AND RESIDENTS Anne Marie Bott, PharmD, BCOP, BCPS IHS Alaska Area - - PowerPoint PPT Presentation
PRECEPTING STUDENTS AND RESIDENTS Anne Marie Bott, PharmD, BCOP, BCPS IHS Alaska Area Oncology Pharmacist Infusion Center Pharmacy Manager Alaska Native Medical Center Courtney Klatt, PharmD, MBA, BCPS Pediatric Pharmacist Alaska Native
Anne Marie Bott, PharmD, BCOP, BCPS IHS Alaska Area Oncology Pharmacist Infusion Center Pharmacy Manager Alaska Native Medical Center Courtney Klatt, PharmD, MBA, BCPS Pediatric Pharmacist Alaska Native Medical Center
No conflicts of interest to disclose.
Identify the four preceptor roles as defined by the American Society of Health-System Pharmacists (ASHP) Produce learning objectives for the learning experience Produce learning activities based on the individual preceptor roles Illustrate effective feedback
1. What is the correct order of the four preceptor roles as defined by the American Society of Health-System Pharmacists?
a) modeling, instructing, coaching, facilitating b) instructing, modeling, coaching facilitating c) modeling, coaching, instructing, facilitating d) instructing, coaching, modeling, facilitating
2. Which of the following is an objective?
a) Interact effectively with the health care teams to manage patients’ therapy. b) Participate in daily rounds. c) Identify medication-related problems and address them with the team. d) Make evidence based recommendations.
3. Learning activities should:
a) Be actionable b) Specific c) Explain how an objective will be met d) All of the above e) B and C
4. Feedback should be ____.
a) Given when you discuss an evaluation b) At scheduled times c) Constructive d) B and C e) All of the above
Instructing Modeling Coaching Facilitating
Builds clinical reasoning abilities
▪ Defined as “higher order thinking in which the health care provider, guided by best evidence or theory, observes and relates concepts and phenomena to develop an understanding of their significance”.
Pattern recognition/nonanalytic reasoning ▪ Subconscious process ▪ Relate verbal and non-verbal input to a past experience ▪ Recognition of when a pattern doesn’t fit or apply Analytical reasoning ▪ Controlled process ▪ Gathering knowledge – chart review, reading guidelines ▪ Applying logic and inference Prevention of cognitive errors ▪ Awareness of potential biases and personal strengths/weaknesses
Image From: Kristin W. Weitzel, Erika A. Walters, James Taylor, Teaching clinical problem solving: A preceptor’s guide, American Journal
Objective ▪ ASHP has these set for residents in the guidelines ▪ Observable, measurable statement describing what the student or resident should be able to do by the end of learning experience ▪ Can be created for students who are on rotation Activity ▪ What the student or resident will do to help achieve the
▪ Should be actionable ▪ Specific
https://www.ashp.org/-/media/assets/professional-development/residencies/docs/learning-activity- examples.ashx?la=en&hash=06B1F8664EB0FB03AFC3A07AC797CE7DBCD467A8
Manage aspects of the medication use process related to formulary management.
criteria for approval.
ensure bar-coding of the medication is completed before dispensing.
formulary medications, as appropriate.
Given the following as an Objective, create two learning activities: Prepare and dispense medications following best practices and the organization’s policies and procedures.
