Precepting: Helping Learners Succeed

In this episode, listen in as our expert panelists discuss tips for creating successful learning experiences for students and residents.  We’ll review various teaching tools and summarize strategies for incorporating learners into your practice. We’ll also discuss different approaches for providing meaningful feedback and managing challenging situations with learners.

Our panel for this conversation includes: 

• Andrea Darby Stewart, MD; Associate Director, Honor Health Family Medicine Residency Program; Clinical Professor of Family, Community & Occupational Medicine, University of Arizona College of Medicine – Phoenix
• Mary Franks, MSN, APRN-FPA, FNP-C; Nurse Planner, NetCE; Adjunct Professor, Bradley University; Nurse Practitioner, Carle Health
• Megan Smith, PharmD, BCACP; Associate Professor, College of Pharmacy, University of Arkansas for Medical Sciences (UAMS); Residency Program Director, UAMS Community-Based Residency Program
• Craig D. Williams, PharmD, FNLA, BCPS; Clinical Professor of Pharmacy Practice, Oregon Health and Science University

None of the speakers have anything to disclose. 

TRC Healthcare offers CE credit for this podcast. Log in to your Pharmacist’s Letter or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.

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The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter and Prescriber Insights: 

• Toolbox: Preceptor’s Guide
• FAQ: Prevention and Management of Burnout for Healthcare Professionals 

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Transcript

This transcript was automatically generated.

[Music Bed Starts]

CRAIG WILLIAMS (00:07):

"I liken it a bit to… people ask, “When am I ready?” because we’re always looking for new sites for our students and people are like, “I don’t know if I’m ready to take on a student" and it’s similar to becoming a parent, you’re never fully, ready, but at some point, if you’re generally prepared, you’re generally going to be fine."

ANDREA DARBY-STEWART (00:24):

"We all want to help people and we tend to give away the answers, but that doesn’t allow us to actually figure out how they’re thinking clinically, and that’s our whole job. There is no way for any of us to teach the breadth of medicine or pharmacy, our job is to teach people how to think clinically, so they can apply that information across their career."

NARRATOR (00:45):

Welcome to Medication Talk, the official podcast of TRC Healthcare, home of Pharmacist’s Letter, Prescriber Insights, RxAdvanced, and the most trusted clinical resources.

[Music Bed Stops]

On today’s episode, listen in as our expert panelists discuss tips for creating successful learning experiences for students and residents.  We’ll review various teaching tools and summarize strategies for incorporating learners into your practice. We’ll also discuss different approaches for providing meaningful feedback and managing challenging situations with learners.  
Our panel for this conversation includes:

Dr. Andrea Darby Stewart from The University of Arizona College of Medicine – Phoenix
Mary Franks from Bradley University and Carle Health
Dr. Megan Smith from the University of Arkansas for Medical Sciences
and Dr. Craig Williams from the Oregon Health and Science University.

This podcast is an excerpt from one of TRC’s monthly live CE webinars. Each month, experts and frontline providers discuss and debate challenges in practice, evidence-based practice recommendations, and other topics relevant to our subscribers.

The full webinar originally aired on July 23rd, 2024.

[Whoosh Sound]

[Music Bed Starts]

NARRATOR 2 (01:55):

And now, the CE Information.

[Whoosh Sound]

NARRATOR (01:59):

This podcast offers Continuing Education credit for pharmacists, physicians, and nurses. Please log in to your Pharmacist’s Letter or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.

None of the speakers have anything to disclose. 

[Music Bed Stops]

[Whoosh Sound]

Now, let’s join TRC Editor, Dr. Sara Klockars, and start our discussion!

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SARAH KLOCKARS (02:24): 

So to kick off today's discussion and give us some background I'm gonna have the panelists briefly share their role as a preceptor. And Andrea I was hoping you can start and let us know how long you've been precepting, your practice setting, and what your current interactions are with students, residents, and and any other learners you may encounter. 

ANDREA DARBY-STEWART (02:46):

Thanks so much Sarah. 

Absolutely so I've had the privilege of teaching in graduate medical education and as well as undergraduate medical education for the last twenty four years. I'm a family physician by training and have served as clinical faculty, associate program director, and even more in the mantle of program director of two different programs. I currently precept our residents in the family medicine residency program in both the ambulatory and the inpatient settings. And I have a lot of fun, particularly with our first year medical students from the University of Arizona during their continuity clinic experience.

SARAH KLOCKARS (03:25):

Wonderful and Mary? 

