Rotation Expectations of Students Vs Preceptor

[ProSpectre]

On 4/30/2018 at 9:54 AM, Sed said:

Agreed. However, you're misunderstanding my concerns. 

While I don't expect students to be an "expert," I do expect them to know how to perform the basic styles, which suture materials to use, surgery-specific topics, and need-to-knows for an ELECTIVE SURGERY ROTATION. Obviously their final product may not be greatest, but they should know how to do it so when they do perform it, they're not asking me, "How do I do this stitch?" Students can learn/practice this on their own with the help of the many resources out there and then work on it with me in the OR. All students of mine have already done a surgical rotation and so they have all been in dozens of surgical procedures prior. And this is the problem I have. I have students coming in to rotate with me at the end of their training having never written a Rx themselves, don't understand pre or postop orders, not sure how to handle a needle driver or needle, how to gown/glove, etc... And then I find out they haven't even prepared for my rotation at all. And then they blame others or copying an attitude at me when I share my disappointment in their lack of responsibility or preparedness. 

I think there has been good advice given in this thread so far. I don't think your expectations are unreasonable, but I would say that it may be a good idea to revamp the e-mail you send out before the rotation. You could list each of your expectations for the basics (review H&Ps, suturing techniques, suture materials and where they're used, etc), and advise students to review this stuff on their own prior to the rotation AND expect to be tested/pimped on them for you to gauge their level of understanding before they are allowed to see patients. If there are certain procedures or types of cases that you commonly see in your sub-specialty, I would include those as well and tell students they are expected to read up on them beforehand (if you have good source material/websites that covers them, you could include that as well). If your cases for the week are known ahead of time, you could even send those to them to read up on ahead of time. There are great resources on youtube (often from medical schools) that cover suturing techniques, gowning and gloving, etc, and these could be "required preparation" for your rotation as well. 

Personally, I think most of this stuff is common sense, and I would hope that a student would take it upon themselves to do these things to prepare and get the most out of their rotation (and certainly not get an attitude if told in a professional manner that they aren't meeting expectations or that they've shown up unprepared). However, if this is more than one or two isolated incidents with a couple students, it may be beneficial to take a new approach to ensure students are more prepared when they begin your rotation. 

[SHU-CH]

8 hours ago, MedicinePower said:

It sounds like you shouldn't be taking students. A good teacher will meet the student where they are.

That is a common belief in educational circles, but I am not sure how valid it is. 

There is this pervasive belief that students today are somehow "different" and that the medical education system - which has worked fairly well for ~ 100 years - needs to go through all kinds of contortions to work with these students. Can't we at least reasonably expect that students should meet us somewhere in the middle?

Neuroscience is showing us that there certainly are better ways to teach some things. However, we have bred a generation of students that come to class looking for "edutainment." The truth is, some lecturers and topics might be a little bit dull. Should a student force themself to pay attention and develop some skill in concentration, or is it ok for them to zone out and surf the web?

I have not seen many employers willing to change their environment to accommodate the needs of new graduates. We can either prepare our students for the "real world" or we can kill our profession by putting out psychologically fragile graduates with no initiative, endurance  or meaningful attention span. 

[Boatswain2PA]

14 hours ago, BayPAC said:

Going to rotation 40+ hours/week, studying for EORE, writing papers/doing homework for online classes...

What "papers and homework" did you have during your rotation?  I don't think programs should task students with such things during rotations, instead allow the student to fully immerse themselves in learning the medicine from the rotation.

[sas5814]

I agree. They, on their rotations, should be fully immersed in the rotation. They will have lots to research on most rotations and having outside work would be a distraction.

[Boatswain2PA]

11 hours ago, MedicinePower said:

These students have zero experience in your expert field and therefore require a lot of hand holding.

 

9 hours ago, MedicinePower said:

It sounds like you shouldn't be taking students. A good teacher will meet the student where they are.

Are you a graduate of or professor at Evergreen State?

https://www.nationalreview.com/2017/07/evergreen-state-professors-grading-student-protesters-feelings/

These aren't grade school kids who need hand-holding, these are GRADUATE STUDENTS who will soon be practicing medicine, and if they still need their damn hands held in their last year of education then they are primed to KILL SOMEONE sometime after graduation.

[Boatswain2PA]

25 minutes ago, SHU-CH said:

We can either prepare our students for the "real world" or we can kill our profession by putting out psychologically fragile graduates with no initiative, endurance  or meaningful attention span. 

