Tips for successfully orchestrating your clinical and teaching responsibilities: Precepting our future generation of pharmacists

Danielle C. Mayer, PharmD, BCACPAssistant Professor of Pharmacy PracticeJefferson College of Pharmacy

Andrea Joseph, RPh, MSAssistant Director of Experiential EducationJefferson College of Pharmacy

Objectives● Discuss challenges to balancing the demands of precepting

with routine professional responsibilities.● Identify strategies that can be utilized to integrate your student

into your daily practice to reduce precepting burden and enhance teaching effectiveness.

● Describe one precepting technique that you can implement into your practice to efficiently assess student knowledge, critical thinking, or professional skills.

Preceptor Play ListPreceptor challengesSelecting meaningful experiences for your studentsStrategies for precepting efficientlyPlan for multiple learners

Why Do We Precept?

Enjoy Teaching

Pay It Forward

Expand Pharmacy Network

Stay Current

Job Fulfillment

Polling QuestionWhat is your biggest challenge in balancing your clinical and teaching responsibilities? A. Time managementB. Location/logisticsC. Support from colleagues and administrationD. Inadequate preceptor trainingE. Other: Explain

National Survey of Volunteer Pharmacy

Preceptors - 2008

Survey for pharmacy preceptors regarding experiential

education

• 1,163 preceptors responded

• Nearly all preceptors felt that the more time they spent with

students, the higher quality the experience

• 20% (~233) felt they did not have enough time to provide a quality

experience

Skrabal, MZ, Jones RM, Nemire RE et al. National Survey of Volunteer

Pharmacy Preceptors. American Journal of Pharmaceutical Education 2008;72:112.

Preceptor Challenges

Dramatic rise in number of US based colleges and schools of pharmacy

• 2000: 80

• July, 2018: 142

Dramatic rise in number of pharmacy graduates

• 2000: 7,260 pharmacy degrees conferred

• 2017: 14,502 pharmacy degrees conferred

American Association of Colleges of Pharmacy. Academic Pharmacy’s Vital statistics.

American Association of Colleges of Pharmacy. Number of Pharmacy degrees conferred, 1965 – 2017.

Zellmer WA. Am J Health-Syst Pharm. 2011: 68: 1843-9

TJUH Study - 2015• 22 TJUH preceptors surveyed• To all pharmacist who had served as IPPE preceptors between the fall of 2010 and February of 2015• 64% response rate • 77% (10 of 13) indicated that they enjoy precepting• 38% (5 of 13) expressed concern about ability to incorporate precepting into daily responsibilities

Lack of adequate time to devote to students

Anagnostis E, Joseph A. Am J Health-Syst Pharm. August 2016; 73 (15) 1126-27.

Further Exploration

Focus Group convened in Fall 2015 for preceptors who had completed the survey and remained employed at TJUH along with preceptors who were new to the IPPE

• Share results and gain additional insight through personal interaction

Preceptors expressed sincere interest in collective student feedback

Anagnostis E, Joseph A. Am J Health-Syst Pharm. August 2016; 73 (15) 1126-27

Statement

No. (%) Students Who Agreed or

Strongly Agreed With Statement

My preceptor provided me with a thorough orientation to the site. 65 (96)

My preceptor was well prepared for each meeting/session. 66 (97)

My preceptor encouraged my participation in the experience. 67 (99)

My preceptor encouraged me to seek help when necessary. 65 (96)

My preceptor was available to answer my questions. 66 (97)

My preceptor provided timely, relevant, and understandable feedback. 65 (96)

My preceptor valued and respected me as a learner. 66 (97)

My preceptor consistently exemplified the characteristics of professionalism. 67 (99)

Student Agreement with Survey Statements About Preceptors (n=68)

Perception vs. Reality

Anagnostis E, Joseph A. Am J Health-Syst Pharm. August 2016; 73 (15) 1126-27

“I’ve learned that people will forget what you said,

people will forget what you did, but people will never forget how you made them feel.”

