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Negotiating Clinical Sites in the Community - Playing the Game 
James B. Alexander, MD 

z.umn.edu/JRMC
All work in JRMC is licensed under CC BY-NC 



 

James B. Alexander, MD; Professor of Surgery, Associate Dean, Atlantic Health System Regional Campus, Sidney Kimmel Medical 
College at Thomas Jefferson University 
 
All work in JRMC is licensed under CC BY-NC  

Volume 2, Issue 3 (2019)             Journal of Regional Medical Campuses                 Abstract 

Negotiating Clinical Sites in the Community - 
Playing the Game 
James B. Alexander, MD 
 
Topic: 
 
Sites for clinical instruction are increasingly in demand. Regional campus deans seek to provide high-quality clinical instruction by 
embedding medical students in practices in their local communities. However, these same clinical sites may be sought for use by 
other learners from other, competing programs. 
 
As the demand for sites increases, regional campus deans may find themselves vieing with other educational programs for 
instructional opportunities in the same communities and among the same clinical faculty. Much to the dismay of deans, this can 
easily become a “sellers’ market”, in which local community clinicians may make clinical training opportunities available in return for 
favorable considerations from programs and schools. Local politics and economics are in play, resulting in substantial challenges to 
achieving curricular objectives. 
 
Regional campus deans have finite resources. In order to secure the high-quality opportunities they need from local community 
clinicians, they need to seek strategic solutions that satisfy both the interests of prospective faculty and their own curricular 
objectives. Deans need to understand the perspective of community physicians.   
 
Deans must understand how the interests of faculty can either coincide or conflict with the interests of the medical school. Deans 
also need to understand how differing strategies can yield either favorable or unfavorable educational outcomes for their students 
and their programs. Successful strategies must achieve a win-win, whereby the goals of regional deans and their curricular objectives 
can be achieved while fulfilling the aims of local community faculty. 
 
Short Description: 
 
This highly interactive session explored the dynamics at work. Participants had the opportunity to play roles as regional campus 
deans or clinical preceptors.   
 
Deans are awarded students with their attendant tuition dollars. Students require clinical training in all core disciplines within an 
academic year. Clinicians seek to optimize their practices while negotiating favorable considerations from the deans in return for 
training opportunities. 
 
Successful deans achieve recognition and acquire increased resources. Successful clinicians receive support from the medical schools 
and are perceived favorably in their communities. Their practices thrive. On the other hand, unsuccessful deans and/or faculty may 
experience deleterious consequences. 
 
Alternative strategies yield different outcomes for students, deans, and clinicians. Reflections of participants and observers at the 
end of the exercise provide deeper understandings of the interplay of forces, tensions, and strategies. 
 
Four questions that were posed to/considered by session participants: 
 

1) What strategies can be used by regional campus deans to obtain clinical training opportunities with community physicians? 
2) What are the salient motivations of clinical preceptors in the community as they take on the training of medical students in 

their practices? 
3) Are there common values or goals that can serve as win-win opportunities for training medical students with community 

preceptors? 
 
 
 



 

 
DOI: https://doi.org/10.24926/jrmc.ADDHERE                                        Journal of Regional Medical Campuses, Vol. 2, Issue 3 

Abstract 

Three take home points from our session: 
 

1) Negotiating clinical sites for training medical students in the community is complex. Nonetheless, some salient issues can be 
realistically portrayed in a game format. The resulting scenarios can yield meaningful insights into the forces at work in 
these transactions. 

2) Alternate strategies for securing clinical training sites can be adopted by regional campus deans. The available sites and 
resulting educational outcomes will vary depending on the strategies chosen. 

3) The interactions of regional campus deans and community clinical faculty may yield unanticipated educational outcomes. 
These outcomes can have substantial impact on both students and the learning environments in which they train.