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Starring Roles: The four preceptor roles

and when to use them

CE Overview | CE Post-Test

 

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Introduction

  

Requirement 5.10 of ASHP's Accreditation Standards for Pharmacy Residency Programs (including PGY1, PGY2, Community, Managed Care and International standards) states:

 

"Preceptors must demonstrate a desire and an aptitude for teaching that includes mastery of the four preceptor roles fulfilled when teaching clinical problem solving (instructing, modeling, coaching, and facilitating). Further, preceptors must demonstrate abilities to provide criteria-based feedback and evaluation of resident performance. Preceptors must continue to pursue refinement of their teaching skills."

 

 

 

 

 

In addition, residents are required to learn these roles, necessitating modeling and teaching of the roles by preceptors.  The relevant excerpt from the residency standards is:

Outcome R5: Provide medication and practice-related education/training.

Goal R5.1: Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.

Objective 5.1.3 (Application) Use skill in the four preceptor roles employed in practice-based teaching (direct instruction, modeling, coaching, and facilitation).

 

The four roles are sequential in nature, meaning that to teach a skill that is new to the resident, you start with the first role, direct instruction, then progress to the second role, modeling, followed by the third, coaching and culminating in the last role, facilitating. However, each resident is different so that you may be able to start in a different role. For example, if the resident already has the background, foundational information for a specific learning experience, you may be able to skip direct instruction and start with modeling. On the other hand, if a resident has numerous problems during coaching, you may want to revert back to modeling and then progress back up to coaching.

 

This program will prepare you for effective use of the four preceptor roles.

 

 

 

 

 

Objectives:

 By the end of this program you will be able to:

1. (Comprehension) Explain the importance of the four preceptor roles.

2. (Knowledge) Define each preceptor role and list the roles in their correct order of progression.

3. (Analysis) Given a description of a preceptor-resident interaction, identify which preceptor role is being used.

4. (Evaluation) Given a description of a resident, determine which preceptor role would be appropriate to use to help the resident progress.

 

 

 

 

Direct Instruction

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Direct instruction is the teaching of content that is foundational in nature.   Direct instruction fills in information that is necessary to acquire before skills can be applied or performed.  For example, before a resident can learn to develop a medication regimen for an asthmatic patient, he or she needs to master information about asthma, potential treatments for asthma, the latest research and its implications and other pertinent information about asthma and its treatment.  Direct instruction in the form of assigned books, lectures, articles and discussions help a resident acquire this information.  This preceptor role is appropriate at the beginning of a residency or learning experience when foundational information is needed before assuming a responsibility. 

 

 

 

 

 

Direct Instruction of Residents vs Students

 

Direct instruction of residents differs from classroom instruction of students. When a resident has a knowledge gap, it is usually most appropriate to refer them to relevant resource materials and then check their understanding of the material. Mini-lectures that resemble classroom instruction of students should be avoided or minimized, keeping in mind residents' greater ability to be independent in acquiring knowledge as compared to students.

 

 

 

 

 

Modeling

 

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Modeling is demonstrating a skill or process while "thinking out loud" so the resident can witness the thoughts or problem-solving process of the preceptor, as well as the observable actions.  For example, the resident observes a preceptor develop a medication therapy regimen and monitoring plan for an asthma patient while the preceptor simultaneously explains the thought and problem-solving process that would normally go on silently.  The resident sees and prepares to emulate the modeling example(s). 

 

This preceptor role is most appropriate after it has been determined that the resident has the appropriate amount of background information and is ready to begin to learn to perform a task or responsibility.  

 

 

 

Coaching

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Coaching is allowing a resident to perform a skill while being observed by the preceptor, who provides ongoing feedback during the process.  For example, after the resident has acquired the necessary background information (direct instruction) and observed the preceptor model the development of a medication therapy regimen and monitoring plan for an asthma patient (modeling), the preceptor allows the resident to develop a regimen and monitoring plan for another asthma patient and asks the resident to "think out loud" so the preceptor can observe the resident's thoughts and actions.  The preceptor gives feedback during the process. 

 

This preceptor role is appropriate after the resident has had the opportunity to observe modeling of the process he/she is about to take on but is not yet ready for independence.  The coaching process allows fine tuning of the resident's skills as well as assuring the preceptor that the resident is ready to move to greater independence.  When the preceptor no longer feels the need to provide corrective feedback to the resident while they perform the task at hand, it is time to move to the next preceptor role: facilitating.

