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Hearing Journal:
doi: 10.1097/01.HJ.0000398147.18626.6b
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Becoming a better preceptor: Part 1: The fundamentals

Newman, Craig W. PhD; Sandridge, Sharon A. PhD; Lesner, Sharon A. PhD

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Craig W. Newman, PhD, and Sharon A. Sandridge, PhD, are members of the Head and Neck Institute at the Cleveland Clinic. Sharon A. Lesner, PhD, is a part of the School of Speech-Language Pathology and Audiology at the University of Akron. Readers may contact Dr. Newman at newmanc@ccf.org.

“What do I do now that I've agreed to be a preceptor for an AuD student? Sure I'm confident in my clinical skills, but I'm not so comfortable with this added responsibility. We never talked about this in graduate school.”

Be assured that many of us have had these same questions, concerns, and thoughts. As a new or even seasoned preceptor, you may be a bit apprehensive about taking on this somewhat daunting challenge. Just remember, you are not alone. In fact, effective clinical education includes active participation from three stakeholders—the student, university faculty members, and you, the preceptor. The coordinated efforts among each of these three key players are essential in providing the best clinical education experience.

Our goal in this four-part series is to provide some essential information and tools aimed at helping you reach your “precepting comfort zone.” More specifically, we will address the following topics:

* Part 1: The fundamentals: appropriate clinical education terminology, multidimensional roles of a preceptor, usefulness of a collaborative clinical education model, and precepting challenges and benefits.

* Part 2: The clinic as classroom: readiness for accepting students into your practice, experiential learning, interactive teaching triads, and creating learning opportunities in the clinical setting.

* Part 3: Adult learning theory: effects of generational differences on learning, learning domains, and styles; acculturation process and learning.

* Part 4: Importance of evaluation: writing learning objectives, the need for orientation, asking the right questions, formative and summative evaluation process, feedback, and managing the difficult student.

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OVERVIEW OF TERMS

AuD students are just that—students.

They are pre-professionals, not independent practitioners.

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Students

Students are learners. At first glance this statement may seem somewhat simplistic; however, as you will see in Part 3 of this series, learners are influenced by a number of variables, including generational factors, learning styles, and the professional socialization/acculturation process.

Whereas in the traditional classroom setting students are typically passive learners (i.e., one professor teaching theoretical knowledge to many students), the clinical environment fosters a more active learning approach (i.e., one clinician to one student with both focusing on patient care) by integrating classroom theory with clinical observation and practice.

In this connection, students participate in clinical care by interacting with the patient and audiologist, thereby becoming an active member on the hearing healthcare team. Accordingly, a student serves two very different roles in the clinical setting—learner and provider. Although clinical education is a “service-learning” opportunity for the student, the ultimate patient responsibility still remains with the preceptor.

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Am I a preceptor, supervisor, or mentor?

These terms are oftentimes used interchangeably, yet each reflects different types of interactions occurring between the student and clinical educator.

* Preceptors are experienced clinicians who share professional knowledge by teaching in the real world using a one-on-one tutorial relationship with the student. The teaching style is focused on interactive learning triads involving the student, clinician, and patient all within the clinical context (covered in Part 2 of this series).

* With careful planning the preceptor can easily use the available caseload as teaching opportunities to provide learning activities that are beneficial for the student, preceptor, and patient alike.

* Supervisors are considered “master clinicians” or experts who oversee or direct students in clinical settings. Historically, audiology supervisors participated in the clinical education process in a more advisory capacity rather than as an active participant in the clinical session along side the student.1 Further, supervisors may have monitored activities of the novice clinician remotely. This practice, for example, is still acceptable for speech-language pathologists completing a clinical fellowship year.2

* Mentors are defined as counselors who serve as an advocate, nurturer, and friend in a professional setting. The focus in a mentor/protégé relationship is on personal development and is typically not the result of an assignment (which is often done in the case of a preceptor). A mentor will help a student select experiences that will facilitate growth, learning, and access to other professional opportunities over the long-term.3

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Clinical placements

A variety of clinical placements should be made available to students throughout their AuD program. These placements vary in time, from as little as one month up to 12 months in duration.