~Dr. Maya Angelou

Selecting Meaningful ExperiencesIntegrate your students into meaningful parts of your daily practice

Concept Overview

Adapted from: Doty, Randell. Getting Started as a Pharmacy Preceptor. APhA. 2011

Preparing and PlanningPreceptor goal• To provide an adequate learning experience that causes minor

disruptions to operational procedures and patient needs/expectations

Review your own calendar• Committee meetings, P&T meetings, manager meetings,

teaching opportunities, flu clinics, etc• What will give your student a holistic exposure to your day-to-day

or to a pharmacist working at your organization?

Burns et al. J Pediatr Health Care. 2006; 20: 172-183Lagasse et al. Hosp Pharm. 2013;48:200-203

Preparing and Planning

• What components can your student own?

List out your daily activities

Ask where you students are in the curriculum (IPPEs)

Identify co-preceptors

Time Efficient Precepting Strategies

SCOs: Structured Clinical Observations● Useful for maximizing time with students AND having students

contribute to workload● Focused observation that evaluates a specific patient-centered

skill● Student greeting and introduction● Assessing chief complaint and HPI +/- physical exam components● Medication use history● Social and family history● Patient education and counseling

Lane et al. Pediatrics. 2000; 105: 973-977

One Minute Preceptor Model

● Get commitment

○ What do you think?

● Probe for supporting evidence

○ Why do you think that? What led you to that conclusion?

● Reinforce what went well○ Specifically you did___ well and that is important because____

● Correct mistakes○ I disagree with____ or You forgot to factor in____ patient characteristics in your

assessment

● Brief general instruction (teach one general rule)

○ The key thing I want you to remember is…

● Expanded tool: plan for future

○ What are you going to do differently when you see a patient like this next time?

What did you learn from this?

Neher JO et al. J Am Board Fam Pract 1992; 5:419-24

SCOOP: Student’s Clinical Observation of

Preceptors

● Intentional role-modeling

● Positive role models are a

key method for learning

● Be selective in the

experience students

observe

•Clinical competence

•Teaching skills

•Personal qualities

What are the attributes, as identified

by students, of effective role model?

Jones WS et al. Teach Learn Med. 2004; 16:264-269

Other Teaching TechniquesGive students time limits

• “You have five minutes to summarize pertinent patient information and three minutes to tell me your Assessment and Plan”

Plan out discussion time

• “Keep a record of your questions that come up through the day and we will review when we take our 20 minute break at X time”

• Daily/weekly debrief sessions, put them in your calendar

• Have student look-up their own clinical questions, preceptor to fill in holes only

Students need to know what to expect!

Does anyone have any additional tips or examples of how you’ve integrated your student into your practice?

Burns et al. J Pediatr Health Care. 2006; 20: 172-183Lagasse et al. Hosp Pharm. 2013;48:200-203

Other Teaching Techniques

• Student to provide rationale and thought process to support conclusion

Think Aloud Method

• Assign literature/readings to reach a clinical topic or role• Example: Informal topic discussions

• Coaching• Provide student with verbal coaching cues only• Immediate feedback

Self-directed learning

Remember to set time limits!

Burns et al. J Pediatr Health Care. 2006; 20: 172-183Lagasse et al. Hosp Pharm. 2013;48:200-203

Plan for Multiple Learners

Polling Question How many students do you precept at one time?

A. OneB. TwoC. ThreeD. More than three

Polling QuestionWhat is the level of your learners? Select all that apply. A. IPPEsB. APPEsC. Residents

Setting The BarACPE Standards for preceptorsStandard 20 - Preceptors: • “Student-to-preceptor ratio – Student to preceptingpharmacist ratios allow for the individualized mentoring and targeted professional development of learners”.

• In most situations, student:preceptor ratios for IPPE and APPE do not exceed 3:1 and 2:1, respectively.

https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf

Layered Learning Model

Primary Preceptor

Resident Preceptor

Student LearnerBates, JS, Buie, LW et al. Am J Health-Syst Pharm.2016;73;e603-9.