MARY FRANKS (03:28):

So I am an adjunct faculty professor for Bradley University. So, while I also precept students I also help them on the Bradley side as well with their FMP program. I particularly work, my urgent care practice PRN. So…the majority of the students I have are the FMP program I usually get the students towards their fifth and final semester.

SARAH KLOCKARS (03:56):

Perfect. Megan. 

MEGAN SMITH (04:00):

What I do uh at the UAMS, University of Arkansas for Medical Sciences, as a full time faculty position, I've precepted…Abby students in different levels of learners for about ten years. And since I've been here at UAMS I developed a at the elective as well as precepting direct patient care in the community's pharmacy settings. And then for the past seven years I've been a resident program director for our PGY1 community based residency where we host up to seven residents. And so I oversee their experiences and aggression. And then I have a new role where I'll be directing community advanced pharmacy practice experiences the whole college and helping with preceptor development over the next few years. And so that role just started, so I'm really excited and happy to be here today. 

SARAH KLOCKARS (04:50):

Awesome Thank you for joining us and Craig. 

CRAIG WILLIAMS (04:54):

I've been doing this almost exactly as long as Andrea has, so I'm a mid-nineties graduate and then went straight into residency and then academia and I've been now more hospital focused for the last ten plus years but first part of my life was in an ambulatory setting, and so experience mostly with family medicine and medicine residents. And then the pharmacy side both the senior fourth year students and their advanced practice clerkships and then the anywhere from first through third year on their introductory, clerkship experiences and in the last seven or eight years, we're seeing a lot more of the junior medical students with us at the hospital as well. So, a broad swath going on three decades of doing this. 

SARAH KLOCKARS (05:36):

Well great. Thank you so much for all that background everyone, I love how we have a little bit of everything, so that is great. I think that's gonna be really helpful as we move on to how you prepare for students and how you kick off an experiential experience.

What type of advice…do you have to help prepare people who might be being their first student or resident on a rotation or experiential experience? And I will ask you Megan, to answer that first.

MEGAN SMITH (06:08):

Thank you so much. And you may see a key theme from my answers and things that um really motivated me over the last few years in increasing the number of learners that I take on experiences with me which is to involve our students in practice transformation, or you may know of it as practice advancement activities or anything that… the way I describe it to preceptors is what is that thing on the back burner that you haven't gotten to yet cause you don't have time? What are those activities or what are those ways that you're wanting to improve the practice as a whole or your specific practice and let those students be a part of a real problem and develop, like a plan and a solution with you with your guidance. I think that's just as what I've learned in the last few years What I've grown is as important it is of course for us to teach them and to in part some of our wisdom, it's just as important and should also be improving our practice too And we're really seeing that a lot of opportunities in the community based settings because we're doing things we've historically haven't done like, test and treat, prescribing, doing a lot of assessments, doing a lot more collaborative work And so there's new ground to be broken and it's very dual benefit for you and your practice and for the student to get them involved in solving those problems as well. 

So how I prepare um or students and I go through this process…every month I promise you every month I have to pre plan and identify what is the nugget What's that little project that they're gonna help me with to get me from point a point B. It might not be launching a full service like point of care testing from the ground up but it might just help me with that overall goal What is just something one step to get me closer to that But I might target other pharmacies so I do an elective as well as um direct patient care myself So if they're on my elective, I'm actually serving multiple pharmacies and so we look towards what's something going on that relevant in practice that another pharmacy is really trying to get off the ground and we target those. So with that I'm trying to really think of what's relevant what's something really interesting and unique that a student can help learn from but also contribute to And with that I'll create a syllabus with defining that project defining who their contact is, outlining the specific like what my expectations are and outcomes and with a specific calendar so they know where to be and where to go And Sometimes my syllabi are kind of bare bones and they're scared on the first day This is where you need to be and what you're doing and all the background time to look at all the background resources. I might not know exactly what the answers are either We're in this together and I'll be with you every step of the way. So those are just a few of the things I do that make sure that every rotation is special and unique and provides a whole experience for them…

SARAH KLOCKARS (09:03):

That's great. Thank you for sharing. Andrea would you mind offering what you do to prepare for your…students and residents? 

ANDREA DARBY-STEWART (09:13):

That's a great question Sarah. I kind of, so it's funny, I kind of chuckled as I listened to this, I think Craig might have been in the same position as I was because having done this nearly a quarter of a century. I don't necessarily feel as if I prepare…my…explicit teaching more than I think about ways that the specific learners that I'm going to be working with will best engage in whatever setting they're in. So you know I have the privilege of working with a large number of faculty members who have great insight into our learners as well So if I'm going on the hospital service one of the things that I'll do to prepare for that process is learn a little bit about how the last week went with this team and where I can help bolster their confidence, increase their learning, where the bright spots that we need to let them really shine with, and where are the weak spots that we need to help them bolster up so that they're able to provide the best patient care in a safe manner. 

