The ASHP residency accreditation standards require that at least one of six criteria be met for a person to be deemed a qualified preceptor. One option is “Demonstrating the ability to precept residents’ learning experiences by use of clinical teaching roles (i.e., instructing, modeling, coaching, facilitating) at the level required by residents”.1-3 The time a preceptor spends in each of these roles can vary during the learning experience. It is also possible that a preceptor may not need to employ each of these on a given rotation based on the learner’s experience and/or rotation goals. The only exception, in my opinion, is modeling.
Modeling should be purposeful and enables the preceptor to demonstrate what is expected of the learner during their learning experience and beyond. Preceptors should consider modeling the expected behaviors during the first few days of rotation regardless of the learner’s previous experience, the time spent in this role may vary based on prior experience in the practice setting. This includes emulating desirable communication and clinical skills, attitude, ethical behavior, etc. With modeling, the preceptor should not only “show” the learner what they are doing and how they interact with others but guide them through each step. The discussion should also include the “why” for what was done. Talking about each step enables the learner to gain insight on your thought process.4-5 Just like we cannot see how learner’s wheels turn when they are thinking through the response to a question, they cannot see what is running through our minds when we are completing a task. Take for instance navigating the patient record before a clinic visit. It may take you, the preceptor, 5 minutes to collect the necessary data that will inform decision making. On the other hand, a learner may spend 30 minutes delving into the patient’s record but still unable to collect all necessary data. This could be for several reasons – not knowing where to find data points, struggling to discriminate what is needed, etc. Talk about what you are looking at on each screen of the medical record and discuss which data would inform your decision making. Regardless of the learner’s prior experience, walk through your process of data collection. Most people will pick up an extra trick or two!
Remember, while a learner may have a completed a rotation like yours or even it if is their last rotation of the year, this does not mean that they have perfected every skill needed for your learning experience. There is always value for them to see someone in action and to hear about their process. I imagine that many of you, like me, employ snippets you picked up from various people over the years. Additionally, modeling is an integral element to setting expectations for the learning experience.6 This will highlight not only clinical elements of practice but also code of conduct for interacting with and discussing patients.4 The learner on your rotation will most likely emulate the respect and empathy that you show to patients in their interactions. This will also decrease any confusion for your learners regarding your expectations for the rotation.
Learners are typically going to present their patient and plan to you or another member of your practice team. It can be helpful to the learner that you “present” a patient or two as you would expect it to be done. Talk about why you included the patient data in the presentation that you did. It is important for the learner to hear you use appropriate language to describe a patient and their co-morbidities, etc. Say for instance someone has a substance use disorder. Unfortunately, in some practices derogatory words may be used, unconscious stereotyping, or making jokes when discussing the patient. It is our job to showcase the terms to use and that we need to treat all patients with the same respect.
Preceptor credibility can be established by role modeling exemplary behaviors.4 Allocating a little extra time for modeling should make the learning experience even more beneficial for you and the learner. This enables us to set expectations and likely allow the learners to pick up new skills. Finally, do not forget to show your enthusiasm when modeling for your practice, teaching, etc. Learners are drawn and captivated by those who are energetic and self-confident. They will likely learn best from someone demonstrating these characteristics.4
Want to read more about the precepting roles? Check out these pieces:
- American Society of Health-System Pharmacists. ASHP accreditation standard for postgraduate year one (PGY1) pharmacy residency programs. https://www.ashp.org/-/media/assets/professional-development/residencies/docs/pgy1-residency-accreditation-standard-2016.ashx (accessed 2021 June 26).
- American Society of Health-System Pharmacists and the American Pharmacists Association. Accreditation standard for postgraduate year one (PGY1) community-based pharmacy residency programs. https://www.ashp.org/-/media/assets/professional-development/residencies/docs/pgy1-community-based-pharmacy-2017.ashx?la=en&hash=C128D3594496763CCB5DDF26E95912AAF0F41AE8 (accessed 2021 June 26).
- American Society of Health-System Pharmacists. Accreditation standard for postgraduate year two (PGY2) pharmacy residency programs. https://www.ashp.org/-/media/assets/professional-development/residencies/docs/pgy2-residency-accreditation-standard-June2017.ashx?la=en&hash=6AB9A9CCAC47929779FB5B9240D4490B2250FCD6 (accessed 2021 June 26).
- Irby D. Clinical teaching and the clinical teacher. J Med Educ. 1986;61:35–45.
- American Society of Health-System Pharmacists. Starring roles: the four preceptor roles. http://www.ashpmedia.org/softchalk/softchalk_preceptorroles/index.html (accessed 2021 June 26).
- Larkin GL. Mapping, modeling, and mentoring: charting a course for professionalism in graduate medical education. Camb Q Healthc Ethics. 2003;12(2):167-177. doi:10.1017/s0963180103122062