Precepting 101
Some helpful hints
Better than a thousand days of
diligent study is one day with a
great teacher."
--Japanese proverb
Goals
Discuss characteristics of interns
Discuss the characteristics of the
effective preceptor.
Discuss the strengths and limitations of
interns.
Ways to deal with problem interns.
The Effective Clinician/
The Effective Preceptor
Characteristics of the effective clinician
Good communication skills
Careful assessment of the patient
Skillful management
Able to motivate the patient
After Tumulty, 1973
The Effective Clinician/
The Effective Preceptor
Characteristics of the effective preceptor
Good communication skills
Careful assessment of the learner
Skillful teaching and practice
Able to motivate the learner
The Effective Preceptor
Communication Skills
The Effective Preceptor
Communication
Possesses and demonstrates broad
knowledge
Explains basis for actions and decisions critical for dietetic interns
Answers learner questions clearly and
precisely
Explain the basis for actions
Interns want cut and dry answers in a
field where there is often more than one
right answer
Experienced clinicians automatically bypass many steps in the decision making
process, which need to be made clear
to interns
Answers learner questions
clearly and precisely
Know when intern should look
something up themselves or when they
need to be given an answer
Fine line between encouraging
independence and promoting frustration
The effective preceptor…
Is open to conflicting ideas and opinions
Connects information to broader concepts
Communicates clear goals and
expectation
The effective preceptor…
Captures learners attention
Makes learning fun
Careful Assessment
of the Learner
Careful Analysis of the
Learner
Accurate assessment of learner’s
knowledge, attitudes and skills
Uses direct observation of the learner
Provides effective feedback
Performs fair and thoughtful
evaluations
Providing Feedback
Should be specific and appropriate
Should honor interns’ efforts
Can be useful to have intern selfevaluate - “what do you think went
well?”, “what would you do differently?”
The Effective Preceptor
Skillful Teaching and Practice
Skillful Teaching and Practice
Provides effective role modeling
Demonstrates skillful interactions with
patients
Presents information with organization
and clarity
Remember the preparation is
for entry level!
Need to know versus nice to know
Example:
need to know - how to calculate basic
TPN
nice to know - some RD’s adjust
electrolytes, etc., but this is NOT an
entry level skill
Skillful Teaching and Practice
Organizes and controls learning
experience
Give appropriate responsibility to learner
Balances clinical and teaching
responsibilities
Talk the talk and walk the walk
Motivating the Learner
Motivating The Learner
Emphasize problem solving
Promote active involvement of learner
Demonstrate enjoyment and enthusiasm for
patient care and teaching
Develop a supportive relationship with
learner.
Motivating the Learner
Many interns are adult learners and
internally motivated
Allowing interns to direct own learning
will help make this transition
What can you expect
regarding your intern?
Most in distance program have
extensive work experience
Some may have families
Many will have greater financial
responsibilities
They are highly committed to doing
well!
Limitations of interns
May have lots of book learning with
limited hands on experience
May have an untested work ethic
May have difficulty prioritizing
May lack confidence in knowledge and
ability (though some may be overconfident)
Strengths
Are generally very enthusiastic
Often very idealistic (may be a limitation
in some cases)
Generally have a good knowledge base
but may need to be reminded of that
fact.
How to promote success
Provide an orientation
But don’t tell them everything - have them
read policy and procedure manual
Make your expectations clear and
provide feedback
Ask them to self-assess periodically
Be focused and enthusiastic
More ways to promote
success
Have interns carry note cards to jot
down questions throughout the day (or
include in their journal)
Give them activities to do during down
time (while you’re on the phone, etc.)
Give your intern responsibility
Create an atmosphere for open
communication
Providing effective feedback
Characteristics of food feedback
Encourages self assessment
Includes positives and negatives
Refers to specific, observed behavior
Is timely
Occurs in an appropriate place
Ends with an action plan
The difficult learner
When the performance does not meet
expectations
Examples
Learner can’t sort out appropriate
versus irrelevant information
Learner misses important details
Using the SOAP approach
Subjective
What does the intern ‘say’?
Has the situation occurred before?
What do others say?
Describe the problem/difficult behavior rather than label it.
Subjective - example
√ Intern has difficulty developing effective
working relationships with other
disciplines
Rather than
X Intern is over-bearing and is alienating
staff members
Objective
Start by identifying specific behaviors
Comes late, leaves early
Provides incorrect information in chart, to
patient, etc.
Avoids eye contact during patient
interviews
Look for other sources of information how did intern get this far?
Assessment
Are your expectations clear?
Is there “stuff” going on of which you are
not aware?
Is there a cognitive problem?
Information processing - e.g.dyslexia,
attention deficit
Reasoning - e.g. can’t recognize
assumptions, difficulty synthesizing
Assessment, continued
Is there an emotional, attitudinal, or
personality problem
i.e. close family member died of cancer, so
intern has difficulty working with this type of
patient
Emotional - e.g. depression, anxiety
Attitude -e.g. intolerance or lack of
motivation
Personality - e.g. obsessive compulsive,
dependent
Assessment, continued
Is the learner having difficulty ordering
his/her environment?
Time management
Inflexible learning style
Inefficient learning style
Assessment, continued
Are the interns’ standards set too low?
Has minimum effort been good enough in
the past?
Do they believe they are performing well,
when in fact they don’t meet your
expectations?
May be some cultural issues
Plan
Do you need further information?
Give feedback - be timely
Reset your educational goals and objectives
Negotiate
Collaborate
Focus on interns’ strengths
Establish plans for follow up
Plan - examples
Knowledge deficit - provide readings to
do outside rotation (or contact director)
Have intern verbally walk through what
they are doing so you can see where
they fall short
Problems for the 21st century
Inappropriate cell phone use - this was
addressed during orientation
Many distance interns have children, so
phone calls often relate to this
Interns should check with preceptor as
to when they can check voice mail or
return calls
Make sure you have all the
information
Real life situation
chronically late intern
renal problem, but MD unable to determine exactly what was
going on.
prescribed meds caused drowsiness
concerned about falling asleep while driving to rotation
cultural issue - did not occur to her to let her preceptor know
what was happening
Solution - negotiated later starting time with site
Finally…
Let the internship director know what is
going on.
Precepting
101
references
Tumulty, Philip A. The Effective Clinician Philadelphia: W. B.
Saunders; 1973.
Irby, D. M.; Ramsey, P. G.; Gillmore, G. M., and Schaad, D.
Characteristics of effective clinical teachers of ambulatory care
medicine. Acad-Med. 1991 Jan; 66(1):54-5; ISSN: 1040-2446.
Irby, D. M. Clinical teacher effectiveness in medicine. Journal of
Medical Education. 1978; 53:808-815.
Stritter, Frank T and Baker, Richard M. Resident preferences for
the clinical teaching of ambulatory care. Journal of Medical
Education. 1982; 57:33-41.
Precepting
101
References
Skeff, Kelley M. Enhancing teaching effectiveness and vitality in
the ambulatory setting. Journal of General Internal Medicine.
1988; 3(Mar/Apr Supplement):S26-33.
Irby, D. M. What clinical teachers in medicine need to know.
Academic Medicine. 1994; 69(5):333-42.
Irby, D, M. Teaching and learning in ambulatory care settings.
Academic Medicine. 1995; 70(10):898-931.
Goertzen, J.; Stewart, M., and Weston, W. Effective teaching
behaviours of rural family medicine preceptors. Canadian Medical
Association Journal. 1995; 153(2):161-8.
Whitman, Neal. Creative Medical Teaching. Salt Lake City:
University of Utah School of Medicine; 1990.