Prepare For Your Role as a Health Professions Preceptor (Part 1)

Podcast Transcript

Dr. James K. Stoller:

Hello and welcome to MedEd Thread, a Cleveland Clinic Education Institute podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Dr. Tony Tizzano:

Hi, welcome to today's episode of MedEd Thread. I am your host, Dr. Tony Tizzano, Director of Student and Lerner Health and Assistant Clinical Professor of Surgery here at Cleveland Clinic in Cleveland, Ohio. Today I'm very pleased to have Dr. Scott Euype, the Director of Education for Rehabilitation and Sports Therapy at Cleveland Clinic; Debra Kangisser, Physician Assistant, the Director of Education for PA services; and Dr. Mari Knettle, with doctorates in physical therapy and education, Medical Director of the Center for Health Professions Education, here to join us. Scott, Deb, and Mari, welcome to the podcast.

Our topic today is professional development for health professions education preceptors, but before we get started, I'd like to take a minute for our listeners to hear a little bit about you, if you could each discuss your respective roles at Cleveland Clinic. Scott?

Dr. Scott Euype:

Oh, great. Thanks, Dr. Tizzano. I oversee the Rehabilitation Department here at the Cleveland Clinic, specifically in education, overseeing student education, our residency education, and professional education for our staff. I've been here at the Cleveland Clinic 22 plus years.

Dr. Tony Tizzano:

Fabulous. Deb?

Debra Kangisser:

I'm a physician assistant. I've worked clinically at the Cleveland Clinic now approaching 30 years, have you beat a little bit there Scott, and I'm the Director of Education for PA services, so that includes physician assistant students, pre-physician assistant shadowing experience, as well as educational platforms for both our new hires and up-scaling present employees.

Dr. Tony Tizzano:

Excellent. A lot on your plate. Mari, how about you?

Dr. Mari Knettle:

As you said, I am the Medical Director for Health Professions Education here at Cleveland Clinic. By training, I am a physical therapist clinically. Got into education early in my career, and here at the Clinic I work with educational programs in the non-nursing and non-physician profession, so quite a wide variety of professions whose students we train here at the Clinic.

Dr. Tony Tizzano:

And in total, how many programs would that be?

Dr. Mari Knettle:

We record that is 93 programs, but that is a combination of internal programs where Cleveland Clinic is the school, affiliate programs where we are providing clinical training to students who are enrolled in outside academic institutions, and residency and fellowship programs. Non-physician residences and fellowships.

Dr. Tony Tizzano:

Fabulous. Well, let's get started. Deb, beginning with you, the role of clinical precepting of students is obviously very crucial to health professions education. That being said, what kind of things do you recommend that a preceptor does to prepare for a student's start date and making those students' first clinical days successful?

Debra Kangisser:

That's an excellent question. I'm gonna skip the part, because we're going to assure that all the students' onboarding is complete, and maybe they've got some email instructions or a welcome letter and it's time for the preceptor to reach out for the student. I think that communication is the key to assuring a successful rotation, and it starts by understanding your student, what type of learner are they, you know, are, are they visual? Do they like reading? Do they need a little bit of an introduction shadow?

So, it starts with a conversation with the student, what their interests are, what their experience is, what kind of skillset? Is this their first rotation, or maybe this is their 10th rotation? So, you know, what type of skillset that they bring. It also requires reaching out to the schools and finding out what their objectives are, and often we'll have schools send us our objectives, and those are available to share with preceptors. Knowing, though, that you might not be able to reach an objective because you never know what your patient population is going to be, the next step I'd advise is to have a, some type of database with information, whether it's journal articles, case studies, um, putting all kinds of apps on your phone. There are so many great applications that you can do from, you know, medications to best practices, and you could share those with the student, and, or you could also look up and share, you know, learning with the student during their time there. So, resources are important to plan ahead.

And then I think lastly is the socialization process, letting people know that you have a student coming. I can't tell you, and we still hear this today, I remember my very first rotation that I showed up too many moons ago and the preceptor said, "I didn't know I had a student and I'm too busy to take you." So that was my (laughs) my introduction. Thank God that I was a good adult learner and found other ways to make it a successful rotation, but not the way you want to start your rotation as a student, not the environment. So, by letting people know that you have a student coming, you're setting yourself up for success by having a welcoming learning environment.

Dr. Tony Tizzano:

Excellent. Mari, you wanted to comment?

Dr. Mari Knettle:

Yeah. I think that Deb brings up a long of excellent points, and when we're thinking about that first day and making the student comfortable, I think back to my many first days, and the things that get into my mind that might, if the student is thinking this way, it could interfere with their ability to start learning. They're caught up thinking, "Where do I park? Is there gonna be a place to put my things, my wallet, my keys, my coat?"