You forgot the fact that these psychologically fragile graduates, with no initiative, endurance, or meaningful attention span also routinely have >$100K in student loan debt.

Of course, we can fix that for them too by having the federal government pay it off for them because, you know, it's just not fair!

[SedRate]

9 hours ago, MedicinePower said:

It sounds like you shouldn't be taking students. A good teacher will meet the student where they are.

Do you have any additional input on how I should meet them in the middle? I can continue to tell you that I have tried, but you seem to be gleaning some other idea that I'm some staunch drill sergeant where it's my way or the highway and I'm whining that students aren't complying. 

 

8 hours ago, ProSpectre said:

 

I think the expectations of students mentioned in the original post are perfectly reasonable. I do think maybe Sed should outline his expectations more clearly up front, but nothing he mentioned is unreasonable or suggests that he shouldn't take students. 

 

 

 

8 hours ago, ProSpectre said:

I think there has been good advice given in this thread so far. I don't think your expectations are unreasonable, but I would say that it may be a good idea to revamp the e-mail you send out before the rotation. You could list each of your expectations for the basics. 

However, if this is more than one or two isolated incidents with a couple students, it may be beneficial to take a new approach to ensure students are more prepared when they begin your rotation. 

Thank you for your support and suggestions.

I do outline them (e.g., "Please review these topics: suture types, fx, post-op, ortho, h&p, etc), but clearly it's not getting through to students. Or maybe it's simply too much to expect early on. After some reflection and discussion with other colleagues, I will plan on having a one-on-one at the beginning like Sas does (or even beforehand to give them time to review) to set the expectations more clearly for both the student and I. And then I'm going to try to incorporate more study assignments rather than pimping and expecting them to self-start their learning/prep. 

[SedRate]

48 minutes ago, Boatswain2PA said:

What "papers and homework" did you have during your rotation?  I don't think programs should task students with such things during rotations, instead allow the student to fully immerse themselves in learning the medicine from the rotation.

 

40 minutes ago, sas5814 said:

I agree. They, on their rotations, should be fully immersed in the rotation. They will have lots to research on most rotations and having outside work would be a distraction.

And to go one further, my rotation is an elective and no exam is afterward. Furthermore, I only take students who want or think they want to go into ortho surgery, hence my high expectations. 

[sas5814]

You have the right idea. Taking students is a "give back" to the profession and you are doing a good thing and clearly your heart is in it. Another thing I did often was at the end of the day say "do a deeper dive into <subject> and we will talk about it some tomorrow." I would pick something we saw that day. I didn't do it every day because they need some down time too and I didn't ask for a big essay or anything just a minute or two on what they learned. It force ME to read because these youngsters often had a much deeper book knowledge than I did.

[SedRate]

37 minutes ago, Boatswain2PA said:

 

Are you a graduate of or professor at Evergreen State?

https://www.nationalreview.com/2017/07/evergreen-state-professors-grading-student-protesters-feelings/

These aren't grade school kids who need hand-holding, these are GRADUATE STUDENTS who will soon be practicing medicine, and if they still need their damn hands held in their last year of education then they are primed to KILL SOMEONE sometime after graduation.

I tried to up vote this but have already met my max.

This is what I'm worried about. I'm worried about these people going out into the real world in a matter of months without learning how to prepare for a case/consult/new pt (preop labs, cardiac clearance, reviewing films and h&p, intraop and postop complications, etc), how to communicate with nursing staff or other providers/physicians, etc. These people will soon be my colleagues in the community and have only learned how to watch, ask people to do the work for them, and look at a computer. Hopefully they end up working with a very patient and understanding SP/CP who's willing to hold their hand as they transition into their first job.

I can't tell you how many times a student didn't know how to find a nurse to discuss pt status, how to communicate with other providers, or give a proper presentation. AND THESE ARE STUDENTS AT THE END OF THEIR TRAINING WHO HAVE ALREADY COMPLETED A SURGICAL ROTATION! I do not take students who haven't already completed a surgical rotation. 

The students are smart and will obviously learn once they're forced to in the real world when it's their career and malpractice insurance on the line, but I won't let them slide by when they're with me. And as Sas said, it's my patient, my career and then my students. Students must respect that.

[PAs12017]

As a student in the clinical year, I want to point out two things:

1. every preceptor has different expectations. Many of you are critical of students who ask questions that can easily be looked up. However, the two preceptors of my first rotation ENCOURAGE this discussion and are more than happy to discuss any questions. It would be easy to transfer this habit over to the next rotation with a preceptor who doesn't want to be bothered with simple questions. 