Layered Learning Model

Primary Preceptor

• Oversee all patient care and education activities• Define expectations for all learners• Orient residents and students to LLPM, practice site, and staff• Review resident and student syllabus• Outline learner responsibilities • Evaluate resident for both clinical and teaching activities• Assist resident in providing student feedback

Loy BM, Yang S et al. Hosp Pharm 2017;52(4):266–272

Layered Learning Model

Resident Learner

• Plan learning experiences with primary preceptor prior to the student’s first day

• Assist in preparation of student calendar and rotation activities

• Orient student to practice site and establish goals

• Integrate student into patient care activities

• Supervise student during patient care activities

• Ensure student has necessary resources to perform required activites

• Provide regular feedback to students

• Lead topic discussions and other educational activities

• Perform final evaluation

Loy BM, Yang S et al. Hosp Pharm 2017;52(4):266–272

Layered Learning Model

Student Learner

• Reports to resident preceptor

• Participates in patient care and rotation activities

• Provides ongoing feedback to resident

• Similar strategies can be utilized in pairing APPE and IPPE students

Loy BM, Yang S et al. Hosp Pharm 2017;52(4):266–272

Polling Question

What teaching strategies have you used in your practice?

A. Student’s Clinical Observation of PreceptorsB. Structured Clinical ObservationsC. One Minute PreceptorD. Think AloudE. Layered learningF. Other: Explain

What has worked well? What have you learned?

What will you implement?

Tips for successfully orchestrating your clinical and teaching responsibilities: Precepting our future generation of pharmacists

Danielle C. Mayer, PharmD, BCACPAssistant Professor of Pharmacy PracticeJefferson College of Pharmacy

Andrea Joseph, RPh, MSAssistant Director of Experiential EducationJefferson College of Pharmacy

References1. Accreditation Council for Pharmacy Education. Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. 2015.

https://acpe-accredit.org/Standards2016FINAL.pdf. Accessed September 27,2018.

2. American Association of Colleges of Pharmacy. Academic Pharmacy’s Vital statistics. https://www.aacp.org/article/academic-pharmacys-vital-statistics. Accessed October 1, 2018.

3. American Association of Colleges of Pharmacy. Number of Pharmacy degrees conferred, 1965 – 2017. www.aacp.org/sites/default/files/2018-05/fall-2017-profile%20of%20pharmacy%20students-degrees%20conferred.pdf Accessed October 1, 2018.

4. Anagnostis E, Joseph A. Feedback from and about preceptors. Am J Health-Syst Pharm. August 2016; 73 (15) 1126-27.

5. Bates JS, Buie LW et al. Expanding care though a layered learning practice. Am J Health-Syst Pharm.2016;73;e603-9.

6. Burns C, Beauchesne M, Prayn-Krause P, et al. Mastering the Preceptor Role: Challenges of Clinical Teaching. J Pediatr Health Care. 2006; 20: 172-183

7. Cobaugh DJ. Layered learning: The confluence of pharmacy education and practice. Am J Health-Syst Pharm. December 2016; 73 (24) 2035.

8. Jones WS et al. An intentional modeling process to teach professional behavior: Students clinical observations of preceptors. Teach Learn Med. 2004; 16:264-269.

9. Lane JL, Gottlieb RP. Structured Clinical observations: a method to teach clinical skills with limited time and financial resources. Pediatrics. 200. 105:973-977

10. Lagasse C, Wilkinson S, Buck B et al. Integrating Precepting Into Your Daily Practice. Hosp Pharm. 2013;48:200-203

11. Loy BM, Yang S et al. Application of the Layered Learning Practice Model in an Academic Medical Center Hosp Pharm 2017;52(4):266–272.

12. Neher JO, Gordon KC, Meyer B, Stevens N.A five-step “microskills” model of clinical teaching. J Am Board Fam Pract 1992; 5:419-24

13. Pinelli NR, Eckel SF et al. The layered learning practice model:Lessons learned from implementation. Am J Health-Syst Pharm.2016;73; 2077-82.

14.Skrabal MZ, Jones RM,Nemire RE et al. National Survey of Volunteer Pharmacy Preceptors. American Journal of Pharmaceutical Education 2008;72:112.

15. Zellmer WA. Expanding the number of positions for pharmacy residents: highlights from the Pharmacy Residency Capacity Stakeholders’ Conference. Am J Health-Syst Pharm. 2011: 68: 1843-9