Track Preceptor Development: From Barriers to Opportunities - - PowerPoint PPT Presentation

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Track Preceptor Development: From Barriers to Opportunities - - PowerPoint PPT Presentation

May 06, 2023 207 likes •780 views

New Practitioner and Resident Track Preceptor Development: From Barriers to Opportunities Christine Ji, PharmD, BCPS Clinical Pharmacist Internal Medicine Massachusetts General Hospital Boston, MA Speaker Disclosures Nothing to disclose

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New Practitioner and Resident Track

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SLIDE 2

Preceptor Development: From Barriers to Opportunities

Christine Ji, PharmD, BCPS Clinical Pharmacist Internal Medicine Massachusetts General Hospital Boston, MA

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SLIDE 3

Speaker Disclosures

  • Nothing to disclose
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SLIDE 4

Learning Objectives

  • Identify ways to integrate the four preceptor roles into teaching

and solving clinical problem

  • Develop practical approaches to optimize the precepting time

with pharmacy learners

  • Demonstrate the role of self-reflection to identify and manage

preceptor burnout

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Define Preceptor Roles

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What Makes a Good Preceptor?

  • Difficult to identify,

quantify, and evaluate what makes a good preceptor

  • Being a good clinician

is a necessary

  • Applying principles of

good teaching is a challenge

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ASHP Four Preceptor Roles

Instructing Modeling Coaching Facilitating

http://www.ashpmedia.org/softchalk/softchalk_preceptorroles/softchalk4preceptorroles_print.html. Accessed: April 16, 2019.

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Instructing

  • Teaching of fundamental content
  • Knowledge that is necessary before skills can be applied
  • Activities: assigned readings, lectures, and discussions

http://www.ashpmedia.org/softchalk/softchalk_preceptorroles/softchalk4preceptorroles_print.html. Accessed: April 16, 2019.

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SLIDE 9

Think-Pair-Share

Discuss with a neighbor ways to assess a resident’s baseline knowledge prior to coming to your rotation?

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Think-Pair-Share

  • Assess baseline knowledge
  • What APPE rotations did the resident have?
  • What work experience or projects did they have?
  • Pre-rotation assessment or quiz
  • Fill in gaps in baseline knowledge
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Modeling

  • Once fundamental knowledge is established, resident is ready

to acquire the skills to perform a task

  • Preceptor demonstrates a skill or process while “thinking out

loud” for resident to witness the thoughts and problem solving process

  • Activities: practice-based observations

http://www.ashpmedia.org/softchalk/softchalk_preceptorroles/softchalk4preceptorroles_print.html. Accessed: April 16, 2019.

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Practice-Based Observations

  • Review patient’s chart and treatment plan
  • Discuss which guidelines or resources you are using
  • Highlight what labs you are monitoring
  • Talk about how you are adjusting medication doses
  • Review any clinical reasoning you are doing
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Coaching

  • Resident has the necessary background knowledge and has
  • bserved the preceptor performing the skill or task
  • Resident performs the skill while being observed
  • Activities: case-based discussions, simulations
  • Experience uncertainty
  • Refine the problem solving skills
  • Build confidence
  • Allow for preceptor feedback

http://www.ashpmedia.org/softchalk/softchalk_preceptorroles/softchalk4preceptorroles_print.html. Accessed: April 16, 2019.

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SLIDE 14

Case-Based Discussions

  • MK is a 45 year old male presents to the ED with the chief

complaint of a generalized throbbing headache with mild neck pain and stiffness. He has a fever of 102 degrees and is found to have a positive Kernig’s sign and Brudzinski’s sign. The team approaches the pharmacy resident asking for empiric therapy recommendations

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SLIDE 15

Case-Based Discussions

  • What is on your differential?
  • No known immune deficiency vs. immunocompromised
  • Drug penetration to the cerebrospinal fluid
  • Beta-lactam allergy
  • Impaired renal function
  • Adjunctive dexamethasone
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SLIDE 16

Facilitating

  • Last step!
  • Resident performs independently once the preceptor and

resident are both confident in the ability

  • Preceptor remains available as needed or for debriefing
  • Activities: increase complexity of patients or situations, learner

self-assessment on performance

http://www.ashpmedia.org/softchalk/softchalk_preceptorroles/softchalk4preceptorroles_print.html. Accessed: April 16, 2019.

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De-Briefing

  • Resident independently participates in emergency response
  • You remain available for questions
  • Help the resident to assess own performance
  • Discuss about what went well
  • Were there any delays in therapy?
  • What could have been improved?
  • Encourage to take more complex tasks!
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Self-Assessment Question #1

  • The resident is beginning their rotation in the ICU. They have

reviewed pertinent treatment guidelines and protocols. They are currently observing as you adjust medication doses for patients on renal replacement therapy. Which of the preceptor roles is described in this case?

