Preceptor Roles in Teaching Clinical Problem Solving

Preceptor Roles in Teaching Clinical Problem Solving

"Preceptors must demonstrate a desire and an aptitude for teaching that includes mastery of the four preceptor roles fulfilled when teaching clinical problem solving (instructing, modeling, coaching, and facilitating). Further, preceptors must demonstrate abilities to provide criteria-based feedback and evaluation of resident performance. Preceptors must continue to pursue refinement of their teaching skills."

1. Direct Instruction

Direct instruction is the teaching of content that is foundational in nature.   Direct instruction fills in information that is necessary to acquire before skills can be applied or performed.  For example, before a resident can learn to develop a medication regimen for an asthmatic patient, he or she needs to master information about asthma, potential treatments for asthma, the latest research and its implications and other pertinent information about asthma and its treatment.  Direct instruction in the form of assigned books, lectures, articles and discussions help a resident acquire this information.  This preceptor role is appropriate at the beginning of a residency or learning experience when foundational information is needed before assuming a responsibility. 

Direct Instruction of Residents vs Students

Direct instruction of residents differs from classroom instruction of students. When a resident has a knowledge gap, it is usually most appropriate to refer them to relevant resource materials and then check their understanding of the material. Mini-lectures that resemble classroom instruction of students should be avoided or minimized, keeping in mind residents' greater ability to be independent in acquiring knowledge as compared to students.

2. Modeling

 Modeling is demonstrating a skill or process while "thinking out loud" so the resident can witness the thoughts or problem-solving process of the preceptor, as well as the observable actions.  For example, the resident observes a preceptor develop a medication therapy regimen and monitoring plan for an asthma patient while the preceptor simultaneously explains the thought and problem-solving process that would normally go on silently.  The resident sees and prepares to emulate the modeling example(s). 

This preceptor role is most appropriate after it has been determined that the resident has the appropriate amount of background information and is ready to begin to learn to perform a task or responsibility.  

3. Coaching

Coaching is allowing a resident to perform a skill while being observed by the preceptor, who provides ongoing feedback during the process.  For example, after the resident has acquired the necessary background information (direct instruction) and observed the preceptor model the development of a medication therapy regimen and monitoring plan for an asthma patient (modeling), the preceptor allows the resident to develop a regimen and monitoring plan for another asthma patient and asks the resident to "think out loud" so the preceptor can observe the resident's thoughts and actions.  The preceptor gives feedback during the process. 

This preceptor role is appropriate after the resident has had the opportunity to observe modeling of the process he/she is about to take on but is not yet ready for independence.  The coaching process allows fine tuning of the resident's skills as well as assuring the preceptor that the resident is ready to move to greater independence.  When the preceptor no longer feels the need to provide corrective feedback to the resident while they perform the task at hand, it is time to move to the next preceptor role: facilitating.

4. Facilitating

 

Facilitating is allowing the resident perform independently, while the preceptor remains available if needed and de-briefing with the resident after the fact.  Facilitating occurs when the preceptor has coached the resident and is confident in his/her ability to function independently.  For example, after assigning readings on asthma, modeling and coaching the development of medication therapy regimens for asthma patients, the preceptor has observed the resident do this successfully and no longer needs to provide corrective feedback.  The facilitator gives his/her contact information to the resident, sets up an appointment to meet with him/her later and leaves him/her with the responsibility for the asthma patients. This preceptor role is appropriate when both the preceptor and resident feel confident of the resident's ability to function independently.  This role normally occurs toward the end of a learning experience and the residency as a whole.

Once you have reached the facilitating role, be sure to make residents responsible for progressively more complex patients. If they are able to treat typical asthma patients, ensure they can treat asthma patients with multiple conditions that must also be considered. It is important to keep challenging residents at this stage of their training.