Precepting a student with a shockingly low-credit program

[jbscoops20]

Agree with this doug.  I can only speak for myself, but after taking 45 credits of pre-reqs over a period of 2 years while working full-time and while meticulously prepping my application, you think I'm going to screw that up and get lazy when I get into a program....not quite.  Often times, people will take what you give them, and be lazy if you let them.  Hold your students accountable, even if it is what they're not used to.  The dedicated ones will rise to the occasion and become better clinicians for it.  Those who don't want to work hard will whine about it and go the other way.  At least you as the preceptor put forth the effort as an educator and gave your students an opportunity to be better.   Whether they take advantage of it or not is entirely up to them.  

[EMEDPA]

agree- at a bare min do the following:

show up on time.

know the material requested of you

show initiative to research interesting cases

show progress over the rotation in terms of better H+Ps , DDXs, procedural skill, etc

you don't have to be brimming with enthusiasm for the specialty. in fact if you tell me what you are interested in I can try to steer relevant cases your way. want to do women's health? great, you get every pelvic, bartholin's abscess, pregnancy complication in the dept while we are on. interested in surgery? you are my go-to guy for procedures and belly pain. psych ? you better believe I can find you lots of those....etc.

[sk732]

I liken teaching students to supervising anyone else - lay out your expectations, be brutally blunt and brutally honest and expect the same in return...and enforce your standards.  If someone is late getting in, let them know it's not acceptable and ensure any repeats are noted on your report.  The old "Karate Kid" analogy of there are no bad students, only bad teachers is largely (not wholly) true - your job is to ensure you and others impart the knowledge they need and their job is to show that they are a least attempting to learn...and if they aren't, find a way to that they can or do.  Don't feed them the answers of course, but attune your methods to their way of learning - I learn by watching and doing...and some by reading.  Others are totally book smart and utterly useless with people or doing stuff, some of which is often a confidence problem.  Fix the confidence problem...mine gets fixed by doing stuff to the point I'm no longer afraid of it (though still respectful), others by making even a basic diagnosis by being able to put together what is in front of them and what they know - that is actually quite difficult for people who are very book oriented.  Of course, it's a two way street - if the student isn't getting what they need/want, they need to actually tell us, and then it's our job to ensure that they do get what they need and be challenged in the way they ought to be.  If the student isn't putting out the way they should, call them on it and find out WTF is going on...if it's attitude, drop the hammer on them and let their school know.  If they're a total bag of hammers, let the school know, let them know and make sure it's documented thoroughly, including the discussions you've had.

 

I know it's time consuming, but DOCUMENT EVERYTHING.  I'd say write something out daily, that way specifics, good and bad, are noted so you don't forget.

 

MM

[EMEDPA]

  If they're a total bag of hammers, let the school know, let them know and make sure it's documented thoroughly, including the discussions you've had.

 

"smart like tractor, strong like bull" is the way a doc I work with describes these folks.

[acozadd]

"strong as a bull, and half as smart"

[RealityCheck]

I have an entire list of employee review commentaries.

 

The best one so far which has applied to one of my own teenagers - 

 

"has a full 6 pack but lacks the little plastic thingy that holds it all together"….

 

If anyone wants the full list, I can scan it in and send it - awesome on a tough day - adds a little humor

 

…."when his IQ hits 50, he should sell…."

"has hit rock bottom and started to dig"

 

etc etc

[sk732]

Best one I heard - "This person will forever go through life pulling on doors that need to be pushed open."

[roger777]

Well-said. I've said repeatedly and often that out in the "real world," the vast majority of NPs I've known and worked with have been great. Very good clinicians, no issues I've been able to see. But on paper, wow, the training is put together in a way that makes the MDs and us PAs look over-qualified, I guess.

That looks like the catalog from Kaplan online where a took a couple perfunctory courses last summer. Probably about as challanging.

[roger777]

I have stopped taking NP students from the universities around me because they are clinically inept at the time of entry into a preceptorship with me, a PA, in an outpatient clinical setting.

They also have little oversight in my region from the 3 universities in our city.

 

My last two students before I stopped made up their own schedules, showed up when they wanted and stayed only as long as they wanted. They could not present. They did not know how to formulate a differential.

 

When it takes 25 minutes to get a history on strep throat and this is this person's FOURTH clinical rotation - I am done.

 

She was an ICU nurse with absolutely no professional reason to obtain a DNP but just wanted one. No financial worries, spent more time with her show horses and was generally just going to school to do something since her nest was empty.

 

The other was pregnant and pretty much figured she knew what to do.

 

Both only needed 80 HOURS of Family Practice to finish their degrees. 80 HOURS in FP - are you kidding me?????

 

One student showed up around 8:30ISH - I start seeing patients at 8. She talked to the staff about knitting and cooking and then got miffed when I was already in a room seeing a patient and "forgot" to come get her. She was an ICU nurse and pretty much thought FPs are overrated and ICU folks are much much smarter.

 

The pregnant one would take off for lunch with her mother and be gone 1-2 hours and return "tired and full" while I had been charting through lunch and seeing a work in.

 

ZERO WORK ETHIC AND NO SUPPORT FROM THEIR PROGRAM.

 

She also faked her write ups to her clinical supervisor and actually just made stuff up in her write ups in order to use limited clinical knowledge and general laziness to cover for her ineptitude.

 

A lot of PA progs. Would have kicked them out I bet

[roger777]

I'd bet that those students spent the better part of at least a couple of years working really hard taking science classes, entrance exams, and putting together a solid application package specifically just to get where they are. It makes sense to keep working hard after admission. Maybe there's some value in having such a rigorous admissions process rather than a plethora of readily available, user-friendly "education opportunities".

60 credits in 2 years from City College of NY (CUNY the hard way). Every summer and winter term. 2 online classes. GRE. CASPA for 10 transcripts. 35 programs and all the secondaries.Cannonballing to Chicago for info session at RFU. Flying to LA to go to an info session at USC. etc. Etc. Never thought of that but yeah.