Assisting Students with Disabilities During Experiential Education

by George Lamare Haines, PharmD, PGY1 Community Pharmacy Resident, The University of Mississippi School of Pharmacy

There is only one way to look at things until someone shows us how to look at them with different eyes.

—Pablo Picasso

At times it is hard to see problems that face others. Often, when a problem doesn’t affect a person, they don’t perceive it as a problem or that it exists because they don’t have to deal with it. This is certainly true when it comes to people with disabilities. There are many things that an able-bodied person takes for granted and never even considers. When it comes to students in college, title II of the Americans with Disabilities Act (ADA) protects people with disabilities from discrimination by universities, community colleges, and vocational schools.¹ Most of us are at least somewhat familiar with accommodations for students with disabilities in the classroom setting, but it is far less common to see these considerations in experiential learning environments.

Every educator tries their best to determine the most appropriate teaching methods for the largest number of students. For most programs, there are special accommodations made for students with learning disabilities in the classroom, like providing extra time during testing or having someone read the exam questions aloud. When students with disabilities enter professional programs, they will be required to participate in experiential education that places them in environments similar to those that they will work in after completion of their program. These “non-academic” settings, which are not under the control of the university or college/school, can be challenging for students with disabilities.

When the University of Colorado School of Medicine was faced with this, they took steps to ensure that their students were set up for success. To illustrate, the school made special accommodations for a third-year medical (M3) student who uses a wheelchair. The student was scheduled to start an Operative/Perioperative clerkship. Before the start of the student’s M3 year, the student met with the medical school dean to discuss requirements, barriers, and reasonable accommodations for the clerkship. The dean then met with preceptors for the clerkship to inform them of the student’s disabilities and to develop a plan for an optimal experience, which included selecting clerkships that would allow for maximal physical access and participation. By putting in this extra effort, the student was able to fully participate in all required clerkships and went on to complete the degree with honors.²

Due to the student’s proactive behavior, there was effective communication and reasonable accommodations made so that they could complete their clerkship. Early communication is the key here. As with most issues, if they are addressed as early as possible, the issue can be addressed before it causes real problems. Often administrators have to do the groundwork to ensure that learners with disabilities are able to complete the requirements of an experience. These steps are important for both physical and learning disabilities. Students with learning disabilities are often hesitant to report these since there is often stigma and shame. Or they may not understand the impact of their disability and the potential benefits of sharing the information with their preceptors.³

Preceptors and faculty in experiential education administration can determine reasonable accommodations for students if they are given adequate time, resources, and knowledge of the disability.⁴ There are five basic principles that should guide institutions to ensure that reasonable accommodations are provided. The accommodations should be based on a reliable diagnosis; they must mitigate factors of the disability that affect student competencies; it should be tailored to each experiential site; they must ensure collaboration and communication occurs between the students, staff, preceptors, and administration; and most importantly, it must uphold privacy. If the accommodation takes away from any of these, it can not be considered reasonable.⁴ Often, accommodations for a student with a learning disability can be made by minor adjustments to the environments, policies, and procedures. Students with physical disabilities may require significant adjustments in the environment.  By having proactive policies and procedures in place, preparing preceptors for what to expect, and monitoring student learning outcomes, students with disabilities have the best chance for success during experiential education.⁴

A recent commentary published in the American Journal of Pharmaceutical Education provides a stepwise approach to addressing these needs.⁵ The first step is to create a system for students to submit a request when entering the experiential program. Once the student has submitted the request, the program is then responsible for exploring accommodation options and sites that either already meet the requirments of the accommodation or that can reasonably accommodate the request. The next step would be applying and fully implementing these accommodations. This will look different for different locations and will depend on the needs of the student. For example, a student who does not have sufficient strength may be accommodated by shortening the length of the rotation day but extending the total number of days in order to meet the required number of experiential hours. Another example would be to avoid rapid-fire questioning for a student that struggles with processing information.⁴ A practice walkthrough by both the student and preceptor may also be useful before the start of the rotation to allow the student to familiarize themselves with the environment and what to expect when they start the experience. The final, and possibly most important, step is to monitor the effectiveness of the accommodation. Continued communication between the preceptor, student, and experiential program director is essential to quickly address oversights and ensuring the accommodation is effective.⁵

When we start looking at these required experiences from the student with a disability perspective, we see problems that we didn’t know were there. It takes students with courage to tell you what their needs are. Open, honest communication seems to be the key to addressing the needs of students with disabilities, especially in experiential education.