With respect to pairing for more junior learners In my case this would be the LCME or the undergraduate learners. It really depends on their level of training and My preparation for those learners in a direct teaching setting either in the clinic or the hospital, is really to assess where they are and ask them to do a self assessment What can I best help you with Because I don't have as much insight into their background I don't have that information from colleagues about, you know this third year medical student who's coming to me from their OB rotation had these challenges i really have to rely on them to provide me with that a moment of self reflection and so that I can meet them where they are and then provide the most effective learning opportunity for them at that moment.

SARAH KLOCKARS (11:00):

That's a great take on that And I think some really good strategies there It's lovely when you have that continuity. We don't always get that lucky in pharmacy. Craig do you have anything else to offer? 

CRAIG WILLIAMS (11:10):

To dovetail on to that It's it's interesting because I do some didactic teaching of our students earlier, of our pharmacy students earlier, in the program before I get them on their advanced…experiential clerkship experiences So I often have a good sense of kind of who they are coming in and and it's interesting But I work with the medical residents I I don't have that luxury at all The and then often they're coming from other programs across the country and it does change it a bit on the at echo Andrea sentiments. When you can learn something about kind of that student that's coming to you it it does help. 

At the same time you know having done this now for over a couple decades, this is you know precepting is a muscle that gets stronger as you exercise it and you do get to the point where it's almost it keeps me a little more on my toes to not know what the skill set is of the learner coming to me So or interns are coming to us soon at the hospital and that's always an interesting pool of learners to get on the surface But I still think becoming medical intern is the biggest kind of transition in the pre accepting world that that we experience from a pharmacy or medical school standpoint And And there I'd say the big lesson there is to be a preceptor as long as you have some time and interest to give to it you're generally going to be fine So you do have to though recognize it It's gonna change your workday a bit and your workflow a bit And so you can't have a busy twelve hour, no time in the day day set up for yourself and…take on a learner So but I think if you have a bit of time, and the interest to give to it you'd be surprised…kinda how well you can do So I liken it a bit to people ask when am I ready because we're always looking for new sites for our students and I don't know if I'm ready to take on a student and get someone to becoming a parent You're never fully ready but at some point if you're generally prepared, you're generally going to be fine So So I'd say you know prepare but don't over prepare And it's great if you can know something about the student coming to you but don't feel like you have to know that much if you have the time and a and a site that has good experiences I think you're generally gonna be fine. 

SARAH KLOCKARS (13:11):

Mhmm. Mary I would be curious about your take with your busy practice. What strategies do you use to engage them?

MARY FRANKS (13:21):

I have not been doing this nearly long as Andrea and Craig I've been an nurse practitioner since twenty nineteen and I took my first…student…right in the middle of COVID. So early twenty one is when I took my first student, and that was a whole different world right because…At that time I was specifically working as a provider in the skilled nursing facilities, and I'm still trying to learn my role myself to an extent But then we're also trying to learn the whole telehealth realm of things too So that was kind of interesting to have a student…come in with me for that because the student actually was very local to me So they came to my house in my home office, and we were able to teach some telehealth points to the student but also be able to have that experience of still seeing patients virtually…As far as the busy urgent care, that in itself, kinda honestly depends on the day And I I would echo Craig's point. Urgent Care is a different beast in itself. And you never know what your day is going to be like Some days I'll have twenty patients in a twelve hour shift When I work a twelve hour shift other times I'll have forty or fifty. And you really have to have that desire and that passion to teach those students that are coming with you because like Craig said if you're If you don't have that drive and that passion and that desire…to provide those experiences to that student and you're just a very type a kind of go do it yourself kind of thing, they're not gonna learn. And and a hands on approach, uh a lot of times in the urgent care setting is something a lot of students need and strive for.

SARAH KLOCKARS (15:01):

Thank you for sharing that I think that's a great introduction to getting started with students and residents.

So This is a good transition to how we can tailor the learning experience for each individual…because as you know sometimes what works for one learner doesn't work for the next And so, Craig what teaching…tools other than, you know wisdom with age…Have you found successful when you're teaching learners?