 

 

 

 

Effective Feedback

During coaching, or anytime you are giving feedback to residents, the type of feedback you give is important. Effective feedback helps the resident improve and accreditation standards specify that this feedback needs to be specific and criteria-based. This is an area on which programs are frequently cited on accreditation surveys.

 

The relevant part of the accreditation standard, Principle 4.1.e. (1), states, in part:

"Preceptors conduct and document a criteria-based, summative assessment of each resident's performance of each of the respective program-selected educational goals and objectives assigned to the learning experience."

 

In addition, Principle 4.2.c. states, in part:  

"Preceptors will provide ongoing, criteria-based verbal and, when needed, documented feedback on resident performance."

 To meet this standard, feedback must tell the resident how they are performing in relation to specified criteria. See the examples on the next screen.

 

 

 

 

Effective vs Ineffective Feedback Examples

 

Let's look at four examples of feedback and determine whether or not they meet the standard and why or why not.

Example 1: "Good job!"

Does this example does meet the standard? No. The feedback does not provide the resident with specific information about why he or she did a good job.

Example 2: "Resident saw all patients in the anticoagulation clinic today."

This is an example of a type of feedback that is frequently seen. Does it meet the standard? No. It only addresses what was done, but not how well it was done. Feedback needs to address the quality of resident performance, not just list tasks completed.

Example 3: "Resident needs to ask self the question, "Are all the recommended therapies ordered for this problem?" for each problem on every patient without losing efficiency in reviewing and analyzing patient data."

Does this example meet the standard? Yes. The resident is given specific information about a weakness and what they need to do to improve.

Example 4: "Resident specified therapeutic goals based on consideration of disease state. He uses practice guidelines appropriately (ex. JNC-7). Goals are measurable and realistic for the patient."

Does this example meet the standard? Yes. The resident is told specifically why he is doing well.

When giving feedback, ask yourself if the feedback is specific enough for the resident to know how to improve or continue doing well. This is what the resident is looking for in feedback.

 

 

 

 

 

 

Facilitating

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Facilitating is allowing the resident perform independently, while the preceptor remains available if needed and de-briefing with the resident after the fact.  Facilitating occurs when the preceptor has coached the resident and is confident in his/her ability to function independently.  For example, after assigning readings on asthma, modeling and coaching the development of medication therapy regimens for asthma patients, the preceptor has observed the resident do this successfully and no longer needs to provide corrective feedback.  The facilitator gives his/her contact information to the resident, sets up an appointment to meet with him/her later and leaves him/her with the responsibility for the asthma patients. This preceptor role is appropriate when both the preceptor and resident feel confident of the resident's ability to function independently.  This role normally occurs toward the end of a learning experience and the residency as a whole.

 

Once you have reached the facilitating role, be sure to make residents responsible for progressively more complex patients. If they are able to treat typical asthma patients, ensure they can treat asthma patients with multiple conditions that must also be considered. It is important to keep challenging residents at this stage of their training.

 

 

 

 

Practice using the preceptor role terms in the following activities. Click on the crossword activity and fill in the correct term for each given definition.

 

 Hyperlink to Crossword Activity 

Click on the sorting activity and arrange the preceptor roles into the correct order. 

 

 Hyperlink to Sorting Activity 

 

 

When should I use each preceptor role?

 

You know the challenge: You don't want to give a resident too much responsibility too soon but you don't want to delay giving responsibility any longer than necessary. How do you know?

 

Orientation to the residency and to each learning experience gives you and the resident an opportunity to exchange information about the resident's level of skill and confidence. Information you gather about your resident as part of developing the customized plan also contributes. The number and type of questions the resident asks when you are in the modeling role may indicate if he/she needs more direct instruction or is ready for coaching. If you have to give lots of correction or direction in the coaching role you may need to model again. On the other hand, if all goes well, move to facilitating.

 

In the following questions, a resident's learning needs are described. Select the preceptor role that would best meet the learning needs.

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Conclusion

Now you are familiar with the four preceptor roles as well as when and how to use them.

 

Best wishes as you continue to play your starring roles!

 

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