Socialized to care: Nursing student experiences with faculty, preceptors, and patients

Effective socialization of nurses has led to positive outcomes for both hospitals and nurses, including higher retention and greater job satisfaction. The importance of faculty, preceptors, and patients in the socialization of nursing students has been documented extensively in the literature. The research presented in this article examines data from qualitative, longitudinal interview transcripts of 15 students as they progressed through a 2-year nursing program to determine how these three types of influence socialize nursing students, and at which points in their education. Using multiple perspective qualitative longitudinal interviews, I interviewed participants every semester of nursing school about their experiences. From the data, these three parties have an impact at different points in their socialization, starting with faculty who socialize students to nursing school by helping them think like nurses. Next, preceptors can be barriers or facilitators of learning by demonstrating how to act like nurses and providing insight about how and why nurses may act the way that they do. Finally, patients help students put everything together by applying classroom lessons to clinical settings. The research concludes with implications for research, practice, and policy.

Understanding of 'generalist medical practice' in South African medical schools

BACKGROUND

In South Africa, medical students are expected to have acquired a generalist competence in medical practice on completion of their training. However, what the students and their preceptors understand by 'generalist medical practice' has not been established in South African medical schools.

AIM

This study aimed to explore what the students and their preceptors understood by 'generalist medical practice'.

SETTING

Four South African medical schools: Sefako Makgatho Health Sciences University, University of KwaZulu-Natal, Walter Sisulu University and the University of the Witwatersrand.

METHODS

The exploratory descriptive qualitative design was used. Sixteen focus group discussions (FGDs) and 27 one-on-one interviews were conducted among students and their preceptors, respectively. Participants were recruited through purposive sampling. The inductive and deductive data analysis methods were used. The MAXQDA 2020 (Analytics Pro) software was used to arrange data, yielding 2179 data segments.

RESULTS

Ten themes were identified: (1) basic knowledge of medicine, (2) first point of contact with all patients regardless of their presenting problems, (3) broad field of common conditions prevalent in the community, (4) dealing with the undifferentiated patient without a diagnosis, (5) stabilising emergencies before referral, (6) continuity, (7) coordinated and (8) holistic patient care, necessitating nurturance of doctor-patient relationship, (9) health promotion and disease prevention, and (10) operating mainly in primary health care settings.

CONCLUSION

The understanding of 'generalist medical practice' in accordance with internationally accepted principles augurs well in training undergraduate medical students on the subject. However, interdepartmental collaboration on the subject needs further exploration.Contribution: The study's findings can be used as a guide upon which the students' preceptors and their students can reflect during the training in generalist medical practice.

Training Health Professions preceptors in rural practices: A challenge for Interprofessional practice and education

The ever-increasing mandate for interprofessional practice and education (IPE) faces challenges in rural settings. Oregon Health & Science University (OHSU) launched a preceptor development program as part of its commitment to training interprofessional student groups in rural settings. The objectives of the program were to (1) encourage preceptors to exemplify team behaviors; (2) characterize contemporary learners and learning styles of trainees; (3) encourage interprofessional precepting skills, and (4) apply practical teaching tools in the clinical setting. This was a qualitative observational project performed at OHSU rural faculty primary care clinics. Subjects were a convenience sample of rural interprofessional preceptors who volunteered to participate. Each educational session was based on a prior interview identifying their specific training needs. Data analysis was based on results from an evaluation survey and comments from providers at these sites. Key factors such as dedicated time for preceptor development, good communication between the rural practices and the academic health center, and concerns about billing revenue were discovered to be critical to the success of the program.

Psychometric Testing of a Scale Measuring Preceptor Preparedness: The Cap-ExPresSTM Study

Background and Purpose: Preceptors educate nursing students to practice as novice, generalist nurses. There are no instruments measuring preceptor preparedness. The purpose of this study was to psychometrically test the Capstone-Experience Preceptor Preparedness Scale (Cap-ExPresS™). Methods: A cross-sectional multi-site survey design was used. Results: A convenience sample of 118 preceptors was recruited from four Midwest hospitals. Exploratory factor analysis supported a 22-item scale representing four factors demonstrating internal consistency reliability using Cronbach's alpha: total scale, 0.95, student-centeredness, 0.90, pedagogic competence, 0.90, clinical competence, 0.81, and nurse professionalism, 0.87. Test-retest reliability was adequate for clinical competence at 0.71, 0.50-0.61 for other scores. Some evidence of predictive validity was observed via regression. Conclusions: Psychometric testing supported the validity and reliability of inferences made about preceptor preparedness with Cap-ExPresS™ scores. Scale scores indicate preceptor learning needs, evaluate interventions influencing preceptor preparedness, and assist clinicians to develop best practices for preceptor preparedness.

Nursing preceptorship in Ekiti State, Southwest Nigeria: Perceptions of nursing students and clinical preceptors

Nursing preceptors play a vital role in providing skills-oriented opportunities for students in the clinical environment. This study assessed the perceptions of nursing students regarding the clinical learning experience provided by preceptors, and the perceptions of nursing preceptors regarding their roles in ensuring beneficial clinical accompaniment in the three nursing institutions in Ekiti State, Southwestern Nigeria. A concurrent mixed-methods design consisting of a survey and semi-structured interviews were used. A multistage (consecutive, purposive, and convenience) sampling technique was used to obtain quantitative data from 120 nursing students and qualitative data from 20 preceptors. Data were analyzed using descriptive and thematic content analysis. Findings showed that overall students' perceptions of the clinical learning experience were good (92%), 91.7% of the students wanted direct supervision and inadequate support was reported due to the low preceptor-to-student ratio. Preceptors acknowledged that clinical accompaniment is one of their roles, challenges mentioned include few number of preceptors, lack of policy requirements to guide their duties, and limited equipment. We conclude that there is a need to provide adequate preceptors in clinical settings, as they are vital to the training of nurses. A unified policy and standardized procedure manual will improve the quality of the delivery of preceptorships in training institutions.

Collaborative clinical facilitation in selected nursing and midwifery colleges in Northern Ghana

Background

Collaborative clinical facilitation converges key players to guide students individually and within groups towards achieving clinical nursing competence. However, experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and nursing and midwifery students are often fragmented and have been largely unexplored in Ghana.

Aim

To describe the experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and final year nursing and midwifery students in Northern Ghana.