References:

1. Americans with Disabilities Act of 1990; 42, USC §§ 12101 et seq.
2. Malloy-Post R, Jones TS, Montero P, et al. Perioperative Clerkship Design for Students With Physical Disabilities: A Model for Implementation. Journal of Surgical Education. 2022; 79(2): 290-94.
3. Vos S, Kooyman C, Feudo D, et al. When Experiential Education Intersects with Learning Disabilities. Am J Pharm Educ 2019; 83(8): Article 7468.
4. Vos S, Sandler L, Chavez R, et al. Help! Accommodating learners with disabilities during practice-based activities. J Am Coll Clin Pharm; 2021; 4(6): 730-37.
5. Kieser M, Feudo D, Legg J, et al. Accommodating Pharmacy Students with Physical Disabilities During the Experiential Learning Curricula. Am J Pharm Educ 2022; 86(1): Article 8426.

Should We Adopt a Two-tier Grading System in Health Professions Education? Benefits and Practical Considerations

by Mary Kathryn Vance, PharmD, PGY-1 Pharmacy Practice Resident, University of Mississippi Medical Center

Grades have long been a cornerstone of educational systems, giving students and educators a way to measure the achievement of learning objectives within courses. Grades were first instituted in the 1700s in Europe to assign a rank order among students. By the late 1800s, several American universities had adopted a grading system with “passing” rates ranging from 26-75%. Eventually, this transitioned to the tiered grading system we recognize today, where an A generally means the student has scored at least 90% on the assessment (or received >90% of available points in the course), a B means 80-90%, a C means someone scored in the 70s, and so forth. Grades typically are attached to a descriptor.  For instance, an A might signify an exceptional level of achievement, a B good but not outstanding level of performance, a C a fair level, and a D signifies significant performance deficiencies but still passing.¹ While this is still the system widely employed by the majority of Doctor of Pharmacy programs in the United States, some programs have adopted a pass/fail or two-level grading system.

Several studies have shown that students in health professions programs, including pharmacy students, experience anxiety, depression, and stress at higher rates than their peers. This places students at a higher risk of developing burnout, which is characterized by exhaustion and a diminished sense of accomplishment.^2,3 Moreover, multitiered grading systems can foster unhealthy competitive environments among students. Two-level grading systems have been proposed as a potential way to mitigate stress, reduce competition, and increase students’ well-being. A survey with nearly 1200 first- and second-year medical student respondents found that students in schools using grading scales with three or more categories had higher levels of stress, emotional exhaustion, and depersonalization when compared to students in schools using two-level grading systems. Students in schools with multi-tier grades were also more likely to have seriously considered dropping out of school.⁴ Another study conducted at Mayo Medical School compared students from classes before and after implementation of a two-level grading system. Students graded with the two-level system had less perceived stress and greater group cohesion than their multilevel peers.⁵

One concern that educators express about two-level grading systems is that they can negatively impact academic performance. Students’ motivation to learn the material might be decreased because they may not have to understand the concepts as deeply to get a passing grade. Some evidence suggests this concern is more theoretical than true. At the University of Virginia School of Medicine, the first two years of the curriculum were changed from graded to pass/fail. When student performance was compared before and after the change, no differences were observed in subsequent course grads, grades during clerkships, or scores on the United States Medical Licensing Examination (USMLE) Steps 1 and 2 Clinical Knowledge boards.⁶ Similar results were seen at the Mayo Medical School — there was no difference in USMLE Step 1 board scores before and after changing from a multilevel to a two-tier grading system.⁵

