Narrator - Dr. Abel  00:00
Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions. This podcast

Narrator - ?  00:11
is provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy.

Narrator - Dr. Abel  00:17
This podcast contains general information for educational purposes only. This is not professional advice and should not be used in lieu of obtaining advice from a qualified health care provider.

Narrator - ?  00:27
And now on to the show.

Speaker 1  00:31
Welcome to HelixTalk, Episode 54 I'm your co host, Dr. Kane. I'm Dr. Schuman, and I'm Dr. Patel, and we have a special guest with us today, someone who's been on the podcast before Dr. Cannon, the Director of Experiential Education here at Rosalind Franklin University, great to be with you all again. Thank you. And we brought you in here today because we thought it would be nice to talk about preceptor development and how to be a good preceptor. So the title of today's episode is So You Think You Can precept advice from the front lines.

Speaker 2  00:59
Yeah, I think Sean, we've gotten to a point now where we're all looking for ways to help preceptors do the things they want to do with students. We know that most preceptors want to give back, want to be the best they can. And every time I've done some type of preceptor development program where we've had large group of people, even a small group, it has always struck me that the expertise in the room is far beyond anything that I could bring to the table. So it's really trying to carve out some time and just talk about the things that you face and the things that you do. Because the one thing we don't get a lot of time to do is talk about our approaches to teaching. So I thought I've got three experts in the room now. Why not pick their brain and share with with a larger audience, if possible?

Speaker 1  01:45
And just to kind of piggyback on that, if you think about it, within the pharmacy education and curriculum, typically you're not given a class on how to be a good preceptor. You know, within residency programs, oftentimes you'll have a teaching certificate type program, which is great, but still not the emphasis of many programs. So just to have some tips and clinical pearls and gotcha moments with precepting, I think is really important.

Speaker 3  02:10
And if you hear from most students or pharmacy students on APPEs, they will tell you that they've learned the most in their APPE years, or the years where they're actually out in practice. So we want to make sure that we make that experience worthwhile and give them a strong experience.

Speaker 4  02:25
And you can also, I mean, you know, if you talk to enough students, you can hear, you know, both ends of the spectrum, but students are very passionate about describing, you know, what they feel was an ideal preceptor, as well as those they felt like maybe I wasn't as involved in my either my preceptor didn't really understand kind of the how to delegate how to have students involved, or otherwise they just there was some sort of a disagreement in terms of how things are approached.

Speaker 2  02:47
Yeah, and I do think that the majority of students choose to practice in a way that mirrors aspects of the providers that they've worked with along the way. So the preceptors have a huge responsibility in literally imprinting how a student is going to pursue not only their career, but how they practice, and in some regard, how they're going to teach to

Speaker 3  03:06
Yeah, and before I guess we get started with those general questions, it would be ideal to give the audience an idea as to where we practice. So for example, I'm in an ambulatory care environment at the Aurora Medical Center in Kenosha, where basically housed within a family practice clinic,

Speaker 4  03:22
and I'm in an ambulatory care clinic that's both a primary care with individuals with mental illnesses as well as with psychiatric care in that same population. And then we also have a little bit of coverage of some domiciliary programs, such as those that are staying with us for six, eight weeks for substance abuse treatment, PTSD treatment and it's involvement with

Speaker 1  03:41
traumatic brain injury. And I'm over at Advocate Condell Medical Center in Libertyville, where we have a mixed ICU. So we see cardiothoracic surgery patients, neurosurgery patients, medical patients, and it's a 17-bed mixed ICU that's a closed environment. So we have one intensivist group that kind of manages those patients outstanding.

Speaker 2  04:00
So again, inpatient, outpatient, federal healthcare system, community based hospital up in Aurora, with a pretty wide variety of patient populations across the board. So I'm curious, from from the standpoint of precepting, though, what's the kind of student that really makes you want to get out of bed in the morning and get to work? Who? What's a student that really excites you in terms of the way you like to teach.

