I am getting ready to take another pharmacy student next month. It is usually a time that I reflect on what it was like to be a pharmacy student – completely broke, living out of a suitcase and most importantly, I was subject to gruesome tortures from some of the high profile “preceptors”. Ok, I exaggerated a bit. Maybe a lot.
As a pharmacy student, I came to understand one golden rule. To survive, it depended on two important factors: the first factor was to have my therapeutic knowledge and clinical skills. The second factor was on how well I knew my preceptors. My preceptors all came in different personalities, different philosophies, different approaches to addressing drug therapy problems. Sometimes it was more stressful learning to deal with the preceptor then learning about a chronic disease. There were also some very exceptional preceptors too. They would inspire you, challenge you and shape you to be a strong and grounded pharmacist.
So now that I am a preceptor myself, I have made a commitment not to be an asshole. After all, I don’t believe in instilling fear to push people to learn or behave a certain way. Pharmacy students are young adults who are capable to discern what they need to know and what they want to learn. My role as a preceptor is to provide a safe environment for the student to transform into a competent pharmacist that fits his or her values and style. Here are few important things I will teach or do for my pharmacy students:
- Welcome the student and introduce to clinical team. Give a very detailed orientation within the first week, explaining as many tasks as I could (within reasons), with the hope the student will have all the necessary resources to complete the work. It is important that key professionals such as nurses, physiotherapists and physicians are introduced to my student, processes are explained and systems are set up for accessing charts, computers and other important sources during the first few days of the rotation.
- Teach my student how to develop strong information gathering skills. One area that all students need to realize is that working up a case requires lots of effort to collect the relevant information in real life. During their therapeutic courses in University, they might be given well written cases with all the necessary information to help them apply their therapeutic thought process. In reality, much of the information is missing, not clearly documented in the chart, ambiguous and you have to do a lot of digging and sometimes make a few educated guesses. They also need to understand why they have to collect specific information, depending on what they are work up or assessing. I won’t worry about a missing routine CBC when none of the medications contribute to hematological problems but if the patient is found to be positive for occult blood stool or is questioning internal bleed, then it becomes clear that an urgent CBC is necessary and also perhaps the need of a colonoscopy.
- Teach my students to trust their own observations and not always trust the chart. I always tell my students if they spent 5 minutes speaking with the patient, they will obtain tons of valuable clinical information than 30 minutes of reading the chart. In the 5 minutes of conversation, you can see if the patient is frail or not, whether there is any shortness of breath, edema, impaired cognition or judgement, over-sedation, and the patient is often able to tell you the immediate concerns verbally or non-verbally. Sometimes, they need to collect the perspectives from the nurses too. But these unwritten information will prove more valuable than the chart.
- Demonstrate how to apply the therapeutic knowledge. I spend lots of time asking my students to work up cases and then discussing how to approach them from identifying what are the concerns to addressing them. This is where they see how to apply what they learned in school to clinical practice. I give them lots of questions but will ask them to look up the answers independently. I find that if I give away the answer too quickly, the information may not retain. But if they have to look up the information, then they will hopefully remember the information for life!
There are few other things I always encourage my students to develop:
- I encourage my students to be independent thinkers. That is, they don’t always have to agree or follow my approach as long as the patents concerns are addressed appropriately.
- I tell my students don’t be afraid to make mistakes but make sure the same mistake is not made twice, or again.
- I encourage my students to take risk during the rotation. I am there to intervene if necessary (e.g. make sure they don’t kill any patients perhaps) But make a bold recommendation to the physician and see what happens.
- I tell my students to pay attention how they word their recommendations to the physicians. It’s not what you say but how you say that matters.
- Finally, I tell my students to focus on how to foster a strong and collegial relationship with physicians, colleagues and allied health professionals. After all, it doesn’t matter if you have all the knowledge to bring to the team; if you are not well liked, they won’t listen. You won’t be able make a difference at all.
Finally, there is one thing I don’t always tell my students. That is, my greatest reward in being a preceptor is that I am learning also from them. It could be related to the latest clinical approach to a therapeutic area, the latest apps that may be helpful to my clinical practice or just the work ethics of the younger generation these days! Trust me, “work-life balance” was not in my vocabulary during my training years.
I like being a preceptor because I am learning just as much. I hope all my pharmacy students will turn out fine. I hope that they will somehow look back one day to appreciate my guidance and not see me as an asshole.