October 16, 2014

Anticipating Difficult Situations in Experiential Learning

by Kaitlin Pruskowski, Pharm.D., PGY1 Pharmacy Practice Resident, Johns Hopkins Bayview Medical Center

Inevitably, all preceptors will be faced with difficult teaching situations in the experiential learning setting.  Both the teacher’s and the student’s skills and expectations can contribute to these difficult situations.  Lack of motivation, either on the student’s or preceptor’s part, can play a big part in a difficult teaching situation.  In addition, not understanding generational differences and expectations can lead to problems.

Teacher-specific factors that can make teaching difficult include poor teaching skills, lack of experience, and not being well-prepared to supervise students.1  Student-specific factors include lack of effective communication skills, poor baseline-knowledge, and lack of ‘real world’ skills.  Because students lack real-world experience, they may question a preceptor’s recommendations.  When this occurs, it may be helpful to direct the student toward the evidence on which the recommendation is based.  Additionally, mismatched teaching and learning styles, personal insecurities, and life events may contribute to difficult teaching situations.1

Lack of motivation may also be a significant contributor.  A student may lack internal motivation and is only motivated by external factors (i.e., grades).  Because the learner may not be interested in the subject matter, she may only be willing to do the minimum work required.  Her actions and body language may reflect this.  The student may be tardy, not prepared, or not willing to participate during patient care rounds or group meetings.  Similarly, a preceptor may not be motivated to teach his student.  The preceptor may not make time to meet with students and may not provide clear instructions about what is required.

Generational differences can also play a role in difficult learning situations.  Today, there can be up to three or four generations sharing a common workplace.2  Each generation has its own unique attitudes with regard to work, work-life balance, and respecting authority.  The ‘Baby Boomers’ tend to be ‘workaholics’ and work until they achieve the goals they have set for themselves.  They usually work to please their managers and coworkers.  Members of ‘Generation X’ tend to be self-reliant and are focused on building their resume.  Most are usually very knowledgeable about technology and how it can be used to improve the workplace.  ‘Generation Y’ value life-long learning and like problems-solving.  They are often dependent on technology and are comfortable participating in virtual meetings and communities.  With all of the technology available to them, they expect their preceptors to be available 24/7 to address questions or concerns.  If a preceptor and learner are of different generations, issues may arise due to these differences in values and expectations.2

So how can you prevent difficult teaching situations?  During the orientation period, teachers need to clearly define their expectations, including rotation schedule, workload, and interactions with the medical team.  The teacher/preceptor should know the school or program’s expectations of its learners; chances are that the learner has already received some instruction about these expectations – but it is up to the teacher to reiterate these to the student or resident, along with any rotation-specific requirements the teacher may have.3

Despite clearly stating the expectations in the beginning of the rotation, teachers may face problems as the rotation progresses.  Be sure to address these issues early! If the teacher ignores them, they will worsen with time.  Ask the student about what is going on.  When talking with the learner, it is important to stay calm and give objective feedback.  Be specific about what was observed and what the student can do to improve.

Hewson and Little conducted a survey of medical residents to see which feedback techniques were the most and least helpful.4  Feedback that was non-judgmental and based on observations was found to be significantly more helpful than disparaging comments that were not tied to specific events.  It is important to elicit the learners’ ideas and to offered suggestions for improvement.

Based on their findings, the authors developed a model for giving effective feedback.4  First, the learner should be given some ‘warning’ that the teacher like to give some feedback and to schedule a time to talk about it.  Next, the learner should be asked to do a self-assessment.  The student should identify what he does well and the areas in which he should improve.  Then, the teacher/preceptor can give feedback as to what the learner is doing well and what he can do to improve.  As a team, the teacher and learner should develop a plan for improvement.  The session should end with a follow-up plan developed by both the teacher and the student.

After meeting with a student and discussing difficult learning issues, the situation may not improve or may get worse.  When this happens, it is time to contact the school or program director.  Program administrators know that not every student is ‘perfect’ and that the teacher may encounter an especially difficult student from time to time.  The school needs to get involve and they are prepared to help if an especially difficult situation arises.

  1. Langlois JP and Thach S. Managing the difficult learning situation. Family Medicine. 2000;32:307-309.
  2. Ginsburg DB. Teaching across the generations: Challenges and opportunities for preceptors. Presentation given at The University of Texas at Austin College of Pharmacy. Austin, TX.
  3. Langlois JP and Thach S. Preventing the difficult learning situation. Family Medicine. 2000;32:232-234.
  4. Hewson MG and Little ML. Giving feedback in medical education: Verification of recommended techniques. J Gen Intern Med. 1998;13:111-116.

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