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Improving the Quality of Clinical Preceptors

Improving the Quality of Clinical Preceptors. Practical Applications for Bench Teaching Donald D. Simpson, Ph.D., M.P.H., CT(ASCP)CM University of Arkansas for Medical Sciences Little Rock, AR 24 February 2011. Don Simpson simpsondonald@uams.edu (501) 686-5776.

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Improving the Quality of Clinical Preceptors

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  1. Improving the Quality of Clinical Preceptors Practical Applications for Bench Teaching Donald D. Simpson, Ph.D., M.P.H., CT(ASCP)CM University of Arkansas for Medical Sciences Little Rock, AR 24 February 2011

  2. Don Simpson simpsondonald@uams.edu (501) 686-5776

  3. “My method (is) to lead my students by hand to thepractice of medicine, taking them every day to seepatients in the public hospital, that they may hear thepatients' symptoms and see their physical findings.Then I question the students as to what they have notedin the patients and about their thoughts and perceptionsregarding the cause of the illness and the principles oftreatment”Dr. Franciscus de la Boe Sylvius, 17th century professorof medicine at the University of Leyden, Netherlands

  4. What “Makes”An Effective Teacher

  5. Effective Teachers . . . • Demonstrates respect for the learner • Challenges the learner to think • Encourages learners to focus on things they can use immediately, practice and take responsibility • Know the difference between “Gremlins” and “Gnomes”

  6. G.N.O.M.E. • G – goals (often silent) • N – needs (learner’s deficit in relation to goals) • O – objectives (‘E’ in GNOME informs about ‘O’) • M – methods (must be compatible with objectives) • E – evaluation (feedback and judgment)

  7. Rationale

  8. What is your teaching mission statement?Example: “I intend to teach the learner the differential diagnoses (in my content area) from clinical cases, such that they can demonstrate this reasoning strategy when seeing patients in the clinic”Relatively short; easily communicated; memorable; and frequently revisited“The unexamined life is not worth living” - Socrates

  9. Habits are Habit-Forming

  10. Training MY Replacement Eager

  11. Workforce Shortage • 43% of laboratories report difficulties hiring personnel • Median age = 48 years • Shortage will exacerbate as baby boomers retire and more people utilize the health care system • ~25% of workforce (73,000 ) will retire in next 10 years • Only 2 laboratorians enter the field for every 7 that retire

  12. National Outlook • BLS projects 13,700 new Medical Laboratory professionals will be needed per year • CLS/CLT employment is expected to grow by 14% by 2016, which is faster than the average for all occupations • The number of openings is expected to continue to exceed the number of job seekers • Most jobs will continue to be in hospitals, but employment will grow faster in other settings (medical and diagnostic laboratories, offices of physicians, and all other ambulatory health care services) * data from the Bureau of Labor Statistics

  13. Graduate Shortfall In 2005 National Accrediting Agency for Clinical Laboratory Science (NAACLS) summarized: # graduates needed/yr = 13,700* # graduating/yr = 4,445 yearly shortfall = 9,200 * data from the Bureau of Labor Statistics

  14. Cost to Train a CLS Student • Student rotations are 19 – 26 weeks • On average there is a 50% productivity impact for the trainer in a hospital setting. • Assuming a CLS salary for trainer = $50,000 • Other miscellaneous costs may be minimal

  15. Clinical Rotation Cost to Educate a CLS Student • Hospital Setting Cost Analysis: • Train for 26 weeks or 1/2 year = 0.5 FTE • 0.5 FTE @ 50% productivity loss = 0.25 FTE in dedicated training time • 0.25 FTE x $50,000 = $12,500 to train CLS student

  16. SHRM Metrics Staffing Report http://www.shrm.org/metrics/library/ Cost to Recruit New Employee • Most HR departments factor 1 to 1.5 times the employee’s annual salary • This includes direct and indirect costs for: • Processing the termination, payout of benefits • Review and authorization to replace vacated position • Job posting and advertising • Interviews • Processing the hired applicant (Health Service and screening) • Orientation and Training • Assuming an annual salary of $50,000, replacement cost will range from $50,000 – 75,000

  17. Math Matters • Assumptions: • Training CLS student for complete internship • Using internship of about 19 - 26 weeks • Using conservative estimate of 1 year salary to replace • Break-even point is to hire 1 student for every 4 trained ! ! !

  18. % of Students Hired Institution Trained (08/10) Hired (08/10) A 14 22% B 3 0% C 4 25% D 8 25% E 3 33% F 7 71% G 4 25% H 1 0% I 5 20% J 5 20% K 2 0%

  19. Cost to Train Non-traditional path Employee to be Eligible for Certification • Minimum 4 months of training for one clinical area • Total of 1 year training for a CLS Generalist equivalent • Productivity loss is much higher due to lack of educational background (75%) • 1 FTE x $50,000 x .75 = $37,500 to train 1 new employee • Plus salary cost of that individual - $35,000 • Total = $72,500

  20. Value to Employer • Having students helps keep procedures up to date and easy to follow • Patient safety • Keeps existing employees “sharp” on their skills, knowledge, and behaviors • Follow and explain procedures • Utilize best practice or standard work practices • Model proper behaviors for customer service, etc. • Ability to “pre-screen” before hiring (i.e., 4 – 5 month interview period

