Many of us practice oncology pharmacy in academic medical centers, in schools of pharmacy, and in practices that actively train various learners, such as interns, students, and residents. Most data surveying preceptors suggest that the majority of preceptor time is spent on imparting clinical knowledge. Much less time is dedicated to the preparative work of defining baseline expectations, individualizing learning plans, delivering feedback, and mentoring young learners. When thinking about your preceptorship, ask yourself:
- Are baseline expectations well defined at the beginning of the learning experience?
- Are these expectations individualized to each learner?
- Have I been giving the learner consistent and constructive feedback throughout the learning experience?
- Is the learner in a position to achieve the baseline expectations?
- Does the learner leave my rotation valuing the contributions made to patient care?
Although imparting clinical knowledge is an invaluable contribution of any preceptor, the answers to these questions are what often turn a basic experience into one learners will remember for the rest of their careers.
Setting baseline expectations
Have you ever limited the feedback that you wanted to give a learner? If you have ever delivered feedback by beginning with “I should have emphasized this at the beginning of the rotation” or “I know I wasn’t able to spend as much time with you as I would have liked,” then you have. You know exactly the things you would like to have said to a learner, but for a variety of reasons you didn’t. Or if you did, you portrayed the feedback in a way where you, the preceptor, take partial responsibility for failure to meet expectations. This is one of the biggest disservices you can do to a learner. Although it may be difficult to deliver feedback, it is our responsibility to give our learners honest, constructive feedback. Setting up well-defined baseline expectations is the best way to lay this foundation.
All goals and expectations must be clearly laid out for learners at the beginning of the experience. Each of these must be mea surable and realistic. In this way, when you give feedback, you will be able to relate it directly to one of the goals or expectations clearly stated at the onset of the experience.
Consider this example of two variations of a similar learning objective for an oncology rotation:
- Following completion of the rotation, the learner should be able to prospectively monitor drug therapy for appropriateness in the management of disease- and treatment-related complications in patients with cancer.
- Following the completion of the experience, the learner should be able to prospectively monitor drug therapy for resolution/failure, toxicities, complications, and possible therapeutic alternatives in the management of disease- and treatment-related complications in patients with cancer.
The major difference in these two objectives is the replacement of the vague term “appropriateness” with better defined activities the learner is expected to apply and practice. If treating a patient with pain, for instance, a plan should be ready in case the implemented plan fails to control the pain. If a patient started chemotherapy, a plan should be in place to treat common toxicities. If switching a patient to oral medications for discharge, the patient’s ability to obtain that medication as an outpatient should be confirmed. If an antibiotic is initiated, an alternative plan should be in place in case the patient develops a rash or his or her condition worsens. Although this objective is not perfect by any means, it emphasizes systematic, directed application of preestablished expectations.
Individualizing the learning plan
Consider the background of the learner. A preceptor should not expect the same from a pharmacy student as from a specialty resident. One must also consider each learner’s timeframe in the educational year and his or her previous experiences. For example, any learner’s first experience in a new environment, regardless of how “good” the learner is, will need to include time to focus on issues that have nothing to do with oncology. Navigating the medical records system, locating key locations throughout the practice, and identifying and communicating with appropriate healthcare professionals are all important aspects that need to be addressed for learners to be effective in their role. One must also consider the learner’s previous experience in any particular setting. For example, a learner who has performed excellently in early rotations in pharmacy distribution or ambulatory care may struggle with the first experience in an acute-care setting. Finally, one must consider the learner’s previous experience in a specialty. A preceptor should not have the same expectations for a learner who has completed several previous oncology experiences as for one who has not had exposure to oncology since the third year in pharmacy school.
Consider the needs of the learner. Needs based on previous and future experiences should always be considered when setting objectives for any learner. One must identify any educational gaps that the particular experience or preceptor can fill. It is often beneficial to identify these needs early in the experience so the preceptor can set this up in advance. Having access to past evaluations as well as knowledge of future plans can greatly aid in this process but is often a barrier to implementing this strategy. It is also important to identify self-perceived areas of improvement. One can ask learners to identify things they would like to develop, not only over the course of the current experience, but also throughout the year. Learners often may not know that opportunities exist within a given experience but, if given the chance to identify areas of development, may discover that such opportunities exist.