necessary information clear instructions foundational learning
Provides foundational knowledge and skills to apply to patient care Lectures ▪ Can include fictional case-based teaching ▪ Rarely used in clinical setting Assigned readings ▪ Guidelines ▪ Site specific policies and procedures
Recommend guidelines ▪ Look up the most up to date guidelines ▪ If from various sources, compare them ▪ Results ▪ Expands knowledge or provides a refresher to fill in knowledge gaps ▪ Guidelines are applied to patients/disease states ▪ Leads to start of applying script theory
Application of script theory ▪ Brain organizes memories and knowledge as structures/scripts ▪ Review guidelines ▪ Review patient chart ▪ Apply guidelines to patient case ▪ Refinement and further development of knowledge base ▪ Develops non-analytic reasoning Script Theory continues into the next preceptor role of modeling
Review medication counseling ▪ Common medications ▪ Compile important information into a document or table for review ▪ Assesses and confirms prior knowledge ▪ Fills in knowledge gaps Counseling expectations are reviewed
Resident verifying new orders ▪ Drug – indication appropriate? ▪ Dose: including compounding dilution ▪ Route: IVPB, IV, SQ, IM, PO etc. ▪ Rate ▪ Pre-medications: any necessary? New order verification can also incorporate discussion of guidelines when determining if all of the above are appropriate
demonstrating important processes
skill sets verbal cues problem- solving
Providing an example for the learner to follow
▪ Also referred to as “active observation” ▪ Takes place during an actual situation ▪ Rounding ▪ Counseling ▪ Patient case discussion
Best used once the learner has foundational knowledge/skills (instructing)
Think Out Loud
▪ Explain observations and thought processes ▪ Describe patterns and missing information if discussing a patient case ▪ Facilitates further development of scripts that were established during instructing role
Medication counseling Preceptor talks through the counseling process ▪ Reviewing orders and filled medications ▪ Key points to educate patients on ▪ New patients vs those that have been on the medication ▪ Explain the process and thoughts or considerations ▪ Student observes counseling patient with preceptor
Preceptor models process of verifying orders
with an order if it needs to be corrected and why
support feedback guidance
Learner performs a task or skill that was previously modeled for them Provides situations for supervised, practical experiences Provide feedback and direction that allows refinement of skill or knowledge ▪ Make sure to give timely feedback to reinforce good habits and prevent bad habits
provide assistance if needed debrief
Observe learner in performing specified duties as appropriate Ensure two-way communication during facilitation ▪ Learner asks questions as needed Engage learner in self-assessment
Continue to perform tasks or skills that were modeled and coached Provide an opportunity for the learner to evaluate their own progress ▪ Helps learners develop a habit of evaluating their own behaviors and clinical skills Leads into feedback
Exchange of information from preceptor to student or resident that describes their performance Is not an “evaluation” ▪ Usually done at the end of a learning experience or APPE rotation. ▪ Renders judgement on where the student or resident is in their development/learning Avoid vague or misleading statements
1. Timing
2. Preparation
3. Discuss strengths
discussing weaknesses difficult
5. Set goals
6. Follow-up
step 5 the previous time
1. What is the correct order of the four preceptor roles as defined by the American Society of Health-System Pharmacists? a) modeling, instructing, coaching, facilitating b) instructing, modeling, coaching, facilitating c) modeling, coaching, instructing, facilitating d) instructing, coaching, modeling, facilitating
1. What is the correct order of the four preceptor roles as defined by the American Society of Health-System Pharmacists? a) modeling, instructing, coaching, facilitating b) instructing, modeling, coaching, facilitating c) modeling, coaching, instructing, facilitating d) instructing, coaching, modeling, facilitating
2. Which of the following is an objective? a) Interact effectively with the health care teams to manage patients’ therapy. b) Participate in daily rounds. c) Identify medication-related problems and address them with the tea d) Make evidence based recommendations.
2. Which of the following is an objective? a) Interact effectively with the health care teams to manage patients’ therapy. b) Participate in daily rounds. c) Identify medication-related problems and address them with the team d) Make evidence based recommendations.
3. Learning activities should: a) Be actionable b) Specific c) Explain how an objective will be met d) All of the above e) B and C
3. Learning activities should: a) Be actionable b) Specific c) Explain how an objective will be met d) All of the above e) B and C
4. Feedback should be ___. a) Given when you discuss an evaluation b) At scheduled times c) Constructive d) B and C e) All of the above
4. Feedback should be ___. a) Given when you discuss an evaluation b) At scheduled times c) Constructive d) B and C e) All of the above
Lynne M Sylvia, A lesson in clinical reasoning for the pharmacy preceptor, American Journal of Health-System Pharmacy, Volume 76, Issue 13, 1 July 2019, Pages 944–951, https://doi.org/10.1093/ajhp/zxz083 Required Competency Areas, Goals, and Objectives for Postgraduate Year One (PGY1) Pharmacy Residencies. (2015, March 8). Retrieved January 7, 2019, from https://www.ashp.org/-/media/assets/professional- development/residencies/docs/required-competency-areas-goals-objectives Kristin W. Weitzel, Erika A. Walters, James Taylor, Teaching clinical problem solving: A preceptor’s guide, American Journal of Health-System Pharmacy, , Volume 69, Issue 18, 15 September 2012, Pages 1588–1599, 1599, https://doi.org/10.2146/ajhp110521 Melissa S. Medina, Providing feedback to enhance pharmacy students’ performance, American Journal of Health-System Pharmacy, Volume 64, Issue 24, 15 December 2007, Pages 2542–2545, 2545, https://doi.org/10.2146/ajhp070316 Melissa S. Medina, Assessing student performance during experiential rotations, American Journal of Health-System Pharmacy, Volume 65, Issue 16, 15 August 2008, Pages 1502–1506, 1506, https://doi.org/10.2146/ajhp080007