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Incorporating Students into Daily Practice

The number one, best tip for successfully incorporating students into your daily practice is to plan ahead.

Orientation

Manage your interactions with your students right from the start by planning a thorough orientation.

Students
Help your student feel more comfortable and simply more aware of how things work in your clinic.  Create an orientation checklist to make sure you stay on track and cover everything you need to, but remember that the orientation does not need to take place all at one time or even first thing.  Schedule time for orientation throughout the student’s first days working with you.  By interspersing those times with shadowing in the clinic, the student will undoubtedly get more insight into the content of the orientation and be able to ask good questions.

Finally, consider conducting exit interviews with students, asking them for feedback about the orientation process.

Patients
Next, let your patients know they may be working with students before they get into the examination room.  You may even want to put up a sign in the reception area with a picture of the student.  You will also want to include information letting patients know they may opt out of being seen by the student before they come face to face with him or her.

Staff and Colleagues
Ask staff and colleagues to participate in teaching.  If possible, let students meet with someone from every department that affects and is affected by the work they will be doing, from reception to the laboratory to billing.  Not only will they get information from the trenches, but it takes some of the burden off of you to be the only source of knowledge for the student.

Likewise, ask your colleagues to let you know if they would be willing to have your student accompany them on particularly interesting cases or look in on some of the more unusual procedures and situations if they arise.

Planning Learning Time

There are a two things you will want to think about before a student enters your clinic.

Planning for content
Realizing that working with patients can be unpredictable in nature, it can help to focus on those topics, issues, and experiences that you know recur regularly.   That way, even if you can’t predict when they’ll occur, you’ll still be ready to teach them when they do.

Selecting patients
It may not be realistic to hand pick each and every patient your student sees, but some thought about whether a student would benefit from seeing new, follow-up, or walk-in patients or some combination can help you plan for the student’s experience.

Balancing patients and students
Take some tips from the Des Moines University Survival Guide for managing clinical teaching minute to minute.(adapted from Clinical Teaching Skills For Community Based Preceptors)

  • Every student does not need to see every patient
  • The student does not need to perform every part of the examination or history taking
  • Incorporate the patient into the teaching; don’t save teaching for between patients
  • However, in-depth discussions should be set aside for down time
  • You aren’t the only teacher.  Encourage your student take part in other educational opportunities offered by your clinic.
  • Try different questioning styles to find your preferences, open up communication with students, and achieve learning objectives faster.  One possibility is the One Minute Preceptor

You may also want to consider changing patient scheduling, perhaps having fewer patients early in the student’s time with you.  Another possibility is using the Wave Scheduling System to help you manage the time between you, your student, and the patients.

Identify Learning Outcomes and Objectives

The next thing to tackle is identifying what you want your students to learn.  Whether you are teaching in a classroom or a clinic, there are goals you want your students to attain.  Those broad goals are called learning outcomes, and when you break down those outcomes into measurable units, those are called learning objectives.   

The learning objectives are the small steps that lead to the larger learning outcome. The more clear the learning objectives, the easier it is to choose experiences that will help students achieve the objectives and ultimately the outcomes as well.  In fact, clear learning objectives can also help you identify the way in which you want to scaffold the experiences, or what are also known as the teaching methods.

If you are new to learning outcomes and objectives, this PowerPoint can help: Writing Learning Objectives: Beginning with the End in Mind

Task Analysis

As you are developing learning objectives, it can be very helpful to take a closer look at the clinical skills that are so crucial to your job.  Even skills that feel as basic to the experienced clinician as taking vital signs or assessing range of motion actually involve quite a bit of clinical decision making.  Students need to learn to:

  • recognize when an action is called for
  • recall the steps and sequence for the action
  • carry out the action with efficiency and confidence

That would all be much easier if every situation was exactly the same.  Because they are not, the student much also be able to

  • monitor the patient’s reaction to the procedure
  • compare those reactions to those that are considered typical
  • appropriately adjust the actions, if necessary

(adapted from Handbook for clinical teaching, by Nancy T. Watts, New York: Churchill Livingstone, 1990)

By first breaking these tasks down and analyzing the clinical decisions that need to be made at each step along the way, you will be better prepared to teach them to your students.

Further Reading

How to be an Efficient and Effective Preceptor (Family Practice Management)

Planning a Teaching Episode

Integrating the Learner into the Busy Office Practice

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