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.
References
- Langlois JP and Thach S. Managing the difficult learning situation. Family Medicine. 2000;32:307-309.
- 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.
- Langlois JP and Thach S. Preventing the difficult learning situation. Family Medicine. 2000;32:232-234.
- 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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