2. every rotation is different. Students at one surgical rotation may get to close enough times to meet competencies, but get no other experience due to competition with other students, while another may be in a rural location and first assist every surgery. I can memorize suture types and sizes per location all i want but until i am applying it regularly it may not stick.

I am sure you all are aware of these things, but you might need a reminder. 

[BearDown]

30 minutes ago, PAs12017 said:

As a student in the clinical year, I want to point out two things:

1. every preceptor has different expectations. Many of you are critical of students who ask questions that can easily be looked up. However, the two preceptors of my first rotation ENCOURAGE this discussion and are more than happy to discuss any questions. It would be easy to transfer this habit over to the next rotation with a preceptor who doesn't want to be bothered with simple questions. 

2. every rotation is different. Students at one surgical rotation may get to close enough times to meet competencies, but get no other experience due to competition with other students, while another may be in a rural location and first assist every surgery. I can memorize suture types and sizes per location all i want but until i am applying it regularly it may not stick.

I am sure you all are aware of these things, but you might need a reminder. 

I think Sed means well and I can respect his stance. I'm sure he's more than happy to help someone who puts in the effort. If you're practicing the wrong technique on procedures it isn't doing you any good. I'm sure Sed would be more than willing to intervene in this scenario. I think the griping (warranted imo) comes from lack of effort.

[sas5814]

Yup.... someone who is working hard and making good effort and asking good questions will get lots of help from me a a preceptor. Someone who wants me to answer every question about everything without doing their basic reading first is going to have a problem. Someone who is lazy..outright lazy...is going to have a bad rotation. Someone who rolls his/her eyes at me is going to find themselves back at school explaining themselves because the rotation is over.

We are teaching people to practice medicine. This is not a place for people who have to be dragged kicking and screaming. It is for motivated self starters.

[ProSpectre]

51 minutes ago, PAs12017 said:

As a student in the clinical year, I want to point out two things:

1. every preceptor has different expectations. Many of you are critical of students who ask questions that can easily be looked up. However, the two preceptors of my first rotation ENCOURAGE this discussion and are more than happy to discuss any questions. It would be easy to transfer this habit over to the next rotation with a preceptor who doesn't want to be bothered with simple questions. 

2. every rotation is different. Students at one surgical rotation may get to close enough times to meet competencies, but get no other experience due to competition with other students, while another may be in a rural location and first assist every surgery. I can memorize suture types and sizes per location all i want but until i am applying it regularly it may not stick.

I am sure you all are aware of these things, but you might need a reminder. 

To address your first point, asking questions is necessary and should be encouraged when appropriate. I don't think that is Sed's issue here. The issue is that students will revert straight to asking questions before even attempting to look it up or find the answer themselves. We are training to be medical professionals, and will have to look stuff up and find answers on our own every single day in practice; you can't just run to your SP every time you can't remember something. Sure, if you've exhausted all resources and still can't find an answer, then I don't think a preceptor like Sed will have any problem with questions, but you should go into the discussion after having made a reasonable attempt first. 

I have seen this mentality of learned helplessness in students in my program (thankfully not too many), and it does not bode well for those students who develop it; hopefully preceptors like Sed can break those habits early on, because while a higher degree of hand-holding may be necessary during rotations, that level of support dissolves quickly after graduation. Being taken out of your comfort zone and taking personal responsibility for your learning is exactly how you grow, learn, and gain confidence. If you end up with a preceptor who doesn't have those same high expectations on some rotations, then fine, but you shouldn't revert to the lowest common denominator on every rotation just because that's how the last guy did it. 

[MusicalPA]

4 hours ago, Boatswain2PA said:

What "papers and homework" did you have during your rotation?  I don't think programs should task students with such things during rotations, instead allow the student to fully immerse themselves in learning the medicine from the rotation.

That would be nice! My husband is in his clinical year. There is a written exam at the end of a rotation. He also has to do an oral exam, practical, or presentation w/ paper(these get rotated). This time around, he has to write an ethical paper during his IM rotation on top of the material he needs to study for. During his elective rotation which he chose ortho, he had the choice of having a written exam or doing 10 one page papers on topics related to ortho. He has to complete a few SOAP notes and H&P's to turn in to be graded. I'm sure he has other stuff to do as well. His biggest stress is the preceptor eval. It is worth 30% of his grade and can make or break a rotation. He does well, but it is still a stress he wishes he didn't feel, so that he could feel more comfortable learning medicine. 