Speaker 4  04:24
For me, I really like the idea about the detective work, kind of aspects about the asking the right questions to then dig into it. So kind of almost like the Holmes and Watson kind of idea about this, this banter or this discussion. So for me, it's the students who say, you know why you know that's strange, and why are they on that antidepressant versus another? Or isn't that the one that's more likely to cause discontinuation? Exactly. So let's talk about what an alternative is, and let's redesign the regimen so that kind of the ability up to ask or the question that then leads to further discussion. Well, that's a great question. Why don't you look that up in a way? So to kind of support the students and bounce off those questions to assess where they're at. So. Always, you know, that idea about pushing the students to the next level based upon what their questions are at you can always then keep moving. So we're not all of a sudden going from a low level to the, you know, the high, high level, but we can continue just to put the same time student who is at that level. We're not keeping them kind of static there.

Speaker 3  05:15
And I had to echo with Dr. Schuman. What he said is that I'm not expecting my students to know everything when they come to my rotation, and that being said, if there is a curiosity and that desire to learn their word they're asking questions, they're actively being engaged. They're there to learn. That excites me.

Speaker 1  05:33
Basically, I would definitely agree. But just to add something different is I love the pharmacy extern student, where they can help me do my job better. That allows me to do, you know, a better job in patient care, which is awesome, right? As opposed to the student that quote, unquote, sucks up resources, the student who can actually make me more effective and more efficient. That's the kind of student I love working with.

Speaker 2  05:57
And, you know, we really strive to put students in an environment where they can be participating peripherally, but in a legitimate fashion, and hopefully add some value to where they're at, particularly through our longitudinal program. But again, six weeks is a period of time that hopefully by the time they're done, they can at least start to engage in the process in a way that doesn't, as you said, suck up resources. So how do you as preceptors, kind of set the stage in those first couple of days in terms of orienting your student to help them understand exactly what's going to come so they get to that point as quickly as possible.

Speaker 1  06:28
So I'm very OCD about my orientation process. I have about 20 to 30 page handbook that I give them before they even come that goes through all of the logistics of the rotation. So I'm not answering the same questions in the email multiple times. It talks about how to work up an ICU patient, where to find things in the chart, how to set up their electronic health record appropriately to see the things that they need to see, basically all of the things that normally would be done face to face. I try to get as much in that as possible, and then also protocols relevant to my practice site. So how we dose medications, and it's, you know, different than what you might see in UpToDate, for example. So all of that helps kind of jump start the whole process by having it all on paper, and saves me time, too.

Speaker 3  07:13
Yeah, our institution is a little bit different, because most of the longitudinal students come to us and they are oriented regards to the database system, which is what we use Epic. And so they're actually taught how to navigate the chart, how to look up the pertinent patient information in the chart itself. When they come to me week or two before, when they email me, I let them know that, you know, these are the guidelines I want you to be updated with. And then the first second or first or second day when they're with me, I basically print out a daily calendar for the whole month or whole six weeks they're with me. I line out their activities, including the projects that they will be doing, and actually get them started on looking up the journal club articles and stuff. So in the first few days, they know how they need to space out throughout the six weeks that they have in order to balance out their workload. And I think what I've the feedback I've gotten so far is that they actually really appreciate it knowing the generation that we are dealing with right now. They like instructions. They like a structured schedule, and I think providing that kind of alleviates some of the unknowns and fears I'm

Speaker 4  08:18
going to echo, for the most part, of what Kathy had mentioned something that I early on, I had not used as much of a solid schedule, just because of that time, my job was even kind of somewhat in flux. But so to give the students a real opportunity to be able to work up patients, especially early on, at their own pace, and then we can kind of increase the pace as we get along, I've been using a schedule, and it's been great too, because then within there, I'm able to embed documents or give them guidance as far as to work up patients certain disease states that they're maybe not as comfortable with, via PTSD (post-traumatic stress disorder) or treatment of radiculopathic pain, for example. So providing them with guidelines as well in advance to be able to let them know these are the kind of things you will be seeing throughout the rotation. So this isn't just and also, one thing I always try to is contextualize what I'm doing too. So explain this is, you know, not busy work. This will be a patient population, trust me, you will start seeing on day one. So to really get ahead, start, start working up these guidelines and then being aware of them. And then we also, at our facility, also have an orientation day that the number of longitudinal students go through our facility, and they learn how to use the VA healthcare system as well to navigate through all the number of systems we have available.

