Preceptor, Mentor, or Both?

by Carmen Nobre, Pharm.D., PGY2 Oncology Resident, University of Maryland

Lines between being a preceptor and mentor often blur.  To be a preceptor is to participate in a prearranged role where one assumes the responsibly of fostering and building the core professional skills of a trainee.  As outlined by American Society of Health-System Pharmacists for pharmacy post-graduate residency programs¹, a preceptor is one that models, coaches, and facilitates a trainee's performance as a professional. 

To be a mentor is to function as a role model within your given profession.  Research on mentoring indicates that a mentor should:²

·      be nurturing

·      be a role model

·      function as teacher, sponsor, encourager, counselor and friend

·      focus on the professional development of the mentee

·      sustain a caring relationship over time

This type of relationship is traditionally freely entered by both parties (i.e. not as a requirement of a curriculum or program).  The mentor and mentee build a closer, more personal relationship than that of a preceptor and student.  Of no surprise, this often means that the two parties share similar interests and characteristics.  A mentor may participate in professional activities with the trainee, and may also engage in discussions relating to the trainee as an individual and not solely as a member of a larger group of professionals.  Topics of discussion often include families, hobbies, frustrations, and ambitions.³

Despite their differences, the terms preceptor and mentor are often interchanged.  This may be due to their shared goal of fostering the development of a young professional.  Yes, both roles have the common goal of guiding a trainee in their professional development, and coaching them through their journey.  Each role may also serve to challenge the trainee, evaluate their performance, or offer advice.  However, there exists a different tone between these relationship.  Most obvious are the differences in the goals and benefits of these relationships, their duration, the socialization process, the support for learning and feedback given.⁴  Simply put, a preceptor is more of an authoritative figure while a mentor acts more like an older sibling.

Can these lines ever be blurred?  Should they be blurred?  If so, when is it appropriate to play this dual role?  Furthermore, how do you juggle between the two?  Playing this dual role can be tricky.  As a preceptor there is a responsibility to evaluate the trainee, and provide constructive feedback to further their growth.  But as a mentor there is an expectation that you offer support and advice in how to handle even the worst of situations.  Is it possible to provide necessary criticism while being supportive?

In my experience, it can be difficult for both the preceptor / mentor to have this overlapping relationship.  From the trainee's perspective, it is difficult to maintain a goal-oriented working relationship with a preceptor, and then switch modes and disclose personal thoughts and feelings to that person.  In addition to identifying when it is appropriate to have a mentoring discussion, it is also difficult to reveal your weaknesses and frustrations (or even pleasant feelings) to a person who will be evaluating your performance.  From the preceptor’s perspective, it must be difficult to transition between nonjudgmental casual conversations and to formal discussions and evaluations of the trainee's performance.  Although it may be possible to carry this dual role, it requires a certain degree of balance.

Nonetheless, the benefit of having a mentoring relationship with a resident outweighs the risk of blurring the line between being a preceptor or a mentor.  There is much to gain.  There are opportunities to exchange ideas, improve job satisfaction, and build networking relationship.  Many institutions have developed formal mentoring programs where the mentor and mentee are paired and given guidance about how to develop an effective relationship.⁵   

Creating a formal mentoring program is one way of incorporating this fundamental practice into a resident's experience.  Another way is to purposely integrate it into the objectives of the residency curriculum.  By including instruction about mentoring, it will clarify the intent and expectations of the mentor-mentee relationship, and would also ensure that important professional development topics are addressed during the year.  This would serve to establish goals and clarify expectations (such as frequency of meetings).  An example: mentors should set aside time to discuss potential career opportunities after residency.  It is important to keep in mind the fundamental distinction between being a preceptor and a mentor, and that any relationship requires effort from both parties to be successful.⁶

Learning to be an effective preceptor and mentor requires training for a successful and positive experience.  As a recent graduate and having precepted my first student, I commend those who are able to fulfill these dual roles.  However, I would encourage new preceptors and mentors to have an open exchange with their trainees about expectations, and even seek advice from more experienced mentors (i.e. become a mentee yourself).

References:

1.  American Society of Health-System Pharmacists. Education and training.   Accessed 2012 Oct 22

2.  Kerry T, Mayes AS.  Issues in Mentoring,   Routledge Publishing Company in association with The Open University; New York, New York: 1995.

