Preceptor Development Research Articles

The art of balance: Preceptors' experiences of caring for deteriorating patients.

To explore nurse preceptors' experiences of caring for deteriorating patients while providing guidance and supervision to a new graduate nurse. Fostering novice nurse development during high-stakes encounters may be challenging for preceptors. Despite myriad preceptor literature, there is limited published research on experience of caring for deteriorating patients while serving as preceptor to a novice nurse. Qualitative interpretive phenomenological analysis. Data were collected through one-on-one, semistructured interviews between August 2016-September 2017 until data saturation occurred. Diekelmann's method was used to analyse the narratives of the purposive sample of 11 nurse preceptors. The findings reveal the experience of preceptors as they balanced their role as nurse with preceptor role to ensure patient safety and novice nurse development. Supporting the novice to care portrays the ways preceptors facilitated novice nurse development in caring for deteriorating patients. Impacting the preceptor role was remembering their own novice experience. Knowing when to step in was influenced by the preceptor's clinical expertise as they came to know (or not) when it was necessary for them to assume care of the patient. Debriefing: an essential preceptor tool emerged as a critical aspect of the experience to review technical aspects of care, vent emotions and provide evaluative feedback and reassurance to the novice. Preceptors' experiences of caring for deteriorating patients while precepting novice nurses require a balancing of roles to ensure patient safety and novice nurse development. Preceptors' clinical expertise was critical in knowing when to step in and assume care of the patient. Caring for deteriorating patients while serving as preceptor to novice nurses requires clinical expertise to ensure patient safety and novice nurse development. Clinical leaders may use the findings from this study to improve preceptor development and support.

Development of a Coprecepting Model for a Preceptor-in-Training Program for New Practitioners

Background: Preceptor development is a focus of pharmacy residency programs across the country. Graduation from residency into the role of preceptor can be a challenge, as it is one of many transitions junior practitioners make in their early careers. Literature in recent years has brought attention to the need to establish preceptor development programs that adequately allow newer preceptors to develop their skills in experiential education, for both pharmacy residents and students. Furthermore, many preceptor development programs as implemented are often didactic in nature, and include readings, webinars, and other passive learning regarding the art of precepting. Objective: Given the need to develop a preceptor development program in our service line that met the needs of preceptors-in-training and full preceptors, we offer a description of our preceptor development program in the intensive care unit. Methods: We focused on active development of preceptor skills for multiple layers of resident and student learners. In addition, this model incorporated instructing, modeling, coaching, and facilitating, as the relationship between full preceptor and preceptor-in-training evolved. It also offered the opportunity for real-time feedback and discussion on precepting performance. Conclusions: We describe our coprecepting model as an opportunity that succeeded for us in helping to transition our preceptors-in-training to full preceptors. It met the needs of our department, staff, and patients, and we believe it has the potential to be valuable as a tool extrapolated to the preceptor development programs of other institutions.

Preceptor confidence and engagement in providing leadership activities to students in advanced pharmacy practice experiences

IntroductionPreceptor perceptions about providing leadership activities during the fourth year of the doctor of pharmacy curriculum were examined. MethodsAn anonymous questionnaire was sent electronically to 610 preceptors of fourth year doctor of pharmacy students in August 2015 inquiring about confidence in leadership ability, extent of student engagement in leadership activities, and preceptor support needed. Differences based on leadership background, such as formal training, were examined using independent t-test. Continuous data are presented as mean (standard deviation). P-value < 0.05 was considered significant. ResultsSurvey response rate was 28% (n = 171). Preceptor confidence in ability to provide leadership activities was 7.38 + /−1.66 [0–10 Likert scale; 0 = cannot do at all, 10 = highly certain can do]. Preceptors were most confident teaching that leadership comes from those with and without titles (8.48 + /−1.64) and least confident engaging students in advocacy (5.41 + /−3.02). Preceptors were most likely to engage students in collaboration [3(1–4)] and least likely to involve them in advocacy [1(1–4)] (measured from 1–4 with 1 = never and 4 = very often). Preceptors with formal leadership training demonstrated higher confidence and more engagement with involving students in leadership activities than those without training (p < 0.05). Examples of common leadership activities shared by preceptors included experiential clinical activities and projects, teaching opportunities, discussions with leaders, and participation in meetings. Leadership training and development was the most requested type of support by preceptors (n = 23, 13.5%). ConclusionPreceptors were overall confident about their ability to provide leadership activities, were involving students in some leadership activities, and had the least confidence and engagement in involving students in advocacy. Preceptors may consider increasing engagement in teaching student leadership skills by utilizing examples in this study. Colleges of pharmacy and organizations may collaborate to increase preceptor access to formal leadership training programs and offer preceptor development programs designed to enhance preceptors’ abilities to facilitate student leadership experience, reflection on experience, and feedback.