Speaker 3  09:26
Something else that I would like to add to, you know, we kind of hold on to that in a professional aspect. So I obviously educate them about what I do in the clinic. But on the first day I take them around the clinic and introduce the students to various different healthcare providers and tell them that, you know, the little clinic that we sit in is not the place you're going to be working with. You're going to be working with all these different people around the clinic. So they feel a little bit more welcomed, but at the same time, more assimilated with the clinic flow.

Speaker 2  09:56
That's great. Now, unfortunately, there are those times when you have a student that. Makes it a little hard to get out of bed in the morning. So I'm curious, and I'm sure people who are listening that are interested in talking about those difficult situations, what is the one type of student that absolutely makes your life miserable?

Speaker 1  10:14
Think it's a student who submits really poor quality work for projects and things like that, where it's almost so bad to the point where it's hard to give constructive feedback because there's no good starting point, then it just again. Is a resource hog in terms of now, instead of talking about a new topic or reinforcing material, we're going through something that should have been done correctly the first time, and we're spending a lot of time on how to give a good presentation, or how to actually cite your resources on your PowerPoint slides, things that are kind of Givens, or you hope would be Givens, but aren't. And that's a problem.

Speaker 3  10:46
In my opinion. I think the students who repeatedly ask questions, even though instructions are already given, again producing poor quality work, because their excuse is that they did not understand the instructions. So rather than reaching out to the preceptors and asking, Hey, I did not understand this. Can you explain it to me? But rather than just producing a poor work and blame it on the poor quality of instructions that were provided, and I think second thing benefits me being a faculty in a program and teaching the same students out in the field, is that I'm very versed to the curriculum. So the moment a student says, Well, I don't think we did that at school. This is the first time I'm doing it, you're catching those students say, no, no, you have done this before. And I think one one advice that I may give a preceptor who wants to stand out is to get an understanding of the curriculum and the type of activity that the students have done throughout the didactic years. And so when the student comes to you, you kind of have those baseline expectations because you've already done it, and then you try to improve their skill sets from there on, rather than starting from scratch.

Speaker 4  11:53
And then for me, I think what I would find, you know, I do find challenging as a student, is students who either non communicative. So if we're trying to look at, you know, how to work something, and we're just, it's kind of like pulling teeth, and we're just getting kind of just the facts, you know, just one or two short answers. And therefore, it's difficult to continue to probe into a topic discussion, and especially also combined with maybe lack of initiative. Again, I love the student who's able to continue to bounce ideas off me, and we're able to discuss it and really turn any kind of patient work up into a miniature topic discussion. I love doing this. So the converse of it is when it just kind of at that bare minimum. So for example, if we're and not only that, but it also can, can be a problem for patient care, if we have somebody, for example, a lot of times we have individuals with both physical and, you know, psychiatric comorbidity. So for working up a patient for their PTSD and one of the things we're finding out is there's been some change in terms of their mood, or their post-traumatic stress sort of symptoms, nightmares and things, and just to kind of say, Oh, okay. And then moving on, and then, but we have an opportunity then to maybe address pharmacologically, some other issues there too, and just that initiative that needs to be there. And so that's that's one that can be difficult.

Speaker 2  12:58
So it seems like a common theme is trying to get the student to the next level, and whether it is taking that step that you just mentioned, Dr. Schuman, or in both of your cases, where you feel like they are well below where you would expect them to be at that point in the curriculum. So what are some things you've done to try and get students to understand their active role in the process of learning, and some of the things they need to do to get to the point that they're not only meeting but hopefully exceeding your expectations.

Speaker 4  13:28
One of the things I generally do is I always start out, you know, with the three stages. I always start out with the with the modeling, and then moving to coaching and then letting the student have more autonomy. So again, what I'll try to do is, depending upon how things are going, try more to model it as well as, again, if a student's really just not getting it from me, then I also will utilize, for example, our residents and so others as well, to try to give maybe there's a relatedness. And so by having you know someone else as well, whether it's the other preceptor or the residents that I work with, and that opportunity and for the student to continue to see maybe what a what would be, I consider the ideal scenario for how to work it up and then kind of navigate through this. This is what I'm going to do next. And a lot of times, to where I have some patients that are more stable, and then I can say, you know, I know, for example, what's going to want. So I'm going to tell the student before, and this is how, you know, this is how it's going to try to be. And if it doesn't go that way, then explain, okay, well, we have to take a deviation. So this is now my thought process for how we're moving forward. And then to give them an example of how you would be able to say, Okay, we'll take the initiative and gonna correct this other issue that maybe came up.

