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Medical Precepting

Medical Precepting, Teaching Medical Students, Teaching Medical Residents, Preceptorship, Medical Education

Approach
General

Help students understand the rotation
1. Distribute a written overview at the start of the rotation (and review with students)
2. Include focus areas, core concepts and expectations
Learn about the students
1. Career goals
2. Prior rotations and experiences
3. Specific topics of interest (might lead to presenting a paper or short presentation during rotation)
4. Student's Perception of their strengths and the areas they need to improve
Give feedback throughout the rotation
1. See the one minute preceptor below
2. Give short, specific feedback each focused on a single teaching point for a few minutes daily
3. Reinforce positive habits
4. Final evaluation should reflect the cummulative feedback given during the rotation
Treat Students as Colleagues
1. Share how do you balance your work and life
One Minute Preceptor
1. Student commits to a diagnosis or clinical syndrome ("What do you think is the cause?")
2. Student presents supporting evidence ("Why do you think this is the cause and what was your DDx?")
3. Teach General Rules that apply to the specific diagnosis (core concepts, pearls, or strategies)
4. Reinforce what was right
5. Correct mistakes
Distribute the teaching (for the student's experience and for the preceptor's time)
1. Medical residents Teaching Medical Students
2. Following the patient's care with a consultant (e.g. surgery of an emergency department patient)
3. Shadowing another provider to see a patient with an interesting presentation
4. Experiencing the front desk, nursing triage, rooming of patients, lab, imaging

Approach
Pearls

Dispell myths
1. Perfectionism
  1. Perfect impedes completion, breeding procrastination and paralyzing progress
  2. Strive for reasonable results that are completed in budgeted time
2. Multitasking
  1. Multitasking decreases productivity and introduces more errors
  2. Apply appropriate, focused attention to important individual tasks, one at a time
3. Imposter Syndrome
  1. High achieving students feel anxiety, stress, self-doubt, and underachievement despite the contrary
  2. Facilitate learners appreciate their accomplishments, competence, strengths through self-reflection
  3. Learners (as well as preceptors) are not expected to know everything, and attendings also make mistakes
  4. Encourage learners to accept positive feedback as real
  5. Consider counselors or employee assistance programs (EAP) for more refractory, persistent feelings
  6. Clance Imposter Phenomenon Scale
    1. https://www.concordia.ca/content/dam/concordia/aar/docs/benefits/careers/Clance-IP-test-and-scoring.pdf
Efficiency
1. Schedule on a calendar, focused time for a single important task
2. Eliminate distractions (phone messages, email)
3. Maintain a To-Do list
4. Perform taks in cycles (e.g. Pomodoro Technique)
  1. Focus on an intended task for a specified period (e.g. 25 minutes) of time
  2. Take a break after the allotted time (e.g. 5 minutes)
Organization
1. Prioritize tasks on a To-Do List
  1. Perform Urgent and Important tasks first
  2. Perform short important tasks (<5 min)
  3. Perform Non-Urgent but important tasks
  4. Unload non-important tasks (does this need to be done at all?)
2. Consider project management software for longterm or complex projects (e.g. Trello)
3. Seek early and regular feedback to avoid unnecessary work and detours

Resources

One Minute Preceptor (Dr. Margaret Dow, Mayo Clinic)
1. https://www.youtube.com/watch?v=eRBdfXRj5N0
1 Minute Preceptor: Precepting Medical Students (Dr. Michelle Rodriguez)
1. https://www.youtube.com/watch?v=Ry8ScYl2Q0c
Tips To Being an Effective Preceptor (Dr. Paul Paulman)
1. https://www.youtube.com/watch?v=tItnc733G4E

References

(2022) Presc Lett 29(7): 41
(2024) Presc Lett 31(5): 27
(2024) Presc Lett 31(7): 38-9