Setting

The study was conducted at two nursing and midwifery colleges and an academic hospital in Northern Ghana.

Methods

A qualitative, descriptive, exploratory design was utilized. Forty-six participants comprising 16 nurse educators, 10 clinical preceptors, 10 nursing students and 10 midwifery students were purposively sampled. Focus groups and in-depth interviews were used to gather data and analysed thematically.

Results

Three themes revealed facilitative experiences of collaborative clinical facilitation: team-based clinical mentorship and supervision, personalised preceptorship, and clinical conferences. Two themes emerged inhibitory to collaborative clinical facilitation: staff shortages and lack of timely communication.

Conclusion

This study found that team mentorship, preceptorship and conferences fostered collaborative clinical partnerships for students' clinical learning. However, failure to engage in timeous communication in the midst of staff shortages hampered its smooth practice. Orientation workshops need to be organised for key players to share relevant updates and explore ways to navigate the challenges often experienced within the clinical training environment.

Contribution

This paper provides insight into the collaborative nature of clinical facilitation; and highlights the need for coordinated clinical placements to enhance students' clinical learning.

Preceptor support during the COVID-19 pandemic: Recommendations for continuing development

Background

Mentally fit preceptors may be more capable and flexible in providing students with system, emotional and cognitive support in the clinical learning environment (CLE) in the face of any life-threatening outbreaks. Existing professional development programmes for preceptors emphasise the development of preceptor competence in a normal CLE with minimal focus on their ability to engage with adverse events that challenge their mental health.

Objective

The study sought insight from preceptors’ experiences during the coronavirus disease 2019 (COVID-19) pandemic to identify their professional development programme needs while providing support to students during accompaniment.

Method

A mixed methods convergent parallel design was used to collect data from 24 preceptors at a nursing education institution (NEI). Eleven preceptors responded to the survey that included the coronavirus disease 2019 (COVID-19) Stress Scale (CSS) and Burnout Assessment Tool (BAT) to collect quantitative data. Semistructured interviews were conducted with five purposively selected preceptors to collect qualitative data regarding their experiences while accompanying students during the COVID-19 pandemic.

Results

Subscales within the CSS and BAT instruments were mapped against an existing preceptor support framework. Overall CSS data for each subscale indicated an average score varying from no stress to moderate stress, while BAT data shows that respondents rarely experienced burnout. However, some respondents experienced very high levels of stress and burnout. Qualitative data supplemented results.

Conclusion

The COVID-19 pandemic influenced preceptors’ role in supporting students and reflecting that they amended their functioning role. Existing preceptor professional development programmes should be reviewed to ensure that the necessary concepts that foster resilience are integrated to enhance the functional role of preceptors in adversity.

Contribution

Existing preceptor professional development programmes should be reviewed to ensure that the necessary concepts that foster resilience are integrated to enhance the functional role of preceptors in adversity.

A Novel, Combined Student and Preceptor Professional Development Session for Optimizing Feedback: Protocol for a Multimethod, Multisite, and Multiyear Intervention

Background

Providing feedback to medical learners is a critical educational activity. Despite the recognition of its importance, most research has focused on training preceptors to give feedback, which neglects the role of learners in receiving feedback. Delivering a combined professional development session for both preceptors and students may facilitate more effective feedback communication and improve both the quality and quantity of feedback.

Objective

The objective of our research project is to examine the impact of a relational feedback intervention on both preceptors and students during a longitudinal integrated clerkship.

Methods

Students and preceptors will attend a 2.5-hour combined professional development session, wherein they will be provided with educational tools for giving and receiving feedback within a coaching relationship and practice feedback giving and receiving skills together. Before the combined professional development session, students will be asked to participate in a 1-hour preparation session that will provide an orientation on their role in receiving feedback and their participation in the combined professional development session. Students and preceptors will be asked to complete a precombined professional development session survey and an immediate postcombined professional development session survey. Preceptors will be asked to complete a follow-up assessment survey, and students will be asked to participate in a follow-up, student-only focus group. Anonymized clinical faculty teaching evaluations and longitudinal integrated clerkship program evaluations will also be used to assess the impact of the intervention.

Results

As of March 1, 2022, a total of 66 preceptors and 29 students have completed the baseline and follow-up measures. Data collection is expected to conclude in December 2023.

Conclusions

Our study is designed to contribute to the literature on the feedback process between preceptors and students within a clinical setting. Including both the preceptors and the students in the same session will improve on the work that has already been conducted in this area, as the students and preceptors can further develop their relationships and coconstruct feedback conversations. We will use social learning theory to interpret the results of our study, which will help us explain the results and potentially make the work generalizable to other fields.

International Registered Report Identifier (IRRID)

DERR1-10.2196/32829

Preceptors' perceptions of assessing clinical associate students at district hospital sites

BACKGROUND

Preceptors are key stakeholders in distributed health professions' education. They supervise students in the clinical setting to enable them to have a practical experience with patients, and they assess students' skills at the highest tier of clinical assessment. The university where this study was done conducts a distributed Bachelor of Clinical Medical Practice course on a distributed platform which is dependent on preceptors at the training sites. Understanding the perceptions of preceptors, as major stakeholders, regarding the student assessment they do will assist the faculty to provide better support and development that might be needed and assist in maximising the benefits of distributed training.

AIM

The aim of this study was to explore the perceptions of preceptors regarding assessing clinical associate students at district hospitals in the Bachelor of Clinical Medical Practice programme.

SETTING

The study was conducted at a rural university in the Eastern Cape province of South Africa.

METHODS

This was a qualitative study involving nine preceptors who were purposively selected from three district hospital training sites based on their involvement in assessing clinical associate students. Semi-structured interviews were conducted, recorded, transcribed and thematically analysed.

RESULTS

Four themes emerged from thematic analysis: assessment issues, preceptor issues, student issues and university support issues. Preceptors are committed and enthusiastic in training and assessing the clinical associate students but require input from the university in terms of training and ongoing support.

CONCLUSION

Lack of training threatens the validity of preceptor assessment. Academic institutions should train and support preceptors to enable them better to fulfil their roles.