Speaker 2  14:30
And I do think modeling is a great way to get somebody to see what you're not only what you're expecting, but how another profession can do it. Dr. Kane, when you're faced with somebody who's well below that point, though, how do you take that stop and kind of try and reset the expectation?

Speaker 1  14:43
Well, sometimes you do have to reset some expectations with the understanding that there's still a minimum bar that the student has to achieve, right? So at the end of my rotation, for example, in the ICU, I like students to be able to work up six patients in the morning before rounds, which is typically about a two-hour time frame, and if they can't get to six, if they're at four or five, I'm usually okay with that, as long as that's a conversation with the student, that I would rather have four quality workups as opposed to six poor quality workups. The other thing to think about is, typically, for a six week rotation, you'll have a three week midpoint sometimes on those more problematic students, a Friday evaluation every Friday may be more appropriate so that they know where they're at, so that you can say, next week, I want you to focus on XYZ, so that they have a feel for where they're at and what they need to focus on, because you just can't say you're doing bad work on everything. Sometimes it's better to focus on one or two things for the following week.

Speaker 3  15:37
And I think I absolutely agree with maybe for those students providing a weekly feedback, especially when we know that they're not meeting the minimum competency. An example in the clinic would be they do not know how to check blood pressure properly. And to me, even though, with all students, I kind of let them check my blood pressure before I let them check my patient's blood pressures, but those are the kind of examples, you know, giving that feedback right away and saying, Well, you know, you approach the patient really nicely, but the cuff wasn't aligned, or the patient wasn't sitting properly. So redirecting their learning right away, or providing that feedback right away is important. What I do with my students in in the orientation of first two day process is that I ask them, like, what are their goals for this rotation, and what are their goals when they graduate from the pharmacy program? Where are they residency or fellowship oriented students? So those students will have a little bit more caliber to begin with. Will have a little bit decorated didactic curriculum, you know, history, and so we will push those students a little bit differently versus those students who, I do not want to stereotype a student over here, but those students who are, you know, they have a job lined up. You know, this is their sixth or seventh rotation. They have a job lined up. They have an opportunity lined up, and their motivation is a little bit low. And usually happens so that it's the last two rotation where you're having hard time pushing the students to do it. And what I tell them is that no matter where they're ending up, these are the expectation of the rotation. They should never be closing any doors going forward, and they need to comply with the

Speaker 2  17:12
rotations requirement. I think there's some special circumstances at those last couple of modules. When you've got somebody who's somewhat and I'll use the term checked out, they can be particularly problematic, and maybe we can talk about that at another time. You mentioned something very quickly. Dr. Patel, I'd like to wrap up with and that is something to the effect of this generation of students. I think most preceptors struggle when they deal with a situation that a student is, and usually it's a behavior or an action that they never would have considered doing as a student themselves, something that is so off the wall. Do you see some things generationally that give you pause, or do you do some things differently knowing this generation and how different they are from the time that you all were in school?

Speaker 1  17:52
So just to clarify, what are some of the characteristics of this generation that kind of stick out versus previous generations?

Speaker 2  17:59
Yes, I think, I think one of the biggest things that I've seen is the use of technology, specifically cell phones, and as well as some thoughts about what time is and how time on a rotation is to be spent, and the time that you're there is a defined period of time, almost like checking in with a clock, versus The patient care aspect. So it strikes me that there are some differences between where generations have been before and their view of the professional responsibilities of the student and as well as the use of technology. And again, younger generations look at that differently than older. So I'm just curious, from your standpoint, what you've encountered.