The IPE performance report: A tool for preceptor development

IntroductionIn order to promote interprofessional education (IPE) within the advanced experiential curriculum, the Office of Experiential Affairs (OEA) at Western New England University (WNE) created a process by which information regarding IPE at the practice sites is collected, verified, quantified, and used for preceptor development. MethodsAn interprofessional education preceptor survey (IPEPS), consisting of 43 standardized questions designed to assess IPE opportunities available at practice sites, was administered to 55 preceptors in spring 2016 using QualtricsTM. Throughout the 2016–2017 academic year, students were required to document two interprofessional interactions that occurred during each of their four required APPE rotations. Results from the IPEPS were used to determine a perceived level of IPE occurring at each site and compared to student field encounter logs, then used to inform preceptor development through a customized IPE Performance Report. Results and DiscussionResponse rates for both the IPEPS and student field encounter logs were 100%. Data relating to preceptors’ perception of IPE opportunities afforded by their sites were collected and compared to data logged by students regarding IPE encounters at the sites. The data were compiled through a customized IPE Performance Report and communicated to preceptors as a form of professional development around IPE.

National preceptor development program (PDP): Influential evidence and theory. The first of a 3-part series

IntroductionPriority #3 of the Canadian Experiential Education Project for Pharmacy provided evidence-based guidance for the design and implementation of a national approach to preceptor development. In this first article (of three), findings from the project and recommendations to achieve a high-quality preceptor development program (PDP) are presented. MethodsA multi-method approach including detailed semi-structured interviews, classic literature review, and advisory committee feedback was employed. The research team performed an integrated analysis of all data to achieve the objectives of Priority #3. ResultsFifteen formal interviews, 167 articles and two stakeholder meetings informed findings. Experiential Education programs exhibited commonality in content and usually delivered programs online using modules or live lectures. Not all programs required preceptor education despite it being mandated by academic accreditors. Academics’ perceptions varied regarding pharmacists’ baseline knowledge, skills and attitudes prior to engaging in the preceptor role. A national approach to a PDP was desired if jurisdictional content was accommodated. Copious interprofessional literature of generally fair quality did not identify superior preceptor development approaches although there were numerous descriptions of interventions. Only 29 articles measured educational outcomes. Outcomes included satisfaction rates, self-efficacy and perceived knowledge, skill retention, skill implementation and participation rates. Discussion and conclusionsTwelve recommendations were identified to guide successful development of a national PDP. In the absence of good evidence, adult educational theory provided a basis for an effective PDP. Findings from Priority #3 may be relevant not only to pharmacy in Canada but other health professions and counterparts in other western nations with similar approaches to professional education.

A Program's Analysis of Communication Methods With Clinical Preceptors.

Preceptors value communication with physician assistant (PA) educational programs. This study describes preceptors' perspectives about one PA program's established and new communication strategies to promote preceptor development and retention. An electronic survey of preceptors was conducted in December 2014. Quantitative and qualitative data were analyzed using descriptive statistics. Eighty-eight of 209 preceptors completed the survey (42% response rate). Preceptors reported satisfaction with communication frequency and quality. The most preferred topics were preceptor benefits, teaching strategies, feedback about students' performance, and program policy updates. Many preceptors reported not receiving communications sent by mail. A majority of preceptors preferred site visits at least once per year and in person. Understanding preceptors' preferred topics helped the study program increase its emphasis on those topics. Knowledge that many preceptors do not receive mailed communications has prompted the program to use electronic communication for all communication types. The results reinforced the program's approach to site visits.

Orientation Process for Newly Credentialed Athletic Trainers in the Transition to Practice.