Consider the goals of the learner. Regardless of a learner’s desired career path, it is the responsibility of the preceptor to respect each learner’s professional development. One can ask learners what tools are going to be needed to be successful in their chosen career. I am always struck by the number of learners who, when asked what they want to do with their career, state that they are too late in the course of their training to pursue a given career path. Preceptors should consider it their responsibility to set up learners not only to succeed over the course of their current experience, but also to lead them toward success in their desired career path.
It was not until late in my third year of pharmacy school that I made the decision to pursue residency training. At the time, I had decent grades but no significant involvement in professional organizations and no student leadership experience. When compared with others in my class, I felt there was no way I could compete for a residency. I was fortunate to have several preceptors who were interested in my career aspirations and were willing to mentor me in achieving residency training. Before applications were due, I was able to add several projects and two publications to my experience with subsequent letters of recommendation. In the end, I was granted interviews at some of the top programs in the country and ended up matching with a great program. When I look back, I know this would not have been the case without the help of my very dedicated preceptors who made sure I was set up to succeed not only during their rotation but also in my chosen career path. This is just my example of how influential, dedicated preceptors can be in helping learners achieve their career goals and establish lasting relationships.
Delivering proper feedback
Almost 30 years ago, Dr Jack Ende provided suggestions for giving feedback in clinical medical education.1 Although the terms “feedback” and “evaluation” are often used interchangeably, he made key distinctions between the two that continue to mold the way I function as a preceptor. Some of these distinctions include that feedback presents facts, not judgment, and that feedback allows learners to remain on course toward their goals. In contrast, evaluations often include judgment of performance, are often summative, and describe how well or poorly a learner is meeting goals.
The delivery of feedback is also extremely important. Feedback must be well timed. Although, giving feedback on rounds in front of the medical team may not be appropriate, neither is waiting until the end of the rotation when learners do not have the ability to do anything to correct their actions. Whenever possible, feedback should be based on firsthand knowledge and should focus on specific performance, not generalizations. Relying on information passed from others clouds the facts of a given situation. Specific examples of a learner’s actions emphasize how these actions are related to the given expectations. Finally, feedback should be regulated in quantity. Although inexperienced learners may have plenty of room for improvement, feedback overload or destructive delivery can lead to hopelessness and desensitization.
There are many possible consequences to allowing learners to pass through an experience without proper feedback. Not only can mistakes go uncorrected, but good performance may not be reinforced. If proper feedback is not given, less forceful learners can get lost and overindependence gains unwarranted approval.
Serving as a role model
Like it or not, we are role models for our young learners. Many of us have been molded by the people who have surrounded us. Although you may not have had the perfect role model, you can pick and choose the characteristics of individuals that are appreciated the most and use them to create the professional you would like to be. Are you pushing yourself as much as you push your learners? Do you have a steep learning curve? Are you getting the most out of your role? If not, your learners will know, and they may not get the most of their experience.
How is your attitude? I have residents and new preceptors who have the same attitude about the department or our practice model as our preceptors who have been here for 20 years. How does that happen in 3 months? Most likely, it is not from their personal experience. My guess is that it is from picking up on the office conversations that are commonplace in every institution. It is good to expose our learners to the reality of our professions, but we need to put on our professional filters so that healthy, constructive information reaches our learners and they are not prematurely jaded before they are able to develop their own opinions.
Conclusion
This short article can barely brush the surface of what it takes to become a great preceptor. We will continue to pass our knowledge to learners we work with, but it is my hope that after reading this article that we will rethink how we are passing on this knowledge. Clear baseline expectations are the foundation of a learning experience. Consistent constructive feedback is necessary to ensure our learners are on the path to success. Finally, preceptors who demonstrate a high level of professionalism and embody the characteristics of a role model will provide learners with a road map for what it means to be a great pharmacist and mentor for tomorrow’s future practitioners.
Reference
1. Ende J. Feedback in clinical medical education. JAMA. 1983;250:777-781.