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Bringing Back the Joy in Education:�The Importance of Effective Precepting��Sarah L. Hutto, MD, MPH, FACOG�January 17, 2023

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Learning Objectives

List Qualities of Good Preceptors
Understand How to Engage Learners
Define Learner Centered Teaching (LCT)
Comprehend Methods of LCT for Clinic and Wards
Learn Ways to Teach in the OR
Recognize Importance of Feedback
Provide Tips for Giving Effective Feedback
Explain Psychological Safety in Medical Teams
Appreciate Preceptorship as Role Model Position
Acknowledge Hidden Curriculum and Impacts on Learners
Discuss Tips and Tricks for Increasing Joy in Medicine and Precepting

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Qualities of Good Preceptors

Communication

Broad knowledge base and ability to explain actions and decisions

Skills

Demonstration of patient care

Assessment

Positive attitude, Fair and thoughtful

Motivate

Capture attention, Give independence, Engage students, Active involvement

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Learner Engagement

Make learners active participants
Emphasize critical points
Rely on logic when possible
Help link new concepts to topics previously learned
Use visual aids when able
Hold them to high standards
Help them find personal meaning and value
Treat learners with respect
PROVIDE FEEDBACK
Be enthusiastic, organized and involved

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Methods to Engage Learners

Small group activities/Simulations
Team competitions
Quiz questions
Teach by example
Experience/Real-life stories

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Learner Centered Teaching

Learner driven discovery of knowledge
Inquiry based methods
Increased learner responsibility

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Responsibilities in �Learner Centered Teaching

Preceptor

Guide learner
Promote thinking and learning

Learner

Proactive
Involved in discussion
Ask questions
Follow-up learning

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Setting the Scene

Expectation setting-DAY ONE
Ensure you understand as their preceptor if they have any required didactics or independent learning time that they need to attend to
Communication is KEY
Recognize when they need help and intervene, remember we are a team on the wards especially!

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SNAPPS

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SNAPPS Example

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One Minute Preceptor

https://geiselmed.dartmouth.edu/on-doctoring/preceptors/teaching/one-minute/

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One Minute Preceptor Example

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Why use these models?

Helps learners gain knowledge and communication skills
Motivates and engages learners
Teaches learners importance of life-long learning
Increases preceptors interaction with learners
Gain perspective of learners skills
Improves ability to give feedback and facilitates learners to read and learn

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Teaching in the OR

Learner Goals

Explore OR environment for students specifically
Develop skills
Enhance knowledge
Gain insight

Barriers To Teaching

Patient safety concerns
Efficiency
Visualization
Team attitude
Various levels of learners in OR

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Teaching in the OR

Make the experience positive
Allow this to be beneficial to learning
Really can be FUN!!!!!!!

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6 Attributes of Effective OR Preceptors

Set Expectations

State learning objectives, roles in OR, goals to achieve during case, introduce learners to OR team

Be Sensitive to Learning Needs

New vs seasoned learner: asses knowledge of sterile technique, case and procedure techniques

Communicate

Talk and teach, Ask pertinent questions, Position for best ability to see

Encourage Active Participation

Depends on level of learner and level of competency

Calm and Courteous Demeanor

Maximizes learner experience, Demonstrates professionalism, Respect, Teamwork

Feedback

Brief, Intraoperative Teaching, Debrief

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Feedback

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Feedback

Constructive and objective appraisal of learners performance
Assists learners to modify behavior
Improves education to achieve skills and objectives
Identifies knowledge gaps and areas to improve

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5 Tips for Giving Effective Feedback

Preparation

Let learner know what is going on, allows them to prepare for feedback and listen

Create a positive environment

Trust, respect, privacy, constructive dialogue, self assessment
Remember to also listen to your learner

Use valid evidence

Performance not generalizations
Focus on behavior that can be changed and be mindful of how much feedback is given at a time
Avoid judgmental and personal characteristics

Be specific

Not time for a laundry list, concentrate on key issues, be focused and concise, Be descriptive

Communicate action plan

Follow-up plan and how to change, END ON A POSITIVE NOTE

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Avoid sink or swim mentality

Did you give immediate feedback and tell learners what to work on or did you only do a final evaluation (or sometimes not even that)?
Did you communicate expectations when you first met and go over them regularly to allow for feedback?
Did you think someone else would provide them with feedback?

