A Preceptor Primer: How to Become a “Top-Notch” Preceptor for Pharmacy Students

1. A Preceptor Primer:How to Become a “Top-Notch” Preceptor for Pharmacy Students Laurie L. Briceland, Pharm.D., FASHP, FCCP Professor of Pharmacy Director, Experiential Education Albany College of Pharmacy and Health Sciences

2. Learning Objectives • Understand and internalize that in your role as preceptor, you are a tangible and powerful role model for students. • Describe four key attributes that lead one to become an effective preceptor. • Specify the characteristics of an optimal learning environment at the experiential practice site, and develop realistic rotation objectives & expectations of students. • Evaluate and express to the student critical formative and summative feedback throughout the experiential rotation. • Analyze & accept pertinent constructive critique of the experiential offering from the students. • Commit yourself to ongoing preceptor development & networking opportunities.

3. Understanding the Preceptor Role: What is a “Preceptor”? • preceptor n. A teacher; an instructor. An expert or specialist, such as a physician, who gives practical experience and training to a student (Answers.com) • A preceptor is a qualified practitioner who provides transitional role support and effective clinical learning for a student within a collegial partnership. • A preceptor supports the growth and development of a student for a predetermined length of time with the specific purpose of socializing and integrating that student into a new role • A preceptor wears the hat of teacher, tutor, mentor, facilitator, and coach • (Northeast Wisconsin Tech College Respiratory Care Practitioner Program)

4. …It All Depends on the Preceptor!

5. “Positive Role Model” Attributes Accreditation Council for Pharmacy Education Standards 2007 • Practice ethically, w/ compassion for patients • Accept personal responsibility for patient outcomes • Have professional training, experience, and competence commensurate with their position • Utilize clinical and scientific publications in clinical care decision making and evidence-based practice

6. “Positive Role Model” Attributes Accreditation Council for Pharmacy Education Standards 2007 • Have a desire to educate others (patients, care givers, health care professionals, students, residents) • Have an aptitude to facilitate learning • Be able to document and assess student performance • Have a systematic, self-directed approach to their own professional development • Collaborate with other health care professionals as a member of a team • Be committed to their organization, professional societies, and the community

7. Ongoing Preceptor Development • “Continuous Professional Development” • Careful Study of college-sponsored course materials • Accept students’ critique of rotation as means of “CQI”, and be open to making rotation changes • Try new things that are suggested by others • Liaise w/ other preceptors of similar type rotations • (e.g., cases, journal club, seminars, industry contacts, rotation ideas)

8. Four Keys toThe Effective Preceptor: Communications! • Explains the basis for actions & decisions • Answers learner questions clearly & precisely, in non-judgmental manner • Is open to conflicting ideas and opinions • Communicates clear goals & rotation objectives • Provide written rotation schedule on day 1 • Review rotation objectives on day 1; ask students for any modifications • Holds Realistic Expectations of students: • #, type, quality of assignments • Captures learners attention & makes learning fun! • Makes the learner feel like a priority

9. Four Keys to The Effective Preceptor: Communications! • Educate Practice Site Personnel as to student’s role & responsibilities • Keep College Experiential personnel “in the loop” • At rotation midpoint, final • As needed, especially if concerns w/ student’s professionalism, attendance, • Exhibit good communication/interpersonal skills w/ students (respond to emails/calls; review/critique assignments in timely fashion; be prompt for meetings; do not accept phone calls during student meetings) • Exercise care when critiquing one student in presence of another

10. Four Keys to The Effective Preceptor: Careful Analysis of the Learner • Accurately assesses the learner’s knowledge, attitudes and skills • Uses direct observation of the learner • Provides frequent and effective feedback to students on rotation • Performs fair and thoughtful evaluations • Documents student progress frequently, giving ample “warning” and opportunity for improvement if rotation failure is a strong possibility • If remediation necessary, uses the Evaluation/Outcomes document to gauge student performance and conduct more frequent (than midpoint/final) evaluations w/ clear instruction on progression

11. Four Keys to The Effective Preceptor: Skillful Teaching and Practice • Demonstrates skillful interactions with patients • Provides effective role modeling • Presents information with organization and clarity • Organizes and controls the learning experience • Gives appropriate responsibility to the learner • Balances clinical and teaching responsibilities • Provides ample learning opportunity at the site (perform activity, be evaluated, see outcomes of interventions/projects)