Standardizing and improving the education of pharmacy students in a large health system

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Accomplishing CAPE Domain 3 During APPE Rotations: Student Perceptions

INTRODUCTION

The purpose of this study is to examine student perceptions of accomplishment among 6 subdomains of Center for Advancement of Pharmacy Education (CAPE) Domain 3 "Approach to Practice and Care" outcomes in Advanced Pharmacy Practice Experiences (APPE) across distinct geographical regions.

METHODS

An 18-item electronic survey was distributed to 88 student pharmacists at a private university completing APPEs in 5 distinct regions and 2 concentrated learning experiences during their penultimate rotation. The survey assessed whether students had at least 1 opportunity to achieve Domain 3 outcomes. Students were prompted to report a percentage of perceived successful accomplishment of outcomes if they stated they had at least 1 opportunity for achievement.

RESULTS

Survey response rate was 52% (n = 46). Respondents reported a median accomplishment of at least 85% for each question. For 2 questions, respondents reported a median accomplishment of 99%. Students perceived successful accomplishment for most of the questions related to communication outcomes, while the lowest completion percentages were noted in outcomes related to patient advocacy (85%) and problem solving (88%). Student perceptions of accomplishment among the 6 subdomains were similar across regions and concentrated learning experiences.

CONCLUSIONS

Students felt confident in accomplishing the outcomes associated with CAPE Domain 3. Regional assignments did not impact student perceptions of outcome accomplishment. Preceptors may play a pivotal role in providing students with opportunities to further polish their skills and increase confidence, specifically in the areas of patient advocacy and problem solving.

Assessment of Volunteer Preceptors at Colleges and Schools of Pharmacy in the United States

Objective. To identify the way colleges and schools of pharmacy in the United States assess the performance of volunteer preceptors who precept students in advanced pharmacy practice experiences (APPEs).Methods. In the summer and fall semesters of 2018, directors of experiential education were invited to complete an online, self-administered questionnaire that included questions dealing with assessment of APPE volunteer preceptors related to promotion and reappointment procedures, abilities and attributes assessed, methods of assessment, and frequency of conducting such assessments. Several attempts were made via email and phone to encourage participation.Results. Eighty-one of 132 (61.4%) fully accredited programs responded with all but one reporting that they evaluated the performance of APPE volunteer preceptors. Forty-one of these 80 (51.3%) indicated that preceptors cannot be promoted in rank, while 47 (58.8%) had a process for preceptor reappointment. The most commonly assessed preceptor abilities and attributes were accessibility, ability to provide feedback to students, communication skills, and professional demeanor. The most reported assessment strategies were summative student evaluations and on-site evaluation of the preceptor by college or school personnel. The frequency of assessments varied based on the assessment method the institution used.Conclusion. Assessment of APPE volunteer preceptors was an integral component of the quality assurance process at almost all responding US pharmacy colleges and schools. The institutions evaluated various preceptor abilities and attributes and used multiple assessment strategies. Findings from this study may help programs review their existing assessment practices, implement new ones, and help to standardize preceptor assessment.

Identifying Teaching Methods Used by Clinical Instructors in Nuclear Medicine

PURPOSE

To qualitatively address the teaching methods, effective pedagogy, feedback delivery, and perceived value of orientation workshops of nuclear medicine preceptors, also known as clinical instructors.

METHODS

Open-ended interviews were conducted face-to-face and by email correspondence to collect data from 11 nuclear medicine clinical instructors in the southwestern United States. A case study method was used to obtain salient themes from the participants.

RESULTS

Findings demonstrated that the most commonly used teaching styles were hands-on and observation. Participants described their self-perceived teaching skills as high quality, even though they had little or no formal teaching experience. Participants were not aware that students completed teaching evaluations, or they did not find value in the students' reviews. The participants perceived orientation workshops as a valuable option, identifying the following relevant topics: types of learners, communication skills, ethical situations, sensitivity training, and cultural competence.

DISCUSSION

This study identified useful teaching methods, including feedback, to fill the existing gap in literature related to clinical instruction in nuclear medicine. Findings of this study indicate a need to better educate clinical instructors. One method for this is conducting orientation workshops that improve teaching method effectiveness, expand the educational experience of students, and strengthen the students' clinical skills.

CONCLUSION

A process that encourages awareness and change is needed to develop instructors' teaching skills in a clinical setting. The absence of review or responses to student feedback through teacher evaluation scores should be at the forefront of change, regardless of the teaching method employed.

Using an Academic-Practice Partnership to Implement a Perioperative Nursing Elective in a Baccalaureate Nursing Program

Many perioperative nurses are reaching retirement age and hospital leaders are experiencing difficulty with maintaining staffing levels. When baccalaureate nursing students seek employment after graduation, they may not consider perioperative nursing because of a lack of familiarity with the specialty. Faculty members at one college of nursing collaborated with hospital leaders in Oklahoma and developed a perioperative nursing elective course to address this gap. During the first three years of the partnership, 34 students completed the course. Nine students accepted perioperative nurse externships and nine graduates accepted perioperative nurse positions. All the students who completed the perioperative nursing course passed the NCLEX-RN examination on the first attempt. The academic-practice leaders continue to offer the course as a strategy to recruit perioperative nurses in Oklahoma. This article describes a process for developing a perioperative nursing elective course to prepare baccalaureate nursing students for employment after graduation.

Characteristics of Individuals Who Chose to Participate in a Preceptor Continuing Professional Development Program

An online program for pharmacy preceptors to improve their clinical teaching using continuing professional development (CPD) was launched in 2017. While 491 preceptors participated in the CPD program, only 35% of potential participants completed this voluntary program. A secondary data analysis was undertaken to determine the characteristics of preceptors who completed the program and identify ways to target program advertising for those who did not complete it. Residency-trained preceptors were more likely to complete the CPD program compared with those without residency training (45% and 37%, respectively; p = 0.011). This may be due to the inclusion of CPD in residency accreditation standards. To improve completion of the CPD program by preceptors without residencies, a brief introduction to CPD, a statement of benefits, and use of a personalized plan should be included in advertisements. Preceptors teaching more experiential students were more likely to complete the CPD program (p < 0.001 for introductory and advanced experiences). To encourage preceptors with less students to participate, the CPD program should be advertised year-round to allow preceptors to complete the training when it is most relevant to their precepting schedule. Future directions include the monitoring of changes in CPD program participation rates following changes in advertisements and exploring other motivations for program completion such as collaborations with employers.