While they do not appear to reduce students’ achievement during school, two-level systems may better position students to become self-regulated learners. Health professionals are expected to engage in a process of continuous learning throughout their careers. This may be difficult for some students after transitioning from a system with strong extrinsic motivators (i.e. grades) to professional life where the individual must muster the internal motivation to figure out what, how, and when to learn. Helping students develop into self-regulated learners while still in school lays the foundation for this to continue throughout their careers and ultimately increases their knowledge and skills to provide better patient care.⁷

Another potential disadvantage of two-level systems is a decreased probability for students to match with residency programs. The American Society of Health-System Pharmacists (ASHP), the organization that is responsible for pharmacy residency program accreditation, will soon be requiring that all accredited pharmacy residency programs develop procedures on how to evaluate the academic performance of applicants from pass/fail (two-tier grading) institutions.⁸ There is still the potential that students from institutions that have two-tier grading systems could be seen as less desirable or competitive. However, this effect was not seen in a study that examined the effect pass/fail grading on advanced pharmacy practice experiences (APPEs) had on residency match rates at 100 pharmacy schools in the United States over the course of 3 years.⁹ Unadjusted analyses showed that there was no difference in match rates between students from schools with multilevel and two-level grading systems. After adjusting for potential confounders, two-level grading was actually associated with higher match rates during one of the three years.⁹ Similar rates of success in residency placement were also seen in the study conducted at the University of Virginia School of Medicine before and after their transition to a two-tier grading system.⁶

Despite the potential benefits, two-tier grading systems have not been widely implemented in pharmacy education and when it has been implemented, they are some inconsistencies. A study examining the implementation of two-tier grading systems within Doctor of Pharmacy programs found that the programs varied in the terminology used to describe student achievement levels, minimum pass levels, and whether a class rank or GPA was calculated, among other factors.¹⁰ This lack of uniformity leads to questions as to how best to implement two-tier grading systems.

Experiential courses such as introductory and advanced pharmacy practice experiences would seem to lend themselves well to a two-tier grading system. These types of courses tend to vary in their rigor and requirements based on the practice site. This can make interpreting and interpreting letter grades assigned to a student’s performance is already difficult. There are a variety of labels that could be used in a two-tier system, such as pass/fail, pass/no pass, or satisfactory/unsatisfactory. These labels haven’t been evaluated, but the connotations with “fail” and “unsatisfactory” would seem to be more negative than “no pass.”

Converting non-experiential courses to a two-level system is controversial. In schools where this has been done, numerical grades given to assignments and assessments are used to calculate a student’s class rank. This could allow high achievers to be rewarded and give residency programs a way to compare applicants. We clearly need additional studies about two-tier grading systems to determine their benefits and risks and how to best execute them.

References

1. Cain J, Medina M, Romanelli F, Persky A. Deficiencies of Traditional Grading Systems and Recommendations for the Future. Am J Pharm Educ 2022; 86 (2): Article 8850.
2. Brazeau CMLR, Shanafelt T, Durning SJ, et al. Distress Among Matriculating Medical Students Relative to the General Population. Academic Medicine. 2014;89(11):1520-1525.
3. Geslani GP, Gaebelein CJ. Perceived Stress, Stressors, and Mental Distress Among Doctor of Pharmacy Students. Social Behavior and Personality: an international journal. 2013;41(9):1457-1468.
4. Reed DA, Shanafelt TD, Satele DW, et al. Relationship of Pass/Fail Grading and Curriculum Structure With Well-Being Among Preclinical Medical Students: A Multi-Institutional Study. Academic Medicine. 2011;86(11):1367-1373.
5. Rohe DE, Barrier PA, Clark MM, et al. The Benefits of Pass-Fail Grading on Stress, Mood, and Group Cohesion in Medical Students. Mayo Clinic Proceedings. 2006;81(11):1443-1448.
6. Bloodgood RA, Short JG, Jackson JM, Martindale JR. A Change to Pass/Fail Grading in the First Two Years at One Medical School Results in Improved Psychological Well-Being. Academic Medicine. 2009;84(5):655-662.
7. White CB, Fantone JC. Pass–fail grading: laying the foundation for self-regulated learning. Adv in Health Sci Educ. 2010;15(4):469-477.
8. American Society of Health-System Pharmacists. (2021). ASHP Accreditation Standard for Prost Graduate Residency Programs Draft Guidance.
9. Pincus K, Hammond AD, Reed BN, Feemster AA. Effect of Advanced Pharmacy Practice Experience Grading Scheme on Residency Match Rates. Am J Pharm Educ 2019; 83(4): Article 6735
10. Spiess JP, Walcheske E, MacKinnon GE, MacKinnon KJ. Survey of Pass/Fail Grading Systems in US Doctor of Pharmacy Degree Programs. Am J Pharm Educ. 2022;86(1): April 8520.

