Winter 2019 ISSUE 07

Submitted by: Lawrence D. Jackson, BScPhm, Pharmacy Clinical Coordinator, Veterans Centre, Sunnybrook Health Sciences Centre and Adjunct Professor, Leslie Dan Faculty of Pharmacy, University of Toronto

Editor’s note: this article is excerpted from an article titled: Strategies Pharmacy students can use to ensure success in an experiential placement, and has been submitted to Update on Respiratory Health, Research & Education by the original author. The citation for the original article is: Jackson LD. Canadian Pharmacists Journal 2015;148(6):308-313.

Students of the health professions look forward to and value their experiential placements (clinical rotations). The twenty strategies provided in this opinion piece were originally directed at pharmacy students to help them take responsibility for their own success; however, the recommendations apply to all students involved in experiential placements. I have observed that students who exhibit certain behaviours and avoid other behaviours achieve a higher level of success and view their experiential training as being more rewarding and fulfilling. In short, the top performers consistently provide patient-centred care and perform to the best of their ability with a high level of professionalism. My hope is that students who are open to considering the behaviours and attitudes described in this article will find their clinical placements more successful overall.

Some of the strategies may already be known, or may be considered intuitive, common sense or possibly too obvious to even mention. Thus, for many, these strategies will simply serve as a review. Nevertheless, due to the range of extant pre-placement experience, personality types, motivation and self-directedness, some students may have more or less self-discovery to do to ensure their success in an experiential placement.

Preceptors are invested in the student’s performance. The preceptor’s responsibility is to facilitate the development of knowledge, clinical skills and professional attitudes characteristic of their profession through guidance, coaching, role modeling and personal development of the student. The preceptor also helps to orient and socialize the student to the clinical environment to optimize learning.

The success strategies reflect my own views and are subdivided into two categories, the obvious and the not-so-obvious, but this is arbitrary and used primarily to pique the reader’s interest, since no strategy is more important than another and a student may find the most valuable strategy in either of the columns in Table 1.

The obvious strategies reflect what I perceive to be expected student behaviours and I believe they are reliably demonstrated by most students. I mention them primarily for the benefit of those few students who lack self-awareness or who fail to approach the experiential placement with the necessary significance. Nonetheless, making these strategies explicit will serve as a review for the majority.

The not-so-obvious strategies reflect what I consider to be anticipated student behaviours based on their preparation from school but may not be demonstrated universally. Students who do not demonstrate these strategies may be simply unaware of them or they may represent areas for growth. Regardless, these strategies will likely be particularly helpful for students who fit any of the following descriptions: have little clinical experience, are reluctant to participate in care for whatever reason, have difficulty picking up on environmental cues, fail to see the applicability of their current clinical placement to future practice, are unaware that their behaviour is being monitored by everyone on the team, or who fail to appreciate the expertise of their preceptor. Making these strategies explicit may be a revelation for those students.

The obvious strategies

1. Understand and fully appreciate the syllabus provided by the educational institution to guide students in clinical placements. The clinical placement syllabus will help you take charge of your learning and along with pre-placement preparation will ensure that you meet rotation goals and requirements. The syllabus is intended to foster directed self-learning and independence, so that the student is not completely reliant on the preceptor for their learning. This enables the preceptor to guide the learner in their self-directed pursuit of real-world experiences.
2. Appear interested at all times and show that you value this experiential opportunity. Show up for work well rested, alert and attentive to learn. Take responsibility for your behaviour to demonstrate independence and maturity, which are necessary traits for any workplace.
3. Show enthusiasm for learning. Take initiative in addressing your learning objectives and demonstrate self-directedness, but ask for direction if needed. Demonstrate your ability to carry your learning forward to the next day.
4. Demonstrate independence. Students who take charge of their learning and demonstrate independence are progressing toward the goal of becoming a competent practitioner. Some of the ways in which students demonstrate independence include taking initiative, initiating contact with patients and the healthcare team, taking responsibility for monitoring outcomes of therapy, advocating on the patient’s behalf, substantiating their recommendations with evidence, and handing off care to the next responsible person when appropriate. By the second week of the placement students should be aware of routines, work flow and expectations, and be able to set their own agenda to accomplish their identified learning needs.
5. Show initiative and make contributions in the clinical setting. Experiential placements are a wonderful opportunity to engage in the various aspects of patient-centred care. Students should be motivated to provide care and contribute to their full scope of practice. Students who show initiative and are open to new experiences have a more rewarding rotation, a bigger impact on patients and the team, and receive more praise. Similarly, students who get involved in various rotation activities fit in faster, acquire more skills, pick up clinical pearls more easily and feel more confident. Students are encouraged to look for opportunities to be involved in care, since too much observation can slow the pace of skill development and maturation.
6. Share your knowledge to gain new insights. You are expected to demonstrate your knowledge but are not expected to know everything. An experiential placement is an opportunity to consolidate your knowledge by applying what you know to real life situations, to gain new or greater insights into the application of the therapeutic thought process, and to gain new knowledge and skills through exploration and exposure to patients and practicing clinicians. Your preceptor will help you realize the potential of your fund of knowledge and encourage new learning. Identifying learning gaps through discussion with the preceptor will help you focus your learning.
7. Be ready to discuss patient care issues with your preceptor. Use your available time to achieve your learning objectives and be prepared for discussions with your preceptor or the team. Read assigned material, complete patient work-ups in a timely manner and obtain the perspective of other team members as appropriate in advance of discussions.
8. Be inquisitive, but expect to answer (most of) your own questions. Inquisitiveness demonstrates curiosity for learning, allows you to express your therapeutic thought process, drives productivity and personal development, and reflects engagement and independence. However, be mindful that inquisitiveness is only virtuous to the extent that it inspires self-directed learning and fosters self-discovery.
9. Do not fall behind with your assignments. Establish expectations with the preceptor on day one of the rotation. Fulfilling rotation expectations according to the recommended schedule is important because it enables formative feedback.
10. When responding to your preceptor or another care provider, never make anything up! Offering a vague or inaccurate generalization to a clinical question is not useful and may be construed as trivializing the situation. At worst, your response may be put into action and result in patient harm. However, it is perfectly acceptable to engage in a discussion with your preceptor regarding material that you are unsure of to identify the learning needs.