Orientation is an important part of socialization and transition to practice, yet the orientation process for newly credentialed athletic trainers (ATs) is unknown. To determine how newly credentialed ATs are oriented to their roles. Cross-sectional study. Online survey. Three hundred thirty-two of 1835 newly credentialed ATs (18%) certified and employed between January and September of 2013 completed the survey (129 men, 203 women; age = 23.58 ± 2.54 years). The survey consisted of demographic information (eg, employment setting, job title) and 2 sections: (1) orientation tactics and (2) usefulness of orientation tactics. For the first section, participants identified if various orientation tactics were included in their orientations (eg, policies and procedures review). For the second section, participants identified how useful each orientation tactic was on a Likert scale (1 = not useful, 4 = very useful). Descriptive statistics were calculated for each survey item. Mann-Whitney U and Kruskal-Wallis tests were used to determine differences between demographic characteristics and orientation tactics. A Bonferroni correction accounted for multiple comparisons. A panel of experts established the content validity of the survey. The Cronbach α was used to establish internal consistency (α = 0.802) Results: The most common orientation tactics were meeting with supervisors (n = 276, 82.9%) and staff members (eg, coaches; n = 266, 79.9%) and learning responsibilities (n = 254, 76.2%). The least common orientation tactics were simulation of the emergency action plan (n = 66, 19.8%) and preceptor development (n = 71, 21.3%); however, preceptor development was not applicable to many participants. The most useful orientation tactics were simulating the emergency action plan (3.45/4.0) and meeting with staff members (3.44/4.0). Participants who felt their orientation prepared them for their roles were exposed to more tactics during orientation (Mann-Whitney U = 17 212, P < .001). Many tactics were used to orient newly credentialed ATs to their roles, but orientations varied based on the practice setting.

Development and Implementation of a Combined Master of Science and PGY1/PGY2 Health-System Pharmacy Administration Residency Program at a Large Community Teaching Hospital.

Purpose: The purpose of this article is to share experiences after the development of a health-system pharmacy administration residency with a MS degree and express the need for additional programs in nonacademic medical center health-system settings. Summary: Experiences with the development and implementation of a health-system pharmacy administration residency at a large community teaching hospital are described. Resident candidates benefit from collaborations with other health-systems through master's degree programs and visibility to leaders at your health-system. Programs benefit from building a pipeline of future pharmacy administrators and by leveraging the skills of residents to contribute to projects and department-wide initiatives. Tools to assist in the implementation of a new pharmacy administration program are also described and include rotation and preceptor development, marketing and recruiting, financial evaluation, and steps to prepare for accreditation. Conclusion: Health-system pharmacy administration residents provide the opportunity to build a pipeline of high-quality leaders, provide high-level project involvement, and produce a positive return on investment (ROI) for health-systems. These programs should be explored in academic and nonacademic-based health-systems.

National preceptor development program (PDP) prototype. The third of a 3-part series

IntroductionPreceptor development is critical to successful delivery of experiential learning. Although many preceptor development programs exist, a more individualized approach to training is needed. To accomplish this a national preceptor development program should be considered based on the continuing professional development model. A detailed prototype for this program has been described. MethodsIn this final installment of the series, the twelve evidence-based recommendations from the first installment were utilized to construct a prototype for a preceptor development program. Over a three-month period, investigators experimented with different designs and models before approving the final prototype. ResultsThe prototype took the form of an electronic learning platform. Several categories were integral to the design and included sections entitled preceptor spotlight, mentorship, global outreach, choose your own adventure, continuing professional development, feedback, virtual online community, highlights/advertisements, what's new, competency assessment, and frequently asked questions. A graphic was developed to depict the process by which a preceptor would navigate through the web-based learning platform. DiscussionThe authors purposefully maintained a creative and unlimited vision for preceptor development. This conceptual model is intended to spark discussion and augment, refine, or develop entirely innovative ideas to meet preceptor needs. Development of a preceptor development platform could foster improved competency performance, enhanced interest in learning, and promote continuing professional development. ConclusionWith a greater focus on experiential education in pharmacy, the need for a national preceptor development resource is only expected to increase.

Top ten best practices for interprofessional precepting

Abstract Background With increasing emphasis on positioning interprofessional education within clinical training, preceptors play a critical role in interprofessional learning. We define interprofessional precepting as intentionally educating learners from multiple professions in authentic practice-based settings, combining clinical teaching and patient care with explicit conversations about how interprofessional collaboration contributes to high-quality, patient-centered, team-based care. Interprofessional precepting requires a unique skillset, and we provide our top ten best practices for interprofessional precepting based on our experiences in the interprofessional education field and evidence from the literature. These best practices support interprofessional preceptors providing interprofessional education experiences in practice-based settings and can serve as a resource to guide preceptor development of the abilities necessary for establishing a high-quality educational experience.