Backchannel Communication to Improve Instruction and Learning

by Claire Calcote, PharmD, PGY1 Pharmacy Practice Resident, St. Dominic Jackson Memorial Hospital

If you are unfamiliar with backchannel communication, it involves using secondary ways to communicate “behind the scenes” of the primary method of communication, like during a lecture presentation. Its use within higher education has grown exceptionally, even before the COVID-19 pandemic. Backchannels have always existed within the classroom - like passing notes or private conversations with a nearby classmate. Now, multiple platforms allow students to submit comments, ask questions, or share supplemental materials without interrupting the primary communication channel (e.g., the teacher’s presentation). Essentially, the discussions and thoughts already occurring within the classroom are given an open environment to foster dialog. These channels don’t cure all problems - like distracting outside conversations, disengaged students surfing non-educational websites, and reserved learners who hesitate to ask for clarification or further explanation. However, a backchannel can create an additional outlet for discussions, engage both introverted and extroverted students, and reveal gaps in learners’ comprehension, which ultimately enriches instruction and enhances learning.

Several benefits of secondary communication through backchannels have been documented.^2,3 By providing an additional outlet for discussions and participation, student engagement is enhanced.² Backchannels also provide opportunities to engage those who are less likely to speak up during lectures or ask questions. Group collaboration can be facilitated when a backchannel is used.³ Additionally, these platforms foster an open environment for exchanging resources. Students can comment and clarify misunderstandings regarding lecture content.  And faculty can respond if needed.² This ultimately builds teamwork and collaboration skills, which are important outside of the classroom. Lastly, from an instructor perspective, the backchannel can reveal gaps in student comprehension, so efforts can be made to review or refocus specific content.³

While it is unclear when backchannel communication using modern technology first occurred, its formal use was described in the early two-thousands.¹ In 2006, a paper described a backchannel communication method using online chatrooms during graduate courses at the University of California, Berkley over a period of two years. Authors analyzed over 200,000 chat room entries, plotting chatroom communication over time to assess utilization trends.¹ They concluded that participation increased over time, with a small number of students participating most frequently.¹

I recently had some experiences working with a backchannel communication method during a course where I was the teaching assistant.  I wondered — is there a relationship between course performance and backchannel engagement? During this four-week course for second-year Doctor of Pharmacy students, a backchannel communication was available using a tool called Discord which includes Voice over Internet Protocol (VoIP) messaging, instant messaging, and digital media distribution platform. The instructor created a separate sever within Discord and enrolled the entire class, including teaching assistants and other faculty who contributed to the instruction. Additionally, students were assigned to small groups in the Discord community for active learning activities and other assignments throughout the course. During each class session, students had required to complete assignments or assessments that involved communicating with their group members in Discord. Individuals often used the general chat feature to communicate with other members of their group, the teaching assistants, and the instructors. Discord possesses helpful features like private messaging and both audio and video calling; therefore, students can contact anyone in the community to get clarification.  The system also provides a mechanism for urgent notification if emergent situations arise. Since Discord is popular among the gaming community, a select number of students were eager to engage on Discord as they were familiar with the platform.

During the first few days a majority of the class seemed hesitant to engage on Discord outside of the required in-class activities. However, as the course progressed, open discussions about lecture content occurred, with some students exchanging graphics and primary literature articles. Additionally, encouraging reminders before exams and amusing captioned pictures were exchanged between students and faculty. Students took the initiative to create topic-specific threads within the platform to organize the discussions for exam preparation. The experience aligned with the University of California, Berkley’s findings – backchannel communication participation increases over time, with a select number of individuals engaging the most.