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Feedback

Our tendency to withhold feedback and save it for a final evaluation is NOT HELPFUL and DOES NOT HELP OUR LEARNERS ENGAGE IN SELF IMPROVEMENT

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Importance of a Safe �Learning Environment

Psychological safety is:

The belief that you won’t be punished or humiliated for speaking up with ideas, questions, concerns or mistakes
A SHARED belief held by members of a team that others on the team will not embarrass, reject or punish you for speaking up

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Benefits of Psychological Safety on Medical Teams

1) Increases Innovation

2) Improves clinical outcomes

3) Improves patient safety outcomes

4) Enhances physician engagement

5) Results in happier teams and increased employee engagement

6) Fosters an OPTIMAL learning environment

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How can YOU promote �Psychological Safety?

Replace blame with CURIOSITY

Approach conflict as a COLLABORATOR

Earn and extend trust to ALL members of the team

Be open to feedback from ALL members of the team

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DEI

Diversity: the unique characteristics, perspectives and life experiences that define us as individuals
Equity: fair treatment, access, opportunity and advancement for all people
Inclusion: creating an environment in which any individual or group can be and feel welcomed, respected and supported and valued to bring their full authentic selves to any space or community

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Role Models

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Role Modeling

Topic	Coaching	Mentoring
Timeframe	Short-term	Long-term
Structure	Regularly-scheduled and typically frequent	Informal and as needed by mentee
Focus	Performance-driven	Development-driven
Agenda	Co-created by coach and the person who is coached	Created by mentee
Questioning	Coach usually asks though-provoking questions	Mentee likely to ask questions
Outcome	Specific and measurable	May shift as relationship is focused on development

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Role Modeling

YOU ARE A ROLE MODEL FOR OUR LEARNERS
Through observation they will learn clinical and interpersonal skills and habits
It is up to YOU if you end up being a positive or negative role model
This is part of hidden curriculum

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Hidden Curriculum

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Professional Development

Through observation learners will imitate clinical teachers they respect. They learn not only from what we say but especially by what we do in our clinical practice and the knowledge, skills and ATTITUDES we exhibit
We can SIGNIFICANTLY influence choice of future career, professional attitudes and the importance they assign to different subjects

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What Preceptors Need To Do

Express Satisfaction with Patient Encounters
Engage in Professional Interactions with Staff
Show Enthusiasm about Teaching
Integrate Professional and Personal life
Demonstrate Quality and Collegial Interactions
Appreciate there is more than one right answer

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Look Familiar???

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Medicine at a Crossroads

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Personal Narrative

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Moving Forward

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How Being A Preceptor Brings Us Joy!

You are making a difference in a learner’s life, possibly getting them interested in what may be their lifelong specialty for students and involved in the career of their choice for residents!
You can help a learner “get” something, empower them to reach their full potential and watch them grow over time!
You get to give back to the medical community who got you to where you are today!
With engaging in DEI efforts you can help diversify the workforce to look like the community we serve!
Precepting decreases Isolation and encourages life-long learning. I learn something every day from our learners!
You can share your amazing knowledge, pay it forward!
We become better clinician for our patients!

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Tips and Tricks for Finding Joy in Medicine

Practicing Daily Gratefulness
Being Intentional in Goals Daily and Long-Term: Not only at Work but Also at Home
Focusing on TEAM Aspect of Work
Finding Joy in our “Ordinary”: what we do is anything BUT THAT
Celebrating and Recognizing Successes and Accomplishments Big and Small
Normalizing Discussion of Challenges and Difficult Outcomes, WE NEED TO DO THIS FOR EACH OTHER, being vulnerable is NOT a weakness, it is a sign of strength and courage
Advocating for Systemic Change