Nurse practitioner students' observations of preceptor engagement in obesity management and weight bias: A mixed-methods approach

BACKGROUND

Obesity is considered a growing epidemic in the United States. Nurse practitioners (NPs) have the opportunity to serve as leaders in addressing concerns related to disease management, particularly obesity. Currently, we lack an awareness of how NP students are learning obesity management from their preceptors.

PURPOSE

Thus, the current study sought to explore how NP students perceive preceptors' behaviors when managing patients with obesity.

METHODOLOGICAL ORIENTATION

This study used a mixed-methods design. Participants were asked to report how often they observed their preceptors engage in different strategies when interacting with patients with obesity (e.g., calculate body mass index, identify goals). Students were then asked to respond to the statement: "share observations you made of how patients with obesity were treated in this environment." Students completed 2 clinical rotations during this period and, thus, were asked to answer the questions twice to capture experiences at both clinical sites.

SAMPLE

Researchers surveyed 225 NP students completing clinical rotations in 3 settings (Family Practice, Pediatrics, and Obstetrics/Gynecology).

CONCLUSIONS

Quantitative results revealed significant differences in the frequency of observed obesity management behaviors by all preceptors. Qualitative results revealed that NP students most often observed preceptors displaying interpersonal warmth without weight bias when working with patients with obesity. Contrary to current literature, this sample of NP students observed their preceptors engaging in positive interactions with individuals with obesity.

IMPLICATIONS FOR PRACTICE

Educators must continue to teach students to engage in unbiased behavior toward patients. It is critical to continue to improve obesity management content offered in NP programs.

Assessment of Practice Management Entrustable Professional Activities by Pharmacists in North Dakota

Objective. To quantify the use of core entrustable practice activities (EPAs) in contemporary pharmacy practice in North Dakota. Methods. Given the large number of core EPAs, this study focused on those supporting tasks categorized within the practice manager domain. The survey instrument was sent to all registered pharmacists living and practicing in North Dakota (n=990). This manuscript reports on the practice manager domain and the activities and examples of supportive tasks in this domain. Results. Four hundred fifty-seven (46.1%) of the pharmacists responded; however, only 102 survey instruments were fully completed and usable. Respondents rated the "fulfill a medication order" activity the highest EPA overall (mean=9.1, SD=2.7). The "oversee the pharmacy operations for an assigned work shift" activity (mean=7.8, SD=3.9) was also rated highly. Responses to "oversee the pharmacy operations for an assigned work shift" were significantly different between independent practice settings and all other practice settings. The manager was more likely than other pharmacy positions to report performing seven of the nine tasks within this EPA. Significant differences in five of nine tasks were found across pharmacies located in rural or more urban communities, including "assist in the evaluation of pharmacy technicians" and "identify pharmacy service problems and/or medication safety issues." Conclusion. This study provides empirical evidence suggesting that EPAs can be a useful means to assess outcomes in pharmacy education.

Teaching Basic Nursing Care: Nurse Preceptors' Perceptions about Changing the Teaching Context from the Clinical Setting to a School Simulation Lab

Research demonstrates that basic nursing care receives less attention in clinical settings and has become visually less prominent in nursing education curriculums. While much is known about the importance of preceptorship in clinical settings, little is known about how preceptors teach basic nursing care to students in a school simulation lab. This study explores the preceptors' perceptions of teaching basic nursing care to nursing students in the school simulation lab compared to clinical settings. Data were collected through focus group interviews and participant observation and analyzed by using qualitative content analysis. Three main categories emerged: (i) Perceived advantages and disadvantages, (ii) Positive attitudes - remembering being a student, and (iii) Knowing what to do and showing how to do it. Awareness of the importance of having knowledge about basic nursing care may contribute to counterbalancing the devaluation of basic nursing care among nursing students.

The Effect of Prior Work Experiences on the Preparation and Employment of Early-Career Midwives

INTRODUCTION

Strategic recruitment, preparation, distribution, and retention of US midwives requires a solid body of knowledge about midwives' education and workforce experiences. Although half of US midwifery education programs currently require or prefer prior registered nurse (RN) employment, data are lacking about whether and how these criteria influence efforts to scale up the workforce to meet reproductive care workforce shortages and maldistributions.

METHODS

This cross-sectional research used an online survey, developed using the framework of Social Cognitive Career Theory. Early-career midwives were contacted through the American College of Nurse-Midwives electronic mailing list and social media during the fall of 2016. Statistical analysis allowed for linkage of data related to the following constructs: personal characteristics, prior RN employment, educational experiences, employment situations, career perceptions, and future plans.

RESULTS

All participants (N = 244) were certified nurse-midwives. Compared with those without prior RN employment, midwives with prior RN employment were more likely to enroll part-time in distance programs and complete single majors or degrees. During enrollment, the 2 groups experienced the same degree of mentorship and cultural support and were similarly likely to attend 30 births and to pass the certification examination on first attempt. In the workforce, those with prior RN employment were 6 years older and more likely to work full-time. The 2 groups demonstrated no significant differences in their career perspectives or future career plans.

DISCUSSION

Despite anecdotal concerns about training midwives who lack RN work experience, an individual without prior RN employment offers the workforce an employee who completes midwifery education at a younger age, may be educated more quickly, and is more likely to have earned a dual major or degree. Those with prior RN employment are more likely to work full-time. Both groups may offer benefits to education and the workforce.

Identification of Key Business and Management Skills Needed for Pharmacy Graduates

Objective. To identify key business, management, and human resources skills needed by pharmacy graduates. Methods. Pharmacy preceptors were recruited for inclusion in one of four focus groups. At each focus group, participants were asked to complete a demographic questionnaire and to identify key skills that new graduates need but do not have. Each focus group was audio-recorded, transcribed, de-identified, and categorized using a data dictionary. Results. Twenty-seven preceptors participated in the focus groups. Fourteen participants had a Doctor of Pharmacy degree. Participants were involved in management positions for a median of 10.5 years (range 5-21 years) and 50% (median) of their time was devoted to management responsibilities (range 20%-80%). Seven themes were identified as being most critical: communication, business skills, decision-making and time management, conflict resolution, leadership and professionalism, personnel management, and computer software techniques. Conclusion. Communication was the most prominent skill identified, followed by decision-making and business knowledge. These skills should be addressed in pharmacy curricula. Future research should focus on how to best teach these skills.