By the second week of the module, particularly following the first exam, students were more likely to directly contact and communicate with the lead instructor and other faculty members. Questions became more specific and targeted as students began to study the materials. From a class administration perspective, in the event of a student emergency, participants were able to notify the faculty through Discord and devise alternative ways for the student to receive the instruction materials. These direct communication features were appealing from a faculty point of view, as they served as a more immediate way to communicate (when compared to email) and messages could be sent without disclose personal information. Platform use persisted until the conclusion of the four-week course, with students continuing to discuss and clarify lecture content prior to their final exam. After grades were finalizing, it was noted by the lead instructor that those who engaged the most within the backchannel were the highest performers within the course.

My observations coincide with experiences reported in a 2020 case study at the University of Aizu in Aizuwakamatsu, Japan.⁴ Professors used external personal social networking systems (SNS) like Twitter, Facebook, and Line for backchannel communication, which allowed students to interact and collaborate on assignments. Participants included those in four Japanese undergraduate English as a Foreign Language (EFL) courses and they were observed over one academic year.⁴ Interaction via the backchannel could be in any language of the students’ choice.  Initially, participants were hesitant to use the various SNS options for backchannel communication; however, reluctance was overcome once students realized the privacy of the backchannel. The study ultimately concluded that backchannel communication provided a comfortable outlet to engage with other classmates who they most likely would not interact with face-to-face.⁴

Backchannel communication can be used to overcome various classroom obstacles. Although multiple platforms exist, a single backchannel would be easier for faculty to maintain, monitor, and respond to. Students will need to learn about backchannel communication etiquette and faculty will need to set expectations on when and how to use the system.  Ideally, the backchannel would be used during the main channel (e.g. the lecture time) to prompt student engagement. This should be continued through several lectures to overcome potential participation hesitancy. Additionally, instructors should routinely send prompts in the backchannel that requires student response or collaboration related to the learning objectives of the course.  Creating a backchannel communication channel can increase classroom discussions, heighten student participation, and reveal misunderstood content.  In so doing, instruction and learning are ultimately enhanced.

References:

1. Yardi S. The Role of the Backchannel in Collaborative Learning Environments. In Barab S A , Hay KE, & Hickey DT. (Eds.), The International Conference of the Learning Sciences: Indiana University. 2006;(2):852-858.
2. Bruff D. Active Learning in Hybrid and Physically Distanced Classroom. In: Vanderbilt University Center for Teaching [Internet]. 2020.
3. Bruff D. Backchannel in Education – Nine Uses. In: Agile Learning: Derek Bruff’s blog on teaching and learning [Internet]. 2010.
4. Ilic P. Exploring EFL Student Use of Digital Backchannels During Collaborative Learning Activities. JALT CALL Publications. 2021;64-74.

Benefits of “Near-Peer” Teaching

by Allison Graffeo, PharmD, PGY-1 Pharmacy Practice Resident, University of Mississippi Medical Center

Near-peer teaching involves students learning from more senior peers, individuals who are one or two years ahead of them in school or post-graduate training.¹ It is a well-established model used by medical education programs; however, not fully established in pharmacy education. Some educators criticize this method, stating that it would lower the quality of teaching, be difficult to implement and be unethical to use students as teachers. However, using near peers in the classroom, practice labs, and experiential learning environment allows pharmacy students to learn from a peer who has been through similar (and recent) experiences. In addition, it contributes to the more senior peers’ growth to teach and develop their professional skills.²

There are two distinct types of near-peer teaching models most commonly employed: classroom-based and experiential learning. The classroom-based model incorporates senior peers to lead lectures, discussion, and other activities in classes or practice labs serving as an assistant to the faculty member. This model engages students to learn from their senior peers who use a similar language. When using near peers in the experiential learning setting, the instructor integrates learners (often at multiple stages of development) to address real-world problems or to gain research experience. Over the last decade, many authors and researchers have investigated the applicability of these near-peer teaching models in pharmacy education.