* Internships should be considered clinical training experiences completed by the student with direct oversight by the university. For example, early clinical training of students often occurs “in-house” at a university-based speech and hearing clinic. Preceptors are typically university faculty members who may or may not have other academic responsibilities.

* Rotations are short-term clinical training experiences, typically one academic semester in length or less, that occur outside of the university. For example, students may be assigned to a semester-length clinical experience three days per week while still completing academic coursework on campus.

* Externships are long-term clinical training experiences that occur outside of the university. Students usually will have completed most, if not all, of their academic curriculum; however, they are still enrolled as students at the university. Accordingly, the university is still responsible for the student and should have an ongoing relationship with both the student and preceptor throughout the course of the externship in order to monitor student progress and intervene if problems arise.

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Preferred terminology

It's time in the development of our profession to put certain terms that have been associated with clinical education in the past to rest. Rather than supervisor, the recommended terminology is preceptor, which more accurately reflects the patient-preceptor-student triad approach to audiologic care.4

The term externship should be reserved exclusively for the fourth-year experience following completion of academic coursework, and should not be used interchangeably with residency. In fact, residency is used by other professions, such as medicine or dentistry, to represent long-term clinical training after receiving a professional degree.

Other terminology such as practicum, fellow, clinical fellowship year, and clinical experience year should be avoided altogether—these terms are associated with education in other disciplines and/or at the pre-baccalaureate or post-graduate level.4

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INTEGRATIVE AND COLLABORATIVE CLINICAL EDUCATION MODEL

The clinical education process involves not only the relationship between the preceptor and student, but also includes a partnership with the university. Effective and ongoing communication among each of these stakeholders is critical in establishing a unified set of educational goals and objectives.

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The model

Figure 1 illustrates the reciprocal interaction among the three stakeholders comprising the collaborative clinical education model. This model provides a framework promoting:5-6

Figure 1
Figure 1
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* Optimal audiologic care for the patient first and foremost;

* Individualized and clinically-focused experiences for students based on principles of service-learning;

* Empowered preceptors who are viewed as an integral component in the overall clinical education process;

* Faculty members who serve as resources for students and preceptors;

* Timely communication among students, preceptors, and university faculty; and

* “Work-ready” audiologists upon completion of the fourth-year experience and graduation who are autonomous and independent practitioners.

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Relationship with university partners

When initiating a partnership between the clinical site and university, it is important to have a frank discussion about expectations from both perspectives. For example, the primary goals of the clinical placement site are on patient care and service provision where “time is money.” In contrast, the university is most interested in developing student knowledge/theory and skill sets to ensure competent graduates of the program.

Discussions of expectations should occur prior to establishing affiliation agreements between the clinical site and university. Only in this way, will it be possible to provide the best clinical learning experience for the student and at the same time meet the clinical and academic goals of the preceptor and university faculty, respectively.

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PRECEPTING ROLES: TAKING A CLOSER LOOK

Students will look to you for your ability to manage clinical and non-clinical situations as they arise and will put faith in your wisdom as an experienced audiologist.

In your capacity as a preceptor you will serve in a number of overlapping roles, including coach, teacher, role model, facilitator, and evaluator.7 As outlined in Table 1 there are a number of common characteristics across each of these roles that will help you become a more effective preceptor.

Table 1
Table 1
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As a coach...

You will help students learn about themselves and identify gaps between what they know and what they need to know. Successful coaching involves the use of several important skills that include:11-13

* Listening. The use of active listening techniques as outlined in Table 2 help you better understand your student's unique set of experiences, personality, and skill sets in order to avoid erroneous assumptions.

Table 2
Table 2
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* Asking powerful questions. Open-ended questions allow learners to think for themselves when posed questions in a non-threatening manner. Be sure to make your questions short and simple and allow time for the student to respond. Specific suggestions about how to ask effective questions and provide feedback will be provided in Part 4 of this series.