CRAIG WILLIAMS (15:33):

I'm not sure if there's any one tool I have other than to kinda go back to earlier point You do have to do some preparation so if you have a mature good clinical site and again you're ready to give the energy to the process then you do need to have having a syllabus prepared and something to send the students so they kind of know what to expect And then sometime early on, if you learn something about who's coming to you that certainly helps And so like for all of our pharmacy students they have to email a preseptice at a time and tell them what they've been doing in their in the year so far what experiences they had kinda what their goals are for the rotation. But before we started doing that I think all of our good would sit down with that student and and just have that open discussion of of where they want to be years down the road what they wanna get out of this particular…four week or six week experience. And then pretty early on you do learn, is this a student who kind of is pretty advanced even when I don't know anything about the learner coming to me pretty quick in the first day you get a good sense of kind of where the students at and what they're gonna need to bring them forward And then it is about kind of tailoring to that individual learners so but beyond the a not too detailed syllabus that I give and a little bit of email work before they show up a lot of that the tools in the first week is really connecting with that individual learner and getting a sense of where do I think they're at now And how do I move them from their point a to their point b? It is a little bit of just jump in and trust that it's gonna work pretty well And and again, you do strengthen that muscle pretty quickly as you work with learners.

SARAH KLOCKARS (17:09):

That's a good point It's just practice. 

CRAIG WILLIAMS (17:12):

Doesn't make perfect but it makes a lot better. Yeah.

SARAH KLOCKARS (17:16):

Yes For sure You definitely learn with with each learner that you have on rotation So that's good. Andrea is there any specific method you use…that you found successful with your learners? 

ANDREA DARBY-STEWART (17:30):

Yeah I think it's a another great question and I would think about it in the context of as an experienced preceptor I think that we just naturally flex into different types of tools or teaching methods. In our program we encourage our residents to act as educators the senior residents to the junior residents and medical students and then I've mentored many new faculty as well And the two techniques that I think are help for them that can set a pretty simple stage are to figure out where your learner is And so in the osteopathic and allopathic medical world, we would think about the learner levels uh according to what's called rhyme or RIME, and R stands for a reporter. I as interpreter, M as manager and E as expert. And the reason that I bring this up is that particularly many brand new preceptors think that…suddenly magically you've graduated from medical school and you must be able to do a pretty good differential diagnosis and come up with a management plan And And the reality is that if a learner has not yet learned how to accurately report the first R in this RIME mnemonic then they can't interpret effectively. The information that they're reporting to be that historical information or diagnostic information…or social information…And if you can't report and interpret effectively you can't manage which means that you can't create that differential diagnosis and come up with that basic management plan. 

And so one of the first things that I try and assess with both the medical students and the residents is where are they in this spectrum? And I encourage our junior faculty and our residents to do that as well because then they get a little less frustrated when a learner isn't at the level that they expected. And they can teach to the level that they're at and meet that learner where they are. 

And then we do teach our learners how to use the one minute preceptor which is if somebody is presenting to you, get a commitment from that learner about what they think is going on And that's a hugely important step We all want to help people and we tend to give away the answers but that doesn't allow us to actually figure out how they're thinking clinically And that's our whole job There is no way for any of us to teach the breadth of medicine or pharmacy. Our job is to teach people how to think clinically so that they can apply that information across their career. So you get a commitment. You try and figure out what they how they figured out what the supporting evidence for that commitment was with their patient has a viral respiratory illness and they have a supporting evidence of this duration of illness a cough, runny nose itchy eyes. Once they're done with their presentation, let them know hey this was great I appreciate the way you structured that information i can see the patient in my head whatever that reinforce of positive that was done well. And then talk a little bit about the errors that they may have made in that clinical reasoning if there were any any emissions that you would want them to bring to lighten the future so that they can be more broad in that differential or that management plan. And then just come up with a general principle You know patients who have upper respiratory tract infections will typically get better after seven to ten days and they do not need thromycin and a Medrol dose pack. And then ask them if they can summarize that back to you as almost the teach back method as well so that you can get clarity from them if they have questions So those are the two things that I try and teach both new faculty as well as our residences educators.

SARAH KLOCKARS (21:01):

That's great And the one minute precepter is just one of the many tools out there. Megan do you have any tools that you have found that have been successful for you?

