Preceptor Orientation Program

1. Preceptor Orientation Program Developed by the Kirksville College of Osteopathic Medicine for health professions preceptors and staff members

2. THANK YOU for your interest in our preceptor training program! KCOM appreciates all the contributions preceptors make to the education of tomorrow’s practitioners.

3. Module One This is the first module in a 3-part preceptor orientation program which provides information to help you, your staff, and the student: • Get off to a good start, • Effectively manage common teaching and learning tasks, and • Collaborate to improve the feedback and evaluation process.

4. FYI • With the program file saved to your computer and in Power Point “slide show” view, slides 7-18 may advance on their own. • Red print on a slide means there’s something for you to think about or do. • To download forms shown in this program, • go to the Preceptor Orientation Module page, right click your mouse, and choose “save target as.” • Windows will then ask you to choose a folder to save the file in (remember where you put it!) • You will then be able to store the forms and print them as MS Word files.

5. The deep breath before you jump into the water . . . . • Whether it’s formally written or has simply been accumulated through living, each of us has a personal “philosophy of teaching” that guides our interactions with students. • Examination of that internal guidance system can help us significantly enhance our efficiency and effectiveness as teachers.

6. On the following 12 slides: are some “trigger phrases” to stimulate and guide your reflections in preparation for this first module of the preceptor orientation program. Please take a moment to view these phrases and reflect on your experiences and ideas about precepting.(The slides are programmed to show for 6 seconds each.)

7. As a student, my worst experience with a preceptor was when . . . .

8. The best preceptor I ever had . . . .

9. Many Preceptors need training on/about . . . .

10. If a colleague asked how to get ready for his or her first student, I would tell them . . . .

11. To make the most of my teaching time, I hope students will . . . .

12. To get the most out of a rotation, students should . . . .

13. The staff in my office think students should . . . .

14. The worst student I ever had . . . .

15. The most difficult thing about being a preceptor is . . . .

16. To help me as a teacher, the school should . . . .

17. To enhance my office as a training site, the school could provide . . . .

18. The most rewarding things about being a preceptor are . . . .

19. Warming up for the race: • Your reflections on the preceding slides should have helped focus your thoughts on the teaching-learning interaction. One further preparatory concept is: • How do you make what you know more available to you (and your students)?

20. The Reflective Practitioner • Physicians constantly reflect-in-action, but seldom reflect on and articulate their reflection-in-action. • Until practitioners learn to deconstruct and articulate their intuitive actions, students must guess at much of what appears to be the art of medicine. • As practitioners become more fluent about their intuitive skills, they can teach and mentor students in a more deliberate, effective, and efficient manner.

21. Reflective practice: • Is a complex and deliberative process of thinking about and interpreting experience (negative or positive), in order to learn from it. • Is commonly used by professionals as they meet new and different situations and challenges. • Results in a changed perceptual perspective. • Can enhance practice standards by avoiding situations that were poorly managed in the past.

22. Keys to reflective practice • Nurture mindfulness (attending to the ordinary, the obvious, and the present). (Be aware of barriers to mindfulness: fatigue, dogmatism, focus on doing (not being), unexamined negative emotions, failure of imagination, and literal-mindedness.) • Use reflection or metaprocessing (thinking about thinking or feeling) in a nonjudgmental way to become increasingly aware of the tacit knowledge and skills you use daily (and the biases you hold).

23. Some questions to guide meta-processing: • What skills and knowledge did I use in this interaction? How can I describe them clearly? • Did I hear all the patient had to say? • Is there a relationship between what I did and how the patient responded? If so, what? • What are my blind spots or biases about this patient? This family? This diagnosis? • Recognize the goals and outcomes of mindfulness and reflection: • goals -- clarity and learning from the tasks at hand • outcomes -- enhanced knowledge of processes used, and ability to communicate that knowledge.