3.  Wensel TM. New Practitioners Forum:  Mentor or preceptor: What is the difference? Am J Health Syst Pharm 2006; 63:1597.

4.   University of Medicine & Dentistry of New Jersy (UMDNJ) Center for Teaching Excellence. Teaching Portfolio: Precepting and Mentoring [Web page]. Accessed 2012 Oct 22

5.  Johnson MO, Subak LL, Brown JS, et al. An Innovative Program to Train Health Sciences Researchers to be Effective Clinical and Translational-Research Mentors.  Acad Med. 2010; 85: 484–9.

6.  Sambunjak D, Straus SE, Marusic A. A Systematic Review of Qualitative Research on the Meaning and Characteristics of Mentoring in Academic Medicine  J Gen Intern Med 2009; 25: 72–8.

Interprofessional Team Teaching, What’s It All About?

by Taemi Cho, Pharm.D., PGY1 Community Pharmacy Practice Resident, University of Maryland School of Pharmacy

When you were a pharmacy student, did you ever experience interprofessional team teaching? Many will probably answer without hesitation, “Yes of course. On rounds during my acute care rotation.”  But consider these questions: What exactly is an interprofessional team? How does an interprofessional team differ from a multidisciplinary team?

Although the terms multidisciplinary and interprofessional are frequently used interchangeably, multidisciplinary teams differ from interprofessional teams. Multidisciplinary and interprofessional teams differ based on the degree of interaction and sharing of responsibilities.¹ In patient care, multidisciplinary teams are described as being led by the highest ranking team member which is usually the physician.¹  Each member works independently but in parallel.  The medical record serves as the primary tool for information sharing.¹

In contrast, interprofessional healthcare teams include members with different professional training coming together to interdependently develop goals.^1,2 In an interprofessional team, leadership is shared, members engage each other and learn from one another.¹ An interprofessional team approach involves the collaboration of people with diverse perspectives to devise a unified approach.² The aim of the interprofessional team is to provide more comprehensive patient care than what is typically achieved today.

Are there real benefits to adopting interprofessional team teaching in healthcare education?  Unlike instruction received from people from a single professional background, interprofessional teaching introduces multiple (two or more) perspectives in a teaching-learning process that enhances each profession.³  Interprofessional teaching challenges students to integrate alternative views and helps them to understand complex issues that must be considered when providing optimal patient care.²  This approach also educates students about conflict resolution and group dynamics, important skills that must be learned in order to be an effective member of a high-functioning team.⁴

A recent paper described interprofessional education at the Rosalind Franklin University of Medicine and Science, the University of Florida, and the University of Washington.⁵   Each of these interprofessional education programs included didactic instruction, a community-based experience, and an interprofessional-simulation exercise.⁵ The didactic instruction taught principles of collaborative patient centered care and clinical concepts.⁵ The community service component included interprofessional teams working with community partners on a community service project.⁵ And the simulation activity had students from different disciplines working together on a skills assessment. All three interprofessional education programs felt they had achieved their programmatic goals.  Students were reported to comprehend their professional roles and understood the contribution of other professional’s roles on the team.⁵    

One pilot study assessed an interprofessional team reasoning framework

(IPTRF) utilized to teach and learn cases studies among student of different health professions.⁶ The following flowchart is the framework used in the study:

Figure from:  Packard K et.al.  Interprofessional team reasoning framework as a tool for case study analysis with health professions students: A randomized study. 
JRIPE Vol 2.3  August 2012.

Eighteen students from dentistry, medicine, nursing, occupational therapy, pharmacy, and physical therapy were randomized into 3 teams of six members.⁶ The first team received only the case; the second received the case and framework; and the third received the case, framework, and a videotaped example of interprofessional interactions. The primary end point evaluated students’ perceptions and the secondary endpoint evaluated students’ performances.⁶ The results found that students’ perception of team skills improved when they were given the IPTRF tool (second and third teams). Moreover, team three’s students’ performance was significantly better when compared to students on the other two teams.⁶

The success of an interprofessoinal education lies in developing a curriculum that prepares students to collaborate in an interprofessional manner. One cannot expect recently graduated pharmacists to successfully work within an interprofessional team without instruction, both didactic and experiential. Many barriers exist in implementing interdisciplinary team education including a lack of administrative/faculty support, insufficient faculty with interdisciplinary training, limited financial resources, entrenched power dispositions/territorial imperatives, logistics, scheduling, and reimbursement.³

