of computer-based interactive learning materials; increased clinical teaching in the ambulatory care training in an interdisciplinary primary care clerkship; effective course and faculty evaluation; establishment and use of an assessment center for instruction and performance-based evaluations utilizing standardized patients; creation of a medical education center as the focal point for logistics support of the teaching faculty and education data handling; creation of a faculty development program; and initiation of mission-based budgeting based on the faculty's teaching effort and quality. Because the faculty were relatively conservative, it was important to identify variables that would facilitate the introduction of changes and those that might hinder it. The following factors were most important: interest and support by the dean and clearly defined delegation of authority to an associate dean; introduction of a mission-based budgeting process that allocates education funds on the basis of faculty teaching effort and its quality; a clear understanding of the empowerment of the curriculum committee; and an identification of the principles that should guide educational planning and implementation. These efforts are considered the beginning of the continuous renewal needed to respond to information networking, scientific and technological innovations, and the fundamental changes in health care delivery. As these changes have taken place, a shift toward greater institutional control of the educational program leading to the MD degree has been evident.