Practical Tips for Effective Precepting Dennis McAllister R.Ph., FASHP Associate Professor of Pharmacy Practice Assistant Dean and Director of Experiential Education Midwestern University College of Pharmacy-Glendale Kevin Boesen Pharm.D. Clinical Assistant Professor Coordinator of Experiential Education University of Arizona College of Pharmacy

Congratulations! 2005 Preceptors of the Year The University of Arizona Ferena Salek, Pharm.D. Director of Pharmacy El Dorado Hospital Midwestern University – Glendale Doug Humphrey Pharm.D. Clinical Coordinator Chandler Regional Medical Center

Arizona Colleges of Pharmacy Working Together Ever feel like you are caught in the middle? (look closely at the picture)

Program Objectives n Describe important elements of clinical teaching. n Identify successful approaches to providing students with constructive feedback. n Discuss a plan or approach to resolve difficult teaching scenarios.

Lecture (5%) Reading (10%) Audiovisual (20%) Demonstration (30%) Discussion Group (50%) Practice By Doing (75%) Teach Others / Immediate Use of Learning (90%) Bethel, Maine: National Training Laboratories (1960s) Average Retention Rate after 24 hours

Characteristics of Learners ADULT LEARNERS n Problem-centered n Results-oriented n Self-directed n Often skeptical about new information n Seek relevancy n Accepts responsibility for own learning YOUTH LEARNERS n Subject-oriented n Future-oriented n Often depend on adults for direction n More accepting n Often train for unclear future n Often dependent on others

How Do We Understand Learning Today? n Humans actively create their knowledge n Knowledge is not passively received n Previous knowledge shapes new knowledge n New knowledge shapes subsequent knowledge (Joint Task Force on Student Learning, 1998, Powerful Partnerships: A Shared Responsibility for Learning,

Subsumption Theory “…The most important single factor influencing learning is what the learner already knows. Ascertain this and teach him accordingly.” (D. Ausubel, 1968)

Learning is not a spectator sport. Students do not learn much just by sitting in class listening to teachers, memorizing prepackaged assignments, and spitting out answers. They must talk about what they are learning, write about it, relate it to past experiences, and apply it to their daily lives. They must make what they learn part of themselves. - Arthur W. Chickering and Zelda F. Gamson “Seven Principles for Good Practice,” AAHE Bulletin 39:3-7, March 1987 Learning is not a spectator sport. Students do not learn much just by sitting in class listening to teachers, memorizing prepackaged assignments, and spitting out answers. They must talk about what they are learning, write about it, relate it to past experiences, and apply it to their daily lives. They must make what they learn part of themselves. - Arthur W. Chickering and Zelda F. Gamson “Seven Principles for Good Practice,” AAHE Bulletin 39:3-7, March 1987 Learning Must be Active

Learning is enhanced when learners are asked to … n State the information in their own words n Give examples of it n Recognize it in various guises and circumstances n See connections between it and other facts or ideas n Foresee some of its consequence n State its opposite or converse

Barriers to Learning n Low self esteem n Unwillingness to ask for help n Lack of confidence n Low/uncertain motivation n Inattentiveness or lack of attendance/participation n Under-developed study skills n Poor listening skills n Anxiety or fear of insecurity n Inadequate knowledge n Low expectations of self n Domestic, financial or personal worries n Physical, mental, or health conditions n Specific learning difficulties

Self directed learning n Organizing teaching and learning so that learning is within the learners’ control n A goal towards which learners strive so that they become able to accept responsibility for their own learning

Self efficacy – roles for the teacher n Modeling or demonstration n Setting a clear goal or image of the desired outcome n Providing basic knowledge and skills needed as the foundation for the task n Providing guided practice with corrective feedback n Giving students the opportunity to reflect on their learning

Applying Adult Learning to the Rotation Experience n Setting expectations n Motivating n Precepting practice n Evaluating

EXPECTATIONS n Statement of what a student needs to know, do, or feel as a result of an educational experience

ORIGINS OF EXPECTATIONS n College of Pharmacy guidelines or objectives n Characteristics of one’s own pharmacy n Student or preceptors progress report n Student’s individual needs and preferences

SETTING EXPECTATIONS n Make the student feel welcomed at the practice site n Set realistic goals and objectives based on the student’s skills and experiences and on the objectives of the rotation n Establish a work schedule - review at mid-point allowing student input n Convey requirements for professional attitude

DETERMINE EXPECTATIONS WITH STUDENT n At the beginning of the rotation n Make expectations specific n Put it in written form n Ensure that an activity is indicated for each expectation n Make expectations flexible

MOTIVATION n To provide with an incentive; move to action

PRECEPTOR AS A MOTIVATOR n Gain student’s attention n Explain relevance n Instill confidence n Reinforce appropriate behavior and performance

PRECEPTOR GUIDELINES: MOTIVATION n Emphasize problem solving approach n Relate concepts in a meaningful way n Demonstrate genuine interest in student n Approach teaching and patient care with energy and good attitude n Relate new concepts to student’s prior learning n Be readily accessible to student n Discuss personal weaknesses and strengths

