Good preceptors vs. bad preceptors

Welcome to optimal outcome precepting session 5, which will be talking about the traits of great preceptors and the qualities and characteristics of great rotations. Flashback we started this series by exposing six steps to becoming a super preceptor. Those steps have been summarized in our first four sessions. We’ve covered all of this information. In the session today is going to focus on the qualities of preceptors and what makes preceptors great and rotations great. I want to emphasize something before we get started. We’ve covered a lot of information with a lot of suggestions on how to put together a first-rate rotation. There’s a lot of work involved.

Preceptors who’ve not done this before and aren’t used to developing APPE rotations, might be somewhat intimidated, to find it very daunting to develop all these materials and do all of the pre-planning and building the structure and organization into rotation. But you shouldn’t be too concerned about that. Understand that there is a significant amount of administrative support from TMU that will assist preceptors and provide much of this infrastructure. So that the preceptor doesn’t have to utilize it. But it’s important for preceptors to understand what’s involved and putting together this information. And so what we’ve covered in these first four sessions will still serve you well when you begin to precept students for (the university).

Everything again begins with learning outcomes, we want to focus our target on the learning outcomes where we’re going to coordinate our methods are content in our assessment, our relationships with students. And essentially we want to coordinate all of this in such a way that we achieve excellence. Our pursuit of excellence is really the foundation for everything that we’ve covered this far in the first four sessions. When I’ve tried to lay it out for you is the the designer of a rotation that represents perfection. And we understand the perfection is not a realistic goal, but the idea here is that if you know all the steps that need to be taken to create a perfect rotation.

And we fall just a little bit short. You’ll still have an excellent rotation. And that’s our goal. We want students at (the university) who go out on their final year of APPE rotations to have an excellent learning experience. And so we want to provide the kind of guidance to preceptors that will enable them to develop an excellent experience for our students. Let me ask you a question. Can you think back to some of the preceptors or teachers that you’ve had in the past? And remember some of the impressive traits. What was it about those preceptors that had such an impact on you? What causes you to feel that that person with an excellent preceptor?

Keep that question in mind as we go through some of these traits and characteristics. Because they’re fairly consistent. Whatever the course was or whatever the learning experience was, the same principles apply to the leadership aspect of teaching and precepting. So if we keep these principles in mind, it makes it easier to develop the kind of rotation that will cause your students to someday think of you as one of the great preceptors they’ve had. I’d like to begin with an article that was written from some faculty at the University of Illinois in Chicago, called “Eliminating bottlenecks to learning among pharmacy students.”

And what these faculty members did was questioned students who were about to go out on their final year APPE rotations. They realized that students amass of vast amount of knowledge during their course work on campus prior to beginning the rotations. But if preceptors don’t have a well-planned learning experience rather than synergizing that information and helping them to apply that information in the clinical setting. It may actually serve as a bottleneck. A poorly planned rotation can inhibit the students from learning to utilize all that information they’ve learned through their years on campus. Ineffective APPEs can actually be inhibitory.

So we want to make sure that we understand the difference between APPE characteristics that enhance learning and facilitate the application of what students have learned. And APPEs that might serve as a bottleneck to inhibit the further advancement of students. What these researchers did was questioned 60 students who were their advisees at UIC, prior to going out on their rotations. And they asked the students to think about what they expect from the preceptors during the fourth year of professional training. Essentially, what the students indicated as to what makes for a good preceptor and how preceptors can fluster their learning was that they were looking for preceptors who were encouraging or supportive, provided detailed information of the expectations and had reasonable expectations.

Preceptors who are committed to teaching and provided good feedback to them during the rotation. Pretty characteristic expectations that we would think students would have of their preceptors before they begin their experiential training. As far as the activities that might be involved in rotation that would serve as a bottleneck. The authors identified that such things as a preceptor is having a low priority of students. Such that students didn’t feel as though they were very important to the preceptors. Preceptors who are condescending or looked down upon the students. Preceptors cause students to feel as they were a burden or they were in the way. Preceptors who dealt with them harshly. Preceptors who didn’t put a lot of effort into planning the rotation.

So much of this is fairly intuitive, based on the material that we’ve already covered. But these authors laid out very clearly and utilize the questions that were answered by the students to provide more detail as to what makes a good rotation and what can make a rotation serve as a bottleneck to learning. Another recent report, this was written back in 2008, by preceptors in Thailand. This was from the first Pharm.D program in Thailand that was developed in 1999. And in the 2006, what they did was question 76 students and 29 preceptors who are using a three-part scale to answer a variety of questions about the rotations that they had completed.

And they were asked to rate each item as to either it was done well or adequate. It was not done or it was done but in adequately. What their results showed was that when rating that the preceptor is accessible to students. Students said fifty-seven percent of the time it was done well or adequate. The preceptors felt that it was done well or adequate ninety percent of time. Shows a clear disconnect between the perception of students and the perception of the preceptors. For setting criteria for performance, the students felt it was done well only thirty-four percent of the time. And the preceptors sixty-six percent of the time.

Not only is there a disconnect between what the student perception was a preceptor perception. But even the preceptors only two-thirds of them admitted that they set criteria for student performance which should have been 99%. The grading is based on performance and effort. Students felt that was done well only forty-two percent of the time. Preceptors, 93% of the time, another disconnect between student perception and preceptor reception. And giving students positive feedback for good work. Students felt that was done well thirty-six percent of time, preceptors eighty-three percent of the time. So as the the (university) rotations are developed, preceptors assume responsibility for (the university) rotations.

We want to make sure that the perception of students and the perceptions of preceptors, though they’re probably never going to match, but we like to pursue a goal in which those perceptions will be closer together. And certainly, for such basic important criteria as those that were assessed in this Thailand study. The perception of preceptor should really be above ninety percent for all of these fundamental criteria.