[8404PA]

4 hours ago, Boatswain2PA said:

What "papers and homework" did you have during your rotation?  I don't think programs should task students with such things during rotations, instead allow the student to fully immerse themselves in learning the medicine from the rotation.

I'm on rotations now starting 4th of 8.

We basically have a case study presentation each rotation, obviously study for the EORe, half of the rotations we have to do 12 hours of various CMEs, work on our capstone research/write the paper, study for a pharmacy quiz each rotation, usually there is simple extra work at the end like a radiology review quiz or drug/alcohol abuse worksheet for example.

 

[sas5814]

Wow...I am learning a lot here. I think school should be fast paced and a bit pressured...it helps take your measure but it seems as if you are watering down the clinical rotations with the outside work. On a surgical rotation? Dive deep into surgery. On an IM rotation? Dive deep into diabetes, BP heart disease etc.

I remember in our didactic phase having amazing amounts of information crammed in all day, going home and studying unto bed time, getting up and doing it again. Lather, rinse, repeat. Monday was test day...2 or 3 tests and then start over with new information.

This is a different paradigm.

[MusicalPA]

32 minutes ago, sas5814 said:

Wow...I am learning a lot here. I think school should be fast paced and a bit pressured...it helps take your measure but it seems as if you are watering down the clinical rotations with the outside work. On a surgical rotation? Dive deep into surgery. On an IM rotation? Dive deep into diabetes, BP heart disease etc.

I remember in our didactic phase having amazing amounts of information crammed in all day, going home and studying unto bed time, getting up and doing it again. Lather, rinse, repeat. Monday was test day...2 or 3 tests and then start over with new information.

This is a different paradigm.

My husband had what you had during didactic phase...constantly be crammed with info and having multiply tests per week. They would start receiving new information for a new section of material before getting the test on the prior section learned sometimes. I believe, to have a masters, you have to have some type of capstone/research project?? His school didn't have a big project, so he was hoping to not have to write any more papers...lol Well they do do multiple papers instead of one big project to fulfill that requirement. He is so tired of writing papers.  This ethical paper is his last, and he is excited for sure. 

[SedRate]

Thank you, everyone, for contributing to this discussion. I, too, am learning a lot. I appreciate the reassurance as well as the criticisms and insight from other views. I'm fairly new to preceptorship and am still learning my own teaching style, so this has been extremely helpful and valuable. I will take these suggestions into consideration and continue to work on providing a quality rotation site for PA students.

I did contact the program and the coordinator said they're encountering similar issues in the classroom and from other preceptors. They have had rotation sites/preceptors drop their rotation agreements due to this.

[PAs12017]

1 hour ago, Sed said:

Thank you, everyone, for contributing to this discussion. I, too, am learning a lot. I appreciate the reassurance as well as the criticisms and insight from other views. I'm fairly new to preceptorship and am still learning my own teaching style, so this has been extremely helpful and valuable. I will take these suggestions into consideration and continue to work on providing a quality rotation site for PA students.

I did contact the program and the coordinator said they're encountering similar issues in the classroom and from other preceptors. They have had rotation sites/preceptors drop their rotation agreements due to this.

Bummer that is seems to be a program-wide problem. Is it a well-known program? Personally, my program has what many would consider the "new generation of PA students" - as in most of us are young (22-28) with little prior HCE. However, our preceptors consistently tell us that we perform better than the local 3rd/4th year med students. So I wonder if you are experiencing a program specific issue....surely there are students in every program that are underprepared but I truly don't think this is the norm.

4 hours ago, sas5814 said:

Wow...I am learning a lot here. I think school should be fast paced and a bit pressured...it helps take your measure but it seems as if you are watering down the clinical rotations with the outside work. On a surgical rotation? Dive deep into surgery. On an IM rotation? Dive deep into diabetes, BP heart disease etc.

I remember in our didactic phase having amazing amounts of information crammed in all day, going home and studying unto bed time, getting up and doing it again. Lather, rinse, repeat. Monday was test day...2 or 3 tests and then start over with new information.

This is a different paradigm.

This was didactic for us too. However in clinicals we have additional small assignments + research paper. I wish we could just delve into the material and fully immerse into the rotation.

[SedRate]

6 hours ago, PAs12017 said:

As a student in the clinical year, I want to point out two things:

1. every preceptor has different expectations. Many of you are critical of students who ask questions that can easily be looked up. However, the two preceptors of my first rotation ENCOURAGE this discussion and are more than happy to discuss any questions. It would be easy to transfer this habit over to the next rotation with a preceptor who doesn't want to be bothered with simple questions. 