The Report of the 2016-2017 Professional Affairs Standing Committee: Formally Embracing and Engaging Preceptors in the Academy — The Time Has Come

The 2016-2017 AACP Professional Affairs Committee (PAC) was charged to examine strategies to include adjunct/affiliate preceptors as AACP members and to determine the value proposition of AACP membership for this group of educators. The PAC defined adjunct/affiliate preceptors as preceptors who are neither full-time employees nor have a primary employment commitment (≥50% of the preceptor's work salary) at a school/college of pharmacy. Specific charges to the PAC included: recommend an approach to increase the number of adjunct/affiliate preceptors as AACP members, examine AACP membership from an adjunct/affiliate preceptor value perspective, and prepare a concise summary of available literature describing value-added contributions of student pharmacists and pharmacy preceptors to pharmacy practice models, interprofessional education (IPE) and interprofessional practice (IPP). The summary of the plan developed by the PAC to address the charges is presented in the following report, which includes three sections: the value proposition of AACP membership for adjunct/affiliate preceptors, expansion of the presence of adjunct/affiliate preceptors in AACP, and the value of student pharmacists in experiential education settings. The value proposition of AACP membership for adjunct/affiliate preceptors section describes results of surveys and focus groups conducted by the PAC. The PAC surveyed experiential education directors at schools/colleges of pharmacy, adjunct/affiliate preceptors (from a request via the experiential education directors), and new pharmacy practice faculty members in order to determine current resources available for adjunct/affiliate preceptor development, as well as explore potential resources AACP could provide for adjunct/affiliate preceptor development. Focus groups were held with adjunct/affiliate preceptors and experiential education faculty/staff to explore some of the results and concepts generated from the surveys. The PAC developed three recommendations for AACP as a result of the surveys and focus groups. The report also describes various factors that should be considered by AACP in developing a membership category for adjunct/affiliate preceptors, including potential membership models, establishment of an advisory board, and collaboration with other stakeholder groups. The final section of the report provides an executive summary and detailed table, which summarizes available literature on the value of student pharmacists in experiential education. The brief literature review reinforces that there are many different practice settings where student pharmacists add value to patient care and the practice site. This information is significant for experiential education faculty/staff, as well as adjunct/affiliate preceptors, and serves as an example of best practices which document the value experiential education provides to patient care and practice sites. The final section of the report provides a policy statement that was adopted by the 2017 AACP House of Delegates and one suggestion to schools/colleges of pharmacy. The report concludes with a call to action regarding the formal involvement of adjunct/affiliate preceptors by AACP and the academy.

Implementation and outcomes of an evidence-based precepting program for burn nurses

IntroductionThere is significant nationwide interest in transitioning new and new-to-specialty nurses into practice, especially in burn care. Lack of a structured transition program in our Burn Center was recognized as a contributing factor for nursing dissatisfaction and increased turnover compared to other hospital units. Employee evaluations exposed a need for more didactic instruction, hands-on learning, and preceptor support. The goal of this project was to implement an evidence-based transition to practice program specific to the burn specialty. Material and methodsThe Iowa Model of Evidence-based Practice served as the model for this project. A working group was formed consisting of nurse scientists, clinical nurse leaders, clinical nurse specialists, lead preceptors, staff nurse preceptors and wound care coordinators. A systematic review of the literature was conducted focusing on nurse transition; preceptor development and transitioning nurse training programs with competency assessment, ongoing multifaceted evaluation and retention strategies were created.The evidence-based Vermont Nurses in Partnership (VNIP) Clinical Transition Framework was selected and subsequent education was provided to all Burn Center leaders and staff. Benchmarks for basic knowledge assessment (BKAT) and burn wound care were established among current staff by work site and education level to help evaluate transitioning nurses. Policies were modified to count each preceptor/transitioning nurse dyad as half an employee on the schedule. Multiple high-fidelity simulation scenarios were created to expand hands-on opportunities. ResultsFrom September 2012–December 2013, 110 (57% acute care nursing) Burn Center staff attended the VNIP Clinical Coaching Course, to include 34 interdisciplinary staff (rehabilitation, education, respiratory therapy, and outpatient clinic staff) and 100% of identified preceptors (n=33). A total of 30 new nurses participated in the transition program: 26 (87%) completed, 3 (10%) did not complete, and 1 (3%) received exception (no patient care). Transitioning nurses achieved passing BKAT scores (n=22; 76%) and WC scores (n=24; 93%); individual remediation was provided for those failing to achieve unit benchmarks and transition training was modified to improve areas of weakness. Transitioning nurses’ weekly competency progression average initial ratings on a 10 point scale (10 most competent) were 5±2; final ratings averaged 9±1 (n=25) (p<0.0001). ConclusionsAn evidence-based team practice approach toward preceptorship created a standardized, comprehensive and flexible precepting program to assist and support transition to specialty burn practice for experienced nurses. Use of objective metrics enabled ongoing assessment and made training adaptable, individualized, and cost effective. Application of this standardized approach across our organization may improve consistency for all transitions in practice specialty.