* Affirming or acknowledging behaviors. These skills allow the student to know that you value their actions. Of course, affirmations or acknowledgments must be authentic in order to reinforce appropriate behaviors.

* Providing opportunities. Effective coaches provide opportunities for the student to demonstrate clinical skills by delegating patient care responsibilities. For many clinicians this is very difficult because they are ultimately responsible for the patient; however, students must be given opportunities to provide direct patient care because they learn by doing.

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As a teacher...

You will share knowledge, information, and expertise with your student by managing learning opportunities in the clinical setting to promote the learner's abilities and confidence. Research on clinical teaching has shown that dynamic teachers are: enthusiastic; make an effort to teach; spend time individually with students; are available and accessible; engage in dialogue with the learner; provide explanations; and answer questions.10, 14

If you observe gaps in the student's academic/theoretical knowledge, it is your responsibility to discuss this with the university program director so that adjustments in the academic curriculum can be made.

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As a role model...

Your student will emulate your professional behaviors. You are the person students will identify with professionally—they will want to model your behaviors. In fact, students will learn from your actions and reactions; from what you say and what remains unsaid; from the tone in your voice and body language; and the atmosphere you create in the clinical environment.7

Accordingly, ways in which you interact with your patients and their families, colleagues, support staff, and other healthcare providers serve as the foundation for developing professionalism in your student. Remember, your student's eyes and ears are focused on your words, style, and actions.

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As a facilitator...

You will become a manager of learning by addressing your student's needs, interests, and goals. Because you are knowledgeable about the unique features of your specific practice (e.g., administrative structure, billing procedures, electronic medical records, clinical protocols, institutional policy, etc.) you will need to help your student gain an understanding about how your practice operates.

Remember, many of the day-to-day policies and procedures may be second nature to you but will be totally foreign to the student. Further, it is important to create a nonthreatening environment in which students feel free to practice unfamiliar or newly acquired clinical skills without fear of embarrassment when making mistakes.

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As an evaluator...

Your responsibility is to assess the student's progress relative to the learning goals and objectives that have been established at the beginning of each clinical experience. The role of an evaluator may be challenging to you, remember that the student will most likely view this process as both intimidating and threatening.

Accordingly, it is important to balance sensitivity in this vulnerable process with an ability to provide an authentic assessment of the student's progress throughout, as well as at the end of, the clinical experience.

Assessments serve two primary purposes: first, it allows the student to improve their clinical skills and decision-making strategies from the ongoing feedback provided throughout the experience (formative evaluation); and second, it allows you to make a final judgment on their progress (summative evaluation) at the end of the clinical experience. The importance of providing ongoing feedback will be discussed in more detail in Part 3 of this series.

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IS PRECEPTING FOR YOU?

Although precepting is an exciting opportunity, expect both challenges and rewards along the way.

Transforming students from novice clinicians to competent, independent, and autonomous practitioners is the overarching goal of today's AuD programs.

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The challenges

The decision to become a preceptor should not be taken lightly. Anticipate that you may face challenges that could include all or some of the following:6,8,15

* Extra time and effort may be needed for planning learning experiences, providing feedback, and completing formal evaluations;

* Increased time demands may conflict when trying to balance clinic, administrative, and/or research responsibilities;

* Your practice may not have sufficient patient volumes and/or clinical diversity to provide the breadth and depth of clinical experiences needed for student training;

* The learning curve for students regarding your practice operations may be too steep for them to master if the clinical experience is too short;

* University timelines and deadlines may not be consistent with the needs of your practice;

* There may be additional direct and indirect costs including items such as student stipends, office space, and utilization of office equipment and supplies;

* Because of the additional time needed to work with the student, you may see a decrease in your productivity;

* Rewards and recognition for your precepting efforts may be poor or non-existent from employers and university partners; and

* Given existing clinical workloads, demands on productivity, lack of monetary compensation for precepting, and the possibility of a “difficult student,” a preceptor may become “burned-out.”