Speaker 1  18:37
I think one thing that stands out for me is that there's kind of this philosophy of it never hurts to ask sometimes, and sometimes it does hurt to ask. So if you're asking for 10 days off of a 20 day rotation, in certain circumstances, it is inappropriate to ask for a big ask, and especially given that typically you're asking for time off before you even start the rotation. You really don't want that to be your first impression with that preceptor as a student to say, hey, I need all of these days off. And it's really an inappropriate number of days,

Speaker 4  19:07
or, you know, the beginning of a day. Oh, by the way, you know, my boss at insert name of big box retail store says, you know, I got to work tonight, so I've got to leave the year rotation early again and just kind of spring that on. Oh, okay, again, that's things like that. The idea that, you know, is there's almost sometimes too much of a fluidity about it, or over sharing. For example, we've talked about, you know, there's an appropriate amount of sharing and communication, but to the point of some of the there's some of this, this over sharing, and some of even with patients about, you know, kind of the dialog about what's formal and informal, appropriate, inappropriate, that sometimes you see it kind of go over that line. You have to kind of bring it back

Speaker 3  19:42
in a little bit, yeah, and that has happened to me as well. We have students come, you know, they have kids, and sometimes they have to pick them up from daycare, and they have to get out of there. And we understand those scenarios happen, although there are forewarned that then there needs to be, you know, all these things needs to be pre arranged. But the work situation is definitely, I. Definitely striking. And I've actually had to, in my orientation email to the student, put down specific instructions that you know in a time and a preceptor is away, which I am, couple days I spent here at the University, and I'm asking students to work on projects that those projects be rotation or education related, if they're studying for their NAPLEX. I'm okay with that, because it's educational. As long as they are not working, that's okay with me. But you bring up a good point. I think this generation actually needs things laid out in writing. And as for the time commitment on the rotation and the orientation day, again, I make them really clear that even though the clinic operates from eight until 430 I leave when I'm done documenting the patient charts on most days, unless I have, you know, student group to watch here at the school and I have to run back to the university, then I finish up on the next day, but all documentation, patient follow ups for that day needs to complete before leaving the clinic itself.

Speaker 1  21:03
That's actually a really important point. That is a transition period from students who are used to working at an hourly rate to take care of patients at Walgreens, for example, to the professional pharmacy where you are, you know, either the APPE student or the pharmacist now and you're taking care of patients. You're not there just to serve out eight hours. Sometimes you have to stay late, and you're staying late because of patient care reasons. And at some point, there's this transition that I love to see, where it's a movement from, well, I have to do my hourly rates to, oh, I have to take care of this patient. That might mean I spend two hours in the evening to figure out what I want to do the next day to help treat that patient better. Things like that

Speaker 3  21:45
point, because I do have patients starting in the clinic at eight o'clock, but if the student shows up, like five minutes before eight o'clock, they're not going to be ready for that patient visit. So I tell them, if you have time the day before, look over the upcoming patients or please come in early. That doesn't mean that you know you cannot come in early. Doors are open.

Speaker 4  22:01
You have this policy as the bare minimum. It's the if I'm here, you're here policy so that you know if I'm going to be staying late to work up these patients, because I feel it's important, you darn well better be too, because that's the expectation, not that. Well, it's 430 you know. Dr, Schuman still, you know, he's still here, but I my rotation is over. Now, that's that's not acceptable.

Speaker 1  22:19
Dr. Kane, to your credit, I've basically never had a cell phone issue with a student that I've precepted and you know, in this kind of day and age, you would expect that to be more commonplace, especially with social media and drug information resources being on a phone. I've actually never had a problem with a student being on their phone on rounds or at inappropriate times, which is good.

Speaker 2  22:38
That's excellent. You know, again, you talk to people of different generations, and they even view somebody having the phone out a younger generation, somebody who's graduated the last five years may very well assume that they've got Micromedex pulled up on their phone rather than Tetris. Well, thanks guys. I really appreciate the time. I hope we can do this again sometime. Absolutely.

Speaker 1  22:57
Thank you for coming on and for the listeners, if you want, you can visit us at HelixTalk.com we're also on Twitter at HelixTalk, and we love five star reviews in iTunes. With that, I'm Dr. Kane, I'm Dr. Schuman, and

Unknown Speaker  23:09
I'm Dr. Patel and thank you Dr. Cannon and study hard.

Narrator - Dr. Abel  23:13
If you enjoyed the show, please help us climb the iTunes rankings for medical podcasts by giving us a five star review in the iTunes Store, search for HelixTalk and place your review there

Narrator - ?  23:25
to suggest an episode or contact us. We're online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.