Transcript INTERNSHIP AND CLERKSHIP The legal and academic

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
Describe important elements of clinical
teaching.
 Identify successful approaches to
providing students with constructive
feedback.
 Discuss a plan or approach to resolve
difficult teaching scenarios.
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Average Retention
Rate after 24 hours
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)
Characteristics of Learners
ADULT LEARNERS
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Problem-centered
Results-oriented
Self-directed
Often skeptical about new
information
Seek relevancy
Accepts responsibility for
own learning
YOUTH LEARNERS
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Subject-oriented
Future-oriented
Often depend on adults
for direction
More accepting
Often train for unclear
future
Often dependent on
others
How Do We Understand
Learning Today?
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Humans actively create their knowledge
Knowledge is not passively received
Previous knowledge shapes new knowledge
New knowledge shapes subsequent knowledge
(Joint Task Force on Student Learning, 1998, Powerful Partnerships:
A Shared Responsibility for Learning, http://www.aahe.org)
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 Must be Active
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 enhanced when
learners are asked to …
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State the information in their own words
Give examples of it
Recognize it in various guises and
circumstances
See connections between it and other facts or
ideas
Foresee some of its consequence
State its opposite or converse
Barriers to Learning
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Low self esteem
Unwillingness to ask for
help
Lack of confidence
Low/uncertain motivation
Inattentiveness or lack of
attendance/participation
Under-developed study
skills
Poor listening skills
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Anxiety or fear of
insecurity
Inadequate knowledge
Low expectations of self
Domestic, financial or
personal worries
Physical, mental, or
health conditions
Specific learning
difficulties
Self directed learning
Organizing teaching and learning so
that learning is within the learners’
control
 A goal towards which learners strive so
that they become able to accept
responsibility for their own learning
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Self efficacy –
roles for the teacher
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Modeling or demonstration
Setting a clear goal or image of the desired
outcome
Providing basic knowledge and skills needed
as the foundation for the task
Providing guided practice with corrective
feedback
Giving students the opportunity to reflect on
their learning
Applying Adult Learning to the
Rotation Experience
Setting expectations
 Motivating
 Precepting practice
 Evaluating
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EXPECTATIONS
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Statement of what a student needs to
know, do, or feel as a result of an
educational experience
ORIGINS OF EXPECTATIONS
College of Pharmacy guidelines or
objectives
 Characteristics of one’s own pharmacy
 Student or preceptors progress report
 Student’s individual needs and
preferences
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SETTING EXPECTATIONS
Make the student feel welcomed at the
practice site
 Set realistic goals and objectives based
on the student’s skills and experiences
and on the objectives of the rotation
 Establish a work schedule - review at
mid-point allowing student input
 Convey requirements for professional
attitude
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DETERMINE EXPECTATIONS
WITH STUDENT
At the beginning of the rotation
 Make expectations specific
 Put it in written form
 Ensure that an activity is indicated for
each expectation
 Make expectations flexible
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MOTIVATION
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To provide with an incentive; move to
action
PRECEPTOR AS A MOTIVATOR
Gain student’s attention
 Explain relevance
 Instill confidence
 Reinforce appropriate behavior and
performance
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PRECEPTOR GUIDELINES:
MOTIVATION
Emphasize problem solving approach
 Relate concepts in a meaningful way
 Demonstrate genuine interest in student
 Approach teaching and patient care with
energy and good attitude
 Relate new concepts to student’s prior
learning
 Be readily accessible to student
 Discuss personal weaknesses and strengths
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PRECEPTING PRACTICE
Perform a behavior to be mastered by the
student
 Explain the behavior - what was done and
why
 Have the student perform the behavior
 Provide feedback
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EVALUATION & FEEDBACK
Evaluate the student based on criteria
established at the beginning of the rotation
 Advise the student of his/her progress
regularly
 Correct the student constructively and
praise for good work
 Discuss progress throughout the rotation
 Conduct an end-of-rotation evaluation
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FEEDBACK CAN BE:
Reinforcement for appropriate
practice
 Constructive criticism for inappropriate
performance
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PRECEPTOR GUIDELINES:
FEEDBACK
Evaluate the student based on criteria
established at the start of the rotation
 Advise the student regularly of progress
 Correct the student constructively and
praise for good work
 Let the student know who has input
 Discuss progress throughout the rotation
 Conduct an end-of rotation evaluation
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“Preceptor responsibility for supervising pharmacy intern”
AJHP Vol. 57, No. 1, January 1, 2000
The Microskills
Teaching Model
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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
1. Set Expectations
 2. Get a Commitment
 3. Probe for Supporting Evidence
 4. Reinforce Good Performance
 5. Correct Mistakes
 6. Teach General Rules
 7. Reflection and Integration
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Set Expectations
Collaborative goal setting with your
learner has set the stage for learning to
occur with each patient encounter.
 Communicate with student before the
patient encounter.
 Select patients based on the potential
for learning.
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Get a Commitment
After presenting a case, students will
usually stop to wait for your response
and asks for guidance.
 Instead, ask the student to state what
they think about the data.
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– “What do you think is going on with this
patient?”
Probe for Supporting Evidence
Before offering your opinion, ask the
learner for the evidence that supports
their opinion.
 Ask what alternatives were considered
and the evidence that refuted those
alternatives.
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Reinforce Good Behavior
Skills that are not well established need
to be reinforced.
 Comment on:
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– The specific good behavior
– The effect it had
Correct Mistakes
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If not corrected, errors are likely to be
repeated.
Do this after the student has self-analyzed
(they may correct the mistake themselves).
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
Find opportunities to extend the
students knowledge and experience.
 Provide general rules, concepts, or
considerations.
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“If a patient is over 65 and presents similar
to “Miss Jones” it is important to ask her
about…
Encourage
Reflection and Integration
Reflection reinforces learning and
integration with previous knowledge/
experience.
 Make a habit of “debriefing.”
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– “Who was the most interesting patient
today?”
– “How is the practice different from your
expectations?”
Scenario One
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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 15-20 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
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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
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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
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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
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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
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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
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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
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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