24. Orientation to site (by staff) Preceptor Orientation Program Overview Initial conference with preceptor Teaching Adult Master Plan for student training Methods Learning Theory The first day(s) Time and Work Savers Facilitating Getting the Started Learning Questions Process Feedback and Evaluation Demonstrations Contributors to Stages of the Evaluation: Evaluation Process: Sources of Information for Evaluation:

25. To help focus, place yourself in the following situation: • You are serving as a preceptor for a 3rd year student who is completing a 4-week primary care rotation. The student approaches you in the middle of the second week of the rotation to make an appointment for an evaluation conference at the end of the clerkship. • Here in MODULE ONE of this program, we will look at things you, your staff, and the student could have already done to prepare to meet the student’s request.

26. Introduction to section content • In this section of the module, we will look at ways to get started in a manner that will help you and the student have the most positive and productive experience possible. • These suggestions will also help you avoid or successfully manage problems that occasionally arise in a training situation.

27. School Goals and Objectives Student Goals and Objectives Resources Expectations Practice Site Goals and Objectives Ground Rules Master Plan for Student Training Initial conference with preceptor Orientation to site (by staff) THE FIRST DAY(S) Getting Started

28. Ready! Set! GO!!! • Ready: Clarifying roles and responsibilities • School roles and responsibilities • Preceptor roles and responsibilities • Student roles and responsibilities • Set: Establishing rotation objectives • School objectives • Preceptor site objectives • Student objectives • GO: Planning and coordinating the student’s first day in your practice

29. READY:Clarifying Roles and Responsibilities • School Role and Responsibilities • Preceptor Role and Responsibilities • Student Role and Responsibilities

30. School Role and Responsibilities • Role: Education program designer • Provide students with stage-appropriate basic and clinical science education and training • Provide preceptors with course objectives, student profiles, evaluation guidelines and materials • Provide formal training opportunities to interested preceptors • Provide Continuing Medical Education (CME) credit for preceptors.

31. Preceptor Role and Responsibilities • Role: Teacher/Mentor/Role Model • As appropriate for their educational stage, help students begin to integrate theory and basic skills • Provide increasingly independent skills practice opportunities as the student demonstrates readiness and competence • Encourage the student to work with and learn from others including: other health care providers, office support staff, patients, and community agencies • Give feedback and evaluate student on the above skills.

32. Student Role and Responsibilities • Role: Student practitioner • Perform clinical skills under supervision with increasing competency and individual responsibility • Demonstrate professional behaviors including: motivation, integrity and accurate self-assessment • Utilize available resources for preceptor- and self-directed learning, i.e. staff, electronic tools, computer, books, and journals • Participate fully and enthusiastically in office, hospital, and community activities

33. SET:Establishing Rotation Objectives • School objectives • Preceptor site objectives • Student objectives

34. SchoolGoals and Objectives • KCOM learning objectives encompass the knowledge, skills, and attitudes required for successful performance as an entry-level intern or first year resident. (Print copies are available upon request.) • Select the school objectives which you and your staff believe you can most appropriately and effectively teach during the student’s rotation. Summarize them in PART A of the Master Plan for Student Training Form.(See form and sample on slides 36 and 37. Forms may be downloaded from Preceptor Orientation Module Page.)

35. Preceptor Site Goals and Objectives • Every office has special staff or equipment resources, unusual patient populations, or practice procedures that the student would benefit from learning about. • Work with your staff to decide which resources or unique practice features you’d particularly like to highlight with students. • Summarize the 3 or 4 most important on the PART B of the Master Plan for Student Training Form. (See form on slide 36) • Make copies of this form(like slide 37) and keep on file for future students.