And so just reaching out to the student, if you can make contact with them before that first day and just answer all of those little questions, should they pack a lunch, is there somewhere that they can sit and, um, reflect and take notes, can they bring a book, should they bring their phone, all of those little things that seem like little things to us sometimes I find are the things that are forefront of that students' mind and they are so caught up in thinking about them that they can't start to learn the things that they're really there for us to teach them.

So I recommend reaching out and making that connection with the student, and/or, if you have the ability to flex your schedule so that you have a light morning and can go over some those things and get them out of the way first thing, I think you'll set yourself off on a good tone for that student.

Dr. Tony Tizzano:

So, take care of some of the logistics. Is there an opportunity usually for a preceptor to be able to reach out in advance of that first clinical experience on the phone, maybe, and just say, "Hey, this is who I am. Tell me a little bit about yourself," and wet their appetite for what they're about to do?

Debra Kangisser:

There should be that opportunity, regardless of the profession. People should have the contact information for the student, whether it's email that you could reach out or get a phone number or that, but there should be that type of ability to reach the student before they start.

Dr. Tony Tizzano:

That's fabulous, so welcoming voice. I think you can't beat that. So, Scott, you know, when you look at that first day and the students arriving, and i-, it's not only challenging for them intellectually, but it's probably anxiety-provoking as well. You know, what's your approach to alleviating student nervousness in that clinical setting as they get started?

Dr. Scott Euype:

Well, that's kind of the dovetail question to what we just answered, the preparation. And so, what Deb and Mari said, contacting the student before they come. Let them know where they're going to go. Those questions about lunch and my phone and where am I going to sit, where are the bathrooms? I had a manager, on their first day, she always told new employees where the bathrooms were and I was always, like, surprised by that, but little things like that make a difference in the student feeling comfortable. But that communication at forehand is a big deal.

And then the day of, typically we'll have that first day, the first morning, the site coordinator or the preceptor to spend a couple hours with the student to orient them. Walk around the building, walk around the site, meet people, get involved with the staff right away, as early as possible. Let them know they're part of our team for this time being while they're here. And I think, going back to communication, and give an avenue of how to communicate to me or to the preceptor, is it cell phone, texting? You know, what's the best way to communicate issues or concerns? That morning, that day, at lunchtime, at the end of the week? You know, I think give that avenue of what, if I'm having issues or concerns, how to express them appropriately.

Dr. Tony Tizzano:

Is there kind of the opportunity for a huddle at the end of the day on the first day or week to say, "Gee, how's it going? What might we be doing better?" Is there anything like that?

Dr. Scott Euype:

Yes, I love that idea. I think it depends on the setting. I mean, if you're in an acute care setting, it may be organically happening right then. In an outpatient area where there's a more structured schedule, it may be at lunch time or at the end of the day or the next morning.

Dr. Tony Tizzano:

You know, one of the things that I always felt when I first started my education in healthcare, and this is different I know for you, but in medical school we all had the notion that, you know, you can ask questions, but remember it's a, it's a sign of weakness. So, how do you set the stage for knowing that they can ask questions, regardless of how they feel about them? Deb?

Debra Kangisser:

It's a great question. We just had a meeting this morning, and one of the preceptors was asking about shadowing time and some students, you know, getting a little frustrated here and there, so it's about setting expectations early, letting students know every site's gonna be different, every preceptor's going to be different. So if you could set expectations, you know, let them know that you'll, you know, they'll have time for questions or getting information early, then sometimes that'll alleviate some of the challenges the student might find in, "I try to ask questions, but you know, they're busy with a patient." So, you know, if you say, "Maybe write that question down while we're talking to the patient and I can come back and, you know, address that with you," that'll let them know what the game plan is for that.

Dr. Tony Tizzano:

That sounds excellent. So, Mari, you know, relationships are key in every endeavor and certainly important education. What is the best way for a preceptor starting out to foster a positive relationship with the student's academic institution?

Dr. Mari Knettle:

I think that you're going to see a pattern in the types of answers that we're gonna give to all of these questions, and that pattern is that all of these concepts revolve around communication. You need to communicate with the academic institution in a way that's going to be helpful for the academic faculty to really understand the student's performance. You want to let them know when things are going well, you want to let them know when things aren't going well, and you need to get away from that instinct to just say, "Yeah, they're doing a great job," because you want to be positive, and you want to be encouraging.