  • A. Instructing
  • B. Modeling
  • C. Coaching
  • D. Facilitating
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Self-Assessment Question #1

  • The resident is beginning their rotation in the ICU. They have

reviewed pertinent treatment guidelines and protocols. They are currently observing as you adjust medication doses for patients on renal replacement therapy. Which of the preceptor roles is described in this case?

  • A. Instructing
  • B. Modeling
  • C. Coaching
  • D. Facilitating
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SLIDE 20

Identify Barriers and Opportunities

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Barriers to Effective Precepting

  • Heavy clinical workloads
  • Competing priorities
  • Increased number of learners
  • Time constraints
  • Lack of experience
  • Poor communication
  • Preceptor burnout

Am J Health-Sys Pharm. 2013;70:1605-8. J Health-Syst Pharm. 2017;74(19):1570-78. Hosp Pharm. 2013;48(3):200-3.

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Think-Pair-Share

Discuss with a neighbor types of time management barriers to precepting residents you have experienced

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Optimize Precepting Time: Overview

Assess Prioritize Delegate Communicate Evaluate

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Assess

  • What is the resident’s prior experience in

the practice area?

  • What are the resident’s professional

interests and goals?

  • Set expectations!

Am J Health-Syst Pharm. 2012;69(18):1588-99

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Prioritize

  • What activities and goals must be

achieved on this rotation vs. later in the residency year?

  • What patient care activities does the

resident need to develop proficiency early in the rotation?

Am J Health-Syst Pharm. 2010;67(3):239-43.

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Delegate

  • What activities can the resident do

independently with instructions? How about with modeling or coaching?

  • How can layered learning model be

applied with the resident and student?

Primary Preceptor Resident Preceptor Student Learner

Hosp Pharm. 2017;52(4):266-72.

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Communicate

  • Which patient care responsibility does the

resident have to complete each day? each week? by the end of the rotation?

  • How and when will the resident be

evaluated and provided with feedback?

Hosp Pharm. 2017;52(4):266-72.

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Evaluate

  • What is the resident’s strengths and areas
  • f improvement?
  • What activities will be done to minimize

the knowledge gaps and become more proficient with the skills in the future?

Am J Health-Syst Pharm. 2010;67(3):239-43.

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Optimize Precepting Time: Daily

One Minute Preceptor

  • A five step process for clinical teaching
  • Can be applied during oral presentation,

bedside or sit down rounds, or any other case based discussions

  • Originated in the business literature and

has been widely applied to clinical medicine

J Gen Intern Med 2001;16:620-624. AcadMed 2004;79:50-55. ACP Press. 2008. pp. 51-73.

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One Minute Preceptor

  • Get a commitment
  • Probe for supporting evidence
  • Teach general rules
  • Reinforce what was done right
  • Correct mistakes

J Gen Intern Med 2001;16:620-624. AcadMed 2004;79:50-55. ACP Press. 2008. pp. 51-73.

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Get a Commitment

  • “What do you think is going on?”
  • “What do you want to do next?”
  • Encourage resident’s ownership of the patient case
  • Not simply gathering information, but processing thoughts
  • Avoid decision making by preceptor

J Gen Intern Med 2001;16:620-624. AcadMed 2004;79:50-55. ACP Press. 2008. pp. 51-73.

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Probe for Supporting Evidence

  • “What led you to that conclusion?”
  • “What else did you consider?”
  • Confirm resident used clinical reasoning to arrive at conclusion
  • Not just “lucky guess”
  • Identify the learning gap

J Gen Intern Med 2001;16:620-624. AcadMed 2004;79:50-55. ACP Press. 2008. pp. 51-73.

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Teach General Rules

  • “Many times when … ”
  • “In our patient population … ”
  • This is the teaching point!
  • Require preceptor to “diagnose” inaccurate or missing

information

  • Apply to current case but try to make generalizable

J Gen Intern Med 2001;16:620-624. AcadMed 2004;79:50-55. ACP Press. 2008. pp. 51-73.

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Reinforce What was Done Right

  • “You did an excellent job of … ”
  • “You were right to continue …”
  • Be specific!
  • More than just a simple “good job”
  • Reinforces good behaviors and encourages to continue

J Gen Intern Med 2001;16:620-624. AcadMed 2004;79:50-55. ACP Press. 2008. pp. 51-73.

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SLIDE 35

Correct Mistakes

  • “Next time this happens, try …”
  • “Good thoughts, but consider ..”
  • This is difficult
  • Consider timing and delivery in a more private setting
  • Again, be specific!

J Gen Intern Med 2001;16:620-624. AcadMed 2004;79:50-55. ACP Press. 2008. pp. 51-73.

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SLIDE 36

One Minute Preceptor Example

  • AJ is a 63 year old female presents to the ED with the chief

complaint of a shortness of breath. She has a 30-pack year smoking history and has past medical history of COPD and hypertension on home lisinopril, HCTZ, and albuterol inhaler.

