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Dr. Brittany Vickery
Assistant Professor of Pharmacy
Wingate University School of Pharmacy
Hendersonville Health Sciences Center
Hendersonville, North Carolina
 
Precepting can be challenging, especially while trying to balance other tasks and responsibilities. With proper incorporation and utilization of precepting strategies, it can be a rewarding experience for both the preceptor and the learner. This article will review some new preceptor essentials, ideas for organization and prioritization, strategies for creating a mutualistic relationship between the site and students, as well as resources to grow as a preceptor.
 

What are the top 3 things that are “essential” for a new preceptor?

  1. Understanding your student(s): This is key when you are precepting an individual learner, but even more so when precepting multiple learners at once.1 This may be accomplished through asking students to complete a “pre-rotation assessment questionnaire”2 (Table 1) and spending one-on-one time with each student on a weekly basis. This may be accomplished by rotating students who attend daily rounds so there is individual time with each student, asking a student to meet early, or dismissing one student first and keeping the other. Finding out how comfortable or uncomfortable students are around each other before providing individual feedback in a group setting is necessary. Utilizing the information gained through the “pre-rotation assessment” to tailor the rotation to each student’s unique needs will help in constructing the rotation. Preceptors can learn a lot by asking each student to describe the role of their “ideal” preceptor. This can help the preceptor determine how much interaction students expect as well as what type of feedback is preferred. Preceptors can also learn more about the student’s personality, learning style, communication skills (as well as other soft skills), and work-style preferences. If any of the students’ expectations misalign with what is available or reasonable, this can be addressed early.
  2. Setting clear goals and expectations: This is key so students are more likely to be evaluated similarly (even during expected fluctuations in schedule, work load, and baseline knowledge or experience).1 Preceptors should spend time developing a syllabus or syllabus supplement that highlights: outcomes and learning objectives, expected activities, professional conduct, calendar or rotation schedule or a “typical day”, planned topic discussions (with a notation that impromptu discussion will also occur regularly), projects / assignments / presentations, and the evaluation and grading criteria.1,2 Goals and expectations should align with the School of Pharmacy’s learning objectives and the evaluation process and feedback should reflect this alignment.4 It is also important to confirm that students understand and accept expectations.1 It is reasonable to ask students to initial the syllabus supplement and expectations indicating that they were reviewed during orientation (Table 2). Preceptors should provide ample opportunity for questions/clarification during this process. This allows everyone to start on the same page and ensure evaluations are more streamlined.
  3. Evaluating students and delivering meaningful and constructive feedback: Most students perform better when given written feedback. Unfortunately, with practice-site demands, it is not always possible to write down the things students need to grasp. Often, beginning verbal feedback with this sentence helps enormously: “I am going to give you some verbal feedback that you may want to write down.” Utilizing positive phrasing as often as possible also seems to help with absorption of feedback. For example, instead of saying “areas of weakness or difficulty”, say “opportunities to improve, learn, or grow.” Preceptors should try to remain open, honest, fair, consistent, and specific while ensuring that the student is being held accountable for expectations.1-4
It is also helpful to try and note differences in students’ perceived performance compared to the preceptor’s evaluation and address these misalignments early. Self-reflection and self-assessment are important tools for continued professional development.1-4 This may be achieved by asking students to complete midpoint and final self-evaluations. Asking for feedback from others who interact with the students is paramount.2,4 Feedback should be frequent.1 The frequency must be learner specific and early intervention is key. A good rule of thumb is that if you notice feedback is warranted, it should be done immediately.1-3 Try giving verbal feedback daily and written feedback weekly to every other week. Feedback should be specific and geared towards a learning goal, not an student’s personality.1,3 If you perceive that a learner is defensive towards feedback, pause, reassess what was said, and consider how you would prefer a superior to communicate that same information to you. Evaluations should contain a feedback component while being comprehensive and reflective of overall rotational performance to date. Students should not be made aware of feedback for the first time during a formal midpoint of final evaluation.3 If students have been given verbal feedback regarding professionalism or performance multiple times but have not yet applied the feedback to address the issue, written notices can carry more weight to help the student understand the seriousness (Table 4).
 

How should a new preceptor organize and prioritize site responsibilities along with precepting responsibilities?

Preceptors should construct a monthly calendar and a daily schedule (Table 5).1,2 Having defined times planned for students (patient work-up, research, etc.) allows for preceptors to prioritize responsibilities and tackle other tasks. A key step is to make learning fun and engaging while promoting independence and autonomy. This will enable students to assist with the patient care workload rather than adding to the workload.2 Often there is initially a lot of work necessary, but it makes the rotation go more smoothly. For example, on the first day of rotation I communicate that the primary goal of the advanced pharmacy practice experience (APPE) rotation is to become autonomous which is demonstrated by taking over the service. This is different from the introductory pharmacy practice experience where the goal is to develop basic clinical skills in preparation for APPE rotations. Patient care and any consults go to the students beginning in week three. By week four they are on their own with hands-off supervision. This model challenges and encourages students to take responsibility for their own learning early so that progression to the final goal is possible.1 In situations, where it is not possible, evaluations should be reflective.1

