a preceptor primer: how to become a “top-notch” preceptor for pharmacy students laurie l....
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A Preceptor Primer:How to Become a “Top-Notch” Preceptor for Pharmacy Students
Laurie L. Briceland, Pharm.D., FASHP, FCCPProfessor of Pharmacy
Director, Experiential EducationAlbany College of Pharmacy
and Health Sciences
Learning Objectives• Understand and internalize that in your role as
preceptor, you are a tangible and powerful role model for students.
• Describe four key attributes that lead one to become an effective preceptor.
• Specify the characteristics of an optimal learning environment at the experiential practice site, and develop realistic rotation objectives & expectations of students.
• Evaluate and express to the student critical formative and summative feedback throughout the experiential rotation.
• Analyze & accept pertinent constructive critique of the experiential offering from the students.
• Commit yourself to ongoing preceptor development & networking opportunities.
Understanding the Preceptor Role: What is a
“Preceptor”?• preceptor n. A teacher; an instructor. An expert or specialist, such as a physician, who gives practical experience and training to a student (Answers.com)– A preceptor is a qualified practitioner who provides
transitional role support and effective clinical learning for a student within a collegial partnership.
– A preceptor supports the growth and development of a student for a predetermined length of time with the specific purpose of socializing and integrating that student into a new role
– A preceptor wears the hat of teacher, tutor, mentor, facilitator, and coach
– (Northeast Wisconsin Tech College Respiratory Care Practitioner Program)
…It All Depends on the Preceptor!
“Positive Role Model” Attributes
• Practice ethically, w/ compassion for patients• Accept personal responsibility for patient
outcomes• Have professional training, experience, and
competence commensurate with their position
• Utilize clinical and scientific publications in clinical care decision making and evidence-based practice
Accreditation Council for Pharmacy Education Standards 2007
“Positive Role Model” Attributes
• Have a desire to educate others (patients, care givers, health care professionals, students, residents)
• Have an aptitude to facilitate learning• Be able to document and assess student
performance• Have a systematic, self-directed approach to
their own professional development• Collaborate with other health care professionals
as a member of a team• Be committed to their organization, professional
societies, and the community
Accreditation Council for Pharmacy Education Standards 2007
Ongoing Preceptor Development
• “Continuous Professional Development” – Careful Study of college-sponsored course
materials
• Accept students’ critique of rotation as means of “CQI”, and be open to making rotation changes– Try new things that are suggested by others
• Liaise w/ other preceptors of similar type rotations – (e.g., cases, journal club, seminars, industry
contacts, rotation ideas)
Four Keys toThe Effective Preceptor:
Communications!– Explains the basis for actions & decisions– Answers learner questions clearly & precisely, in
non-judgmental manner– Is open to conflicting ideas and opinions– Communicates clear goals & rotation objectives
• Provide written rotation schedule on day 1• Review rotation objectives on day 1; ask
students for any modifications– Holds Realistic Expectations of students:
• #, type, quality of assignments– Captures learners attention & makes learning
fun!– Makes the learner feel like a priority
Four Keys to The Effective Preceptor:
Communications!• Educate Practice Site Personnel as to student’s
role & responsibilities• Keep College Experiential personnel “in the loop”
– At rotation midpoint, final– As needed, especially if concerns w/ student’s
professionalism, attendance, • Exhibit good communication/interpersonal skills
w/ students (respond to emails/calls; review/critique assignments in timely fashion; be prompt for meetings; do not accept phone calls during student meetings)
• Exercise care when critiquing one student in presence of another
Four Keys to The Effective Preceptor:
Careful Analysis of the Learner
• Accurately assesses the learner’s knowledge, attitudes and skills
• Uses direct observation of the learner• Provides frequent and effective feedback to
students on rotation• Performs fair and thoughtful evaluations• Documents student progress frequently, giving
ample “warning” and opportunity for improvement if rotation failure is a strong possibility
• If remediation necessary, uses the Evaluation/Outcomes document to gauge student performance and conduct more frequent (than midpoint/final) evaluations w/ clear instruction on progression
Four Keys to The Effective Preceptor: Skillful Teaching
and Practice
• Demonstrates skillful interactions with patients• Provides effective role modeling• Presents information with organization and clarity• Organizes and controls the learning experience• Gives appropriate responsibility to the learner• Balances clinical and teaching responsibilities• Provides ample learning opportunity at the site
(perform activity, be evaluated, see outcomes of interventions/projects)
Four Keys to The Effective Preceptor: Motivating the
Learner
– Emphasizes problem solving– Promotes active involvement of the
learner– Demonstrates enjoyment and
enthusiasm for patient care and teaching
– Develops a supportive relationship with the learner
The Optimal Experiential Learning Environment
Kolb’s Cycle of Experiential Learning
Importance of Feedback Process
• Assure that the future pharmacist has the knowledge, skills, attitudes appropriate for the profession
• Assist the student in assessing strengths and weaknesses
• Identify specific strategies for the student’s improvement
• Contribute to the student’s growth and development (“lifelong learner”)
Principles to Guide Feedback
• Feedback should be..– Constructive
so that students feel encouraged and motivated to improve their practice
– Timelyso that students can use it for subsequent learning and work to be submitted
– Prompt so that students can recall what they did and thought at the time
– Supportive of learningshould be linked to a clear statement of orderly progression of learning so that students have clear indications of how to improve their performance
Principles to Guide Feedback
• Feedback should be..– Focused
on achievement, not effort. The work should be assessed, not the student
– Specific to the learning outcomesso that assessment is clearly linked to learning
– Consequentialso that it engages students and they are required to attend to feedback, removing the need for continually giving the same student the same advice
– Fostering of independence so that it leads students to being capable of assessing their own work
– Efficient for staff to do.