I am so thankful to be doing what I do every day, I am taking care of patients, doing the specialty I love, teaching the next generation who will care for our community, improving the quality of lives of the people I interact with in so many different ways
What are we doing today, what are we going to accomplish, what to I need to do for myself and others and how to ensure these things happen, communication, delegation. It gives so much life satisfaction when these things arer achieved.
My skill isn’t really the thing that is questioned anymore, but how I lead, teach and how our team functions is. I can continue to grow as attending and in these ways and can ensure that my patients have great caer by making sure my team is great, so I have to lead my team and manage my team the best I can and hold them accountable. I want to inspire them to do their best and continue to aspire them to grow. I want my team to win, I want them happy, I want them to feel fulfilled.
It is so important to recognize when things go well. We are really good at acknowledging when things don’t go wellm, but we are not good at recognizing all the things that we do so well on a daily basis. I try to end each day thinking of all the good things that happened that day and all the amazing things we did that day. It truly is impressive and we have become used to it because that is what we do every day, that is NOT normal.
We should not shy away from these discussions. We need to be open and vulnerable to having these discussions. Our industry is losing excellent clinicians at an alarming rate and it needs to be ok to have open discourse about how challenging our roles are in a system that is incredibly flawed and does many times not provide an environment that does not set us up for success but yet we continuye to come in here every day and go to battle because that is who we are and we took an oath to care for our patients each and every day.

Success and Happiness is contagious. There is a reason why everyone in general loves Disneyworld and it is called the happiest place on earth. I invite you to create an infectious work environment of joy, I truly believe it is possible to do and will ultimately make our careers and lives so much more rewarding.

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Hutto’s You are Amazing/Finding Joy Playlist

Lizzo: Special
Alicia Keys: Good Job and Superwoman
Destiny’s Child: Survivor
Journey: Don’t Stop Believing
Survivor: Eye of the Tiger
Bill Withers: Lovely Day
Katy Perry: Roar and Firework
Pharrell Williams: Happy
Bruno Mars: Just the Way You Are
Justin Timberlake: Can’t Stop The Feeling
Beyonce: Run the World (Girls)
Andra Day: Rise Up
Mariah Carey: Hero
Des’ree: You Gotta Be
The Greatest Showman Soundtrack: This Is Me

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References:

APGO Effective Preceptor Series. https://www.apgo.org/effective-preceptor-series/
CREOG. Surgical Training. Faculty Development Resources Module. February 2020. https://www.acog.org/education-and-events/creog/curriculum-resources/faculty-development-curriculum
CREOG. Teaching When Time is Limited in Clinic & In Procedures. Faculty Development Resources Module. February 2020. https://www.acog.org/education-and-events/creog/curriculum-resources/faculty-development-curriculum
CREOG. Creating A Safe Learning Environment. Faculty Development Resources Module. July 2020. https://www.acog.org/education-and-events/creog/curriculum-resources/faculty-development-curriculum
Wolpaw T, Papp KK, Bordage G. Using SNAPPS to facilitate the expression of clinical reasoning and uncertainties: a randomized comparison group trial. Acad Med. 2009;84(4):517–524.
Neher J, Gordon K, Meyer B, Stevens N. A five-step “microskills” model of clinical teaching. Journal of American Board of Family Practice, 1992; 5: 419-424.
Pangaro LN. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med. 1999;74:1203 –7.
Stephens MB, Gimbel RW, Pangaro L. Commentary: The RIME/EMR scheme: An educational approach to clinical documentation in electronic medical records. Acad Med. 2011;86:11–14
Gisondi, Michael. “Leadership In Medical Education: Teaching Senior Residents”. International Clinical Educators Blog. July 21, 2020. https://icenetblog.royalcollege.ca/2020/07/21/leadership-in-medical-education-teaching-senior-residents/
Harden RM, Crosby J. “AMEE Guide No. 20: The good teacher is more than a lecturer-the twelve roles of the teacher.” Medical Teacher. 2000;22(4):334-347.
Morgan, HK, Winkel, AF, Nguyen AT, Carson S, Ogburn T, Woodland M. “Obstetrics and Gynecology Residents’ Perspectives on Wellness: Findings from a National Survey”. Obstet Gynecol. 2019 Mar;133(3):552-557.
Paturel, A. “Healing the very youngest healers”. AAMC. https://www.aamc.org/news-insights/healing-very-youngest-healers
Medscape Physician Burnout & Depression Report 2022: Stress, Anxiety, and Anger
Center, C., Davis, M., Detre, T., Ford, D. E., Hansbrough, W., Hendin, H., Laszlo, J., Litts, D.A., Mann, J., Mansky, P.A., Michels, R., Miles, S.H., Proujansky, R., Reynolds, C.F. 3rd, Silverman, M. M. (2003).
Confronting Depression and Suicide in Physicians. JAMA, 289(23), 3161. doi:10.1001/jama.289.23.3161

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Discussion/Questions