1. Precepting Challenging Students
Faculty Development UCLA Multicampus Program in Geriatric Medicine and Gerontology
Precepting Challenging Students
Sponsored by:
The Donald W. Reynolds Foundation
Faculty Development to Advanced Geriatric Education (FD~AGE) 1

2. Objectives Communicate and set expectations for trainees’ performance
Analyze trainees' difficulties in oral case presentations
Recognize and correct own improper precepting behavior and attitude
Recognize and correct inappropriate behavior and attitudes of challenging trainees
This slide lists what the participants will learn during this exercise. 2

3. Challenging Students
Trainees do not exhibit a lack of knowledge or skills because of insufficient interest or caring.
Errors in knowledge or skills are typically the result of
insufficient preparation,
limited experience,
and inadequate feedback.
This slide discusses potential reasons for mistakes by trainees. 3

4. Behaviors of Effective Preceptors
Set clear and appropriate expectations
Stimulate interest enthusiastically
Give meaningful responsibility and allow students to contribute
Role model desired behaviors
Provide constructive feedback
Involve the learner in the teaching process
These points will be discussed in greater detail in later slides. 4

5. Pitfalls in Precepting
“Taking over” the case
Giving inappropriate lectures
Asking unfair questions (e.g., “What am I thinking?”)
Giving insufficient time for thinking and reflecting
Giving only positive feedback
Having unclear or unreasonable expectations
Bullet 1: preceptor fails to allow trainee to articulate assessment and plan
Bullet 2: preceptor launches into medical lecture during the presentation
Bullet 3: preceptor expects trainee to guess what is expected of him/her
Bullet 4: preceptor does not allow trainee time to think before the preceptor answers his/her own question
Bullet 5: preceptor offers only praise and offers no constructive criticism
Bullet 6: preceptor does not explain what is expected from trainee or expects performance which is beyond trainee’s level of training 5

6. Setting Expectations Understanding Orientation Expectations
Level of training and experience
Special interests and goals
Orientation
Setting, facilities, medical records
Responsibilities and autonomy
Expectations
Oral presentations
Written documentation
Assessments and plans
Bullet 1: Preceptor must understand/discover trainee’s training and skill level and trainee’s career goals and interests in order to stimulate trainee’s interest and teach appropriately
Bullet 2: Preceptor must ensure that trainee understands the workings of the training setting and his/her level of responsibility and autonomy in the setting
Bullet 3: Preceptor must clarify what is expected of trainee in each category in advance 6

7. Feedback Facts
Students recognize feedback from faculty in only 3-6% of case presentations
(Irby, 1995)
Positive feedback is given more often than negative
Feedback given to residents has been linked to improved patient satisfaction
Bullet 1: Trainees do not understand that they are receiving feedback most of the time, so it is necessary for preceptor to identify his/her comments as “feedback.” (Irby, DM. Teaching and learning in ambulatory care settings; a thematic review of the literature. Acad Med 1995;70: )
Bullet 2: Preceptors are often reluctant to give “negative feedback,” but constructive criticism is necessary for trainee’s growth and development into an effective physician
Bullet 3: Patient satisfaction studies have linked attending feedback to residents to higher patient satisfaction 7

8. Giving Feedback The Feedback “Sandwich”
What was done right
What needs improvement
What to do next time
Effective feedback, which helps trainees improve, has 3 components, given in that order. 8

9. Feedback Pearls
Get their attention, “Now I’m going to give you some feedback about your presentation.”
Give feedback now. Don’t wait.
Link to goals and objectives.
Link feedback to modifiable behaviors.
Be specific.
Make it constructive.
Bullet 1: (self explanatory)
Bullet 2: (self explanatory)
Bullet 3: “Goals and objectives” means the official ACGME approved goals and objectives of the rotation.
Bullet 4: Make sure that you set reasonable and achievable expectations when giving feedback.
Bullet 5: (self explanatory)
Bullet 6: Do not just criticize. Explain how to improve. 9

10. Feedback Pearls (continued)
Make sure feedback is understood
Don’t give too much
Expect learners to develop skills in self assessment
Follow-up your feedback
Bullet 1: Ask trainee if he/she understands and/or ask him/her to explain it back to you.
Bullet 2: When overwhelmed with too much content, trainees will not remember any of it.
Bullet 3: Ask trainees how they thought they performed in response to your previous constructive criticism.
Bullet 4: There are many options for following up on feedback, for example:
Ask trainee to submit new write-up incorporating your feedback
Tell trainees that you expect your feedback to be reflected in future presentations, and make sure that it happens
Ask higher level trainee (e.g. resident on medical student's team) to review presentations with trainee prior to next presentation to you
Make sure to praise trainee for improvements made in response to your feedback over time 10