Clint Ross, PharmD, BCPP

Dr. Clint Ross is the Residency Program Director for the PGY2 Psychiatric Pharmacy residency and a Clinical Pharmacy Specialist in Psychiatry at the Medical University of South Carolina (MUSC) in Charleston, SC. He also serves as an Adjunct Assistant Professor at the South Carolina College of Pharmacy. He received his PharmD from the University of Arkansas for Medical Sciences College of Pharmacy and completed his PGY1 Pharmacy Practice and PGY2 Psychiatric Pharmacy residencies at MUSC. Dr. Ross is Board Certified in Psychiatric Pharmacy, an active member of the College of Psychiatric and Neurologic Pharmacists (CPNP), and serves as a Senior Editor for CPNP’s Peer Reviewed Journal, the Mental Health Clinician.

All new psychiatric pharmacists will encounter situations they struggle to handle, no matter how robust their training. At best, residents will formally precept a handful of students during their residency. Despite the lessons learned during these co-precepting experiences, practitioners cannot be fully prepared for the challenges they will encounter throughout their years as preceptors. Each trainee on rotation presents with various levels of baseline knowledge, clinical reasoning, and aptitude that can result in a multitude of unique scenarios. While stories of challenging trainee scenarios can be attention grabbing, it is better to focus on ways to prevent or mitigate problems on rotation from the beginning.

Guidelines to Prevent Rotation Problems

  1. Establish clear expectations from Day 1 (or before)
    1. Anecdotally, most problems on rotation are related to unmet expectations. Despite what may seem obvious to a preceptor, trainees may not be aware of your expectations. For instance, if a rotation doesn’t allow students (or potentially residents) to make recommendations prior to preceptor approval, make that clear early on through a document such as a syllabus supplement or “top 10 rules” (see below). Additionally, if appropriate, make the consequences clear. For example “Plagiarism (of any kind or level) will not be tolerated. Your work is always expected to be your own. If it is not, this is grounds for immediate failure/dismissal from the rotation. If you are ever unsure if your work could be consider plagiarism, ask for help”.
    2. Take home tip:
      1. Create a “Top 10 Rules” document for your rotation and have trainees review and sign on day 1. This became very useful when a student (from an out of state school) on rotation committed plagiarism and I needed documentation to support immediate failure.
  2. Always provide direct, specific and timely feedback
    1. Despite how busy preceptors can be, it is crucial to quickly and clearly provide feedback. Rotations are short, and if you don’t address things as they come up, trainees will likely continue to behave or perform similarly throughout the rotation. Feedback should occur prior to the trainee being formally evaluated to allow the trainee time to correct the behavior or improve their performance before the end of the rotation. For instance, if a trainee’s “assertiveness” is argumentative or aggressive, it is more helpful to professionally and privately correct that in the moment than it is to become a surprise on a midpoint or final evaluation. At times this can be uncomfortable, but it will save a lot of trouble later!
    2. Take home tip:
      1. Create a calendar reminder for a “Feedback Friday”. ‘In the moment’ verbal feedback is important but can be too rushed to allow trainees to comprehend it in the scope of the rotation. Frequently scheduled sessions, where specific examples are provided, allows trainees to self-evaluate and have timely formative feedback to improve their performance. This practice would have helped me early in my career when, at midpoint, my student (with very poor insight into their performance) believed they deserved a B rather than the failing grade they were receiving.
  3. Make a habit of self-evaluation and requesting feedback
    1. Though trainee evaluations of preceptors are often done at the end of the rotation (and sometimes anonymously), a much more useful approach is incorporating this into the rotation. If preceptors consider constructive feedback regarding their own performance, it can strengthen their teaching skills and develop their trainee in professionally providing feedback. Additionally, it can be helpful to ask trainees at the beginning of rotation about characteristics of their most/least effective preceptors (anonymously).
    2. Take home tip:
      1. Immediately following your feedback sessions to trainees, make a habit of verbally providing your own self-evaluation, including what is going well and things you plan to change, then asking your trainee for feedback regarding your performance. A colleague of mine initiated this practice following a resident writing a scathing preceptor evaluation about things that could have been easily resolved during the rotation if the preceptor had only known!
  4. Be willing to ask for help
    1. Some of the most challenging rotation situations occur when a preceptor cannot pinpoint the problem with a trainee’s performance or behavior. For instance, students who perform at drastically varying levels on different days, residents who can’t seem to recall any information previously discussed, or a trainee becoming tearful when the situation doesn’t seem to warrant it. This can be for any number of reasons. When needed, asking for help from available resources (e.g., mentors, experiential department from the school) can often assist you and the trainee in progressing, rather than potential failure. If the issue is particularly confusing or concerning, asking “Is there anything else I should be aware of that might be preventing you from performing your best on this rotation?” can be helpful while waiting on assistance.
    2. Take home tip:
      1. Identify what assistance you have within your site or the trainee’s institution (BEFORE you need them) and write down the contacts beside your desk. Other preceptors (particularly with more experience), rotation coordinators, student health, employee assistance, and others can be invaluable in determining what the underlying issue may be. Over the past few years, I have seen or had colleagues mention where issues identified included learning disabilities, substance misuse, side effects from topiramate, and homelessness of a student.
  5. Documentation is everything
    1. Pharmacists get tired of hearing it, but documentation is critical. When you are faced with providing a low or potentially failing grade, it is crucial that you have documentation to justify it. Particularly given how busy preceptors can be, a method for efficiently collecting this is necessary.
    2. Take home tip:
      1. Create a de-identified physical or electronic document to take notes daily on your trainee’s performance. Small notes by date can help you keep up with progress, provide meaningful “Friday feedback” sessions, complete your formal evaluations, or justify any grade/score that comes into question. As an advisor for a PGY1 resident undergoing remediation, their clinic preceptor indicated that their progress still needed improvement, but struggled to provide any examples. It was unclear whether the resident score was warranted or if interpersonal issues may have been a factor.