MEGAN SMITH (21:14):

Oftentimes I'm getting a student for example on a community rotation who has already given a lot of vaccinations and immunizations throughout their learning experiences either before a previous rotation or just previously in their curriculum. If I get them the first time on my rotation I'll say okay I know you've done a lot of these but you have not done one with me. So you're gonna watch me first and what I knew and then we're gonna talk about it And then I'm gonna hear what you do one and we're gonna talk about it So I kinda set that up right away up front and I have them comment on what they saw and picked up on me and what I was doing in my encounter with the patient kind of have them analyze that even as a starting point to discuss some of those pearls And then when it's ready for them to do a will of course get feedback on how they performed as well And that is just sort of my go to is the instruction modeling I'm coaching you and then you're out facilitation…

SARAH KLOCKARS (22:14):

Thank you for sharing that And I think another thing that's different with each learner is different learning styles. Can you comment on how you kind of adapt…activities to different learning styles…

MEGAN SMITH (22:26):

I don't try to just go to one specific learning style I think we also tend to teach that way too. It's just a way that bring input in and then a learner has to sort and process that information. Correct So what I like to do is have just a variety of materials we start with with that whole preparation and background. I give them materials to read to prep them guidelines to look at things that are gonna be we're gonna be talking about a lot on our rotation so they have the physical that can visualize that and input in that sense. And then I do a lot of topic discussions and we will okay what just happened here and the why A lot of times, I'm not even pre prepping some of those topics It's just something happened or occurred or a new question was thrown our way or a new patient encounter was thrown our way And I have to well of course take care of the patient if that's the case But then I'll stop and say why? Why is that How does it relate to everything else we've done on this rotation Why is it important how the financial model works So why is it important how this patient got here What can we do for them next and with the continuity of care So I try to just keep it as a whole using all of them all this input So if they need an input to read and write it they have that If they need an input of doing it and being with me they have that as well…

SARAH KLOCKARS (23:54):

Awesome. It's good to provide them with everything and then they'll figure out what works for them. 

I'm gonna move us along to talk about Some of these other big questions that are coming in from the audience We had another question about incorporating learners into your practice. So Craig, how do you get accomplished Your day to day tasks, having the student or resident help out but yet still fostering that learning environment. 

CRAIG WILLIAMS (24:21):

It's a good question I think go back to the the four preceptors role is a good example of where for someone who's very new to presepting that is the great way to just think about and to model it you've been doing it for a while it does become a little bit more embedded and just kind of it's just the way you kind of do it for almost every learner who comes to you. There does need to be some modeling early on.

And so it's interesting You know our pharmacy program is four years And then the medicine residency program I work with is four years So I get to meet our pharmacy students in their first p one year and then see them again in their fourth year and it is quite a transformation i get to see our family medicine residents as interns in their first year and then again in the fourth year And there's just It it is such a a difference so…the way I would handle a first year pharmacy student or if I miss an intern and discussion we have is different than what you do for a fourth year medical resident or for senior pharmacy students So I'm directly pre accepting senior pharmacy students I think you need to structure day such that…at least early on in their experience you are kinda going about your work and they are seeing what you do So I we have six week rotations and I just kinda tell them the first week is for the most part you're gonna be orienting and learning and kind of and then we kinda move you along during the six week I think just being realistic and kinda doing that modeling early on that we've talked about And then…gauging where the your learner is at and then moving them along their curve as quickly as you can. 

That is about having your work day set such that at least early on they can watch what you're doing and and then kinda move towards modeling. And then you can let them go on their own a bit but still be around and able to kind of be that kind of preceptor from afar and watch them progress So it it really is kind of the operationalization…of that four preceptor role model. Just in the real world practice setting. 

SARAH KLOCKARS (26:18):

Mhmm. Mary I have a question from the audience for you that kinda ties in to We we just think that we're always busy Everybody's busy, but those questions how do you keep students or residents engaged and involved If your clinical site is not as busy as others may be. You had mentioned earlier some days you'll have a lot of patients in urgent care other days You will not And so How do you engage students on those slower days? 

MARY FRANKS (26:45):

That's a actually a great question because I am a lifelong learner. So If I have downtime myself, I will look up something that I haven't seen in a while or something that I'm not quite as comfortable with that someone else has seen in the clinic within the past couple of days or weeks. A few of the clinics I work at do have primary care providers in them as well. If I have a slower day and I have a a student with me, I always talk to that provider that I'm working with that day and just say hey you know if you have something interesting, let me know or if you've got a patient that seems like they would be a really good case for the student to sit in on with you Let me know so we can kind of get them a little different look on how you may practice as well Or what you might do in a different situation than myself. 

SARAH KLOCKARS (27:35):

That's awesome Thank you for sharing. 

I'm gonna move us along. Let's talk a little bit about feedback because I think this is always where folks feel uncomfortable. Megan what are some…tips that you have methods that you use to provide feedback to your learners?

MEGAN SMITH (27:54):

Well I am a big fan of the stop start and continue method, and that's really effective for written feedback especially I found the most positive experiences with that one I'm having to write out um what they need to stop start or continue So that method is commenting on things that you want the learner to continue doing behaviors you want them to up or behaviors or actions you want them to start. You're commenting on those…really objective…qualities. 