12. Four Keys to The Effective Preceptor: Motivating the Learner • Emphasizes problem solving • Promotes active involvement of the learner • Demonstrates enjoyment and enthusiasm for patient care and teaching • Develops a supportive relationship with the learner

13. The Optimal Experiential Learning Environment Kolb’s Cycle of Experiential Learning

14. Importance of Feedback Process • Assure that the future pharmacist has the knowledge, skills, attitudes appropriate for the profession • Assist the student in assessing strengths and weaknesses • Identify specific strategies for the student’s improvement • Contribute to the student’s growth and development (“lifelong learner”)

15. Principles to Guide Feedback • Feedback should be.. • Constructiveso that students feel encouraged and motivated to improve their practice • Timelyso that students can use it for subsequent learning and work to be submitted • Prompt so that students can recall what they did and thought at the time • Supportive of learningshould be linked to a clear statement of orderly progression of learning so that students have clear indications of how to improve their performance

16. Principles to Guide Feedback • Feedback should be.. • Focusedon achievement, not effort. The work should be assessed, not the student • Specific to the learning outcomesso that assessment is clearly linked to learning • Consequentialso that it engages students and they are required to attend to feedback, removing the need for continually giving the same student the same advice • Fostering of independenceso that it leads students to being capable of assessing their own work • Efficient for staff to do.

17. Feedback: More than a Final Evaluation/Meeting and Grade • Ongoing process • Beginning: setting rotation expectations • During: continual observation and assessment of student’s performance; specific feedback to the student • Final: incorporate “During” assessments into final evaluation session • Individualized – there is no “one size fits all”

18. GRADE Strategy • G: Get ready • Review course syllabi, standardized objectives, evaluation form • Consider incorporation of site-specific unique opportunities • Set student expectations (factor in rotation sequencing; prior experiences; IPPE or APPE, etc.) Langlois JP and Thach S. Evaluation Using the GRADE Strategy. Fam Med 2001;33(3):158-60.

19. GRADE Strategy • R: Review Expectations w/ Student • Meet early (day one) to review objectives • Determine student’s knowledge, skill level, previous experience (portfolio) • Review goals (preceptor, program, student) • Describe feedback/evaluation process Langlois JP and Thach S. Evaluation Using the GRADE Strategy. Fam Med 2001;33(3):158-60.

20. GRADE Strategy • A: Assess • Observe student in rotation activities • Record observations frequently • Provide Timely, Specific Feedback routinely to student • Include Positives & Negatives • Include Program Coordinator if needed • Ask student to self-assess Langlois JP and Thach S. Evaluation Using the GRADE Strategy. Fam Med 2001;33(3):158-60.

21. GRADE Strategy • D: Discuss assessment @ Midpoint • Set Formal Meeting • Preceptor & Student fill out evaluation form in advance • Compare evaluations together; rectify differences • “Formative” feedback: agree upon plan for continuation and improvement Langlois JP and Thach S. Evaluation Using the GRADE Strategy. Fam Med 2001;33(3):158-60.

22. GRADE Strategy • E: End with a Grade • Schedule formal meeting • Complete evaluation in advance • Support evaluation with documentation • Highlight items to work on in future • “Summative” grade Langlois JP and Thach S. Evaluation Using the GRADE Strategy. Fam Med 2001;33(3):158-60.

23. Potential Evaluation Pitfalls • Halo Effect • Certain traits (negative or positive) cause preceptor to overlook important aspects • Enthusiastic, caring individual w/ lackluster skills receives A grade; • “Oops” – Insufficient Documentation • Describing shortcomings without providing specifics • “your work is sloppy; your manner is abrupt” Langlois JP and Thach S. Evaluation Using the GRADE Strategy. Fam Med 2001;33(3):158-60.

24. Potential Evaluation Pitfalls • “But You Never Told Me That” • Stating at rotation end that student hasn’t met expectations when expectations were not spelled out • When in doubt –spell out again, in writing • “But I need a high grade” • Student presses for high grade • Provide documentation to support your assessment Langlois JP and Thach S. Evaluation Using the GRADE Strategy. Fam Med 2001;33(3):158-60.

25. Potential Evaluation Pitfalls • “Last day: Should the Student Pass?” • Realizing on the final day that student has been and remains sub-standard and he/she should not pass • Crucial to contact program official earlier in rotation • Lake Wobegon Effect • All students rated above average • Disservice to students, profession, etc. Langlois JP and Thach S. Evaluation Using the GRADE Strategy. Fam Med 2001;33(3):158-60.