Barriers and Strategies to Engaging Our Community-Based Preceptors

ISSUE

This article, from the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is a review of commonly cited barriers to recruiting and retaining community-based preceptors in undergraduate medical education and potential strategies to overcome them.

EVIDENCE

Community-based preceptors have traditionally served as volunteer, nonsalaried faculty, with academic institutions relying on intrinsic teaching rewards to sustain this model. However, increasing numbers of learners, the burdens of incorporating the electronic medical record in practice, and increasing demands for clinical productivity are making recruitment and retention of community-based preceptors more challenging.

IMPLICATIONS

General challenges to engaging preceptors, as well as those unique to women's health, are discussed. Potential solutions are reviewed, including alternative recruitment strategies, faculty development to emphasize efficient teaching practices in the ambulatory setting, offers of online educational resources, and opportunities to incorporate students in value-added roles. Through examples cited in this review, clerkship directors and medical school administrators should have a solid foundation to actively engage their community-based preceptors.

Preceptor Perceptions of Virtual Quality Assurance Experiential Site Visits

Objective. To determine preceptor perceptions of the value of experiential quality assurance site visits between virtual and onsite visits, and to gauge preceptor opinions of the optimal method of site visits based on the type of visit received. Methods. Site visits (12 virtual and 17 onsite) were conducted with 29 APPE sites located at least 200 miles from campus. Participating preceptors were invited to complete an online post-visit survey adapted from a previously validated and published survey tool measuring preceptor perceptions of the value of traditional onsite visits. Results. Likert-type score averages for survey questions ranged from 4.2 to 4.6 in the virtual group and from 4.3 to 4.7 in the onsite group. No statistically significant difference was found between the two groups. Preceptors were more inclined to prefer the type of visit they received. Preceptors receiving onsite visits were also more likely to indicate no visit type preference. Conclusion. Preceptors perceived value from both onsite and virtual site visits. Preceptors who experienced virtual site visits highly preferred that methodology. This study suggests that virtual site visits may be a viable alternative for providing experiential quality assurance site visits from a preceptor's perspective.

Athletic Training Student Core Competency Implementation During Patient Encounters

CONTEXT

  Health care research evidence suggests that early patient encounters (PEs), as well as the purposeful implementation of professional core competencies (CCs), for athletic training students (ATSs) may be beneficial to their ability to provide care. However, no investigators have related facets of the clinical education experience with CC implementation as a form of summative assessment of the clinical experience.

OBJECTIVE

  To determine the relationship between the frequency and length of PEs, as well as the student's role and clinical site during PEs, and the students' perceived CC implementation during these encounters.

DESIGN

  Cross-sectional study.

SETTING

  Professional athletic training program, National Collegiate Athletic Association Division I institution.

PATIENTS OR OTHER PARTICIPANTS

  We purposefully recruited 1 athletic training program that used E*Value software; 40 participants (31 females, 9 males) enrolled in the professional phase (12 first year, 14 second year, 14 third year) participated.

INTERVENTION(S)

  Participants viewed a 20-minute recorded CC educational module followed by educational handouts, which were also posted online for reference throughout the semester. The E*Value software was used to track PEs, including the type of encounter (ie, actual patient, practice encounter, didactic practice scenario), the type of site where the encounter occurred (university, high school), and the participant's role (observed, assisted, performed), as well as responses to an added block of questions indicating which, if any, of the CCs were implemented during the PE.

MAIN OUTCOME MEASURE(S)

  Variables per patient were PE length (minutes), participant role, site at which the encounter occurred, and whether any of the 6 CCs were implemented ( yes/ no). Variables per participant were average encounter length (minutes), encounter frequency, modal role, clinical site assignment, and the number of times each CC was implemented. Separate 1-way analyses of variance were used to examine the relationships between role or clinical site and implementation of total number of CCs. Multiple linear regressions were used to determine how the average length and frequency of PEs were related to the average and total number of implemented CCs. Binary logistic regression models indicated how the length of each encounter, role of the participant, and type of clinical site related to the implementation of each CC.

RESULTS

  The roles of participants during PEs were related to their ability to implement the total number of CCs ( F = 103.48, P < .001). Those who observed were likely to implement fewer total CCs than those who assisted (M diff = -0.29, P < .001); those who assisted were likely to implement more total CCs than those who performed (M diff = 0.32, P < .001). Frequency of encounters was the only significant variable in the model examining all independent variables with CC implementation ( b_4,32 = 3.34, t = 9.46, P < .001).

CONCLUSIONS

  The role of the student, namely assisting during PEs, and the volume of PEs should be considered priorities for students to promote greater CC implementation.

A qualitative assessment of West Virginia pharmacist activities and attitude in diabetes management

AIMS AND OBJECTIVES

The role of pharmacists in chronic disease state management has been shown to significantly improve patient health outcomes and reduce overall health care costs. The current study is designed to assess the roles and attitudes of West Virginia (WV) pharmacists toward diabetes, evaluate services provided, address pharmacist clinical understanding and training, and demonstrate the challenges that limit pharmacists ability to deliver an efficient disease state management.

METHODS

We invited 435 preceptors affiliated with the University of Charleston School of Pharmacy to participate in the study using Qualtrics online survey software. The survey was divided into sections related to pharmacists, practice environment, pharmacist's roles in diabetes management, and challenges faced that limit their ability to deliver effective care to diabetic patients. Data were analyzed using 1-way analysis of variance, and a P value ≤.05 was considered statistically significant.

RESULTS

Of all eligible invited preceptors, 104 accessed the online survey based on the Qualtrics tracking tool, while 58 participated in the survey with a 56% response rate. Generally, WV pharmacists have positive attitudes regarding the provision of primary activities related to drug use and its associated problems. However, we report that WV pharmacists are less involved in providing education or recommendations regarding diabetes-associated risk factors such as nephropathy, retinopathy, foot care, and gastroparesis. In addition, the majority of pharmacists indicated that they face many challenges related to patient and the practice site environment that limit their ability to provide optimum diabetes patient care services.

CONCLUSION

Despite the mounting evidence that pharmacists can improve diabetic patient outcomes while significantly reducing overall costs, WV pharmacists are less involved in providing education or counseling in a variety of areas related to disease state management. In addition, identifying pharmacist challenges provides significant information for future planning toward improving diabetic patient care.