Interprofessional objective structured teaching exercise (iOSTE) to train preceptors

Background and purposeInterprofessional education (IPE) is important in the education of all health care students, yet limited IPE training has been provided to preceptors who train these students in the clinical setting. Simulation using the standardized student model has been used to train health care preceptors in medicine. To our knowledge, there are no reports utilizing interprofessional objective structured teaching exercises (iOSTE) to train pharmacy preceptors. The primary objectives of this pilot study were to evaluate the effects of iOSTE on the pharmacy preceptors’ perceived importance of the Interprofessional Education Collaborative (IPEC) core competencies and confidence in precepting interprofessional students. Additionally, data were collected regarding pharmacy preceptors' prior experiences in simulation and debriefing. Educational activity and settingPreceptors (n=23) participated in an iOSTE and debriefed with trained standardized nursing and pharmacy students caring for a trained standardized asthma patient. FindingsPre- versus post-iOSTE survey data showed statistically significant improvements in all self-confidence related items, including the following abilities: precept students from different disciplines (p=0.004), facilitate a simulation activity (p=0.001), conduct the debriefing process (p<0.001), and discuss with students the IPE core competencies (p=0.001). Additionally, responses to post-iOSTE survey questions assessing the learning activity showed high ratings (median=5, interquartile range=4 to 5). Pharmacy preceptors increased their teaching ability and confidence level in communicating with students from other health care professions. SummaryThese findings indicate that iOSTE is a useful and well-received method for preceptor development.

Supporting Nurse Practitioner Preceptor Development

Abstract Increases in the number of nurse practitioners (NPs) completing their educational programs create a challenge for universities as well as health care organizations. More clinical preceptors are needed to support students and new professionals transitioning to clinical practice. Although preceptors are critical in the evolution from new NP to competent provider, there is a lack of information available to NP preceptors related to developing effective clinical teaching skills. This comprehensive literature review evaluates current, evidence-based strategies for preceptor development. The findings in the literature show improvement in clinical reasoning when structured preceptor methods are incorporated into clinical practice.

Reframing Nursing Preceptor Development: A Comprehensive Approach to Improve Education, Standardize Processes, and Decrease Costs.

High preceptor turnover and mandates for cost efficiency in a rapidly changing healthcare environment require innovative approaches for developing and supporting nurse preceptors. Responding to new organizational strategic and cost containment initiatives, a quality improvement project was initiated that combined several evidence-based approaches to align traditional processes and programs. The resultant preceptor development program decreased costs and standardized processes. It also showed improved learning and preceptor satisfaction and increased educational, networking, and recognition opportunities.

Preceptorship in Family and Community Medicine: challenges and achievements in a Primary Health Care in progress.

Strengthening Primary Health Care (PHC) relies directly on training medical specialists in primary care. This text aims to report the Family Medicine training experiences in Rio de Janeiro between 2008 and 2016. It brings to reflection the development of preceptors in medical specialization through an experience report on three Family Medicine medical residency programs, namely, the Municipal Health Secretariat program, the Federal University of Rio de Janeiro program and the National School of Public Health program. The PHC reform in Rio de Janeiro created a demand for medical specialists working in networks, leading to the expansion of already established medical residency programs and the establishment of a new program sponsored by the Municipal Health Secretariat, providing new teaching positions in several health facilities within the municipal network. These three residency programs progressed through different paths to provide training to their preceptors, offering permanent courses and local actions seeking higher professional qualification and better balance between care and education responsibilities. Permanent investments to strengthen medical residency programs and preceptors training are essential to consolidate the PHC reform nationwide.

