by Andrea
Passarelli, Pharm.D., PGY1 Pharmacy Practice Resident, The Johns Hopkins
Hospital
Preceptors play an integral role in the development of pharmacists. Most schools of pharmacy provide formalized
training and education to their preceptors in order to help them master
effective precepting techniques, but literature surrounding this topic is
scarce. Preceptors should use a variety
of teaching strategies throughout a rotation and these should be tailored to the
learner’s stage or professional development.1 As learners grow in their ability and
confidence, they should be performing more tasks independently, such as medication
reconciliation, discharge counseling, and "rounding" with the medical team. In
these situations, the preceptor might use an assessment technique known as 360-degree
feedback to evaluate the student’s performance.
The 360-degree feedback technique generally involves the preceptor asking
other healthcare professionals as well as patients about the student’s
performance. This evaluation technique is
gaining popularity in healthcare and other sectors. I wanted to research this technique further so
that I could use this assessment strategy during my career.
One paper published by Joshi et al. in Academic Medicine described the successful
implementation of 360-degree feedback for obstetrics and gynecology residents
at Monmouth Medical Center.2 Residents were assessed on their
interpersonal and communication skills by nurses, faculty members, allied
health professional staff, medical students, patients, and co-residents. In addition, each resident completed a
self-assessment. The researchers found good correlation between evaluations within each group of evaluators as well reasonably strong agreement among evaluators regarding each resident's rank among the peer group. Interestingly,
there was a negative correlation between the rankings by faculty, staff, and medical students with the rankings given by peers. The highest-rated residents
(based on faculty, staff, and student evaluations) received low marks from their
co-residents and vice versa. This may
perhaps be due to some perceived competition or a desire to “get ahead” by
rating high-achieving residents poorly.
On self-assessment, junior residents typically rated themselves highly
while senior residents rated themselves average or low. This may have been because senior
residents were setting higher standards for themselves or have increased
self-awareness later in the curriculum. A potential advantage of 360-degree
feedback employed at Monmouth Medical Center: evaluators were eager
participants because their feedback was anonymous. The 360-feedback technique
has been widely described in medical education journals, but has been most
often been used in residency training rather than student education.3-6 360-degree feedback can be an extremely
effective tool for a preceptor, as learners will often communicate differently
in the presence of a preceptor and when independently communicating with peers,
staff (who may be perceived to be at different social ranks within the
organization), and patients.
When I was a student I had one experience with 360-degree
feedback during my first acute care rotation.
On the last day of the rotation, my preceptor allowed me to round independently
with the team. After the team finished
rounding, my preceptor asked the medical interns, attending physicians, and
nurse case-manager about my performance.
In subsequent advanced practice experiences, both as a student and
resident, preceptors have occasionally sought feedback from physicians
regarding my performance. But most based
my evaluation solely on their direct observations.
While my experience with the 360-degree technique from the
perspective of a learner is limited, I believe there are some important points
that should be considered prior to implementation. First, it is important to inform the learner
that this technique will be used.
Although the goal is to assess the learner’s performance without
influence from the preceptor, learners might be taken aback if their
performance is discussed with other individuals without their knowledge. Further, it is important for preceptors to
remember that in order to effectively implement this technique they must ask a
breadth of individuals (with different roles) to participate in the process. This was done during my first rotation, but
not in subsequent rotations as preceptors only asked physicians for their
input. I have never had a preceptor ask
one of my patients about their perception of my abilities. And with the notable exception of my first
rotation, my preceptors haven’t asked medical interns, medical students, or
nurses for feedback.
360-degree feedback appears to be an incredibly valuable
assessment tool that can enhance the quality of evaluations provided to both
pharmacy students and residents. This
technique allows preceptors to more accurately assess a learner’s communication
skills, especially in the absence of preceptor supervision. Research has shown that this is an effective
and accurate evaluation technique when used in medical residency training, but its use has not (yet) been described in the pharmacy education literature. Preceptors utilizing this technique should be
familiar with its fundamentals, and should ask individuals in multiple roles,
including patients, for feedback regarding the learner’s performance. When used appropriately, 360-degree feedback
allows the preceptor a unique opportunity to obtain a complete picture of the
learner’s strengths and can help them identify areas for improvement.
References
1. McDonough RP, Bennett MS.
Improving communication skills of pharmacy students through effective precepting.
Am J Pharm Educ. 2006 ;70(3): Article 58.
2. Joshi R, Ling FW, Jaeger J.
Assessment of a 360-degree instrument to evaluate residents’ competency ininterpersonal and communication skills. Acad Med 2004;79:458-63.
3. Meng L, Metro DG, Patel RM.Evaluation professionalism and interpersonal and communication skills:implementing a 360-degree evaluation instrument in an anesthesiology residencyprogram. J Grad Med Educ 2009;1 (2):216-20.
4. Wood J, Collins J, Burnside ES et
al. Patient, faculty, and self-assessment of radiology resident performance: a360-degree method of measuring professionalism and interpersonal/communicationskills. Acad Radiol 2004;11(8):931-9.
5. Sorg JC, Wilson RD, Perzynski AT
et al. Simplifying the 360-degree peer evaluation in a physical medicine andrehabilitation residency program. Am J Phys Med Rehabil 2012; 91(9):797-803.
6. Chandler N, Henderson G, Park B et
al. Use of a 360-degree evaluation in the outpatient setting: the usefulness ofnurse, faculty, patient/family, and resident self-evaluation. J Grad Med Educ 2010;2(3):430-4.