38. StudentLearning Objectives KCOM Student Information Forms • Biographical data will come from the school in a variety of forms – a biographical data form, skills self-assessment, or resume/curriculum vita. (Forms can be downloaded from the Preceptor Orientation Module page for gathering biographical and professional histories.) • Most forms ask the student what he/she hopes to accomplish on the rotation. (See sample questions, sample student responses, and sample 2nd year student skills self-assessment next 3 pages)

39. Students can respond to the questions below prior to meeting with the preceptor. This information will be helpful through the initial goal-setting meetings. List the clinical rotations you have taken that have included an outpatient service. What do you specifically hope to accomplish by the end of this rotation? In addition to the basic curriculum, what types of patients would you like to see or what areas of medicine would you like to emphasize? What interviewing or physical examination skills would like to develop or improve? What educational resources do you use most often to answer clinical questions? Describe your ideal format for supervision and teaching during this rotation. What are your long-term goals? What other information should I/we know about you? Adapted from the work of Lesky, L.G. and Hershman, W.Y. “Practical Approaches to Major Educational Challenge” Archives of Internal Medicine: 1995:897-904 Ambulatory Care Student Self-Assessment (Key items from questionnaire):

40. List the clinical rotations you have taken that have included an outpatient service. I have observed approximately 20 surgeries including orthopedics and general surgery. I have also shadowed medical and radiation oncologists, a thoracic surgeon, a general surgeon and a pediatricion. I volunteered for 3 months in a pediatric war in which I assisted doctors, nurses and patients. What do you specifically hope to accomplish by the end of this rotation? By the completion of the preceptorship, I hope to be competent in basic history taking and physical exam skills and have a quality introduction to some more advanced practice techniques. I am interested in a well-balanced introduction to everyday clinical medicine and I wish to get plenty of hands-on experience. Ambulatory Care Student Self-Assessment (Sample student responses):

42. Just before the student arrives . . . . • Prior to the student’s arrival, review the Master Plan for Student Training Form with your summary of achievable school objectives and site-specific objectives. • Review the student’s biographical data, self-assessments, and written goals (and/or determine what information forms you want the student to complete when he/she arrives).

43. GO:The student’s first day in your practice • Orientation activities by staff • Initial conference with preceptor on their first day in the office

44. Student Orientation • Discuss with your staff the Ground Rules and Expectations Form(slide 45).(Download from Preceptor Orientation Module page.) • Add, delete, adapt, and edit items as needed. • Determine which items should be handled by whom.

46. Initial preceptor-student conference • VERY early in the rotation, discuss with the student and agree upon specific “student objectives for this rotation.” • Enter those into PART Cof the Master Training Form. • Display the completed Master Training Form(see sample, slide 47) in a location where you, the student, and the staff can refer to them easily and check off objectives as they are completed. (This will be a very helpful reference when it’s time for mid-rotation and final feedback and evaluation.)

48. Many thanks and much recognition to: • Terri Spear, Michelle Mollick, and Lori Schuerman who conceived, articulated, and pilot-tested KCOM’s site-based training program; • KCOM administrators, Dixie Rawlins, D.O., Mike Kuchera, D.O., Barry Robbins, D.O., who have strongly supported the idea of training resources for community-based preceptors. • Linda Heun, Ph.D., Julie Lochbaum, Ph.D., and Jeanne Kangas, Steve McKernan, D.O., Nancy Miller, and Michelle Mollick, for serving as original audiences before we took the revised materials “on the road.” • Phyllis Blondefield,Ph.D.; David Patterson; Julia McNabb, D.O.; and Stephen Laird, D.O. for assistance with development and review of these materials.

49. References: • Epstein, R. M., (1999) “Mindful Practice.” JAMA, Vol. 282, No. 9, pp. 833-839. • Lesky, L.G. and Hershman, W.Y. “Practical Approaches to Major Educational Challenge” Archives of Internal Medicine: 95:897-904. • Society of Teachers of Family Medicine, Preceptor Education Project Instructors’ Manual. Kansas City, Missouri. • Schön, Donald, The Reflective Practitioner: How Professionals Think in Action.

50. Development of this module was supported by KCOM’s Faculty Development in Family Medicine grant from DHHS, HRSA, Bureau of Health Professions, Grant Number 5D45HP50086-06.