During the first weeks there is a focus on understanding and explaining outcomes of recommendations (including potential problems or harm), gaining understanding of the student’s insight, and aiding in necessary learning or expounding on baseline knowledge. Through this process, students develop an enhanced awareness of their patients realizing that this is a real human, not just a case on a paper. Students begin to understand that they are responsible for the patient. During the first portion of the rotation it is especially important to constantly ask students probing, concept questions even if they seem easy.1, 4 If preceptors only ask questions when students are incorrect, two things are happening. 1) The student learns to become defensive and 2) the preceptor misses opportunities to help the student build confidence. Asking questions constantly helps students learn the preceptor’s thought process which will aid them in caring for patients. If the preceptor has developed meaningful rotation activities for the students, they should be actively learning how to carry out the roles of a pharmacist, which should help with prioritization of responsibilities. 1,2

What are some ways to engage both the learner and site to create a mutually beneficial relationship?

Preceptors should start by building relationships and gaining buy-in from the site because doing so leads to student opportunities.2 For example, because of relationships with the social workers at my practice site, students create pharmacy education games to facilitate an hour-long group. Students also provide in-services to nursing or other staff. New preceptors can start by looking at the facility’s current operations to identify opportunities for student learning that will be mutually beneficial.2 These services may include medication reconciliation, discharge counseling for new medications, and other patient education opportunities. Each of these are valuable to the site and allows students to practice and thus develop skills necessary for a pharmacist.2

How do I grow as a preceptor?

Preceptors should ask for and utilize student feedback throughout the rotation experience and during final evaluations.2 I incorporate this into “Feedback Friday” (Table 3). Ask your learners questions like: “What do you think is going well (likes), or what can go better (dislike)”, “What would you like to do more of or less of this week”, and “How can I improve the rotation?” Preceptors should reflect on questions like “How can I make a student’s time more meaningful?”, “What went well and should continue?”, and “What should be changed for the next rotation?” Preceptors should try to empathize with students while standing firm in their own teaching philosophy. Most importantly, lead by example and remember we reproduce what we are.1,2

Where are good places to search for precepting resources?

First, check with the School of Pharmacy where you are serving as a preceptor, as some provide free resources as an incentive of precepting.

Table 1: Example Pre-rotation assessment questions2
  1. What do you hope to accomplish on this rotation?
  2. Which soft skills do you consider to be strengths and weaknesses?
  3. What area of pharmacy would you like to practice upon graduation and why?
  4. What rotations have you previously completed?
  5. Which was your MOST favorite rotation and why?
  6. Which was your LEAST favorite rotation and why?
  7. Which therapeutic or patient care topics interest you? 
  8. What skills would you like to improve?
  9. How do you plan to use this rotation to improve these skills?
  10. State 3-5 goals that you would like to achieve during this rotation.
  11. List 3-5 topics that you feel you are strong in or have a good understanding of, and list 3-5 topics that you feel you are weak in and need to focus on more.
  12. How would you describe your ideal preceptor?
  13. How do you deal with stress?
  14. Is there anything else you would like for your preceptor to know about you?

 

 

 

 

Table 5: Typical Rotation Schedule2
Time (may vary daily) Activity (will vary daily)
Will also include department meeting, topic discussions, presentations, etc.
8:00-9:45 Pre-round on patients (Look at newly admitted patients or as assigned)    
9:30-9:55 Time sensitive interventions (Discuss with preceptor, prepare to make recommendations to providers before treatment team)
10:00 -11:00 Daily Treatment Team Meetings
11:00-12:00 Complete patient work up; begin writing daily patient care notes
12:00-12:30 Lunch
12:30-1:15 Review patients (pending labs, tests, etc.); Follow up on monitoring for previous patients any pending information, DI questions from team
1:15pm – 2:00 Present and discuss patients, patient cases, learning issues, drug information questions; Attend and/or facilitate group sessions as available
2:00-3:00 Patient rounding (see patients in person, interview, educate, etc.)
2:00– 4:00
**Stay until all patient care complete**
Follow-up on any consults, recommendations, or questions
Provide patient education as needed or requested
Topic discussion, research, review, reading time, or project time, etc.

 

References

  1. Nappi J. Chapter 9 Effective Precepting In: Zlatic TD, Clinical Faculty Survival Guide. Lenexa, KS: American College of Clinical Pharmacy; 2010
  2. Harp F. Preceptor CE: Community Pharmacy Preceptor Development Series Part 1: Getting Started. Volume 2017, Course No. 222. Pharmacist’s Letter Preceptor Live CE. 3120 W. March Ln., Stockton, CA 95219. 2012. Available at: PharmacistsLetter.com. Accessed 7/3/2018.
  3. Wilkinson ST, Couldry R, MS, Phillips H. Preceptor Development: Providing Effective Feedback. Hosp Pharm 2013;48(1):26–32
  4. Cuellar L, Ginsburg D, et al. Preceptor’s Handbook for Pharmacists. American Society of Health Systems Pharmacists Third Edition; 2016.
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