At the University of Toronto, near-peer teaching was assessed in an experiential teaching model that was led by a clinical pharmacist/preceptor and assisted by a recent graduate PharmD student with 3 years of previous hospital experience.  The learners included a pharmacy resident who had been with the institution for 6 months, a third-year pharmacy (cooperative “Co-op”) student, and a fourth-year pharmacy (Structured Practical Experience Program “SPEP”) student. The recently graduated PharmD and resident were considered the senior peers to the third- and fourth-year students. These clinical experiences consisted of patient-care rounds on a hemodialysis unit with a medical team. The lead pharmacist would provide articles on specific topics to the students and residents to prepare for patient and therapeutic discussions. Senior learners led the discussions, and all members of the group were expected to be in attendance to bring various experiences to discussions. This allowed the senior peers to use concepts and language that the third- and fourth-year students could more easily understand and relate to while also having the preceptor available to explain concepts more deeply and fill in the gaps. These sessions occurred at least three times a week and included minimal direction from the pharmacist to allow the senior peers to take the lead.² Although the expected hierarchy was for the students to rely on the resident, it turned into a collaborative group with each member of the team contributing. This method provided a unique and positive approach, particularly with regard to collaboration with healthcare teams and the students reported that they greatly benefited from having a near-peer role model. They explained that they felt comfortable approaching the recently graduated pharmacist and resident and they developed a better understanding of pharmacy interventions.

The Oregon State University College of Pharmacy recently assessed the effectiveness of a classroom-based near-peer teaching model.  They measured third-year pharmacy students’ knowledge and confidence related to frequently prescribed medications. There was a total of 98 third-year pharmacy students involved in the “RxReady” near-peer teaching series which occurred immediately prior to their advanced pharmacy practice experiences (APPEs). Twenty-four students were randomly selected and were required to study a certain medication and present a 10-minute presentation to other students (with a faculty member present). Students who participated in the presentation had to complete pre- and post-quizzes (test of knowledge) as well as a survey to determine the effectiveness (change in student confidence) of this teaching style.³ Out of the 96 students who took part in the pre- and post-quizzes and surveys, there was a 15% increase (p<.001) in post-scores compared to the initial quiz and survey. Additionally, 96% of students achieved a higher score on the final knowledge assessment compared to the initial ones. Student confidence scores significantly improved after the presentations (IQR [(0-0.5) – 1]; p<.05).² Targeted questions on the surveys included recalling dosing and formulations, side effects, pharmacokinetics and pharmacodynamics, drug-drug interactions, and counseling points.³ This method may be a useful way to assist students with learning gaps and prepare students to give presentations and engage in patient education during the APPEs.

Lastly, a review article examined six educational research studies that assessed the various models for near-peer teaching. The paper examined near-peer teaching activities in pharmacy schools. Of the six studies included in the review, surveys and questionnaires were used to assess knowledge, problem-solving skills, attitudes, and values towards near-peer teaching methods. These studies revealed that near-peer teaching was accepted and had a positive impact on students’ experiences. Students strongly agreed that near-peer teaching promoted collaboration and that they were excellent role models.¹

The purpose of experiential learning is for students to see real-life situations which reinforce drug knowledge, help develop communication skills, and provide opportunities to practice problem-solving. Near-peer teaching enhances student experiences by providing mentorship and assistance from a senior peer. However, barriers remain within pharmacy programs to implement near-peer teaching as a structured teaching model. To be most effective, senior peers should be assigned a faculty preceptor to ensure all daily responsibilities are being met and are receiving adequate feedback. Additionally, senior peers could create “notebooks” including classroom-based and experiential learning activities which they can pass down and updated annually, aiding the transition from student “learner” to senior “near-peer” teacher. If pharmacy schools routinely had near-peer teachers throughout their curriculum, it would not only provide a unique learning environment for students and residents but help to increase the confidence and clinical skills of pharmacists.^1,2,3

 

References: 

1. Aburahma MH, Mohamed HM. Peer teaching as an educational tool in Pharmacy schools; fruitful or futile. Curr Pharm Teach Learn. 2017;9(6):1170-1179.
2. Leong C, Battistella M, Austin Z. Implementation of a Near-Peer Teaching Model in Pharmacy Education: Experiences and Challenges. Can J Hosp Pharm. 2012;65(5):394-398.
3. Tsai T, Vo K, Ostrogorsky TL, McGregor JC, McCracken CM, Singh H. A Peer-Teaching Model to Reinforce Pharmacy Students’ Clinical Knowledge of Commonly Prescribed Medications. Am J Pharm Educ. 2021;85(5): Article 8451.