Feedback: More than a Final Evaluation/Meeting
and Grade • Ongoing process
– Beginning: setting rotation expectations– During: continual observation and
assessment of student’s performance; specific feedback to the student
– Final: incorporate “During” assessments into final evaluation session
– Individualized – there is no “one size fits all”
GRADE Strategy
• G: Get ready – Review course syllabi, standardized
objectives, evaluation form– Consider incorporation of site-specific
unique opportunities– Set student expectations (factor in
rotation sequencing; prior experiences; IPPE or APPE, etc.)
Langlois JP and Thach S. Evaluation Using the GRADE Strategy.Fam Med 2001;33(3):158-60.
GRADE Strategy
• R: Review Expectations w/ Student– Meet early (day one) to review
objectives– Determine student’s knowledge, skill
level, previous experience (portfolio)– Review goals (preceptor, program,
student)– Describe feedback/evaluation process
Langlois JP and Thach S. Evaluation Using the GRADE Strategy.Fam Med 2001;33(3):158-60.
GRADE Strategy
• A: Assess– Observe student in rotation activities– Record observations frequently– Provide Timely, Specific Feedback
routinely to student– Include Positives & Negatives– Include Program Coordinator if needed– Ask student to self-assess
Langlois JP and Thach S. Evaluation Using the GRADE Strategy.Fam Med 2001;33(3):158-60.
GRADE Strategy
• D: Discuss assessment @ Midpoint – Set Formal Meeting– Preceptor & Student fill out evaluation
form in advance– Compare evaluations together; rectify
differences– “Formative” feedback: agree upon plan
for continuation and improvement
Langlois JP and Thach S. Evaluation Using the GRADE Strategy.Fam Med 2001;33(3):158-60.
GRADE Strategy
• E: End with a Grade – Schedule formal meeting– Complete evaluation in advance– Support evaluation with documentation– Highlight items to work on in future– “Summative” grade
Langlois JP and Thach S. Evaluation Using the GRADE Strategy.Fam Med 2001;33(3):158-60.
Potential Evaluation Pitfalls
• Halo Effect– Certain traits (negative or positive) cause
preceptor to overlook important aspects• Enthusiastic, caring individual w/ lackluster
skills receives A grade;
• “Oops” – Insufficient Documentation– Describing shortcomings without
providing specifics• “your work is sloppy; your manner is abrupt”
Langlois JP and Thach S. Evaluation Using the GRADE Strategy.Fam Med 2001;33(3):158-60.
Potential Evaluation Pitfalls
• “But You Never Told Me That”– Stating at rotation end that student
hasn’t met expectations when expectations were not spelled out• When in doubt –spell out again, in writing
• “But I need a high grade”– Student presses for high grade
• Provide documentation to support your assessment
Langlois JP and Thach S. Evaluation Using the GRADE Strategy.Fam Med 2001;33(3):158-60.
Potential Evaluation Pitfalls
• “Last day: Should the Student Pass?”– Realizing on the final day that student
has been and remains sub-standard and he/she should not pass• Crucial to contact program official earlier in
rotation
• Lake Wobegon Effect– All students rated above average
• Disservice to students, profession, etc.Langlois JP and Thach S. Evaluation Using the GRADE Strategy.Fam Med 2001;33(3):158-60.