PRECEPTING PRACTICE n Perform a behavior to be mastered by the student n Explain the behavior - what was done and why n Have the student perform the behavior n Provide feedback

EVALUATION & FEEDBACK n Evaluate the student based on criteria established at the beginning of the rotation n Advise the student of his/her progress regularly n Correct the student constructively and praise for good work n Discuss progress throughout the rotation n Conduct an end-of-rotation evaluation

FEEDBACK CAN BE: n Reinforcement for appropriate practice n Reinforcement for appropriate practice n Constructive criticism for inappropriate performance 

PRECEPTOR GUIDELINES: FEEDBACK n Evaluate the student based on criteria established at the start of the rotation n Advise the student regularly of progress n Correct the student constructively and praise for good work n Let the student know who has input n Discuss progress throughout the rotation n Conduct an end-of rotation evaluation “Preceptor responsibility for supervising pharmacy intern” AJHP Vol. 57, No. 1, January 1, 2000

The Microskills Teaching Model n A 7-step approach to structure effective precepting encounters that last five minutes or less OR address problems that arise during teaching sessions.

Clinical Teaching Microskills n 1. Set Expectations n 2. Get a Commitment n 3. Probe for Supporting Evidence n 4. Reinforce Good Performance n 5. Correct Mistakes n 6. Teach General Rules n 7. Reflection and Integration

Set Expectations n Collaborative goal setting with your learner has set the stage for learning to occur with each patient encounter. n Communicate with student before the patient encounter. n Select patients based on the potential for learning.

Get a Commitment n After presenting a case, students will usually stop to wait for your response and asks for guidance. n Instead, ask the student to state what they think about the data. –“What do you think is going on with this patient?”

Probe for Supporting Evidence n Before offering your opinion, ask the learner for the evidence that supports their opinion. n Ask what alternatives were considered and the evidence that refuted those alternatives.

Reinforce Good Behavior n Skills that are not well established need to be reinforced. n Comment on: –The specific good behavior –The effect it had

Correct Mistakes n If not corrected, errors are likely to be repeated. n Do this after the student has self-analyzed (they may correct the mistake themselves). n As soon after the mistake as possible, find a time and place to discuss –What was wrong –How to correct the problem –Avoid the error in the future

Teach General Rules n Find opportunities to extend the students knowledge and experience. n Provide general rules, concepts, or considerations. “If a patient is over 65 and presents similar to “Miss Jones” it is important to ask her about…

Encourage Reflection and Integration n Reflection reinforces learning and integration with previous knowledge/ experience. n Make a habit of “debriefing.” –“Who was the most interesting patient today?” –“How is the practice different from your expectations?”

Scenario One n You asked a student to obtain information to dose a patient. The student must go to the nursing unit, find the patient’s chart, extract the information and return to the pharmacy. The student is in the final professional year and you are sure that this task is a familiar one for that individual. You expect that this task should take approximately minutes and the student is gone for almost 90 minutes. Exasperated, you say, “Where were you? This was a simple task and you took forever”! Discuss what went wrong How could this have been avoided?

Scenario Two n You told the student to prepare an inservice to be presented in 3 weeks on pain management in the dying patient. You supply numerous resources for information and give ample time to prepare. The day arrives for the presentation and you sit in the room to observe. A one paragraph outline is used for a handout and the presentation lasts 10 minutes. (You reserved the room for an hour and provided snacks.) Discuss what went wrong How should this be approached next time?

Scenario Three n A student is assigned to your site during April of their last year in school. Whenever you are not immediately supervising, the student disappears for 1-2 hours. After numerous occurrences, you ask about the problem. The student confides that he/she is terrified of the board exam and tries to study whenever possible. Discuss how to approach the student about the issue What can be done to assist the student while fulfilling the objectives of the rotation?

Scenario Four n It is the last rotation of the year and your student is consistently performing at or below minimum requirements. You have had 2 mid-rotation verbal evaluations and, at the final evaluation, you inform the student that his/her performance was not sufficient to pass this rotation. The student becomes emotional and claims that graduation will be delayed due to you. What is the preceptor’s role in grading? Could this outcome have been prevented?

Scenario Five n You are observing a student counseling a patient on a complicated regimen. The appropriate points are covered, the patient is satisfied, and the student is confident that he/she has done a good job. You say, “Good job!” and return to your work. What, if anything, could have been done to make this more of an educational experience? What else could have been said?

Scenario Six n A student attempts to provide a pharmacokinetic consult and has apparently done everything according to the book. They are confident that all will occur as planned. The results are returned the next day and are dangerously high. The student is devastated and loses confidence in their future ability to practice pharmacy. How can you spin this into an educational exercise?

Scenario Seven n The rotation is ending and you ask the student into your office for the evaluation. You thank him/her for their participation at the site, tell them everything was fine, and wish them luck. You sign the evaluation forms and ask the student to fill in the necessary information. What is missing?

Scenario Eight n You must leave on vacation prior to the rotation ending so you complete the evaluation with the student, leaving some final assignments to be completed during the last few days. You return to find the student did not complete the activities and you have already submitted the grade assuming that all assignments would be completed. What should you do?

Tell me and I’ll forget; Show me and I may remember; Involve me and I’ll understand. Chinese Proverb