Best Practices in Preceptor Training and Development

by Natasha Lewis, PharmD,  PGY1 Pharmacy Practice Resident, Mississippi State Department of Health Pharmacy

A preceptor is a teacher who facilitates practice-based learning. They serve as an instructor or coach for students and residents, providing them with support as well as direct instruction that facilitates their professional development. Preceptors practice in a variety of settings and have different teaching styles and expectations. New and experienced preceptors may inquire about ways to start or improve their teaching skills as a preceptor. Others may feel that they lack time or resources to be an effective preceptor. Successful preceptor development and training should include educational activities and resources to meet the diverse needs of all students. Many of these qualities, such as assessing a learner’s clinical skills, developing relationships with other healthcare professionals, and being a positive role model should all be part of the preceptor’s professional development. Since preceptors play a vital role in a student/resident’s clinical learning, preceptor training programs are essential to keep them up to date on learning theories and practices to prepare future health professionals with the knowledge and critical thinking skills to be successful. The purpose of this article is to evaluate the literature pertaining to pharmacy preceptor development activities.

A recently published article entitled “A Scoping Review of Pharmacy Preceptor Training” identified and evaluated the literature pertaining to preceptor training programs. This article provided evidence-based options for colleges and schools to use in their preceptor training program.¹ Many of the preceptor training programs were face-to-face sessions and web-based modules, combined with written materials such as a preceptor manual, pre-session assignments, and self-study readings.¹ The responses to these programs were generally positive and described as beneficial.  The participants indicated that easy access to the training was important.  They also found that preceptor training was a great opportunity to share ideas, could illicit positive changes in behavior and attitudes, and a great way to gain insight into learning science.¹

In the scoping review, the authors suggested using online preceptor self-reflection/self-assessment tools as part of their training programs.¹ One program provided preceptors with a computer-mediated support network following a development workshop.^1,4 This workshop covered ways to provide feedback and teaching skills in patient care settings, and rotation design.⁴ After several of these programs, preceptors reported feeling adequately trained to be effective educators while still meeting their employment responsibilities.⁴

The University of Iowa College of Pharmacy’s constellation of preceptor development and training programs is a great example of a comprehensive program that follows best practices.² Their program includes four development tools: live events, printed documents, one-on-one experiences, and web-based programs.²

 

Preceptor Development and Training Programs
Live	Print	One-on-One	Web
Regional events On-campus programs State association educational seminars	Preceptor manual Preceptor newsletter National organization resources	Practice site visits Student feedback Available experiential faculty and staff	On-demand CPE webinars On-the-fly training videos Monthly journal club

Web-based programs were developed to provide preceptors with the convenience of learning and developing skills at their own pace. The program created a web-based development tool with four 30-minute modules for initial preceptor development.² They were made available online to be completed at the preceptors’ convenience. Periodically, new modules were added to the website with content relating to learning strategies, ethics, generational learning, continuing professional development, and mentoring.² Several other opportunities were created to complement these program elements, such as clinical topics, monthly journal club, and a preceptor discussion guide to facilitate dialogue with students.² At the end of the modules, preceptors were asked to complete an anonymous evaluation of the program. Preceptors highly rated several of these modules, stating that it helped improve their clinical practice, enhanced their knowledge, skills, attitudes, and values.

Printed documents included newsletters and manuals with guidance on educational philosophies, resources, policies, and curriculum.² The guides were created by faculty and staff members of the professional experience program.² Preceptors were also provided with links to websites with helpful resources.