  • She received a dose of azithromycin, methylprednisolone, and

ipratropium-albuterol nebs in the ED and is now transferred to the floor for further management.

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Think-Pair-Share

How would you apply one minute preceptor into this case?

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Self-Assessment Question #2

  • What is the first step in the one minute preceptor model?
  • A. Teach a general principle
  • B. Keep the interaction moving
  • C. Get a commitment
  • D. Probe for supporting evidence
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Self-Assessment Question #2

  • According to the “one minute preceptor” model, what is the first

step?

  • A. Teach a general principle
  • B. Keep the interaction moving
  • C. Get a commitment
  • D. Probe for supporting evidence
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Self-Assessment Question #3

  • Which of the following might be an appropriate comment for

preceptor to make at this first step?

  • A. What do you think of the patient’s history of sweating and

shaking?

  • B. Has the patient had a recent hemoglobin A1c?
  • C. You went over the major counseling points for insulin therapy
  • D. Patients with type 2 diabetes should be screened for

increased urinary albumin excretion

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Self-Assessment Question #3

  • Which of the following might be an appropriate comment for

preceptor to make at this first step?

  • A. What do you think of the patient’s history of sweating and

shaking?

  • B. Has the patient had a recent hemoglobin A1c?
  • C. You went over the major counseling points for insulin therapy
  • D. Patients with type 2 diabetes should be screened for

increased urinary albumin excretion

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Preceptor Reflection

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Why We Teach

Identity Giving Back Develop Next Generation Enable to Learn Energizing and Gratifying

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Self-reflection

  • Important component of preceptor development
  • Residents self-evaluate, and preceptors should do the same!
  • Making the unconscious conscious
  • Consider experience from different viewpoints
  • Identify learning needs
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Practice Assessment - Preceptor

  • Was I prepared for the rotation?
  • Was the rotation well-organized?
  • Did I provide a regular and timely feedback?
  • Was the resident progress observed?
  • What steps can I take to improve as a preceptor?
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Practice Assessment - Clinician

  • What common disease states or medical problems are seen in

your patients?

  • What drug information questions do you frequently receive

from your patients or physician/nursing colleagues?

  • What professional services do you currently provide at your

practice site?

  • What professional services do you want to provide?
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Self-reflection

  • Important component of preceptor development
  • Residents self-evaluate, and preceptors should do the same!
  • Making the unconscious conscious
  • Consider experience from different viewpoints
  • Identify learning needs
  • Promote well-being and resilience
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Clinician Well-being and Resilience

  • Well-being
  • Positive emotions and esteem
  • Satisfaction with life, fulfillment, and positive functioning
  • Resilience
  • Having the ability to rebound from

adversity and overcome difficult situations

  • Contribute to personal well-being and

prevent burnout

J Am Pharm Assoc. 2004;44(3):326–36. Flourish zone. http://flourish.zone/build-productivity-wellbeing-and-resilience/ Accessed: April 16, 2019

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Preceptor Burnout

  • Emotional exhaustion
  • Fatigue, no longer invested
  • Depersonalization
  • Negative attitudes toward all
  • Decreased personal

accomplishment

  • Poor performance
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Individual Strategies

  • Learn the extent of the problem
  • Address the influencing factors and change what you can!
  • Assess your own contributors to burnout
  • Explore ways to incorporate better work-life balance
  • Share support with your colleagues
  • Learn new things
  • Develop a better self-understanding

Hospital Pharmacy 2017, Vol. 52(11) 742–751.

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Rotation Strategies

  • Group onboarding with training manuals
  • Share topic discussions among service lines
  • Resident-led topic discussions
  • Utilize layered learning models
  • Limit teaching pearls to one per case
  • Integrate residents into workflow

Hospital Pharmacy 2017, Vol. 52(11) 742–751.

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Self-Assessment Question #4

  • Which of the following is true about the characteristics of

preceptor burn out?

  • A. Emotional exhaustion
  • B. Depersonalization
  • C. Decreased personal accomplishment
  • D. All of the above
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Self-Assessment Question #4

  • Which of the following is true about the characteristics of

preceptor burn out?

  • A. Emotional exhaustion
  • B. Depersonalization
  • C. Decreased personal accomplishment
  • D. All of the above
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Conclusion

  • Being a preceptor is a challenging, but rewarding experience
  • Clinical reasoning can be taught through the steps of

instructing, modeling, coaching, and facilitating

  • Optimizing precepting time can maximize the learning

experience by precepting smarter, not harder!

  • Self-reflection leads to not only becoming a better preceptor

but building resilience to overcome burn out

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Preceptor Development: From Barriers to Opportunities

Christine Ji, PharmD, BCPS Clinical Pharmacist Internal Medicine Massachusetts General Hospital Boston, MA