Progressive Assessment and Competency Evaluation Framework for Integrating Simulation in Nurse Practitioner Education

Competencies for nurse practitioner students have been published with the goal of preparing graduates who are ready to meet the challenges of an increasingly complex health care system. Standardized preclinical assessment of graduate-level competencies have been suggested as a means to optimize the student experience in clinical rotations and maximize the preceptor's time toward preparing students for the transition to independent practice. The main objectives of this study are to describe progressive assessment and competency evaluation as an integral framework for integration of simulation in graduate-level curriculum and present the feasibility and challenges to consider during implementation of Progressive Assessment and Competency Evaluation-directed simulations.

Qualitative Evaluation of a Practice-based Experience Pilot Program for Master of Pharmacy Students in Scotland

Objective. To determine the views of pharmacists in central Scotland regarding experiential education for MPharm students. Methods. A thematic analysis was completed by Ms. Gillian Hendry and Dr. Sally Wiggins of interviews conducted with ten practicing pharmacists paired with first-year master of pharmacy (MPharm) students during the 2011-2012 academic year. Relevant comments from the interviews were manually sorted in a Microsoft Excel spreadsheet to bring similarly themed material together to facilitate the identification and naming of recurring themes and subthemes. Results. The pharmacists were unanimous in their opinion that experiential education was valuable for MPharm students and, in particular, that it helped students to develop self-confidence. The pharmacists derived personal satisfaction in developing mentor/mentee relationships with students. They also recognized the value that students provided to the workforce as well as the educational value to themselves in supervising students. The participants' primary dissatisfaction was that the pharmacy workflow limited the time they could spend mentoring students. Conclusion. The results provide guidance to the academic community and the pharmacy practice community in the United Kingdom (UK) regarding the design and integration of experiential education courses in MPharm degree programs.

Description and Evaluation of an MPharm Practice-based Experience Pilot Program

Objective. To determine the level of support among pharmacists in central Scotland to serve as mentors and provide practice-based experience to students enrolled in a master of pharmacy degree program. Methods. A study was conducted during the 2011-2012 academic year in which first-year MPharm students in Scotland were paired with practicing pharmacists for 2 half-day visits per month. The students were integrated into the pharmacy workflow and engaged in activities ranging from date checking to counseling patients. The pharmacists and students who participated were asked to complete a survey in spring 2012 regarding their experiences and, in addition, the students were asked to maintain diary entries describing their experiences. Results. Thirty-nine students were paired successfully with 38 pharmacists. Every pharmacist stated their student was welcome to return in the 2012-2013 academic year and 29 agreed to accept a second student. Nine of 12 participating chain community pharmacies asked for program expansion and 11 chain community pharmacies and one other community pharmacy that did not participate in 2011-2012 asked to join in 2012-2013. Conclusion. Large numbers of pharmacists in central Scotland are willing to mentor and provide practice-based pharmacy education for students in a manner consistent with General Pharmaceutical Council accreditation standards for the master of pharmacy degree curriculum.

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations

The objective of this article is to describe the key areas of consideration for global/international advanced pharmacy practice experience (G/I APPE) preceptors, students and learning objectives. At the 2013 Annual Meeting of the American Association of Colleges of Pharmacy (AACP), the GPE SIG prepared and presented an initial report on the G/IAPPE initiatives. Round table discussions were conducted at the 2014 AACP Annual Meeting to document GPE SIG member input on key areas in the report. Literature search of PubMed, Google Scholar and EMBASE with keywords was conducted to expand this report. In this paper, considerations related to preceptors and students and learning outcomes are described. Preceptors for G/I APPEs may vary based on the learning outcomes of the experience. Student learning outcomes for G/I APPEs may vary based on the type of experiential site. Recommendations and future directions for development of G/IAPPEs are presented. Development of a successful G/I APPE requires significant planning and consideration of appropriate qualifications for preceptors and students.

Survey of Pharmacy Preceptors' Expectations and Experiences with Students on Rotations in an Inaugural Combined BScPhm/PharmD Class

BACKGROUND

In September 2011, the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, began offering a combined BScPhm/PharmD program to third-year students and postbaccalaureate graduates. Learning consisted of in-class teaching and Advanced Pharmacy Practice Experience (APPE) rotations.

OBJECTIVE

To explore preceptors' expectations and perceptions of student performance in the APPE rotations of the new combined degree program.

METHODS

A survey was distributed via email to 132 pharmacists from the Toronto Academic Health Science Network who had acted as preceptors for the combined degree program in academic year 2011/2012. The 17 questions were designed to gather information on preceptors' demographic characteristics and their expectations and evaluations of the combined-program students. Responses were analyzed qualitatively for common themes and quantitatively using sums and means. Survey responses were compared to identify alignment and discrepancies between preceptors' expectations and evaluations of students.

RESULTS

The survey response rate was 48% (63/132). Most respondents (46 [73%]) were from a teaching hospital, and the same proportion (46 [73%]) reported being preceptors for a direct patient care rotation. Forty-four (70%) of the respondents expected students to be at the level of traditional PharmD students, hospital residents, or advanced-level Structured Practical Experience Program students, and 35 (80%) of these 44 respondents reported that their students met or exceeded expectations. According to survey responses, 31% of respondents (18/58) ranked students at the corresponding level of performance on the faculty's assessment form, while 62% (36/58) ranked students at a higher level (5 respondents did not complete the question). Only one-third of respondents felt that they personally had received adequate training before taking on preceptor duties for combined-program students.

CONCLUSIONS

Preceptors' perceptions of the rotation and their expectations of students varied widely and were influenced by prior teaching and learning experiences. There was a disconnect between preceptor-specific expectations and preceptors' final evaluations of students. Training to standardize the expected level of performance and additional training for preceptors would further enhance the APPE rotations of the combined degree program.

Does a transition in education equate to a transition in practice? Thai stakeholder's perceptions of the introduction of the Doctor of Pharmacy programme

BACKGROUND

Pharmacy education and pharmacy practice are facing remarkable changes following new scientific discoveries, evolving patient needs and the requirements of advanced pharmacy competency for practices. Many countries are introducing or undertaking major transformations in pharmacy education. The Thai pharmacy curriculum has been changed from a 5-year BPharm and a 6-year PharmD to only a 6-year PharmD programme. Curriculum change processes usually involve stakeholders, including both internal and external educational institutions, at all levels. This study aims to understand the experiences and perceptions of stakeholders regarding the transition to an all-PharmD programme in Thailand.

