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Author: Kristin Watson, PharmD, BCCP
I still remember the first time that I was involved, as a preceptor, with a residency accreditation visit. I recall making sure that I memorized the “four preceptors roles” and could explain how I applied each of these. I also recall being mindful about incorporating them into my learning experiences after hearing other discuss these during the accreditation visit. The four preceptor roles (instruct, model, coach and facilitate) and ideas on how to apply these will be discussed in this two part blog series (Figure).1-3
The purpose of the preceptor roles is to ensure that we meet the needs of our learners and to enable them to grow and succeed.4 Each preceptor should determine how much time is spent on each of these roles during a given rotation. In some learning experiences, not all of the roles are necessary and/or possible. (In my opinion, modeling should occur on every rotation…more to come on this.) Additionally, receptors may take on differing roles for an individual learner depending on the task being conducted during the learning experience. Sometimes more/less time than planned needs to be allocated to one specific role after spending time with each learner. Similar to other precepting activities, how and when to utilize these roles need to be based this on the learner’s prior training, skills, abilities and progress on the rotation. Finally, one may occasionally find that circumstances necessitate going back to a role that was already deemed as fulfilled in a given rotation.
Some may think that this role occurs only in the classroom setting. However, there is a role for direct instruction on many rotations. For example, in a heart failure clinic, patients may be screened to determine if a cardiac device (e.g., implantable cardioverter defibrillator, cardiac resynchronization therapy) is warranted. Only handful of learners will likely be familiar with these devices prior to starting their rotation. Therefore, direct instruction about what the devices are, indications for use, etc. can be delivered. Supplemental handouts and/or assigned readings can be provided.
Learners should be made aware of common concepts on your rotation and encouraged to review the ones you expect them to be familiar with before the rotation starts. The caveat is that we need to consider the learner’s level of training and prior experiences. Consider posting recorded lectures for concepts that you know your students/residents may need to review before starting your rotation. Completion of self-assessment questions to determine each learner’s foundational knowledge may prove useful.
Typically, topic discussions are not direct instruction on experiential rotations. Learners should be made aware of the format of these discussions. Some may anticipate that topics will be more direct instruction and may not come prepared to be able to engage in the discussion. It is important to set these expectations early on.
Over the years, I have found that it works best to incorporate this into each trainee’s rotation, no matter their level of training or prior experience. No matter the amount of experience, learners and practitioners can all benefit from watching someone else “in action”. Preceptors can tell their learners why they personally find it valuable to observe others. For instance, maybe you recently learned a new trick or two by watching someone else (e.g., physician, pharmacy resident) interview a patient.
Modeling one’s own actions/behaviors for learners also serves to set the stage for when trainees are observed. Learners can also better understand what is expected of them. It is important to communicate to learners that some of what their preceptor does is style-based and not always the right/only way to do things. Make your expectations clear.
Have your learners observe you in whatever their primary function(s) will be. Explain (when possible) what you are doing. For example, while performing a physical examination of a patient, walk through the steps you are taking, what you see/hear and how this will impact your decision-making.
Share your thought processes with your learners. For example, have learner(s) observe you review a patient’s profile. Walk and talk them through:
– how you navigate the patient’s chart
– what data you are analyzing
– how you assess if a problem is appropriately managed
– what further data, if any, you would like to collect before you make a treatment plan/recommendations
Even a seasoned resident can learn something from you; even it is something as simple as finding a new way to locate data in the medical record.
When possible, have learners observe others in your practice setting. In addition to modeling your own behavior, have pharmacy residents observe at least one other practitioner. This can be a non-pharmacy practitioner or a pharmacy resident who is a year ahead of them.
In addition to skills, preceptors should model professionalism behaviors (communication, timeliness, etc.). This could include communication via email or how we interact with our patients and colleagues.
After modeling, consider asking the learner(s) for feedback on what they observed – what is something that they learned or can incorporate into their own practice? Is there anything they would have done differently? This catalyzes the feedback process and may make it less intimidating for the learner when moving on to the next role – coaching.
Stay tuned for part two of this blog series in which coaching and facilitating will be discussed. Share how you incorporate these roles into your rotation with me (@cards_pharm_gal) on Twitter. Always eager to learn new ways to up my preceptor game!
Kristin Watson, PharmD, BCCP
- American Society of Health-System Pharmacists. ASHP accreditation standard for postgraduate year one (PGY1) pharmacy residency programs. https://www.ashp.org/-/media/assets/professional-development/residencies/docs/pgy1-residency-accreditation-standard-2016.ashx (accessed 2019 August 13).
- American Society of Health-System Pharmacists and the American Pharmacists Association. Accreditation standard for postgraduate year one (PGY1) community-based pharmacy residency programs. https://www.ashp.org/-/media/assets/professional-development/residencies/docs/pgy1-community-based-pharmacy-2017.ashx?la=en&hash=C128D3594496763CCB5DDF26E95912AAF0F41AE8 (accessed 2019 August 13).
- American Society of Health-System Pharmacists. Accreditation standard for postgraduate year two (PGY2) pharmacy residency programs. https://www.ashp.org/-/media/assets/professional-development/residencies/docs/pgy2-residency-accreditation-standard-June2017.ashx?la=en&hash=6AB9A9CCAC47929779FB5B9240D4490B2250FCD6 (accessed 2019 August 13).
- American Society of Health-System Pharmacists. Starring roles: the four preceptor roles. http://www.ashpmedia.org/softchalk/softchalk_preceptorroles/index.html (accessed 2019 August 1).
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