III. Preceptorship – Community Experience

The provisions of this section are in addition to the provisions of Section I of this handbook. Nothing contained in Section III is intended supersede the provisions in Section I. In the event there is any conflict between the provisions in Section III and Section I, the provisions of Section I will apply and are controlling.

Section 1: Mission Statement and Educational Goals of Preceptor Program

1.1 Mission Statement

It is the mission of the Community Experience (ComEx) preceptorship program to facilitate clinical experiences for students with community-based preceptors in order to provide exposure to diverse patient populations and practice styles while enhancing their clinical skills.

1.2 Student Learning Objectives

Medical Knowledge

  • Observe or elicit the taking of a complete and accurate medical and biopsychosocial history.
  • Observe or perform complete and appropriate physical examinations.
  • Observe the creation of or demonstrate the ability to write progress notes in a standard format with pertinent content.
  • Demonstrate increasing proficiency in case presentation skills.
  • Recognize the appearance of varied clinical pathologies and formulate differential diagnoses.

Patient Management

  • Provide evidence-informed ideas in discussion of treatment protocols that are consistent with naturopathic principles.
  • Observe and participate in the formulation of therapeutic interventions, and assess their effectiveness.

Communication and Collaboration

  • Demonstrate the ability to function as part of a patient care team.
  • Demonstrate the ability to establish patient rapport.
  • Recognize strategies for dealing with difficult encounters, increasing patient compliance, and encouraging return visits as appropriate.
  • Demonstrate or observe the delivery of diagnostic findings and diagnoses, and provision of patient education around those findings.
  • Observe the process of patient referrals and consultation with other healthcare providers as required.

Practice-Based Learning and Improvement

  • Demonstrate a commitment to independent learning.
  • Demonstrate acceptance of critical feedback.
  • Demonstrate integration of basic science and clinical knowledge.
  • Demonstrate ability to accept uncertainty.
  • Demonstrate clinical curiosity.

Professionalism

  • Demonstrate respect, compassion, and integrity in patient and professional interactions and maintain professional boundaries.
  • Demonstrate a commitment to ethical principles of medicine.
  • Demonstrate sensitivity to patients with a variety of cultural, ethnic, and financial backgrounds. Adhere to NUNM requirements of professional conduct and attire.

Practice Management

  • Observe business strategies for the creation of a successful practice

1.3 Compliance

Students are responsible for familiarizing themselves with the learning objectives of the preceptor program, and fulfilling all requirements listed in Sections 2, 3 and 4.

Section 2: Student Eligibility Requirements

2.1 Prerequisites

Students must meet the following requirements to earn preceptorship hours beginning the winter term of their first year:

  1. Successfully complete the first term of ND coursework.
  2. Attend a ComEx program orientation (offered during Clinic Observation I, winter term of the first year).

ND students meeting requirement 2.1 are eligible to earn a maximum of 72 ComEx hours during the first academic year.

Section 3: Program Requirements

3.1 Required Hours

The total number of required ComEx preceptorship hours is 216 for students who matriculate after fall 2015 and 240 for students who matriculated before fall 2015. Of the total hours required, at least 145 hours must be completed with an approved naturopathic physician (see Section 6 for ComEx Preceptorship Eligibility and Responsibilities). Non-ND hours may be completed with any of the following approved physicians or allied healthcare practitioner types in clinical practice:

  • MD (Medical Doctor)
  • DO (Osteopathic Doctor)
  • DC (Chiropractic Doctor)
  • DPM (Podiatric Doctor)
  • PA (Physician Assistant)
  • NP, CNM (Nurse Practitioner, Certified Nurse Midwife)
  • PT (Physical Therapist)
  • PsyD, PhD, LCSW, LPC, MFT (Clinical Psychologists only)

Non-ND hours may not include registered nurses, licensed acupuncturists (LAc), or midwives without a medical license. Students holding another medical degree (e.g., MD, DO, DC) are required to complete only 145 ND hours.

Students may earn credit for no less than eight (8) hours and no more than 50 hours with the same ComEx preceptor except as specified herein; this is to encourage diversity in clinical experience and allow a greater number of students to work with each preceptor. Students may receive credit for no more than four (4) rotations of eight (8) or fewer hours each. Students wishing to earn credit for more than 50 hours of ComEx with a single preceptor must submit a Petition to Deviate and receive approval from the associate dean of clinical education in advance of exceeding the 50 hour maximum. The “Petition to Deviate” request will only be considered if the student has worked with a total of at least five (5) different ComEx preceptors.

Students are registered for ComEx hours in their required summer (five credits) and in spring of their last year (four credits).

