Walkin’ Into a Pharmacy Wonderland: Incorporating Pharmacy Trainees Into a Busy Practice Mary Bridgeman, Pharm.D., BCPS, CGP Clinical Associate Professor Ernest Mario School of Pharmacy Rutgers, The State University of New Jersey Internal Medicine Clinical Pharmacist and Preceptor Robert Wood Johnson University Hospital

Preceptor Development Learning Objectives Explain the importance of balancing daily pharmacy practice responsibilities with student or resident precepting List two strategies that can be utilized to help integrate pharmacy trainees into your area of practice

Preceptor Development How Do Students Learn? Three stages of learning to solve patient care problems exist: –Foundation skills and knowledge The most fundamental and rudimentary type of learning Recollection of learned material –Practical application Using foundational skills/knowledge to solve a patient case –Culminating integration Using rules, concepts, knowledge and applying it to new situations These principles correlated with the roles of the preceptor in student and resident development

Preceptor Development Things to Consider… Learner’s level of education –Introductory practice experience students –Advanced practice experience students –First-year pharmacy resident –Second-year or specialty resident Practice needs and responsibilities Efficiency and effectiveness of “teaching on the fly”

Precepting Learners in the Short-Term It’s the Monday after the 4 th of July weekend… The Director of Pharmacy calls, “Can I send a new pharmacy student to shadow you for the day?”

Preceptor Development Managing Learners in the Short-Term

Preceptor Development Managing Learners in the Short-Term Pharmacy trainees can be integrated into busy practices and satellites with a little advanced thought and planning Benefits for the: –Preceptors –Students/trainees –Technicians and other staff members –Practice setting –Patient care

Preceptor Development Managing Learners in the Short-Term Be flexible –Use opportunities that arise in your day-to-day schedule as “teachable moments” Make trainees feel welcome and comfortable –Introduce them to other staff, pharmacists, patients, physicians, etc. Explain your practice –Be honest! –Think out loud so they can observe your thought process –Immediately engage them in the daily activity of whatever clinical area you are working in

Preceptor Development Managing Learners in the Short-Term Identify “walk-on” tasks –e.g., picking and labeling oral or IV medications, observing rounds, counseling –Meaningful tasks, jobs, activities that a new trainee can step into without much preparation Designate a back-up teacher –We all precept, whether we like it or not Pharmacists to model and teach pharmacist activities Pharmacy technicians to help teach operational issues

Preceptor Development Managing Learners in the Short-Term Inquire about their goals, aspirations, previous experiences –Why do you want to be a pharmacist? –Previous pharmacy experience? What did you enjoy the most? The least? –Any leadership roles or organizational involvement? –Community service? Role? Debrief once activities slow down –Structured orientation –Identify and recap teaching points from the day –Elicit trainee feedback on how the day went

Precepting Learners in the Long-Term Tomorrow… and the next day, and the next day, and the next day…

Preceptor Development What Service Areas Can Learners Have a Role In? Depends on: –Learner’s educational level Introductory vs. advanced vs. resident –Student characteristics Interests, strengths, confidence, licensure (resident) –Pharmacy experience Practice, clinical, in-patient vs. ambulatory, longitudinal –Course or residency program expectations –Practice site needs and requirements

Preceptor Development Consider Practice Needs and Opportunities Identify activities that benefit your practice area and contribute to patient care –Examples: Responding to drug information questions from nursing or medical staff members IV-to-PO conversion Vancomycin and aminoglycosides pharmacokinetic monitoring Renal dosage adjustment Others…

Preceptor Development Define Your Expectations What will the learners role be in your practice area? –Outline responsibilities Reasonable Challenging Communicated to other staff members Appropriate for the scope and level of learner you will be interacting with –Determine accountability –Provide feedback

Preceptor Development Gather and Provide Resources What will learners need to perform patient care or other activities as required in your area of service? –Will they have knowledge they need? –Needed skills? –Do they know what resources are available to help them find what they need? Investing the time to give learners the resources they need will improve your practice

Preceptor Development Communicate Expectations Define and explain learners responsibilities early on in the experience –Syllabus, goals, objectives, evaluations, etc. Discuss knowledge and skill development needed for students to meet expectations Establish accountability for completing plan and responsibilities

An Introduction to Effective Practice-Based Teaching

Preceptor Development Clinical or Case-Based Teaching: Characteristics of Effective Clinical Teachers Clinical competency –Ability to interact skillfully with patients and other healthcare providers Nonjudgmental approach Role model Clarity in communicating expectations Stimulate interest and enthusiasm for topic Passion for teaching Involve the learner and provide feedback Fam Med. 2005;37(1):30-5.

Preceptor Development “Questioning” as a Teaching Tool Employ effective questioning techniques –Allow the learner to weigh-in: “What did you think?” –Use questions for clarification: “Can you explain that again?” –Encourage learners to elaborate: “Can you expand on that?” Role of the student vs. resident in this environment –Pre-designate roles, if needed –Give resident some responsibility in asking questions Med J Aust. 2005;182(3):126.

Preceptor Development Self-Directed Learning and De-Briefing What was the most important thing that happened to you today? What is one thing that you learn today? Can you identify one question or topic that you encountered today that you would like to learn more about? What areas or skills can you improve upon?

Preceptor Development Common Mistakes with Clinical Teaching Strategies Taking over the case and correcting the learner Not allowing sufficient “wait time” –Ask a question… and count to 10 –Don’t say anything, let the learner think and respond “Lecturing” inappropriately Teaching at the wrong level –Introductory vs. advanced student vs. resident –Pushing learners past their ability –Not challenging learners appropriately

Preceptor Development Conclusions Working with a trainee or resident together in your clinical area or practice can be a beneficial situation –Service learning benefits the preceptor, the patient, other providers, other services, as well as the learner In a busy environment, use what’s at your fingertips –Patients, providers, and daily responsibilities establish the curriculum –The learner’s self-directed or self-identified areas for improvement will promote knowledge and skill development Provide appropriate feedback to “close the loop” and create a positive atmosphere that promotes learning

Walkin’ Into a Pharmacy Wonderland: Incorporating Pharmacy Trainees Into a Busy Practice Mary Bridgeman, Pharm.D., BCPS, CGP Clinical Associate Professor Ernest Mario School of Pharmacy Rutgers, The State University of New Jersey Internal Medicine Clinical Pharmacist and Preceptor Robert Wood Johnson University Hospital