Preceptorship at Boreal: What Students See in a Rehab-First Clinic
A clinic is a workplace, but for a student on placement it is also a classroom, and not every classroom teaches the same lessons. Boreal Spine & Sport is an active preceptor for Northwestern Health Sciences University and is building a placement pipeline with the Canadian Memorial Chiropractic College. That means we regularly have students and interns in the building, watching how decisions get made. What they see in a rehab-first, assessment-driven clinic shapes the kind of clinician they become, and it is worth describing what that looks like.
The habit of assessing before treating
The first thing a student notices in a rehab-first setting is how much happens before any hands-on treatment. We assess, we test, we watch movement, and we form a working hypothesis. That order is deliberate. It teaches a student to ask "what is actually driving this?" rather than reaching for a familiar technique out of habit.
It also teaches them to look beyond the painful spot. A cranky knee might trace back to a stiff ankle or a hip that is not doing its share of the work. Learning to think in terms of the whole kinetic chain, rather than the site of symptoms, is a mindset that has to be modeled and practiced. When a student sees an assessment reveal a driver two joints away from the pain, the lesson lands far harder than any lecture could.
Clinical reasoning is the real curriculum
Technique can be taught from a manual. Clinical reasoning has to be developed. Research on how clinicians reason shows that expertise is not a single all-purpose skill you switch on, but a web of organized knowledge and prior examples that experts draw on to make sense of a new case.1 That has a direct implication for training: students build reasoning by working through real cases, comparing them, and being challenged to explain their thinking out loud.
In practice that means we do not just tell a student what we are doing. We ask why they think a pattern is presenting the way it is, what would change their mind, and what they would do if the first plan does not work. The goal is not to produce someone who can copy a protocol, but someone who can reason through a case they have never seen before. That skill transfers to every patient they will ever treat.
What evidence-based practice really means on the floor
Students arrive having heard the phrase "evidence-based" many times, sometimes to the point that it has lost its meaning. A rehab-first clinic is a good place to see what it actually involves. The classic definition from Sackett and colleagues describes evidence-based medicine as the integration of the best available research, individual clinical expertise, and the patient's own values and circumstances.2 It is explicitly not cookbook care, and it is not research overriding judgment. It is all three working together.
Watching that integration happen, choosing an intervention because the evidence supports it, adjusting it because this particular person has different goals or constraints, is more instructive than any single reading. We dig into what this looks like day to day in our note on what evidence-based practice means, and it is a theme students hear about constantly during a placement here.
Mentorship is the mechanism
None of this transfers by osmosis. It happens through mentorship, which is the quiet engine of professional development. A systematic review of mentoring in academic medicine found that mentorship is widely valued and associated with career development, while also noting honestly that the research base is still developing.3 Our read of that is not to shrug, but to be intentional: good mentorship is deliberate, involves feedback, and gives the learner room to make decisions with support rather than just observe.
For us, that intentionality means a few concrete things:
- Thinking out loud. A student cannot learn reasoning they never hear. We narrate why we choose one path over another.
- Graded responsibility. Students take on more decision-making as their judgment develops, with a supervisor close by. There are no bad exercises, only too much too soon, and the same principle applies to loading a learner.
- Feedback that is specific. "Good job" teaches nothing. Feedback tied to a particular decision is what moves the needle.
- Modeling evidence habits. When a student sees a clinician look something up rather than guess, they learn that curiosity is professional, not a weakness.
Why the pipeline matters
Building a strong student pipeline is not only about staffing the future. It is about shaping the kind of care that gets delivered across a whole profession as these students move into their own practices. A clinician who learned to assess first, reason carefully, and integrate evidence with the person in front of them carries those habits everywhere they go. You can read more about how we are structuring these placements in our overview of the NWHSU and CMCC student pipeline.
A rehab-first clinic gives students a particular vantage point: one where movement, load, and reasoning sit at the center, and passive treatment is a supporting player rather than the whole show. For the students who spend time here, that vantage point tends to stick.
References
- Norman G. Research in clinical reasoning: past history and current trends. Med Educ. 2005;39(4):418-427.
- Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71-72.
- Sambunjak D, Straus SE, Marušić A. Mentoring in academic medicine: a systematic review. JAMA. 2006;296(9):1103-1115.
Dr. Michael Minenna D.C., B.Sc., SFMA, FMS