The other thing that makes a good feedback session is being objective as possible and giving a qualifier to it Are they doing it appropriately I like to use adverbs Are they doing it appropriately consistently? Um and then any feedback don't leave them hanging make sure you know like what should they do to get better? 

So I love to start stop and continue when I'm kind of assessing an overall large learning experience or multiple encounters or kind of how are they doing, you know over the course of a week let's say. But if I'm giving feedback at a specific clinical encounter that has happened, I like to comment on everything. I just go through the whole encounter I'm not just highlighting, oh you did great You did great You did great. Comment on everything and you're not just picking out the great things or just focusing on the negative things. I go through for the example of maybe giving immunizations. It's okay When you started you establish good rapport with the person. I saw you do this. I saw that you asked appropriate questions. And then you know at this step you could have done x y z or what else did we miss And we would go through the entire encounter a to z So for my nervous students, ask them how they think they did And I think that's very valuable that I can tell there it's my first time with them and they're anxious I kinda let the wind out there So I'm like overall it's okay Alright Let's get into specific feedback so I could teach something And they're like oh okay You know so they're not kind of waiting going Did I do Okay Or did I completely miss something? And so I think asking them though how they feel how confident are they with their performance, but as you get into those details and going step by step, can help validate what they're feeling can help you know, if that was a intended choice that they made or not So those are just a few tips about getting feedback that I've used.

SARAH KLOCKARS (30:24):

Excellent Craig what do you have to add to that? Yeah I always start with how do you think it's going or how's it going from your standpoint? 

CRAIG WILLIAMS (30:28):
 
Learners often have a really good idea how the experience is going. And they know a lot more about kinda what's going on their head than I know about what's going on in their head So whether or not they think they're nailing it or they think they're really struggling And their perceptions often not exact we're often close but It's often not the same So I don't know if that's officially the ask to ask system but I always start with that before I give them my formal feedback. If your formal assessments at end of week one or end of week three they shouldn't be surprised by what you're going to say because it really should be an ongoing kind of dialogue with that learner there's many touch points during the day and even meet touch points in typical hour in the hospital setting to kinda give some constructive feedback. So it's not just modeling what you want them to do but then gently pointing them towards things they did well in a in a way from things that they didn't do well So so again it shouldn't just be one formal time But when you do do that formal one and there's not a bunch of people around ask you to learn how they think it's going because you do learn a lot from their perception.

SARAH KLOCKARS (31:28):

Yes That's great And then I think Andrea can you comment too about how…your feedback process is…

ANDREA DARBY-STEWART (31:38):

Yeah I think it's really dependent on the learner And again what level that they're at if I'm working with somebody with significant deficits that we've identified previously and there is a significant focus on a particular area in graduate medical education We refer to milestones and core competencies…then that may be the subject of my feedback. As Craig alluded to I think the best way to start this session with learners of any level are to say tell me a little bit about how you thought that segment or that week and the case of my inpatient service went for you and what were your bright spots or your areas for growth that you identified over the last week And we've set the stage for this because at the beginning of the week I've asked them what are the things that they think they're doing well and what are they really working on So we've been able to kind of go through that over the course of a week together on our hospital service. Uh then validate or correct the statements And I think for the most part people are fairly self aware We do have you know we all have some learners and individuals in our lives who definitely have some blind spots. Part of our job as educators is to help them understand those areas that are good areas for growth as well as the things that they should continue doing.

I always end these sessions with a question to them about what I could potentially do differently for them in the future. Or what should I continue to do that was effective that will help them advance in their education? I'd like to close with that as well because I think that they deserve the opportunity to provide us with feedback. That's a mature…adult thing to do and we are trying to teach them how to be professionals in a world where we would hope that we would have strong professional relationships with all of our colleagues in the future. 

CRAIG WILLIAMS (33:19):

And I'll just say if you don't you know for someone who's maybe…doesn't wanna hear something constructive from their learning you always ask like what can we do different about the experience? Just the the workflow of the day I mean for us sometimes it's as simple as like how do they get into med center in the morning and what time they need to be there and just how's that work So it It doesn't have to be necessary just about you as the teacher but it'd be about just kinda what we do to figure out the experience to help you for the last week or the last two weeks or whatever it is. 

MEGAN SMITH (33:44):

I ask what can I change about your schedule? The rotation Should we prioritize anything else new for the next two weeks So I love it.

