The Transition from Resident to Preceptor

Leah Edenfield, PharmD BCOP BCPS
Hematology/Oncology Clinical Pharmacy Specialist
Wake Forest Baptist Health
Winston-Salem, NC

Adapting to postresidency life brings several challenges, one of which is adjusting to a new role as preceptor. After spending years focusing on your own learning, being responsible now for the development of others into oncology pharmacists can seem daunting. A few obstacles you may encounter include managing time, working with people who have different levels of experience and ways of learning, keeping up with your own professional development, and learning to give effective feedback. You can continue to acquire the skills needed to address these issues while you are growing as a new practitioner.

The trajectory for your learning when you were a resident was generally set by your preceptors. As a preceptor, however, you have the task of setting the right course for learners by deciding what aspects of the ever growing body of pharmacy knowledge should have priority. In planning a learning experience, you must take into account your practice setting and specialty area as well as the experience and individual goals of the learners. You will also need to develop a strategy for your own lifelong learning so that you are teaching students and residents the most current and evidence-based information. Getting updates from journals and organizations in oncology can help you stay current. Your institution may also provide for continuing education. In addition, you can learn from your residents, who see with fresh eyes and bring their own inquisitiveness, especially as new guidelines are released and pharmacy practice changes. Precepting students and residents as they learn about novel therapies provides excellent motivation for your own learning.

Though having a plan is the first step, finding the time to execute it can be another hurdle. On a typical day of residency, you likely expect to stay at the office longer than your preceptor. Between tending to patient care responsibilities, projects, and topic discussions and locating drug information, you have honed your time management skills in order to fit so much learning into a single residency year. However, as a preceptor you may find yourself working long hours on the other side as you organize the learning experience, ensure that the patient care interventions of your preceptees are complete, address any questions, plan discussion sessions, and complete evaluations. In one survey of pharmacy residency preceptors, 60% reported that their greatest challenge was “effectively precepting while meeting employment responsibilities.”¹ It is crucial to strive to maintain a healthy work-life balance after residency, so you will want to increase your efficiency as a preceptor, dedicating adequate time to your preceptees without experiencing burnout. With the first few learners, you can develop tools (syllabi, schedules, and other learning materials) that can be used in the future. When precepting residents in particular, giving them increasing autonomy over the course of a rotation will free up some of your time and encourage them to develop confidence and responsibility. You can provide oversight without micromanaging when both you and the learner are comfortable with an increased level of independence. Layered learning and resident-preceptor models encourage residents to take more ownership of the precepting process when multiple levels of learners are completing a rotation simultaneously, and this helps residents develop skills for precepting on their own in the future.^2,3 Additionally, you can involve students and residents in research projects, quality improvement initiatives, and teaching in your institution.

During residency, you became familiar with how you learn best and became accustomed to your own preceptor’s expectations. Though residents are often involved in some teaching, the primary focus is on their own learning and professional development. Now you will be involved with more learners and will need to adapt your precepting to other learning styles, skill levels, and goals. You may encounter a variety of learners— from students who do not plan to think about oncology again after this rotation to PGY-2 residents eager to expand their oncology knowledge. Some learners will require more external motivation and direction, while others will be high performers who can still be challenged to advance their clinical judgment. Setting clear expectations and goals while seeking to understand those of the learner can help you tailor your approach to individual students and residents. For example, knowing the preceptee’s career plans allows you to look for the most relevant learning opportunities and discussion points to keep the learner engaged. Depending on the learner’s experience level and comfort, different levels of independence and coaching may be appropriate. You may find that some students and residents learn best from hands-on application, while others do well with reading or repetition. Giving and receiving feedback continually throughout a rotation will provide insight into how to personalize the experience.

Self-assessment is part of residency, but it should also continue throughout your career. Giving feedback helps your students and residents grow and helps you develop as a preceptor. Students and residents want to know how they are doing, and feedback is best received when given in a timely manner. Rather than just saving your thoughts and suggestions for a formal evaluation, you can give on-the-spot guidance on communication skills, projects, and presentations. Also, learners should be actively engaged in these conversations and encouraged to reflect on their own performance.⁴ For more significant concerns, it may be necessary to bring in faculty members from the school of pharmacy or the residency program director for students and residents, respectively. Having specific examples and documentation in these situations is useful.

As you evaluate your preceptees, give constructive feedback and positive reinforcement that can help the person succeed in the future. Buck and colleagues offer a series of questions that prompt the preceptor to assess whether evaluation comments are effective. These questions address topics such as development of skills to meet the resident’s goals, areas for improvement, reinforcement of strengths, and plans for future learning experiences.⁵  You can also seek feedback from other preceptors and providers with whom you work, because the learner will likely be spending time with others on the rotation too. This can help you identify issues and opportunities you may not have thought of and ensure that the learner is receiving consistent guidance regarding professionalism and communication. In addition to giving feedback to learners, seek their suggestions for improvement. Especially if they are beginning a new rotation, they can give insight into preferences for organization, experiences, and content. Although learners will likely have different opinions on some issues, you may see some themes emerge.

Fortunately, you do not have to embark on your journey of precepting alone. Remember to take advantage of support from your colleagues, mentors, and those who have gone before you in precepting. There is always room for improvement, but you do not have to reinvent the wheel if your fellow preceptors or residency program director have tools such as a syllabus and discussion topics that have been useful in previous rotations. The residency program director will be able to provide guidance on a resident’s goals and overall progress in the course of the residency that can be helpful in designing a rotation or giving feedback. Meeting with your fellow preceptors at regular intervals can aid in identifying problems and inconsistencies, which can lead to smoother transitions for those working with multiple preceptors and provide more experiences for the learner than your specific practice area entails. You can sometimes share the work of arriving at discussion topics, for example, with other preceptors. In addition, pharmacy organizations such as the American Society of Health-System Pharmacists offer tools for preceptor development.⁶ You can also turn to schools of pharmacy for preceptor development resources and assistance with difficult students. Staff members at those institutions also want your learners to succeed and have the ability to look at the bigger picture in the student’s progress to address growth needed from rotation to rotation. They can also provide additional resources, which can be especially helpful for those at smaller practice sites.

As a new preceptor, you will have the opportunity to pass on what you have recently learned as a resident. You will face questions and obstacles specific to both your own learning experience and that of your individual students and residents, but these are just a few areas where you can adapt to a new perspective and grow in your oncology practice. Finally, be excited about the challenging but rewarding work of precepting ahead of you.

References

1. Hartzler ML, Ballentine JE, Kauflin MJ. Results of a survey to assess residency preceptor development methods and precepting challenges. Am J Health-Syst Pharm. 2015; 72:1305-1314.
2. Loy BM, Yang S, Moss JM, Kemp DW, Brown JN. Application of the layered learning practice model in an academic medical center. Hosp Pharm. 2017;52(4):266-272.
3. Anderegg SV, Christenson JC, Padgett CP. An accelerated, practice-based model for fostering precepting skills in pharmacy residents. Hosp Pharm. 2014;49(8):713-716.
4. Wilkinson ST, Couldry R, Phillips H, and Buck B. Preceptor development: providing effective feedback. Hosp Pharm. 2013;48(1):26-32.
5. Buck B, Wilkinson ST, Phillips H. Preceptor development: providing effective feedback, part 2. Hosp Pharm. 2014;49(6):521-529.
6. American Society of Health-System Pharmacists. Mentoring and Preceptor Development. https://www.ashp.org/New-Practitioner/New-Practitioners-Forum/Resources/Mentoring-and-Preceptor-Development. Accessed February 22, 2018.