First-time preceptor

[SedRate]

Hello,

 

I will soon be taking on my first PA student as a preceptor. I've had experience working with students that were rotating with other providers, but I haven't had my own. This is for an elective rotation for a student who about to graduate. Any advice?

 

Thanks,

 

Sed

[rev ronin]

Make them do all the work!  That is, all the provider work, including formulating their own plan first.  Teach by augmenting their plans, not making ones up for them. Don't let them go off the rails or waste patients' time, but right before graduation is a great time to make them own things entirely and give them gentle guidance and teaching to refine things.

[SedRate]

Thanks for your advice. I did that with the other students (have them see the patient first and then present to me), and that seemed to go over well. However, both of them were more passive rather than go-getters and preferred to follow me around, which made my job difficult. We shall see what kind of student this one is :)

[Guest ERCat]

TOTALLY AGREE! The rotation in which I learned the most is the one where my preceptor made me do the entire patient encounter on my own, write up my chart, and tell him what I thought the plan should be. The rotations in which I mostly shadowed and asked questions just weren't very helpful. Work your student hard - they will appreciate you for it!

[LT_Oneal_PAC]

I agree with rev and do the same. They do everything beginning to end with me giving the head nod or gently steering back in the right direction by asking questions of incidence, prevalence, physiology, ect.

 

To help with the unmotivated, I set the expectations upfront. This is what you have to do for getting a passing grade with me...this will get you an excellent grade...these are the things that are automatic fails...these are my ideals for medical practice...

[dphy83]

As a related question, how many years of practice are reasonably needed before one can serve as a solid preceptor? I understand that this is a loaded question, as this varies from PA to PA, but generally speaking...

[SedRate]

Thanks for your input, ERcat and LTJGonealPAC. Regarding setting up expectations from the get-go, that was another thing I was mulling over. I couldn't decide if I wanted the student to reach out to me regarding what they want so they could make the rotation how they want (study time versus clinic time versus hands-on, so they can work on things they need/want to) or if I wanted to lay down the law. I, personally, had rotations both ways and learned plenty from both. I suppose I could set the expectations I have and allow negotiation of the former.

 

Dphy83, as a student, I had a preceptor who was out 5 years and she was very good. My other preceptors were out longer or MDs/DOs. I'm sure it really depends on your overall experience, confidence, and willingness to teach and not necessarily years out. I'm almost two years out and feel like I can offer a well-rounded student experience. I'll letcha know what my students' preceptor/rotation review says ;)

[rev ronin]

Study time?  Heck no.  They can pull out a book if the walk-in clinic is idle and they have nothing else to catch up on, but rotations are a time for seeing patients and the attendant work (documentation, etc.) not for practicing for their end of rotation exams.  They do that on their days off.

[rev ronin]

As a related question, how many years of practice are reasonably needed before one can serve as a solid preceptor? I understand that this is a loaded question, as this varies from PA to PA, but generally speaking...

Pacific expects graduates to start volunteering as preceptors after two years in practice.  I'm coming up on four, and getting my 4th student next month.

[LT_Oneal_PAC]

The expectations I set are broad about working hard, showing up on time, reading, professionalism, seeing where they are and how I expect to see improvement, and being prepared. Being prepared typically is my killer because they have not worked with someone that has them do so much. The

 

I allow some flexibility. If my patient schedule looks like a bunch of sniffles, I'll look at other provider schedules (the people I think are good teachers) to see if they have something that looks more interesting. Since I'm with an FM residency I give them some inpatient, OB, procedural clinic, and sports Med time. I don't adjust based on what they like, but if some shitty residents are on the OB service and they are just sitting there not getting to do anything, I'll pull them and have them do something more productive back in procedures or whatever. I had feedback from one student that she preferred the PAs over the residents because we expected more and let them do more. After discussion with the residents it came out they thought they were treating them appropriately like a 4th year. I had to explain that these are people who are joining the military and will be independent providers next year. A 4th year has residency to learn. pa students here need to be treated like interns.

 

I'm also not a slave driver. Some times I have to work the weekend and make the student come, but I'll give them an extra day off if they had a great attitude about it and worked hard. Also since I'm a long 8 hour drive from the school that sends me students, I'll give the last day off for the drive home and get some study time in for their exam because I don't think it's fair that all their buddies have extra study time having a local site.

[SedRate]

You bring up some good points.

[SedRate]

Revision: Both of you do.

 

My program also requires a minimum of two years in order to precept.

 

On another note, what hours do you require they work? I often work more than 40 hours per week but I know the rotation only requires 40.

[RuralER/Ortho]

I would require that they work at least as many hours as their primary preceptor. You only get the chance once to learn in the clinic with essentially no negative ramifications. If a student refused or complained about working >40 hours, that would reflect pretty negatively in my opinion.

[LT_Oneal_PAC]

Revision: Both of you do.

 

My program also requires a minimum of two years in order to precept.

 

On another note, what hours do you require they work? I often work more than 40 hours per week but I know the rotation only requires 40.

They work my hours, which often quite exceeds 40 hours. However, like I said, I'm not a slave driver and i let people who are hitting all my marks off a few hours early once or twice on the rotation. I'm a big proponent of mental health in students and I can see when my schedule/work load is taking its toll. Looking tired, drinking that extra cup of coffee, moving slower. Now the slackers don't that because they have no reason to be tired. They thought FM was going to be a coosh rotation of coughs and runny noses, in by 830 and out by 4 with half day Friday, refer everything to the specialist. They thought wrong.

[SedRate]

Update: Rotation was a success. It helped that the student was competent, so I made them do just about everything. The student stated they didn't get to do much in other rotations and so they really appreciated the extra experience and challenge, especially right before graduation.

 

Thank you all for your input!