You have to make sure that you're giving information that is concrete. Why do you say they're doing a good job? What types of things are they doing well? What might the student be struggling with? And really start having those conversations early. Don't be afraid to reach out to the school to let them know if you have a concern, instead of waiting until feedback is due, that paperwork that the school asks you to send out and you wait until you fill that out and let them know there's a problem. Sometimes, at that point, it's too late to do something supportive to help the student.

On that note, that school is going to be a lot happier with you as a preceptor if you are timely with your paperwork, and also to be welcoming, invite the school faculty for on-site visits, particularly if you have a particular concern where you can sit down face-to-face. And I think that in this day and age, that may not necessarily be on-site. It could be, but it could be a, a Zoom meeting or a Microsoft Teams or something like that, so that you can make that connection with the school.

Dr. Tony Tizzano:

Well, that's probably one of the things that we have had the advantage of COVID, that we can now reach out virtually in ways that we never did before. So, is it important then for the preceptor to have some sort of idea of what that particular educational program is like? Do they need to review it? Do you expect those students to come with a certain amount of information, or is the experience, the clinical experience, a standalone?

Dr. Scott Euype:

I'm gonna say yes to your question. I, I think knowing the curriculum, the program. The good programs usually send out that curriculum prior to the student's arrival to the program, so we know what educational things they've already had. Therefore, we can then move forward with, you know, our expectations, sending down what you're coming to this center, this is what our expectation is as well, and if we can meet that curriculum guideline that the school's requesting.

Dr. Tony Tizzano:

And I would imagine that, for many of your various programs, and professions, there is an expectation for certification that you are a standard somewhere?

Debra Kangisser:

That's true. I mean, but that's kind of, looking for certification and boards and that, that's towards the end, and each rotation builds towards that, and I was just gonna dovetail a little bit on what Scott had mentioned. It's not only the knowledge base. We tend to focus a lot on curriculum and knowledge base, but part of core expectations, whether medical students, physician assistants, are topics that are a lot harder to judge like professionalism, and I think not only reaching out to students but reaching out academically, not only to understand what the student's training is but what our expectations, when they come on sites, what are our expectations of the students? Whether it's travel, timeliness, dress code. Because if that's set up in the beginning with the school, then, you know, the students sometimes don't have a misunderstanding that, "I didn't realize I was gonna be going to three different hospitals, or that I might be working a night shift." So, I think those type of expectations is as important to reaching success in professionalism, and success in knowledge.

Dr. Tony Tizzano:

Boy, Deb, I like that emphasis on professionalism. I think across anything in healthcare, it is a profession. You know, we conduct ourselves in a way that is different because of who we treat, because of the colleagues that we have, so on and so forth. So, Scott, you know, what tips can you share related to goal setting when precepting a student, letting them know specifically what's in front of them and what's expected of them?

Dr. Scott Euype:

I think one success is that early communication, even before the student comes. Typically, the preceptor reaches out to the student saying, "What are your goals?" And have the student, Or, the student may initiate that themselves based on the pro-, you know, professional level of saying, "These are the goals I have for this clinical," and then the re-, preceptor would communicate back and say, "I think we can meet those goals," or, "Here are some goals I have too. Let's kind of find a middle point here."

And then every week I think we address those goals. And so, I look at them as a short-term goal and a long-term goal, very similar to clinical care. I want to see how we're doing each week, and, of a clinical experience, and then expanding on that maybe at the midterm or final to see where we're at. So, as Mari said earlier, early communication to the school, we want to make sure they're making progress towards those goals, or if they're not making progress, what remediation or what plan can we make to make sure those goals are obtained.

Dr. Tony Tizzano:

Along those lines, as you try to develop the pipeline, and any of you can comment on this, and you look at Cleveland Clinic as a site for these programs and these clinicals, what is it that the student gets to see to select a preceptor from Cleveland Clinic in front of other organizations they may go to? Why Cleveland Clinic?

Dr. Scott Euype:

Well, I, I'll say Cleveland Clinic number one is the quality that we provide off, you know, quality of care to our patients. You know, we say patients first is our mantra, then when we bring students in, it's patients first and the students second. You know, in the sense of they're our priority to teach, and they're going to see this quality of care that we're giving to our patients.

Debra Kangisser:

I think it can differ very much from practice setting to practice setting. People want to come and experience the Cleveland Clinic. It's, you know, a number one healthcare facility, it's academics, its research, it's innovation. So, you know, that's quite an opportunity for someone, but they also might be put in an Express Care area where it's a smaller group and it has a feel of more of a private practice team setting.