Athletic Training Preceptors' Perceived Learning Needs Regarding Preceptor Development

Context: Athletic training programs can develop their own content and mechanisms for developing preceptors. Ideally, preceptor development sessions should meet the needs of both the educational program and the preceptor; however, there is a gap in the existing literature regarding athletic training preceptors' perceived learning needs. Objective: To examine preceptors' perceived learning needs regarding preceptor development and determine if differences occur based on preceptor characteristics. Design: Cross-sectional. Setting: Online survey platform Qualtrics. Patients or Other Participants: Seventy-nine preceptors (31.66 ± 8.63 years, male = 32, female = 47, years certified = 9.46 ± 8.27, years as preceptor = 6.08 ± 5.88) affiliated with professional programs in National Athletic Trainers' Association District 4. Main Outcome Measure(s): The Preceptor Needs Assessment included 5 sections (Teaching and Learning in the Clinical Setting, Evaluating Students, Communication, Student Development, and Mentorship). Preceptors were asked to rate topics in each section on their perceived level of helpfulness (1 = not helpful, 2 = somewhat helpful, 3 = very helpful) if they were to be included in a preceptor development session. Descriptive statistics (ie, means) were used to examine the data, and differences in perceived needs based on demographic characteristics were assessed with χ2 analysis. Statistical significance was set a priori at P ≤ .05. Results: Topics in evaluating students (2.39 ± 0.47) and teaching and learning in the clinical setting (2.38 ± 0.41) were rated most helpful and concepts in mentorship (2.13 ± 0.59) least helpful. No significant differences in perceived helpfulness of any topics were noted in relation to participant characteristics, including years as a preceptor, clinical setting, and educational background (P &amp;gt; 0.05). Conclusions: Learning needs of preceptors do not appear to be based on years of experience, clinical setting, or educational background. Athletic training programs should aim to offer preceptor development related to teaching and learning in the clinical setting while specifically providing guidance on developing students' critical thinking skills and teaching clinical decision making.

Enhancement of Professional Development of Front-Line Nurse Preceptors in a Dedicated Education Unit.

Dedicated education units (DEUs) have been well established throughout the country as a means of developing clinical skills in nursing students. In a DEU, maintaining an adequate number of well-prepared clinical nurse preceptors is essential for unit sustainability and effective student perception. This study was a quasi-experimental design using self-reported survey data. A comparison analysis was conducted using the initial results of the Revised Professional Practice Environment (RPPE) survey (i.e., pre-participation and no orientation) after completion of an orientation program and participation as preceptor in a DEU. Front-line nurses who participated as preceptors for one semester in a DEU demonstrated statistically significant improvement in two of the eight components of professional practice measured by the RPPE. This study lends support to the notion that preceptors do experience improvement in professional practice as a result of participation in a DEU. J Contin Educ Nurs. 2017;48(1):40-46.

Interprofessional Interactions and Competencies on Clinical Rotations: Preceptors' Perspectives of Student Experiences.

This study describes (1) preceptors' perceptions of interprofessional encounters that PA students had at clinical sites and (2) ways that the preceptors report evaluating the PA students' interprofessional practice skills. This study disseminated a single electronic survey of clinical preceptors who were affiliated with an accredited PA program. Descriptive statistics were used to analyze the results. Of 195 preceptors, 66 completed the survey. Practice specialties of respondents and nonrespondents were similar. Preceptors indicated that PA students had frequent interactions with a wide variety of health professionals and students. These interactions occurred with greater frequency in specialty settings and academic medical centers than in other settings. Preceptors reported that they assess interprofessional practice competencies, although many were not familiar with the definitions that the health care profession has endorsed. Findings suggest that educators may identify specific clinical sites or settings that are more optimal for interprofessional education interventions and that focused preceptor development may encourage deliberate assessment of students' interprofessional practice competencies.

WISE-Family Medicine: A Statewide Faculty Development Collaborative

Background: In many states, family medicine residencies and medical schools compete clinically for patients, educationally for trainees and, more recently, for community preceptors (CPs). As Wisconsin’s medical schools and health care systems have expanded their geographic footprints, our CPs now teach trainees from competing institutions. Yet residency and medical student accrediting bodies require faculty and preceptor development.