METHODS

Semi-structured interviews were conducted in Thailand with 130 stakeholders (e.g., policy makers, pharmacy experts, educators, health care providers, patients, students and parents) from August-October 2013. The interviews were audio recorded, transcribed verbatim and analysed using an inductive thematic analysis.

RESULTS

Three main themes were derived from the findings: 1. influences on curriculum change (e.g., the needs of pharmacists to provide better patient care, the US-Thai consortium for the development of pharmacy education); 2. perceived benefits (e.g., improve pharmacy competencies from generalists to specialists, ready to work after graduation, providing a high quality of patient care); and 3. concerns (e.g., the higher costs of study for a longer period of time, the mismatch between the pharmacy graduates' competency and the job market's needs, insufficient preceptors and training sites, lack of practical experience of the faculty members and issues related to the separate licenses that are necessary due to the difference in the graduates' specialties).

CONCLUSIONS

This is the first study to highlight the issues surrounding the transition to the 6-year PharmD programme in Thailand, which was initiated due to the need for higher levels of competency among the nation's pharmacists. The transition was influenced by many factors. Many participants perceived benefits from the new pharmacy curriculum. However, some participants were concerned about this transition. Although most of the respondents accepted the need to go forward to the 6-year PharmD programme, designing an effective curriculum, providing a sufficient number of qualified PharmD preceptors, determining certain competencies of pharmacists in different practices and monitoring the quality of pharmacy education still need to be addressed during this transitional stage of pharmacy education in Thailand.

Towards an Operational Definition of Clinical Competency in Pharmacy

OBJECTIVE

To estimate the inter-rater reliability and accuracy of ratings of competence in student pharmacist/patient clinical interactions as depicted in videotaped simulations and to compare expert panelist and typical preceptor ratings of those interactions.

METHODS

This study used a multifactorial experimental design to estimate inter-rater reliability and accuracy of preceptors' assessment of student performance in clinical simulations. The study protocol used nine 5-10 minute video vignettes portraying different levels of competency in student performance in simulated clinical interactions. Intra-Class Correlation (ICC) was used to calculate inter-rater reliability and Fisher exact test was used to compare differences in distribution of scores between expert and nonexpert assessments.

RESULTS

Preceptors (n=42) across 5 states assessed the simulated performances. Intra-Class Correlation estimates were higher for 3 nonrandomized video simulations compared to the 6 randomized simulations. Preceptors more readily identified high and low student performances compared to satisfactory performances. In nearly two-thirds of the rating opportunities, a higher proportion of expert panelists than preceptors rated the student performance correctly (18 of 27 scenarios).

CONCLUSION

Valid and reliable assessments are critically important because they affect student grades and formative student feedback. Study results indicate the need for pharmacy preceptor training in performance assessment. The process demonstrated in this study can be used to establish minimum preceptor benchmarks for future national training programs.

Content and Rationale of Junior and Senior Preceptors Responding to Residents' Educational Needs Revisited

THEORY

Feedback and debriefing, as portrayed in expertise development and self-assessment, play critical roles in providing residents with useful information to foster their progress.

HYPOTHESES

Prior work has shown that clinical preceptors' use of conceptual frameworks (CFs; ways of thinking based on theories, best practices, or models) while giving feedback to residents was positively associated with a greater diversity of responses. Also, senior preceptors produced more responses, used more CFs, and asked more probing-challenging questions than junior preceptors. The purpose was to confirm the generalization of these initial findings with a broader and better defined sample of preceptors.

METHOD

We conducted a mixed-method study with 20 junior and 20 senior preceptors in a controlled environment to analyze their responses and rationales to residents' educational needs as portrayed in 6 written vignettes. The preceptors were recruited from 3 primary care specialties preceptors (family medicine, internal medicine, pediatrics) of the 3 French-speaking faculties of medicine in Québec, Canada.

RESULTS

The preceptors increased the 2012 list of response topics (96 to 126) and doubled the number of distinct CFs (16 to 32). The junior and senior preceptors expressed the same number and diversity of CFs. On average, senior preceptors asked more clarification questions and reflected more than juniors on the learning process that occurs during case discussions. Preceptor specialty and prior training in medical education did not influence the number and diversity of responses and CFs, except that preceptors with prior training generated more responses per vignette and were more reflective. Senior preceptors had a stronger positive relationship between the number of total and distinct CFs and the number of responses than the juniors.

CONCLUSIONS

Although senior preceptors did not give more responses or use more CFs compared to the prior study, they continue to probe residents more and reflected more. The positive relationship between responses and CFs has important implications for faculty development and calls for more research to better understand the specific contribution of CFs to feedback.

Enlisting New Teachers in Clinical Environments (ENTICE); novel ways to engage clinicians

PURPOSE

To explore the barriers and incentives that affect primary care providers who precept students in outpatient clinics in the US.

METHOD

In 2013, leadership of our large primary care group sent a 20-question survey via e-mail to all of the 180 providers within the network. The survey assessed provider demographics, precepting history, learner preferences, and other issues that might affect future decisions about teaching.

RESULTS

The response rate was 50% (90 providers). The top reasons for precepting in the past were enjoyment for teaching and personal interaction with learners. The most commonly cited reason for not precepting previously was a perceived lack of time followed by increased productivity demands. When questioned about the future, 65% (59 respondents) indicated that they were likely to precept within the next 6 months. A desired reduction in productivity expectations was the most commonly cited motivator, followed by anticipated monetary compensation and adjusted appointment times. A top barrier to future precepting was a belief that teaching decreases productivity and requires large amounts of time.

CONCLUSION

This survey represents an opportunity to study a change in focus for a cohort of busy clinicians who were mostly new to teaching but not new to clinical practice. The survey provides further insight into clinician educators' perceptions regarding the education of a variety of different learners. The results align with data from previous studies in that time pressures and productivity demands transcend specific programs and learner backgrounds. This information is critical for future clerkship directors and hospital administrators in order to understand how to increase support for potential preceptors in medical education.

