Frequently Asked Questions by Externship Sites
Does a clinic need to be offering patient-centered medical home and team care to be an externship site?
Externship sites need to be committed to, and already moving towards, person-centered, team-based care or they are unlikely to be interested in this kind of training. Moreover, just training the MAs in this fashion will not work well unless the overall practice is ready for that approach. Therefore, in selecting externship sites for Phase 3 of NIMAA, the threshold questions are where a potential candidate clinic is on this journey. CHC’s Weitzman Institute can provide a variety of tools to support overall practice or other staff transformation/training.
Our health system has to meet certain PCMH/ACO metrics. Do you teach this?
Absolutely. PCMH principles, along with data measurement, are a central part of the curriculum, including the Uniform Data System, HEDIS, and other data measurement. NIMAA participants must learn how to manage data to be successful in today's healthcare environment.
What about different MA rules of practice in different states?
We are researching and reviewing the regulations for MAs for every state in which we teach. As practice is changing rapidly, and clinics have varied practices, we focus more on team-based care needs for the patient, not just the specific job of an MA in a particular clinic or state.
How many students should each externship site have?
Each externship organization will determine their capacity to host students, but we are hoping that each will agree to between five and 10 students. Usually these students are spread out over multiple clinics of the externship organization, with three or four at most in a single physical location.
How much work does a participating externship site need to do to get the team ready to support the NIMAA model?
First, a externship site will need to establish leadership and systemic support of the NIMAA program. This means communicating the program goals, timeframe, and expectations of both the staff and the students, and setting aside about two days for preceptors to attend a workshop. We will help each site prepare for success.
Is the externship site responsible for providing training rooms/space?
Externship sites need to provide a conference room or exam room for skills practice and coaching two hours a week or four hours every two weeks, and one hour every week for synchronous sessions.
Who is responsible for the performance and actions of the student in the clinic?
NIMAA was founded by clinics; patients always come first. The patient is always the responsibility of the clinic and like any other externship, the clinic should supervise student actions and performance in their facility. NIMAA provides the instruction, and NIMAA has the most involvement in externships we have encountered. NIMAA is involved throughout the entire externship; we provide ongoing office hours with each externship site to discuss any potential concerns. We support each externship site and insist on updates about our students on a regular basis; we have weekly meetings with some of our externship sites, particularly new ones. NIMAA externship clinics have the students practice what NIMAA has taught them using the EHR, protocols, and policies of the externship site.
NIMAA has three tiers of skills acquisition and practice; these three are repeated over and over throughout the 7 month course, adding new skills every week. Skills training starts with on line didactics and labs, including simulations. That is followed by externship practice on fellow students under the guidance of an externship site skills coach. S/he makes sure students are competent in the skill before they are cleared for applying it in clinical practice (and reports this on the NIMAA LMS). Finally, externship site preceptors supervise the actual application of skills in the clinical setting (again reporting outcomes).
What are the qualifications of the NIMAA Program Coordinator at an externship site?
The liaison to NIMAA needs to be an individual who is in an upper management position, such as an operations person, nurse manager, or a provider. The person should be in daily communication with senior MAs (i.e. preceptors). It is important for the NIMAA Program Coordinator to have frequent communication with NIMAA.
Who should be the preceptors?
We have found the best success with senior MAs. Although the student will have the opportunity to learn from everyone in the clinic, the preceptor is the primary person who will monitor and facilitate student experiences. The individual in the preceptor role should be a qualified medical assistant with experience in the clinic. We have found that the most senior MAs, who are already experienced with training new hires, do not have any trouble taking on a NIMAA student.
One major benefit of participation is that NIMAA preceptors receive a companion training program to support their own learning and development.
Have you considered the impact of your preceptor model on productivity?
We have considered the impact of the preceptor model on productivity, as you suggested. Because it is similar to training new staff, most clinical sites are already well versed with this. Initially, in both instances, productivity is challenged; but, as more skills are added, the students become more helpful. Providers can give critical feedback to support the students’ experience all along the way. Moreover, we have found that providing preceptors with a strong support program focused on teaching skills increases their knowledge and effectiveness.
Assigning preceptor to the student will affect scheduling and budget in the clinic. Does NIMAA pay for the preceptor?
We have considered the impact of the preceptor model on productivity, as you suggested. Because it is similar to training new staff, most clinical sites are already well versed with this. Initially, in both instances, productivity is challenged; but, as more skills are added, the students become more helpful. Providers can give critical feedback to support the students’ experience all along the way. Moreover, we have found that providing preceptors with a strong support program focused on teaching skills increases their knowledge and effectiveness
Could this program be part of a paid MA apprenticeship through workforce development programs?
Most definitely, yes. We think this is an exciting option for both providers and students, and we will strongly support externship sites that want to go this route.
How much is payment for NIMAA training?
The total cost is $6000, plus about $600 for books and other expenses, for each MA for the seven-month course.
Do you have findings on hiring MAs as front desk staff and rotating the teams through front desk and back office?
We do not have specific findings. We do believe that it is best to have staff focus on one role so that we can truly develop it to its highest level. It is challenging for staff to really function at the highest level as an MA if they must also review and attain competency for front desk/billing, etc. The NIMAA Program certainly does speak to competencies that would translate to front desk work (professionalism, customer service, etc.), but does not focus on this split role.