Live educational events provide preceptors with networking opportunities, discussions, and continuing education credit on specific practice-based teaching skills.² Examples of these events include dinners, annual events, and workshops held for professionals within the field. These events afforded preceptors with a safe space to interact with other preceptors and gain knowledge, or “preceptor pearls” based on successful experiences of others.²

One-on-one training provide preceptors with the opportunity to open their practice site to students and provide quality practice experience while also increasing students’ communication skills with other professionals.² Students gain actual experience on site, while also building a relationship with their preceptors. This type of training provides students/residents with the opportunity to provide an assessment before and after the experience.² Students/residents interact with patients, as well as the staff at these practice sites, to gain a better understanding of what the preceptor does every day and learn more about the preceptor’s role.² After engaging in several of these activities, students rated their preceptors as “good” and “excellent”.^2,4 Several instructors reported that they felt more confident in guiding student learners.

Dental preceptors are encouraged to use the iCARE method for precepting, which stands for Inquire, Cultivate, Advise, Reinforce, and Empower.³ It is used to assist students with gathering and analyzing important information, assessing the patient’s condition, coming to a diagnosis, and developing a treatment plan and course of action.³ This process has been successful in providing students room to reflect on their knowledge and thought process while also providing time for preceptors to assess the learners’ understanding of key concepts and the scientific literature.

1. Inquire: Ask the student about the patient’s history, condition, diagnosis, and treatment plan options
2. Cultivate: What evidence does the student use to support the diagnosis and treatment?
3. Advise: Preceptor discusses information that student did not bring forth or perhaps overlooked. This helps build upon the student’s knowledge for future cases.
4. Reinforce: Preceptor discusses with the student what was completed well and areas for improvement
5. Empower: Students evaluate and reflect on the process. They propose changes they would like to make.

Medical preceptors often use the One-Minute Preceptor method to teach their students.³ This provides open communication between the preceptor and students while also providing time to teach clinical topics.³ When discussing a clinical case, the preceptor and student completed five tasks:

1. Get a commitment: The student is encouraged to commit to the next steps in a patient case. This can range from forming a diagnosis to creating a treatment plan. The student’s knowledge of the subject is applied to formulate a plan for the patient.
2. Probe for supporting evidence: The preceptor asks for evidence that supports the student’s plan. This provides the student an opportunity to explain how they at their plan.
3. Teach general rules: After listening to the student’s thought process and ideas, the preceptor then provides information to address general concepts.
4. Reinforce what was done right: The preceptor reinforces what the student completed correctly when analyzing the case. This creates a positive relationship between the preceptor and student, increasing the student’s confidence.
5. Correct mistakes: The preceptor corrects any mistakes and provides an explanation on anything missed. They can also prompt the student to critique their own process.

Both of these teaching approaches provide a great communication framework.³  Training preceptors to routinely use these communication and questioning strategies can enhance the student’s learning, problem-solving skills, and confidence.

Preceptor development and training programs provide resources and instruction to improve field-based teaching. By offering a variety of methods, preceptors have options to choose from for self-directed learning. Preceptor training and development programs are especially beneficial for new practitioners. With the guidance and assistance from these programs, preceptors can become comfortable and confident, adding their own personal touches to these experiences, demonstrating interest and enthusiasm for teaching, and with a caring attitude. Regardless of the profession, it is important to continuously improve our skills as healthcare practitioners and teachers to prepare the future members of our profession for the benefit of patients. 

References:

1. Knott GJ, Mylrea MF, and Glass BD. A Scoping Review of Pharmacy Preceptor Training Programs. Am J Pharm Educ 2020; 84(10): Article 8039.
2. Vos SS, Trewet CB. A comprehensive approach to preceptor development. Am J Pharm Educ. 2012 Apr 10;76(3): Article 47.
3. Sakaguchi, Ronald L. Facilitating Preceptor and Student Communication in a Dental School Teaching Clinic. Journal of Dental Education 2010; 74(1): 36-42.
4. Bolt J, Baranski B, Bell A, Semchuk WM. Assessment of Preceptor Development Strategies across Canadian Pharmacy Residency Programs. Can J Hosp Pharm 2016;69(2):144-8.