Preceptor - New York State Council of Health

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A Preceptor Primer:
How to Become a “Top-Notch”
Preceptor for Pharmacy Students
Laurie L. Briceland, Pharm.D., FASHP, FCCP
Professor of Pharmacy
Director, Experiential Education
Albany 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
Accreditation Council for Pharmacy Education Standards 2007
• 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
“Positive Role Model” Attributes
Accreditation Council for Pharmacy Education Standards 2007
• 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
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 to
The 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
– Timely
so 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 learning
should 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 outcomes
so that assessment is clearly linked to
learning
– Consequential
so 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 reemphasized 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.
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