To progress, these barriers need to be addressed. Collaborators from successful schools that have implemented interprofessional education indicated that their success relied on resolving conflicts in the initial stages of developing an interprofessional course.⁷   Collaborators need to understand each other’s pedagogical views and negotiate those differences.⁷ Integral to an interprofessional education are the core competencies identified by the Interprofessional Education Collaborative Expert Panel.⁸

You may be wondering if I have experienced interprofessional team teaching.  I can honestly say, “Yes!”  I took a class as a pharmacy student that had interdisciplinary components. My Geriatric Imperative class had a geriatric dementia team consisting of a physician, nurse, pharmacist, psychologist, and social worker from the Veterans Affairs (VA).  The team members discussed how they met with their patients and shared their perspectives to optimize each patient’s care. Later, as a P4 student, I rotated through the Dementia clinic at the VA.   For 3 months, I worked in this interdisciplinary team where we made assessments based on our various perspectives, integrated the information, and together developed a patient care plan.

References

1.   Cooper BS, Fishman E. The interdisciplinary team in the management of chronic conditions: has its time come? Partnerships for Solutions Better Lives for People with Chronic Conditions [Internet]. New York: Mount Sinai School of Medicine; 2003 June: 2-4.

2.   Goldsmith AH, Hamilton D, Hornsby K, Wells D. Interdisciplinary Approaches to Teaching. Lexington (VA): Washington and Lee University; [updated 2012 May 29; cited 2012 Nov 17].

3.   Page RL, Hume AL, Trujillo JM, & Leader WG. ACCP White Paper Interprofessional Education: Principles and Application. A Framework for Clinical Pharmacy. Pharmacotherapy 2009; 29: 145e-164e.

4.   Allen DD, Penn MA, Nora LM. Interdisciplinary Healthcare Education: Fact or Fiction? Am J Pharm Educ 2006 April 15;70(2): Article 39.

5.   Bridges DR, Davidson RA, Odegard PS, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Med Educ Online 2011 April 8;16:6035.

6.   Packard K, Hardeep C, Maio A, Doll J, Furze J, Huggett K, Jensen G, Jorgensen D, Wilken M, Qi Yongyue. Interprofessional Team Reasoning Framework as a Tool for Case Study Analysis with Health Professions Students: A Randomized Study. JRIPE 2012; 23: 251-263.

7.   Shibley I. Interdisciplinary Team Teaching Negotiating Pedagogical Differences. College Teaching. 2006; 54(3): 271-274.

8.   Interprofessional Education Collaborative Report of an Expert Panel. Core Competencies for Interprofessional Collaborative Practice [Internet]. 2011: 1-47.

Cross-cultural Communication: Know Your Audience

by Mamta Karani, Pharm.D., PGY1 Pharmacy Practice Resident, University of Maryland Medical Center

In 2008, I had the life-changing opportunity to volunteer at a medical mission camp in Bidada, Kutchh, India. The Kutchhi people lived in a rural, desert area and travelled over 100 kilometers to get medical care at the Bidada Sarvodaya Trust Hospital. Health care practitioners and volunteers flew in from all over the world to provide care for these patients. For some volunteers, this was their fifth trip. For others, like me, this was our first.

During our trip, we had multiple opportunities to educate and provide medical services to the Kutchhi people, a population with a different language and culture than ours. This experience sparked my interest in teaching because I was assigned to teach these patients about how to properly use the medicines that we were dispensing. Patients would quietly wait in line while I read a piece of paper and filled medications in a little plastic bag. I learned how to say “take it once a day” in Kutchhi and give other simple instructions on the proper administration of the medications. However when patients were prescribed over five medications to take on a daily basis, I really had to reassess my methods to make sure they understood what I was saying.  In an attempt to help patients remember, I learned how to write the directions.  After I’d given written instructions, I would ask the patient to teach me regarding the proper administration. However, when checking the patient’s understanding of the regimen, I'd often get a blank stare. I had explained the directions and wrote them out, why hadn’t the patient understood?  I learned the language, collaborated with the local people, and provide both verbal and written instructions.  What went wrong?