Introduction of a continuing professional development tool for preceptors: lessons learned

Accreditation Council for Pharmacy Education (ACPE) guidelines state that preceptors should "have a systematic, self-directed approach to their own continuing professional development (CPD)." The objective of this study was to encourage preceptors to take advantage of the ACPE CPD resources and implement the concept of CPD (reflect, plan, act, evaluate, record) as a framework for guiding individual preceptor's continuing development as educators and to determine their opinion regarding the usefulness, effectiveness, and obstacles to implementation of this approach. A total of 3713 preceptors from the participating schools were encouraged to undergo CPD training and invited to respond to a series of questions. Of the initial respondents, 48% represented health system/hospital preceptors, followed by community/independent pharmacists (64 of 236, 28%). Preceptor respondents often train students from multiple schools/colleges (average = 1.9 schools/colleges per preceptor) and 90% agreed or strongly agreed with the statement, "the CPD model, as learned in the webcasts, is beneficial for ongoing preceptor development." The general consensus was that the preceptor portfolio provided motivation to reflect, plan, and set more defined and realistic goals for students, residents, and themselves as educators and could be a valuable starting point for promoting preceptors' reflection, planning, and action related to rotation management, professional teaching, and student learning goals.

Assessment of full-time faculty preceptors by colleges and schools of pharmacy in the United States and Puerto Rico

OBJECTIVE

To identify the manner in which colleges and schools of pharmacy in the United States and Puerto Rico assess full-time faculty preceptors.

METHODS

Directors of pharmacy practice (or equivalent title) were invited to complete an online, self-administered questionnaire.

RESULTS

Seventy of the 75 respondents (93.3%) confirmed that their college or school assessed full-time pharmacy faculty members based on activities related to precepting students at a practice site. The most commonly reported assessment components were summative student evaluations (98.5%), type of professional service provided (92.3%), scholarly accomplishments (86.2%), and community service (72.3%). Approximately 42% of respondents indicated that a letter of evaluation provided by a site-based supervisor was included in their assessment process. Some colleges and schools also conducted onsite assessment of faculty members.

CONCLUSIONS

Most colleges and schools of pharmacy assess full-time faculty-member preceptors via summative student assessments, although other strategies are used. Given the important role of preceptors in ensuring students are prepared for pharmacy practice, colleges and schools of pharmacy should review their assessment strategies for full-time faculty preceptors, keeping in mind the methodologies used by other institutions.

Development needs of volunteer pharmacy practice preceptors

OBJECTIVE

To determine the training needs and interests of volunteer pharmacy preceptors.

METHODS

Volunteer preceptors (n=576) were surveyed on various aspects of precepting and their needs related to additional training.

RESULTS

Two hundred thirty-six preceptors (40.9%) responded. Preceptors were less confident about enforcing attendance policies, identifying and managing unmotivated or failing students, identifying dishonesty or plagiarism, and handling conflict. While only 29.5% of respondents agreed that having an APPE student decreased their overall workload, approximately half (48.1%) indicated that student pharmacists helped them complete their daily tasks and 67.8% agreed that APPE students extended patient care. Respondents who had received training were significantly more confident than preceptors who had not received training in their abilities to clarify expectations, evaluate a student's knowledge, and foster skills related to critical thinking and problem solving.

CONCLUSIONS

Training programs for pharmacy preceptors are effective; however, important areas in which additional training is needed or desired were identified among both new and experienced preceptors.

Remote library access for pharmacy preceptors

OBJECTIVE

To institute and evaluate the response to a program providing access to electronic library resources for pharmacy preceptors.

DESIGN

The pharmacy experiential office and the library collaborated using existing programs and technology to provide and market secure remote access for preceptors.

ASSESSMENT

Preceptor participation was tracked in the experiential office, and response to the program was assessed using an online survey instrument that included questions about use of and preference for specific library resources. Three hundred thirty-four adjunct faculty members registered, representing 34% of all preceptors with active e-mail accounts.

CONCLUSION

Preceptor participation in the program exceeded expectations. Some minor flaws in the logistics of delivering the service were identified and remedied.

Barriers to expanding advanced pharmacy practice experience site availability in an experiential education consortium

OBJECTIVES

To compare 2006-2007 and projected 2010-2011 advanced pharmacy practice experience (APPE) availability and needs for 4 colleges and schools of pharmacy in Georgia and Alabama and to examine barriers and offer potential solutions to increase APPE site and preceptor availability.

METHODS

Data on APPE needs and availability were gathered prospectively and evaluated relative to current and projected enrollment and planned programmatic changes.

RESULTS

Combined 2006-2007 non-community APPE needs and availabilities were 3,590 and 4,427, respectively, with a surplus availability of 837. Combined projected 2010-2011 non-community APPEs were estimated at 4,309. Assuming 2006-2007 non-community availability remained unchanged, the surplus availability declined to 118.

CONCLUSIONS

The need for quality experiential education represents a significant barrier and rate-limiting step to the matriculation of the increased numbers of pharmacists. Barriers to expanding APPE availability include: introductory pharmacy practice experience (IPPE) and APPE expansion, growth of new and existing pharmacy programs, financial instability of acute care facilities, and lack of preceptor development resources. Regional experiential education consortiums can provide a constructive approach to improve access to quality sites and preceptors through standardizing processes and leveraging resources.

Are fourth-year medical students effective teachers of the physical examination to first-year medical students?

OBJECTIVE

To determine if fourth-year medical students are as effective as faculty in teaching the physical examination to first-year medical students.

DESIGN

Stratified randomization of the first-year students.

SETTING

A public medical school.

PARTICIPANTS

All 100 first-year medical students in one medical school class were randomly assigned (controlling for gender) to either a faculty or a fourth-year student preceptor for the Physical Examination Module.

MAIN RESULTS

The first-year students of faculty preceptors scored no differently on the written examination than the students of the fourth-year medical student preceptors (82.8% vs 80.3%, p = .09) and no differently on a standardized patient practical examination (95.5% vs 95.4%, p = .92). Also, the first-year students rated the two groups of preceptors similarly on an evaluation form, with faculty rated higher on six items and the student preceptors rated higher on six items (all p > .10). The fourth-year student preceptors rated the experience favorably.

CONCLUSIONS

Fourth-year medical students were as successful as faculty in teaching first-year medical students the physical examination as measured by first-year student's performances on objective measures and ratings of teaching effectiveness.