SARAH KLOCKARS (33:53):

That is awesome. Great Thank you guys so much I think we'll move along now to managing challenging situations. 

We have a lot of questions coming in about managing student burnout. How do we help them with time management So…what are some of the biggest challenges that you faced with learners Megan and how do you go about handling them Maybe just pick one? We'll we'll have you each pick one to talk about.

MEGAN SMITH (34:21):

Okay. I've had some instances in the past of an overly confident person the overly confident though one around I know what this is I've been in the community pharmacy a long time, at the very end of my education experience ready to take the boards and be done. So for those particular learners, I'll still try to find something I think making that commitment and that one minute preceptor works really well And then I've had to sit down with one person and say okay, this didn't go well. And being very specific of this drug you know you did not know the indication for this medication. Tell me about that. We need to set time aside for you to study for your boards if that is the case. These are things that are expected for you to know at this point because I think it's we all might be able to to point to areas of improvement for those that are overly confident. They just don't see it And being as explicit as possible I love to think how Andrea said earlier that this is our job Remember it's our job to give feedback, even the things that are saying this is not up to par or the way that you have interacted with me and this email being late being these things and pointing them out they might not have been told that before, and you might be the only thing between them and their future employer so take that to heart as well that it's okay to give hard feedback as well and working through some of those challenges if they do have a a learning deficit or almost overconfident…or unprofessionalism that it might present as happy to hear other other thoughts

There's a lot of these and and I think Craig did really well in the beginning of you just see a lot of them to get more comfortable with the more experience you get. 

CRAIG WILLIAMS (36:12):

I'll kinda echo what they make instead of it I often tell my students I'd rather have you be less confident than overconfidence…coming into, API So you know with most pharmacy curriculum structure they don't they don't really get to do a lot until that API year It's kinda like their medical intern year in the medical residency world I always tell them you're allowed to guess on tests You can't guess in practice.

So think the biggest challenge I have is for the student who just seems to be able to not…form the harsh answer of all which is I don't know We have a lot of students just don't seem to be able to just kind of say I just I do not know And like we tell them like you're we're putting you with preceptors that you're there to learn from them But particularly our students are kind of in the upper quartile of the GPA they kinda they don't want you to know what they don't know So let us started giving me lots of answers and they just will not you know five minutes later you're like I'm looking for one simple answer You haven't gotten there yet because you're giving me every guess you remember from your classes So So a challenge for us is just getting students to admit There's a lot of things you don't know and that's okay You're still a learner even though you're within like maybe two months of graduating and it's okay to say I don't know and then use the experts around you to become a better…pharmacist position whatever track you're on. 

SARAH KLOCKARS (37:26):

Excellent Mary do you have any comments…

MARY FRANKS (37:30):

One student I had most recently…I had been with her probably about seven weeks of the fifteen weeks She was gonna be with me The student came out of her room one day and was like this person's totally faking it. And I…kind of snapped my head real quick and was like what did you just say? And she's like they're just faking it And so she She gave me a very brief you know history of what was going on and she's like but we're not gonna do anything because they're faking it. What it came down to as I did have to be kind of that firm…speaking person that I really don't like to be and say we don't come out of a room and just instantly say someone's faking it You have to have a professional attitude about every patient that comes in. You really need to have a professional attitude with me or any other preceptor that you encounter because what you may think someone is faking there could be something seriously wrong with this person. And truth be told they did have a serious issue, and we ended up sending that patient to the emergency room and they had surgery later that night So when I filled the student in the next day when she was with me on what happened, I just said how do you think things went the other day I feel like me personally we kind of had a a bad setting that day. And she's like well I just I just felt that they were faking it so I thought you should know. So I kind of told them you know what went on with that patient And that really changed her attitude with me that day from what I gathered. I try to be the most positive person I can when I'm around my students even if I'm having a really busy stressful day or I'm getting behind on charts and things like that but bringing that positive attitude and that positive energy to that student is really going to help them portray themselves to even when they're in a room with a patient. Because if they go in with the attitude of oh they're faking it with a patient, They're gonna miss differentials that are gonna be significantly important. 

