Development and Implementation of a Novel Learner-driven Precepting Model for Pulmonary Fellowship

Background: Ambulatory education is currently underemphasized in pulmonary and critical care medicine (PCCM) fellowship training. Existing clinic precepting models, originally developed for students and residents, do not meet the unique needs of fellow-level trainees. Objective: We aimed to develop and implement a novel fellow-led precepting model to improve ambulatory education for PCCM trainees. Methods: We performed a mixed-methods needs assessment, including surveys, focus groups, and direct observations, to explore perceptions of ambulatory training, define current precepting practices, and identify target areas for improvement. On the basis of these findings, we developed, implemented, and evaluated a novel model for PCCM outpatient precepting. Results: A targeted needs assessment identified that current precepting practices did not meet fellows' needs for graduated autonomy, development of assessment and management skills, and self-directed learning. We developed and implemented a novel, learner-driven precepting model (Set the Stage, Tell the Story, Educational Goals, Preliminary Plan, Uncertainties, Plan Recap [STEP-UP]), designed to prioritize clinical reasoning skills and self-identification of learning goals. Implementation of the STEP-UP model improved perceptions of overall outpatient training and precepting. However, we faced several barriers to uptake of the new model, including increased cognitive burden of integrating a new process. Conclusion: A robust assessment of ambulatory education at a single PCCM fellowship program identified a need to align precepting processes with the unique goals of advanced trainees. We developed a learner-driven precepting model focused on development of clinical reasoning skills and self-directed educational objectives. Additional study is warranted to refine, adapt, and test the model in different setting.