Responding to challenges will be an inevitable part of precepting; however they should not deter you from participating in the clinical education process. Table 3 provides some “survival” tips to help you face these challenges.

Table 3
Table 3
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The benefits

While the challenges may encourage you not to precept, the benefits and rewards of precepting significantly outweigh the negatives. Some of the benefits you will gain as a preceptor include:6, 8, 13, 15

* The opportunity to give back to the profession by influencing future audiologists;

* Validation and reinforcement of your professional values and practices;

* Networking with the audiology community;

* Ability to shape and improve academic curriculum concerning current clinical practices based on your feedback;

* Learning new information from the students;

* Ability to provide “added-value” services for patients such as hearing aid, walk-in clinic, and audiologic rehabilitation classes;

* Bridging the generational gap;

* Exposure to recent theoretical knowledge;

* Reduction in workloads as students progress and gain independence; and

* Future staff recruitment potential.

As a preceptor you play an important role in educating the next generation of audiologists. In this series of articles we hope to provide a foundation on which you can build your skills as a preceptor. In the July, September, and November issues of HJ we will take a closer look at maximizing training opportunities at your clinical site, adult learning theory, and evaluation methods.

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REFERENCES

1. Rassi JA: Supervision in audiology. Baltimore: University Park Press, 1978.

2. American Speech-Lanaguage-Hearing Association: Information for clinical fellowship (CF) mentoring SLPs. http://asha.org/certification/CFSupervisors.htm. Retreived February 22, 2011

3. White SJ, Purcell K, Ball R, Cuellar L.ML: Precepting fundamentals. In Cuellar LM, Ginsburg DB, eds., Preceptor's Handbook for Pharmacists (2nd ed). Baltimore: American Society of Health-System Pharmacists, Inc, Special Publishing, 2009.

4. American Academy of Audiology: The AuD externship experience, 2004. www.audiology.org/resources/documentlibrary/Documents/externship.pdf. Retreived February 22, 2011.

5. Mallette S, Loury S, Engelke MK, Andrews A: The integrative clinical preceptor model: a new method for teaching undergraduate community health nursing. Nurse Educ 2005;30(1):21-26.

6. Rodger S, Webb Devitt L, Devitt L, Gilbert J, et al.: Clinical education and practice placements in allied health professions: an international perspective. J Allied Health 2008;37:53-62.

7. Myrick F, Yonge O: Nursing preceptorship: Connecting practice and education. Philadelphia: Lippincott Williams & Wilkins, 2004.

8. Irby DM, Ramsey PG, Gillmore GM, Schaad D: Characteristics of effective clinical teachers of ambulatory care medicine. Acad Med 1991;66:54-55.

9. Ramsbottom-Lucier MT, Gillmore G M, Irby DM, Ramsey PG: Evaluation of clinical teaching by general internal medicine faculty in outpatient and inpatient settings. Acad Med 1994;69:152-154.

10. Ullian JA, Bland J, Simpson DE: An alternative approach to defining the role of the clinical teacher. Acad Med 1994;69:832-838.

11. MacDonald PJ, Bass MJ: Characteristics of highly rated family practice preceptors. J Med Educ 1983;58:882-893.

12. Hekelman FP, Vanek E, Kelly K, Alemagno S: Characteristics of family physicians' clinical teaching behaviors in the ambulatory setting: a descriptive study. Teach Learn Med 1993;5:18-23.

13. DiLeonardi BC, Gulanick M: Precepting graduate students. Chicago: Loyola University, 2008.

14. McLeod PJ, James CA, Abrahamowicz M: Clinical tutor evaluation: a 5-year study by students on an in-patient service and residents in an ambulatory care clinic. Med Educ 1993;27:48-54.

15. Spencer J: Learning and teaching in the clinical environment. Brit Med J 2003;326(15):591-594.

16. Danielsen R: Is clinical precepting a lost art? http://healthjobsnationwide.com/news.php?articleID=18, 2008. Retreived February 22, 2011.

© 2011 Lippincott Williams & Wilkins, Inc.

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