The not-so-obvious strategies

1. Use clinical reasoning as the basis for your contributions to care. Clinical reasoning involves the amalgamation of inputs such as core knowledge and cognitive processing using your profession’s model of care. It requires the analysis and synthesis of information and knowledge and reflects your understanding and will be the basis of your expertise. The clinical reasoning skills you acquire will enable you to solve future clinical problems. Expertise is more than just looking up information.
2. Integrate yourself into the placement environment to optimize learning. Integrating yourself into the learning environment enables personal growth. Despite the preceptor’s efforts, some students do not integrate quickly into their new team. Students who are reserved, reticent, quiet, shy or feel intimidated by the environment need to put these personal feelings aside so that academic performance is not compromised. Students need to feel they are welcomed by the preceptor and the clinical team, that their work is valued and that their presence enriches the learning environment. If you are slow to fit in, the surest remedy to employ is to simply do your best work.
3. Discuss your observations with your preceptor. Reflect on your learning or on an interaction you have had at the site to gain further appreciation for the significance of events. Reflection and debriefing are powerful learning tools. The power of the clinical experience is magnified when issues are discussed or pointed out.
4. Receive questions from other team members with grace and appreciation. Treatment-related questions directed to you by another healthcare professional represent an invitation into the patient’s circle of care, which is an honour. Your response to these questions is part of your contribution to patient care and teamwork, and reflects positively on you, your profession and your educational institution. Always clarify the timeline for your response, since the urgency for providing a response will vary with each clinical scenario.
5. Consider therapeutic recommendations carefully because they will likely be put into action. Constructive working relationships among healthcare professionals are built on trust and respect. Such environments foster the student’s development of clinical skills. You should be aware that the healthcare team will assume your treatment recommendations are accurate and have been endorsed by your preceptor and therefore, they will likely be accepted and enacted. Remember, the team will expect you to emulate the diligence and professionalism exhibited by your preceptor.
6. Embrace spontaneous learning experiences. You must be “present” in routine clinical encounters to gain experience. Each interaction with a patient or physician or other healthcare professional is unique and has something to contribute to your development. Presence in the environment enables you to participate in care decisions and follow up on outcomes. You will be able to observe how other care providers apply their clinical skills, and interact with patients and colleagues—yielding valuable lessons in teamwork.
7. Be respectful of the clinical environment. Be cautious when using electronic devices when in the presence of the team. Clarify the culture at the site regarding use of hand-held electronic devices or ask permission if unsure. Observe how others make use of hand-held electronic devices. It is also important to be aware of space and computer access limitations and make appropriate accommodation.
8. Use the mentorship and coaching skills of your preceptor. The preceptor-student interaction is dynamic and no two preceptor-student relationships are identical. Preceptors have much to offer their students and students have much to gain. Mentorship and coaching are two important benefits that preceptors provide for their students. Mentors pose thoughtful questions to their students that enable the student to evaluate their options and formulate their own decisions. Coaches help their students to refine their skills, experience new things, learn in new ways, expand their capacity, think creatively and grow in confidence. This process sometimes takes a student out of his or her comfort zone, however the resulting growth is rewarding and fulfilling. Receive feedback graciously and respond appropriately.
9. Be appreciative of the time and energy being invested in you by your preceptor or other clinicians. All professions and trades devote considerable effort to grooming the next generation of practitioners. Students should think carefully about their learning objectives for each rotation and be sure they accomplish those objectives while the responsibility is shared with a mentor. Acknowledging the time invested by others in your development by expressing thanks demonstrates maturity and promotes further investment. For example, when appropriate say: “Thank you” (two of the most important words in any language), “I enjoyed that discussion”, “I found that discussion helpful”, and “Thank you for demonstrating that skill”, “That’s good feedback”.
10. Consider your experiential placement as an extended job interview. While the student is focused on completing academic requirements, work colleagues are evaluating the student’s attitude, behaviour and work quality. Ensure that your conduct will enable the preceptor to consider you for employment or provide a good reference. Be sure to demonstrate your flexibility to accommodate various situations that arise in the work place. Offer suggestions to overcome challenges and demonstrate your ability to accept responsibility. The relationships you develop during the placement will be helpful to you in your career.

Conclusion

The strategies presented here can be valuable to students and preceptors as guidance for ensuring student success in experiential placements. While this list of strategies is neither comprehensive nor a formula for success, awareness of these behaviours can help students perform to the best of their ability. I believe there is value in making certain behaviours explicit for new learners.

I have avoided making comments about personality because I do not believe it should be the prominent driver of performance in a placement. Each student has their own skill sets, talents and personality and expresses himself/herself in their own way and to the best of their ability, and this makes each one unique. Attempting to change aspects of someone’s personality to affect his or her performance in a placement leads to frustration for all parties and can be a source of conflict.

Hopefully students and preceptors find at least one strategy here that helps the student achieve their learning objectives, facilitates their socialization to the team and leads to a successful experiential placement.