Precepting students is a skill as well as a relationship. Below are strategies gleaned from several sources they may be helpful in precepting.

Orientation

A formal orientation to the practice and preceptor’s practice style is helpful to begin the preceptor-student relationship.

• Set aside time for orientation at an hour that works to cause the least disruption to the practice flow.
• Introduce the student to clinic staff and key personnel.
• Discuss “ground rules” (e.g., patient selection; reviewing protocols specific to setting, preceptor expectations of the student)
• Review charts to outline documentation requirements used in setting
• Explain your role and process for precepting (e.g., how you will introduce students to patients; how you will check student findings);
• Get to know the student (e.g., student's past professional and student experiences; student perception of learning needs).
• Consider having the student shadow you for the first half day in clinic so they understand the flow of visits and your style of patient care.

Teaching and Learning 

• Create an environment that is conducive to learning and decrease anxiety
  • Students are often anxious initially
  • Reassure student that you are ultimately responsible for client's care
  • Give positive as well as constructive feedback
  • Seek appropriate patients for the student’s level of experience
• Demonstrate new skills such as joint injection or bring students in on complicated patients you see to provide an example of how you approach the patient
• “Think aloud” as you reason through a complex patient you are seeing to role model clinical decision making
• Assign readings or resources you have found helpful
• Use charting to teach.
• Use guided questioning, directing students to think about their patient encounters
  • Ask them what they think is going on with the patient
  • Ask for supporting evidence. What in the history or exam lead to the conclusion?
  • Assist them in broadening their differential
• Reinforce what they do right. “You did an excellent job of….”
• Correct mistakes. “Next time this happens, try….”
• Try the “Five-step Microskills Model of Clinical Teaching” or the “Feedback Sandwich” to direct the discussion and use your time efficiently. (see Resources)

Indication of student readiness for increased responsibility

• There is a mutual increase in comfort, almost intuitive; a mutual decision;
• Trust is built between you and the student; helps student to not get in over her/his head and to be responsible for her/his own actions and decisions;
• Student proves she/he will not miss anything important;
• There is no longer a need to review every detail with the preceptor;
• Student has proven physical assessment skills.
• Student gives accurate clinical presentation of significant positives and negatives;
• Data presented by student proves she/he has covered all bases with the patient;
• Student shows ability to tie in past experience with new skills and apply them to new scenarios;
• Student recognizes limits of knowledge; admits to weaknesses;
• Student asks appropriate questions;
• Student becomes a self starter; can cope with an unstructured setting or a change in schedule;
• Student asks for more challenging experience; exhibits confidence

Suggestions for managing patient flow while precepting

• Look at schedule ahead of time and plan which patients the student may see
• Allow time for the student to think
  • Have the student see a patient while preceptor sees another patient
  • Student presents history and physical to preceptor
  • Preceptor sees patient to confirm findings
  • While preceptor seeing patient, student develops plan
  • Students presents plan to preceptor
  • Student and preceptor return to room to communicate plan to patient
  • Student charts encounter while preceptor sees next patient
  • When charting complete, student sees another patient
• Students may only see 2 patients a half day in the beginning of a quarter and build up to 5 in a half day at the end of their program depending on the complexity of the patient.
• Scheduling “focused half days” where there is a specific focus to the learning, diabetes or COPD for example. The student spends time before and after the visit reading the chart of 2 or 3 patients and reviewing guidelines for management and only sees the patients with diabetes or COPD that half day. The preceptor sees the rest of the patients and then can focus their teaching time on diabetic or COPD management. The focus can be either tied to what the student is learning that week in class or an area they find challenging.

Documentation of Visit

Students may document in the patient chart their history, physical, assessment and plan for the patient. Preceptors need to document in the patient’s note that they were present for or conducted themselves (rechecked the student’s findings) the key portions of the history and physical, as well has helped the student develop the plan of care. This will ensure you comply with Medicare/Medicaid billing rules.

Evaluation of Student

Honest student evaluations are critical for the student, faculty and the patients cared for by the student. We ask that you complete a formal written evaluation at the end of the quarter. An email will be sent to you with further information on accessing and completing the evaluation form on Typhon. We encourage informal evaluation and feedback to the student throughout the quarter.

Constructive evaluation is:

• Timely
• Based on skill development. Don’t expect a student to know they have a skill deficit if you don’t tell them about it. Tell them, teach them and let them learn.
• Based on student’s level in the program
• Specific rather than general
• Positive as well as constructive

If you have concerns about a student’s progress or a difficult situation arises:

• Communicate early with the faculty and the student
• Document any concerns you may have in the formal evaluation
• Trust your judgment