2. every rotation is different. Students at one surgical rotation may get to close enough times to meet competencies, but get no other experience due to competition with other students, while another may be in a rural location and first assist every surgery. I can memorize suture types and sizes per location all i want but until i am applying it regularly it may not stick.

I am sure you all are aware of these things, but you might need a reminder. 

Many of us are critical for a reason. You will soon be doing this stuff for real so certain things are expected, especially when you're interacting with our patients for which we are ultimately responsible. I cannot always take time away from them and my job duties to answer every question you haven't tried to look up or to allow you to practice on patients if you haven't even picked up a needle driver since skills lab or your gen surg rotation 5mo ago. Practice at home! Watch YouTube videos! Read a book! Show me you've at least thought about it. Given the right attitude and work ethic, I will teach you everything I know and allow you to do everything. Given laziness and entitlement, please do us all a favor and move on to someone else. 

Remember, I too was a PA student at one point and actually not too long ago, so I understand the nuances of the clinical year. Everyone has a different experience depending on where they are in rotation year, interests, personalities, prior experience, attitude, you name it. I am glad to hear you had some good ones, especially right off the bat. I also had some really good preceptors myself, and they were the ones who pushed me beyond my comfort zone and invited (and expected) active learning and quality discussion. As a student, I made sure to be as prepared as possible to insure I was getting the most out of what little time I had with them and with the opportunities I did get from them. I found that it was difficult to have any valuable or insightful discussion on a topic or procedure I didn't study or review, which was rare. I can only imagine how it would've all turned out had I not practiced on my down time, reviewed topics or procedures beforehand, arrived early, stayed late, looked up things on my own, and listened to lectures to and from sites.

I eventually graduated and transitioned into my first and current PA job, something that you too will soon encounter. And with that, despite all of my preparation and hard work throughout clinical year, learned quickly which areas I was still somewhat deficient in and now couldn't exactly rely on anyone else to do or think for me. These are things that I also try to work on with students in addition to actual medicine: self-awareness, critical thinking/troubleshooting, confidence, interpersonal skills, contract discussion, etc. This seems to be increasingly hard to do as PA students nowadays are younger and have limited prior healthcare and real world experience. 

[BayPAC]

9 hours ago, Boatswain2PA said:

What "papers and homework" did you have during your rotation?  I don't think programs should task students with such things during rotations, instead allow the student to fully immerse themselves in learning the medicine from the rotation.

Some of the papers: ethics in healthcare, healthcare management, etc... Homework and quizzes on these topics as well every-single-week during clinicals. No one in my cohort enjoyed those classes. Waste of time and money. 

[SedRate]

16 minutes ago, PAs12017 said:

Bummer that is seems to be a program-wide problem. Is it a well-known program? Personally, my program has what many would consider the "new generation of PA students" - as in most of us are young (22-28) with little prior HCE. However, our preceptors consistently tell us that we perform better than the local 3rd/4th year med students. So I wonder if you are experiencing a program specific issue....surely there are students in every program that are underprepared but I truly don't think this is the norm.

Yes, and it is my alma mater so I know the quality of the program and rotation sites from personal experience. This program has a similar student demographic and remarks. 

However, see some of the posts above regarding recent shift in student attitudes, so I don't think this is necessarily a program-specific issue. I will continue to trend my students to see. 

[ak004]

I start rotations in a few weeks. I hope to meet my preceptors standards, but more importantly, if I’m not being the kind of student I should be, or need to work on things or do things differently, I hope my preceptor sits me down and tells me to shape up! I want to be a good student, a good PA, and I want to represent my program well. It’s hard to know you’re doing something wrong if someone doesn’t tell you.
Good luck with the students OP. I hope you don’t take them as being representative of the entire next generation of new PAs/younger PAs

[PA-SGuy]

9 hours ago, ak004 said:

I start rotations in a few weeks. I hope to meet my preceptors standards, but more importantly, if I’m not being the kind of student I should be, or need to work on things or do things differently, I hope my preceptor sits me down and tells me to shape up! I want to be a good student, a good PA, and I want to represent my program well. It’s hard to know you’re doing something wrong if someone doesn’t tell you.
Good luck with the students OP. I hope you don’t take them as being representative of the entire next generation of new PAs/younger PAs

as a current student on rotations, one thing i always asked the first day: "is there anything i should work on or something i should be doing that I did not do today" presentation, soap note style etc. This shows you're interested in learning/improving from day 1 and helps you build your skills.