This study incorporated neurology preceptors and college students enrolled at Johns Hopkins University (JHU) from 2013-2017. The institutional review board approved this study and students signed a consent form.
Objective 1. Defining the PreDoc Mission: Developing Program Statement, Goals and Objectives
The mission of the PreDoc program is to provide a modern apprenticeship that allows the apprentice (i.e., college students) to engage in the development of critical skills necessary to be successful in healthcare. The apprenticeship incorporates an organizational structure of a traditional medical residency program (i.e., internship, residency, and chief levels) to provide college students with an accelerated exposure into the medical training paradigm, and to gain some familiarity with the growing focus on team-based delivery of healthcare that involves various stakeholders (patients, clinicians, trainees, students, administrators, ancillary health providers, family members, etc.). As they progress in the program, the PreDocs receive critical professional development skills training (e.g., resiliency skills, team building, communication skills, inclusiveness and unconscious bias awareness) inarguably viewed as essential in demonstrating leadership potential. Although the program has five formal and established goals, it also offers versatility in both the educational exposure and project opportunities. These five goals of the PreDoc program are: (1) To execute an effective program using a novel, efficient curriculum that fosters development of the professional skills necessary for being a successful in healthcare; (2) To execute an effective program that cultivates an educational environment that facilitates excitement and innovation about healthcare; (3) To execute an effective program that cultivates an educational environment that promotes successful scholarly activity; (4) To execute an effective program that fosters an inclusive environment that promotes diversity; (5) To expose premedical students to interprofessional collaborative practice in healthcare.
Objective 2. Program Design and Implementation
The PreDoc program is a credited course, thereby ensuring students are accountable. Each year, the program takes two to five students (i.e., interns) into the Academic Medicine Preview (AMP) as the initial step (See Supplemental File (SF): “Figure 1 PreDoc Overview”, Part A). Prospective students first apply for a position by completing an application and interview. Chiefs (senior PreDoc students), under the guidance of the director(s), review the applications, complete the interviews, and offer the positions to selected students. Once selected, students set learner goals (Strowd et al., 2016) for the semester, discuss their interests and goals with the director, and meet with the chiefs for an orientation to discuss expectations, roles and responsibilities. A program curriculum (SF: “Table 1 Training Opportunities”) details the evolution of the required and optional learning opportunities in the program and (SF: “Table 2 Student Activity Tracker Examples and Narratives”) gives examples and narratives of the experiential components of the program. During the AMP semester, enrolled interns are given “mini-projects” in clinical, research, or education topics to provide students with a breadth of opportunities somewhat analogous to a medical intern. For example, a student (under the guidance of the preceptor) may develop a patient-geared educational document on narcolepsy. Each “mini-project” has a deadline with some guidance but intentionally without too many instructional specifics to encourage new ideas and perspectives (SF: “Table 2 Student Activity Tracker Examples and Narratives”). Students are monitored on accountability, quality of work, innovation, and communication. Many of these “mini-projects” and activities serve as opportunities for scholarly products or dissemination (SF: “Figure 1 PreDoc Overview”, Part B). For example, the finalized patient brochure could be handed out in clinic or as a “smart set” that could be incorporated into the electronic medical record.
It is the intention that most of the interns participating in the Academic Medicine Preview class will be selected to participate in the PreDoc program (similar to interns advancing to residents). However, this is not a guarantee. Interns must be engaged and invested in the program to be selected as PreDocs, be reliable and demonstrate an “in it to win it” attitude to be part of the team. In this way, students are more accountable and committed to the program. To personalize the opportunities to the learner interests, students meet with the director to determine interests and focus areas (analogous to a resident going into a specialty). For example, the director may ask the PreDoc to reflect on their time in the AMP and recall the “mini-projects” engaged in over the last semester to identify particular interests (SF: “Table 2 Student Activity Tracker Examples and Narratives”). There are also opportunities to recognize interests not previously exposed. The director then identifies a main project to match the PreDoc’s interest with the scholarly opportunities that are available.
Objective 3. Measuring Program Success
Program effectiveness was assessed by number of scholarship products (e.g., manuscript), activity tracking, reflections, and satisfaction. An anonymous, online internally developed survey was also administered via Qualtrics at the conclusion of the program to assess student demographics, students’ satisfaction with PreDoc Program, and PreDoc program influencing students’ interest and likelihood of pursuing a career in healthcare. Data analysis was blinded and not performed by the directors. The number and percentage of the potential responses to each of the survey items were calculated. To examine demographic differences (e.g., group, race, and sex) across the survey items, Fisher’s exact tests were run due to the small sample size. A p-value of < 0.05 was considered statistically significant. All students enrolled into the AMP and PreDoc Program were eligible for inclusion in the study.