When addressing cultural differences and learning how best to effectively communicate, knowledge is key and understanding the audience is vital.¹  As in any teaching plan, we need to:

• prepare by performing strong background research
• actively teach, learn to adapt, keep an open mind, and be patient
• evaluate and make changes when necessary

To effectively address cultural differences, what research is required? First, self-knowledge and self-awareness are needed.  Before we can try to understand someone else’s culture, we have to be aware of our own. Next we should learn about our patients through observation and collaborating with a local team member. Some questions to consider in your research include:

What is the preferred style of the communication for the audience? Are the communication preferences similar or different from our own? In the United States we tend to be low-context communicators — meaning we speak directly. In some cultures, people prefer high-context communication which involves speaking in conceptual terms to get a point across. In general, high-context communicators find nonverbal messages and gestures equally if not more important than what’s verbally stated.  Building a good relationship contributes to the effectiveness of communication over time; and indirect routes and creative thinking are important. In the Navajo culture, for example, if I told a patient that his/her poor blood sugar control might one day lead to a limb amputation if he/she doesn’t take the prescribed medications, the patient may feel insulted and disrespected.  Rather, if I created a story of how a person with high blood sugar required an amputation after not receiving treatment, the patient would be more motivated to learn and intuit the importance of adherence with treatment.

Does the audience believe in individualism or in communitarianism? Do members feel like they each are entitled to make their own decisions or are decisions driven by society and/or family.  Understanding this concept is vital to gaining the respect and trust from the individual and community.

What is the audience’s baseline knowledge?  Are they well educated regarding health issues?  Have they ever attended school?  What is their level of literacy? Can they read? Learning the answers to these questions up front is really important to making certain the audience can understand our take home messages.  As I learned, this was one step I neglected to research.

After having the baseline research, how can we overcome language and cultural barriers? Intercultural trainer, Kate Berardo, states we should:²

1. Speak slowly and clearly.  Even if the patient speaks some English, its hard to digest complex instructions.   If using a translator, simplify your statements and questions — discuss one issue at a time.
2. Ask for clarification. If someone asks questions, assess if you have answered the question and do not make assumptions.
3. Frequently check for understanding. Engage the learner by asking open-ended questions to see if your message is coming across as intended.
4. Avoid idioms. Idiomatic phrases and slang terms that are well understood in one culture, may not translate or make sense to someone in another culture.  Avoid them. Provide examples of things they might be familiar instead. For example, when educating someone about diet, talk about foods that are commonly eaten in that culture. Teaching vegetarians to increase their protein intake by eating meat would be insensitive. Rather teaching vegetarians to increase their protein source by consuming more legumes and beans would be more effective.
5. Be careful of medical jargon. Use simple terms.  Although as practitioners we may be comfortable talking about hypertension, diabetes, condoms, etc, using these terms may confuse or even insult some patients. Consider using simple terms like high blood pressure, high blood sugar, and safe sex practices to get your message across.
6. Be patient and attentive. They are trying to understand us as much as we are them.

In my case, I could have prepared better by asking the organizers more information about the patients and their literacy levels.  Fortunately, I checked for understanding and asked the patient to teach me about the medications.  In doing so, I realized that many patients were not able to read.  I was able to make changes in how I communicated to get the point across.  I drew a sun and a moon and explained that the sun meant morning and the moon meant evening.  It was like a light bulb turning on and the patient’s eyes gleamed with happiness. When asked again, the patient was able to explain how to appropriately take the medications.  I now realized the importance of doing an analysis and truly understanding your audience before delivering instruction. Without preparation before and evaluation after, we can’t overcome cultural barriers and educate patients.  But, the same is true for any teaching assignment.

References

1.   Cross-cultural communication strategies.  International Online Training Program on Intractable Conflict.   Conflict Research Consortium, University of Colorado.  Accessed on: December 15, 2012

2.  Berardo K.  10 Strategies for Overcoming Language Barriers.  The Culturosity Group, LLC.  Accessed on:  December 15, 2012

3.  LeBaron M.  Communication Tools for Understanding Cultural Differences.  Beyond Intractability.  Accessed on:  December 15, 2012

4.  HubPages.  Identifying and Overcomign Communcation Barriers.  Accessed on:  December 15, 2012