ComEx hours may not be obtained for the following:

  • Working with healthcare providers who are not approved ComEx preceptors.
  • Working with an NUNM Health Center physician during an NUNM shift (with the exception of designated shifts that are five (5) hours in length, in which case a student may receive up to one (1) hour of ComEx for the extra 30-60 minutes if a tracking form is signed and submitted for those hours).
  • Viewing or taking cases during NUNM classes.
  • Doing a job for which the student is already being paid.
  • Working with a healthcare practitioner in a non-clinical capacity (i.e., research, advocacy, etc.)
  • Any other situations that do not meet ComEx requirements and policies.

3.2 Program Documentation

All documentation noted below must be filed by the deadline for credit to be given for a ComEx rotation.

  • ComEx Learning Goals: This document outlines the student’s goals for their ComEx rotation. The preceptor signs the document prior to, or on the first day of, the rotation and may optionally add their own goals for the student.
  • ComEx Student Evaluation and Tracking Log: This form provides a tool for tracking ComEx hours and evaluating the student. The tracking log is maintained by the student and signed by the preceptor. The evaluation is completed and signed by the preceptor.
  • ComEx Reflection and Goals Assessment: This exercise allows the student to review their experience and reflect on what they accomplished during their ComEx rotation.

3.3 Program Documentation Timelines

Students should submit all completed ComEx documents together to the clinical education coordinator at the end of their rotation, with the exception of the student evaluation, which may be submitted separately by the preceptor. Please note that the following deadlines are strict and documentation not received by the stated deadlines will result in no credit given for the hours completed.

Document Due Date Responsibility
ComEx Preceptor Application and Agreement Two (2) weeks prior to their first student rotation. Notification of approval must be given prior to the rotation. Preceptor
ComEx Learning Goals Week 2 of the quarter following the end of the ComEx rotation Student
Student Evaluation and Tracking Log Week 2 of the quarter following the end of the ComEx rotation Student and Preceptor
ComEx Reflection and Goals Assessment Week 2 of the quarter following the end of the ComEx rotation Student

Section 4: ComEx Rotation Scheduling

4.1 Preceptor Scheduling

ComEx preceptorship rotations must be completed only with healthcare providers who have been approved by the program. It is the student’s responsibility to ascertain if a provider has been previously approved prior to beginning a rotation by checking the ComEx database or consulting with the clinical education coordinator. If the provider has not been previously approved, the student will not receive credit for the rotation. Credit will not be given retroactively if a provider was approved during or after the student’s rotation was completed. For liability reasons, this policy will be strictly followed without exception.

There are three (3) ways to schedule a ComEx preceptorship:

  1. Develop a new ComEx preceptorship

If a student has an eligible healthcare provider with whom they would like to work, the student must ascertain if they are already in the ComEx database of approved Student Contact preceptors (available on the ComEx Moodle Page). If they are not, the provider must apply and be approved at least 2 weeks prior to the date the student wishes to begin the rotation.

  1. Utilize the Student Contact Preceptor Database

The ComEx program maintains a database of approved ComEx preceptors that students may contact directly (this may be found on the ComEx Moodle page). This database contains information about the preceptor, including where they are located and areas of practice focus. These preceptors have agreed to receive direct communication from students in regard to scheduling rotations.

  1. Complete a ComEx Lottery Request form online

The lottery form can be completed online at the ComEx website. Students will be scheduled by the clinical education coordinator with ComEx preceptors and prioritized according to their graduation date, desired preceptor, and schedule availability. Since many students apply and very few doctors participate in the lottery, students must be aware that the ComEx Lottery does not guarantee placement with a preceptor and should not be the only method by which a student schedules ComEx hours.

Section 5: Professional Expectations of Students

5.1 General Expectations

Student behavior and demeanor must conform to the preceptor’s needs and preferences. It is the student’s responsibility to contact the preceptor prior to the beginning of the ComEx rotation to clarify the preceptor’s expectations.

A professional appearance is required of all students. While on a ComEx shift, students should wear a clean, white, ironed clinic jacket with a name label on the lapel. In addition, students should observe the same dress code as required at NUNM Health Centers and delineated in the student handbook, unless the preceptor requests the student to do otherwise.

5.2 Attendance and Punctuality

Students must arrive at the preceptor’s office on time for their scheduled shifts. If a student cannot attend a ComEx shift, it is the student’s responsibility to notify the preceptor’s office at least one day in advance. In case of absence due to illness or a sudden emergency, the preceptor’s office must be notified as soon as possible. If a student fails to notify the preceptor’s office within a timely manner, absences will be considered unexcused and the student can be penalized up to 10 hours.