26. Case Study #1: Lack of Knowledge/Application • Student is assigned to your advanced pharmacy practice ambulatory care rotation; it is the first APPE rotation of the year and the student has no previous work experience except for 4-week IPPE in community setting. • During the first week, the student does not know routinely used “top 280” drugs, doses, indications. Student lacks confidence in counseling, and shies away from it. When directly requested to counsel a patient, student did so with great difficulty; you witness several errors in the counseling and step in to correct for the patient. Student is unable to demonstrate use of MDI for asthmatic patient. • What are your options as primary preceptor??

27. Case #1: Preceptor Options • 1. Call the College Experiential Personnel • 2. Document in writing the specific shortcomings (specific examples of lack of knowledge or application of such), and provide this feedback to student promptly • 3. Devise plan for improvement with specific timeline: by Friday, I expect… • 4. Assign additional work products in which students can demonstrate improvements • 5. Provide frequent feedback informally and formally (“midpoint” – can do multiple evaluations) • 6. Recognize that not all rotations will be “salvageable” - meaning some deficiencies cannot be rectified ever or in the timeframe needed: lead to remediation

28. Case #1: Remediation Options • Repeat similar rotation experience • Review certain therapeutics areas (class notes, textbooks, case studies) • Work (part-time) in pharmacy practice setting • Read, read, read • Refer to college counseling for time management skills

29. Case Study #2: Communications • A student with previous hospital experience is assigned to your hospital rotation, in which she will be assigned to work with many pharmacists within the facility. • Several pharmacists report to you that the student basically refuses to follow your hospital policy, citing that it is “all wrong” and that Hospital X teaches us to do it a more efficient way. You are aware of Hospital X’s policies, and have purposefully selected your own methods for your own reasons. The student continues to ruffle feathers of your staff. • What are your options?

30. Case #2: Preceptor Options • 1. Call the College Experiential Personnel • 2. Document in writing the specific shortcomings (specific examples of poor communications), and provide this feedback to student promptly • 3. Devise plan for improvement with specific timeline: by Friday, I expect… • 4. Provide frequent feedback informally and formally (“midpoint” – additional prn) • 5. Recognize that it is possible this student will not change his/her ways and will not be able to continue at your site because of inability to communicate with the staff.

31. Case #2: Remediation options • Refer to college counseling for appropriate services (depression, anxiety, coping, time management, eating disorders, etc.)

32. Case #3: Professionalism • Student is on your hospital rotation and is overheard by several of the pharmacy staff in the breakroom as saying that this rotation is “useless –I am counting the days” and “my preceptor is the worst I’ve ever had”. This information is reported to you. • The nurses on the two units report that your student has been rude in trying to obtain patient charts on their floors. • What are your options as preceptor?

33. Case #3: Preceptor Options • 1.Call the College Experiential Personnel • 2. Document in writing the specific shortcomings (specific examples of lack of professionalism), and provide this feedback to student promptly • 3. Devise plan for improvement with specific timeline: by Friday, I expect… • 4. Provide frequent feedback informally and formally (“midpoint” – can do multiple evals) • 5. Recognize that it is possible this student will not change his/her ways and will not be able to continue at your site because of inability to behave in a professional manner.

34. Case #3: remediation options • Assign student to write paper on professionalism, after researching topic

35. Professionalism • Erosion of Values & Civility in today’s society (lack of politeness, manners, courtesy; cell phones in public; road rage; culture of self-absorption) • Pharmacy education (locally & nationally) has re-emphasized professionalism by: • Developing/implementing explicit standards of conduct (email, computer use in classroom, no plagiarism) • Developing a continuum of expectations and accountability throughout the curriculum for students in a professional program (labs, IPPEs, APPEs): work ethic, communications w/ site, meeting deadlines • Instituting professional ceremonies (White Coat) • Producing a White Paper and Toolkit on Professionalism

36. Professionalism References • 1. Boyle CJ, Beardsley RS, Morgan JA, et al. Professionalism: A determining factor in experiential learning. AJPE 2007; 71(2): 1-7. • 2. APhA-ASP/AACP-COD Task Force on Professionalism: Toolkit for professionalism 2005. Available at http://www.aphanet.org/students/ • 3. APhA-ASP/AACP-COD Task Force on Professionalism: White paper on pharmacy student professionalism. JAPhA 2000;40:96-102. • 4. Hammer DP, Berger BA, Beardsley RS et al. Student professionalism. AJPE 2003; 67(3): article 96.