Case Study #1: Lack of
Knowledge/Application• Student is assigned to your advanced pharmacy
practice ambulatory care rotation; it is the first APPE rotation of the year and the student has no previous work experience except for 4-week IPPE in community setting.
• During the first week, the student does not know routinely used “top 280” drugs, doses, indications. Student lacks confidence in counseling, and shies away from it. When directly requested to counsel a patient, student did so with great difficulty; you witness several errors in the counseling and step in to correct for the patient. Student is unable to demonstrate use of MDI for asthmatic patient.
• What are your options as primary preceptor??
Case #1: Preceptor Options
• 1. Call the College Experiential Personnel• 2. Document in writing the specific shortcomings
(specific examples of lack of knowledge or application of such), and provide this feedback to student promptly
• 3. Devise plan for improvement with specific timeline: by Friday, I expect…
• 4. Assign additional work products in which students can demonstrate improvements
• 5. Provide frequent feedback informally and formally (“midpoint” – can do multiple evaluations)
• 6. Recognize that not all rotations will be “salvageable” - meaning some deficiencies cannot be rectified ever or in the timeframe needed: lead to remediation
Case #1: Remediation Options
• Repeat similar rotation experience• Review certain therapeutics areas
(class notes, textbooks, case studies)• Work (part-time) in pharmacy
practice setting • Read, read, read• Refer to college counseling for time
management skills
Case Study #2: Communications
• A student with previous hospital experience is assigned to your hospital rotation, in which she will be assigned to work with many pharmacists within the facility.
• Several pharmacists report to you that the student basically refuses to follow your hospital policy, citing that it is “all wrong” and that Hospital X teaches us to do it a more efficient way. You are aware of Hospital X’s policies, and have purposefully selected your own methods for your own reasons. The student continues to ruffle feathers of your staff.
• What are your options?
Case #2: Preceptor Options
• 1. Call the College Experiential Personnel• 2. Document in writing the specific
shortcomings (specific examples of poor communications), and provide this feedback to student promptly
• 3. Devise plan for improvement with specific timeline: by Friday, I expect…
• 4. Provide frequent feedback informally and formally (“midpoint” – additional prn)
• 5. Recognize that it is possible this student will not change his/her ways and will not be able to continue at your site because of inability to communicate with the staff.
Case #2: Remediation options
• Refer to college counseling for appropriate services (depression, anxiety, coping, time management, eating disorders, etc.)
Case #3: Professionalism
• Student is on your hospital rotation and is overheard by several of the pharmacy staff in the breakroom as saying that this rotation is “useless –I am counting the days” and “my preceptor is the worst I’ve ever had”. This information is reported to you.
• The nurses on the two units report that your student has been rude in trying to obtain patient charts on their floors.
• What are your options as preceptor?
Case #3: Preceptor Options
• 1.Call the College Experiential Personnel• 2. Document in writing the specific
shortcomings (specific examples of lack of professionalism), and provide this feedback to student promptly
• 3. Devise plan for improvement with specific timeline: by Friday, I expect…
• 4. Provide frequent feedback informally and formally (“midpoint” – can do multiple evals)
• 5. Recognize that it is possible this student will not change his/her ways and will not be able to continue at your site because of inability to behave in a professional manner.
Case #3: remediation options
• Assign student to write paper on professionalism, after researching topic
Professionalism• Erosion of Values & Civility in today’s society (lack of
politeness, manners, courtesy; cell phones in public; road rage; culture of self-absorption)
• Pharmacy education (locally & nationally) has re-emphasized professionalism by: – Developing/implementing explicit standards of conduct
(email, computer use in classroom, no plagiarism) – Developing a continuum of expectations and
accountability throughout the curriculum for students in a professional program (labs, IPPEs, APPEs): work ethic, communications w/ site, meeting deadlines
– Instituting professional ceremonies (White Coat)– Producing a White Paper and Toolkit on Professionalism
Professionalism References• 1. Boyle CJ, Beardsley RS, Morgan JA, et al.
Professionalism: A determining factor in experiential learning. AJPE 2007; 71(2): 1-7.
• 2. APhA-ASP/AACP-COD Task Force on Professionalism: Toolkit for professionalism 2005. Available at http://www.aphanet.org/students/
• 3. APhA-ASP/AACP-COD Task Force on Professionalism: White paper on pharmacy student professionalism. JAPhA 2000;40:96-102.
• 4. Hammer DP, Berger BA, Beardsley RS et al. Student professionalism. AJPE 2003; 67(3): article 96.