5.3 Student Behavioral Expectations

  • Students should refrain from asking questions in the presence of a patient, unless it is in the context of the medical interview. Questions may be asked respectfully at a time when the student is alone with the preceptor.
  • Students are not to give advice, comment on treatment protocol, or offer unsolicited suggestions without specific permission from their preceptor.
  • Students should refrain from taking notes in the presence of patients unless permission is granted by the preceptor in advance.
  • Students must abide by the NUNM Code of Conduct, discussed in Part I, Section 14.3, of the student handbook.
  • Students may participate in patient care at the discretion of their ComEx preceptor who holds a valid license in their state of practice and has malpractice coverage. Otherwise, a student may only observe the preceptor in practice.
  • Students are expected to engage in site-specific activities while at their ComEx site, and not conduct personal business or do work for other classes.

Section 6: ComEx Preceptor Eligibility and Responsibilities

The purpose of this policy is to clarify the eligibility requirements and responsibilities of ComEx preceptors. Further information for ComEx preceptors may be found in the ComEx preceptor handbook.

6.1 Eligibility Requirements for All ComEx Preceptors

ComEx preceptors must hold an ND, MD, DC, DO, or DPM degree from an accredited medical institution. Nurse practitioners, physician assistants, clinical psychologists and physical therapists licensed in their state of practice are also eligible to be ComEx preceptors. Licensed acupuncturists, registered nurses without an advanced practice degree, and midwives without a medical license are not eligible for the ComEx program.

All ComEx preceptors will hold a current license to practice in their state of residence, unless there are no licenses in that state or province. NDs practicing in states without licensure laws must be a graduate of an accredited naturopathic medical school. Students practicing with NDs who are not licensed in their own state may only observe and not participate in patient care, including the medical interview, physical examinations, diagnostic testing and therapeutic procedures. Should an unlicensed ND allow a student to participate in patient evaluation or care in any way, the student is not covered under the NUNM malpractice policy and can be considered to be practicing medicine without a license, which may directly impact their ability to obtain a license in any jurisdiction. It is important to note that ComEx preceptors are not covered by NUNM’s malpractice insurance and are not considered NUNM faculty.

All ComEx preceptors must have at least two years of experience practicing in their licensed field.

ComEx preceptors must be practicing in a clinical capacity (i.e., not solely performing research, advocacy, laboratory work, etc.).

Non-U.S.-based preceptors must have a valid medical license in the country where they are practicing, or evidence from their government that they have permission to be practicing in that country. This documentation should be provided with the ComEx Preceptor Application and Agreement.

NUNM Health Center physicians may act as ComEx preceptors only at their off-site practices, and not at any NUNM Health Center.

6.2 Responsibilities of ComEx Preceptors

All ComEx preceptors must submit a “ComEx Preceptor Application and Agreement” and receive approval before students may begin their first rotation; and resubmit an application once every three years.

Preceptor offices must be compliant with HIPAA regulations. The presence of observation students in exam rooms can be considered part of normal health care, and does not require specific patient consent. However, students should be made aware of privacy policies in the preceptor’s office, and the preceptor should document this training when the student begins observation.

All scheduled (lottery) preceptors must notify the clinical education coordinator with any changes to their availability, schedule, requirements for students, or contact information. NUNM schedules students and notifies preceptors each quarter of the students who have been scheduled with them. The preceptor has the right to refuse any student in advance, in writing, and has the right to terminate a student placement for any reason in writing.

The preceptor will evaluate the performance of each student at the end of their scheduled assignment in writing. This should be provided directly to the clinical education coordinator, or given to the student for delivery to the clinical education coordinator, if the preceptor is comfortable doing so.

Section 7: ComEx Administrative Organization

The purpose of this policy is to define the administrative organization of the ComEx preceptor program.

7.1 Associate Dean of Clinical Education

  • Oversees the ComEx Preceptor Program, including policy maintenance and creation of new policies as deemed appropriate.
  • Maintains and updates the ComEx program syllabus and handbooks.
  • Conducts site visits for prospective local ComEx preceptors.
  • Conducts the ComEx Preceptor Program orientation for students.

7.2 Clinical Education Coordinator

  • Serves as a liaison between NUNM and ComEx preceptors.
  • Maintains the ComEx preceptor database, ComEx Moodle page, and website.
  • In conjunction with the associate dean, conducts site visits for local prospective ComEx preceptors.
  • Receives ComEx documentation from students, approves hours, and submits to the Registrar’s Office.

7.3 Registrar’s Office

  • Coordinates scheduling of students with “Lottery” preceptors.
  • Documents completed ComEx hours in the student record.