Mastering the Fundamentals of Precepting

by Sahil Sheth, Pharm.D., PGY-1 Pharmacy Practice Resident, Suburban Hospital

Residency training is a unique experience in the life of pharmacists. They are expected to demonstrate and develop clinical knowledge, organizational skills, and interpersonal communication while practicing pharmacy for the first time.¹ Therefore, effective teaching in this setting is essential. It requires flexibility, time commitment, and devotion to the resident. Preceptors need to address the resident’s desires as well as have flexible teaching methods and approaches.² This can be difficult because many preceptors are new to their roles and are developing their teaching skills. In one recent study, thirty percent of pharmacists indicated that they have been a preceptor for less than two years and over fifty percent had been a preceptor for less than five years.³ Using appropriate preparation techniques, effective teaching methods, and honest feedback strategies can help alleviate potential problems between preceptors and their trainees. Moreover, implementing these fundamentals can help the resident succeed.

Preparation and planning are key components of a successful practice-based teaching and learning experience. At the beginning of the clinical experience, preceptors should meet with the resident to discuss the resident's learning style, learning goals, and career aspirations so that the experience can be tailored to meet the resident’s needs. For example, a critical care preceptor can tailor major presentations such as journal clubs and patient cases in infectious diseases for a resident who is interested in applying to a PGY-2 Infectious Diseases residency. In addition to tailoring the rotation to residents’ interests, preceptors should outline day-to-day activities as well as longitudinal projects that the resident is expected to complete by the end of the experience. For instance, the preceptor can create a flow sheet outlining pre-rounding, discharge counseling, and follow-up tasks that needed to be completed each day. As a result, there is no miscommunication regarding the daily requirements and expectations.

Preceptors should teach critical thinking skills so that the resident becomes a detective able to gather relevant evidence, reflect on the information gathered, and manage patient interactions and follow-up.⁴  This can be done using different teaching styles. The two general preceptor approaches are the “sink or swim” method and the “manipulated structure” method.⁴ In the “sink or swim” method, the resident is assigned a panel of patients and is expected to manage those patients independently with no visible support from the preceptor.⁴ This includes pre-rounding on patients, attending interprofessional care rounds, performing medication reconciliations, and following up with interventions. There is minimal support from the preceptor besides providing “back up.” The “manipulated structure” approach involves selection of patients accompanied by preceptor consultations before and after interprofessional patient care rounds.⁴ Using this teaching strategy, the preceptor’s determines what the appropriate patient volume and complexity is based on the resident’s current level of skill and future developmental needs. There are several important factors that influence the selection of teaching approaches, but the most important factor is the resident’s prior experience. New residents (in July and August) will likely flounder if the “sink or swim” method is used, whereas residents in the final half of the residency year will likely thrive and appreciate the independence. It is important to select an approach that best fits the resident’s current skills and to conservatively advance the level of independence.

In addition to effective preparation and use of appropriate teaching methods, providing constructive feedback is essential to the resident-preceptor relationship. It is important for preceptors to provide ongoing feedback to residents – not just during the midpoint and final evaluation.¹ Moreover, feedback should always be done in a manner that helps the resident to perform better in the future.¹ Detailed and specific examples can help residents understand their strengths and weaknesses. For example, saying “You were lackluster today” is not sufficient. Instead, a more complete explanation like “Your medication reconciliation was incomplete for 5 out of the 10 patients that you followed today.  Be sure to ask about over the counter medication use in the future” is constructive. Preceptors can also conclude feedback sessions by asking the resident to reflect on the lessons learned.  This can help residents refocus and renew their efforts to perform better in the future.⁴

It is imperative for preceptors to prepare for the arrival of residents (and students), to use effective teaching methods, and to provide honest but constructive feedback. Developing a framework with these fundamental principles in mind will make the teaching and learning experience better for everyone. The roles and responsibilities of preceptors may differ, but the basic skills and teaching approaches are the same.

References

1. Anderegg SV, Christenson JC, Padgett CP. An accelerated, practice-based model for fostering precepting skills in pharmacy residents. Hosp Pharm. 2014;49(8):713-6.
2. Vaughn L, Baker R. Teaching in the medical setting: balancing teaching styles, learning styles and teaching methods. Med Teach. 2001;23(6):610-612.
3. Hartzler ML, Ballentine JE, Kauflin MJ. Results of a survey to assess residency preceptor development methods and precepting challenges. Am J Health Syst Pharm. 2015;72(15):1305-14.
4. Burns C, Beauchesne M, Ryan-krause P, Sawin K. Mastering the preceptor role: challenges of clinical teaching. J Pediatr Health Care. 2006;20(3):172-83.