SARAH KLOCKARS (39:26):

Thank you for sharing that Yes Having those hard conversations. Andrea do you have anything to offer? And I would be very interested in some of your tips that you have for residents on time management…

ANDREA DARBY-STEWART (39:40):

Set o'clock. Um I I I I kind of say that a little tongue in cheek but really and truly. Time management is about…being able to set an agenda in a compassionate way set your own personal boundaries with patients reassuring them particularly in the context to being a family physician a continuous comprehensive care clinic that you will eventually get to all of their concerns it just may not happen in your twenty or forty minute visit. And really enlist the aid of the people around you the mas and…colleagues that can help you with that gentle knock on the door and kind of moving that visit along Patients have no idea how long their visits are And when a kind person sits down in front of them and engages them in a compassionate conversation they are very happy to tell you everything. That they think you need to hear And so learning that skill of being able to put some boundaries on your time is just really important and effective for my learners 

SARAH KLOCKARS (40:45):

Excellent And I have one other question coming in about…How do you precept that high performing learner that actually…gets it and continues to just push you…

ANDREA DARBY-STEWART (40:59):

Oh gosh Those those are fun Um…uh set up new projects Oh that's a great question Why don't you come back and tell me about that You know what I would love to have you I think that's a terrific observation about the multiple causes of hypercalcemia it's a great teaching point that you might be able to bring to our next resVAC meeting. There's so many ways to help engage…a learner in that area and in our practice as I'm assuming in all of my colleagues practice on the team We've got plenty of opportunities for quality improvement patient safety patient experience, and so engaging them at a higher level than just the this patient has this condition and I'm going to treat it with this intervention. If we can engage them across a higher level at a systems level that's sometimes we'll see if you hate their appetite for new learning…

SARAH KLOCKARS (41:50):

Excellent Thank you And I do want to…Have you each share one piece of advice with our listeners to help them improve their effectiveness as a preceptor? We talked about a lot of tips but I I guess I want you to reflect on your journey and what is one of those pieces of advice that you really think was impactful and changed the way you precepted that might help some of our listeners. I will start with you Megan. 

MEGAN SMITH (42:20):

You know I think that Mary's…Pearl and the example that she just showed is a good example that you're there to teach them clinically and they need that experience for sure But you are also there to teach them how to be a professional and their professional identity. So it involved them in those things that maybe there's projects or patient cases or things that are not yet realized and help them see how you solve that How do you handle a challenging situation How do you handle…professionalism in your setting Or how do you advocate for your profession, both in small and big ways. So I think that's that's what I leave as my one advice, but also with my new role experiential education I really wanted to put in a plug that if you have a challenging learner…to also…make sure you check and lean on and report to use folks that are in experiential education or equivalent. They will have policies on how to deal with that and make sure it is reported because you you make me the last stop or you might be you know the fourth time that someone and it's like four times and there's red flags and there's other things happening and they're waiting for you to bring it up So make sure that you engage with them and let them know because those…overseeing departments and colleges or you know educational programs really need to hear the input from everybody and what is going along with that that student or that resident.

SARAH KLOCKARS (43:49):
 
Thank you That is a very good point I think many of us have had to do that Craig what are your thoughts What are your final thoughts? 

CRAIG WILLIAMS (43:55):

Oh so you know once you are comfortable…in your practice setting you really are ready for a learner So if you have a setting that would just be a good exposure for again for sure medical resident medical student pharmacy student, then you're ready So back to my knowledge if it's you know it's like trying to be preparing to be a parent You can only do so much. So once you're kinda site is is kinda mature and you're compliment. Then I'd say my advice to that person would be do something to prepare, but don't over prepare so I liken it to when our students give their oral presentation I can tell when someone's tried to memorize every line of every slide they wanna say and they inevitably fail along the way because they were so over prepared and built it up so much their minds that it doesn't go perfect. It's like a disaster to them And and that's not the way to prepare it Just kinda be comfortable in your practice setting and then just be ready for every day is gonna be different with your learner But again if you're comfortable in your setting you really ready And it's it'll be a great experience for them You may not think it was a perfect day from your standpoint but if you remember back to like five ten thirty years ago, when you were a student it's like a good exposure to practice setting is just huge or rewarding for students who have been in the classroom setting for a lot of years So it it doesn't need to be perfect and it's gonna be good for the learner. 
SARAH KLOCKARS (45:14):

Awesome Andrea Do you have any quick tips in thirty seconds or less? 

ANDREA DARBY-STEWART (45:18):

I just say model the professionalism that she wants Oh excellent Across clinical competency compassionate, communication and life long learning because each learner you touch will have a ripple effect over years. So you're not just seeing and working with your patients You're working with every single page that that learner will touch in the future. It's a huge privilege and a wonderful opportunity and I encourage you all to take it.

SARAH KLOCKARS (45:42):

That's great Mary…

MARY FRANKS (45:45):

I would say make sure you can take away something from the experience with that student. You never know as a pre acceptor and a professional yourself what you might be able to learn from someone else So I always try to make sure that I can take something away from my experience with that student…

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