  21. Value to Employer • “Many of our students stay on and become valuable employees” • “They may one day become employees in our facility and by training the students we are re-training ourselves and learning along with them” • “We were all students at one point in our careers and we want the students to become good practitioners who will care for us some day”

  22. The Challenge Consider the value to your organization to provide additional clinical laboratory rotation opportunities

  23. UAMS MT Program Tracks 2008 2009 2010 2+2 12 11 7 Fast-Track 5 9 13 Distance 9 7 11 Part-Time 2 1 1 MLT-MT 7 4 13 BOC Pass Rate 78% 80% 90% Attrition 18% 20% 18%

  24. Methodology

  25. The Five P’s of Effective Teaching • Preparation • Perceptions • Professionalism • Presentation • Participation

  26. Preparation • Determine the need of students • Integrate previous learning into present lesson • Determine the educational level of the students • Assemble teaching accessories

  27. Perceptions • Student and preceptor • Integration of one’s ideas during teaching • Positively reinforce the practice of medicine • Attitudes are easily conveyed

  28. Professionalism • Appearance (clean lab coat) • Demeanor • Polite without being overly friendly • Preceptor is addressed as Dr., Mr., Ms., etc. • Know students name

  29. Presentation • Competing student interest and material • Focus on student attention • Positive learning environment • Three points (presented at first meeting): • What you are going to do • How you are going to do it • What the students are expected to do

  30. Participation • Bilateral participation • Eye contact • Questions=feedback • Questions=fact finding mission • Orient learners to lesson • Review past material • Reflect on learning • OK to say “I don’t know” • Give feedback to learners often • Praise is important to the group and individual

  31. Conclusion • Reflect on the five P’s and make adjustments for the next teaching experience • Prepare early • Discuss your perceptions • Be professional • Design your presentation • Allow bilateral participation

  32. Teaching in the Clinical Setting In-depth Lectures Seminars Formal Educational Sessions Extensive Discussion

  33. Efficient and effective bench teaching requires that both the student and preceptor accept the limitations of the setting Example: in an outpatient ambulatory care setting - extensive discussions of differential diagnoses, pathophysiology and psychosocial problems are not possible nor necessarily desirable

  34. Demonstrate enthusiasm • Give meaningful (“authentic”) responsibility • Possess credible clinical skills

  35. Pitfalls in clinical case-based teaching • “Taking over” the case • Inappropriate lectures • Insufficient “wait-time” - 3 – 5 second wait to answer your questions • Pre-programmed answers - What do you think is going on? Could it be an ulcer?

  36. Pitfalls continued… • Rapid reward - Effectively ends the student’s thinking process • Pushing past ability - Persisting in carrying the students beyond their understanding of what is being asked

  37. The “One-Minute Preceptor” 1. Get a commitment 2. Probe for supporting evidence 3. Tell them what they did right 4. Teach general rules - Take each encounter to a learning point 5. Provide feedback (correct errors) A. Positive B. Corrective

  38. “One-Minute Preceptor” Microskills • Get commitment (Assess) • “What do you think is going on?” • Probe for rationale (Assess) • “What led you to that conclusion?” • Reinforce what was correct (Feedback) • “You did an excellent job of…” • Teach general rules (Instruct) • “When this happens, do this…” • Correct mistakes (Feedback) • “Next time this happens, try this…”

  39. “One-Minute Preceptor” Quiz 1. Get a _______________________ 2. Probe for ___________________ 3. Tell them ___________________ 4. ____________ general rules 5. _____________ errors

  40. “Trainees do not perform required skills incorrectly on purpose…errors in performance are typically the result of insufficient feedback” “They (errors) are seldom the result of insufficient interest or caring” Microskills of the One-Minute Preceptor (W. Fred Miser, M.D.)

  41. Q: Information you provide to learners about their clinical performance that is intended to guide their future clinical performance A: What is feedback

  42. The Feedback Sandwich What was done “right” What needs improvement What to do next time

  43. Feedback Checklist Make sure learner is ready  Give it soon and often  Link to goals  Be specific & non-judgmental  Give positive and constructive comments  Suggest correct performance  Don’t give too much  Make sure feedback is understood  Follow up your feedback  Expect learners to develop skills in self-evaluation

  44. Case StudyUAMS Example

  45. Advantages to Serving as Clinical Internship Site • Source of potential employees • Keeps staff current on theory • Reputation of facility • Increase job satisfaction and self esteem of staff • Professional responsibility

  46. Disadvantages • Use more supplies • Increase in daily duties • Already overworked professionals • Staff resistance – not all are teachers

  47. Making Internships Successful • Make students feel welcome • Reassure students as they progress • Keep the roles of instructor and student well defined • Selector instructors who have patience, positive attitude, and want to teach • An Orientation on the first day • Cover safety regulations • Lab/hospital regulations • Dress code • Expectations • Exam dates • Introduction to staff

  48. CLS/MT Program will Provide • Support to clinical rotation site • Student internship manual • Evaluation forms • Learning Objective • Complete with study questions for each discipline and answer keys • List of Required tests • Exams

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