Preceptorships: A practical approach to education in heart failure

Abstract

Heart failure is increasing in incidence and prevalence and is associated with significant morbidity and mortality (1–3). The heart failure center, although well equipped to handle more complex cases of moderate to severe heart failure, cannot accommodate all heart failure cases. Because the majority of heart failure patients are, and should be, treated at the primary care level, the heart failure center can have an important role in both disseminating information on state-of-the-art care and creating a partnership between the center and the community physician. Thus, preceptorships may be an excellent tool for enabling physicians to increase their depth of knowledge about optimal treatment strategies and develop stronger relationships with regional and local physicians who specialize in heart failure management. In turn, referral networks will be strengthened and the likelihood of appropriate consultations increased. Finally, closer interaction with experts in heart failure may help clinicians in the community be aware of clinical trials suitable for their own patients. An excellent setting for sharing ideas and strategies, the preceptorship should be a comfortable training environment for most physicians. When group size is small, participants can work with preceptors to individualize the experience by identifying subject matter in which they have the most interest. First-hand observation of functional heart failure teams may enhance participants' comfort with a team approach and may provide a referral base for ancillary services, such as dietary counseling or patient education. Based on the experience at the University of Cincinnati, preceptorships are an excellent way to disseminate and encourage the adoption of standards for the prevention, diagnosis, and management of heart failure. The program also permits us to advise participants on developing their own heart failure practice and establish criteria and critical pathways for patient referrals. Preceptorships provide a unique opportunity to share with practicing physicians many of the advances that have occurred in heart failure management while clarifying and distilling the finer points of patient management into easy, memorable, and practical approaches.