I think no matter where somebody is we have to be cognizant as preceptors to integrate our mantra, you know, as far as how we treat patients, how we treat teaching, and how we treat opportunities for development, whether it's innovation or research, and I think the student can feel that no matter where they are if you do it right.

Dr. Scott Euype:

And Deb, would you s-, agree that the variety we provide throughout the Cleveland Clinic system, so if a student has a special interest or request to maybe observe or watch a surgery or go into a specialty area, I think within our system we have the ability to provide the student that experience.

Dr. Tony Tizzano:

It almost seems like an infinite variety. Mari, any thoughts along these lines?

Dr. Mari Knettle:

Yeah. I think Scott hit the nail on the head when he talks about the variety of experiences that we have here at the Clinic are unmatched, but we also have resources that are available. When you think about the structure of the Cleveland Clinic and the Education Institute, and all of the professional development opportunities that are open to our clinical caregivers and staff, students are invited to take part in sessions to learn how to better give feedback or, you know, to learn about a diversity, equity, and inclusion topic, right alongside of caregivers, and that's something that I think is really unique to the offerings that we have here at the Clinic.

Dr. Tony Tizzano:

Well, I would agree with that, and my mom just happens to be in the hospital right now, and as I watch students come by in physical therapy and occupational therapy, they are definitely part of that team. There is a, an exchange that occurs inside the room and then there is a revisiting of what they had just done outside the room, and you can see the way they're treated is impressive. And you mention Education Institute, and that being sort of new to me in my career in the last two years, I am absolutely astonished at the depth and breadth of what's offered and the meticulous manner in which things are dissected to try to optimize our approach in so many areas.

Debra Kangisser:

And, and then when I mentioned about innovation and you're talking about the Education Institute and to give some kudos to everything that's been developed out of Mari's office, even the interprofessional education, there's a group that can meet where students from different professions come, and they present what their profession is and what it's like to be a student in that profession, so starting early to work in teams and let people identify and learn from each other is, you know, part of what we talk about with innovations, those type of opportunities.

Dr. Tony Tizzano:

Excellent. Well, before I open it up, I had another question that, again, in terms of mentoring, we all know how important that can be, is there a, a way for mentoring for preceptors when they get started, is there somebody they can have as a coach that they can get started maybe their first time with students and then come back and have a conversation?

Dr. Mari Knettle:

Absolutely. I think that each profession here at the Clinic that takes students has a structure where they have somebody like Deb or like Scott who is kind of at the tip of the pyramid for the preceptors in that profession, who can help match experienced preceptors with those who are just starting out to form that type of mentoring relationship. But beyond that, we have a Center for Educational Resources that has a wide variety of different professional development opportunities for preceptors and educators here at the Clinic. You're going to be able to find a lot of different ways to develop yourself, so if mentoring is right for you, we have programs for that. If you need to be in a classroom, if you need to be in a group discussion, whatever it is that would fit your learning style, or multiple things, that's available to you here.

Dr. Tony Tizzano:

Deb, please.

Debra Kangisser:

And that was a great point, and I don't know if some listeners might be from outside of our geography, but if they are teaming up sometimes is an opportunity to slowly wean into precepting, so if there's someone in their practice that precepts, and it could be even a, a different profession, them taking the student for the day, doing something, reaching back to that preceptor as a mentor might be a way for them to slowly gain experience precepting, or taking a shadow student, whether it's high school or college, and getting a feel for what it's like to have someone alongside you during your work day is another way to kind of wean in and get an experience of the precepting.

Dr. Tony Tizzano:

I agree, excellent idea. So, there may be some other things you'd like to discuss, and, and things I may have missed, and are there resources that you would identify, places that you would actually go for someone to get started and look at the precepting endeavors that we have? Where do you find that information? We have so many things, but how do you get there?

Dr. Scott Euype:

And I know we have our internal preceptor educational modules, which are free for all of our staff to watch and attend, and so it gives education on how to be a preceptor.

Dr. Tony Tizzano:

And when you stand in front of your computer, how do you find that? Where is it at?

Debra Kangisser:

MyLearning.

Dr. Scott Euype:

Specific disciplines have their own clinical education training, so those are available to a lot of different disciplines, like in physical therapy, occupational therapy, I know there's specific clinical education training that we support our staff to attend.

Dr. Tony Tizzano:

Well, thank you so much Scott, Debra, and Mari. This has been a great podcast. To our listeners, thank you very much for joining in, and we'll see you on our next podcast. Have a wonderful day.

Dr. Scott Euype:

Thank you.

Debra Kangisser:

Thank you.

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic Education Institute podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, SoundCloud, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread, and please join us again soon.