No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Developing a process to manage challenges encountered by experiential education administrators
Abstract
Introduction
This study explored preceptor and student related issues reported in pharmacy experiential education settings and solutions that experiential education administrators (EEAs) applied to inform a process to manage these challenges.
Methods
This mixed-methods study was conducted in two phases. In phase one, five EEAs from three schools of pharmacy collected quantitative and qualitative data over a two-year period on issues reported by students and preceptors and the solutions EEAs employed. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data, respectively. Interviews with six EEAs from four schools were completed in phase two. An additional school was added in phase two. Open coding, pattern coding, and summative analysis were completed on interview data.
Results
Preceptors and students reported 156 and 65 issues, respectively. The most common issues reported were student reliability/responsibility (22, 14%) and preceptor communication (13, 20%). The most frequently applied solutions were coach preceptor (51, 24%) and meet with student (20, 24%). Interviews revealed more information about the strategies EEAs used. Approaches included reactive responses such as talking to and coaching preceptors or students. Preventative strategies were desired, such as tracking data and training.
Conclusions
Results informed two approaches that EEAs can employ to resolve student and preceptor issues. In the proactive process, issues are tracked to inform student and preceptor development. The reactive approach involves meeting with the preceptor or student, gathering information from both parties, coaching the preceptor or student, and involving other administrators as needed for serious concerns.
... Everyone within the university community should sing the same song, "We live to serve, and serving is the reason for our existence." As said by (Minshew et al., 2021) upon no grounds should student requests be turned down they are to be treated like kings and queens. Constant in-service training on customer orientation should be organised for faculty members on how to serve student needs as upheld (Hilton et al., 2021). ...
The purpose is to explain to university management in Ghana how to use strategic relationship marketing stratagems (SRMS) to attain sustainable retention which is viewed from a sustained competitive arena. A hypothetical model (“Susten Model”) is provided to serve as a guide (which is yet to be subjected to intellectual scrutiny). A cross-sectional survey was used with the help of a structured questionnaire. Data was collected from 500 respondents (senior members- both staff and non-teaching staff) and were examined through SmartPLS 3 and SPSS. The former was used to analyse the structural relationship of the variables while the latter was equally used for the descriptive analysis. The finding publicized that within the context of Ghana, universities can attain sustainable retention through the use of strategic relationship marketing stratagems if these stratagems are treasured as a strategic marketing resource. The phenomenon deserves further research because data were collected from some selected universities in these cities (Accra, Kumasi, and Cape Coast) in Ghana. Future research can expand on the database for empirical legitimacy. For retention sustainability, the SRMS advocates that management should have a conflict resolution chamber to resolve students’ protests promptly, deliver first-class educational services and institute an effective and efficient educational communication system. These stratagems are competitively enhanced when management is well trusted, accessible, students are made to feel part of university management and finally, the conflict resolution mechanism is made to be swift. It underpins and advances the frame of information concerning relationship marketing by introducing this new concept “strategic relationship marketing.”
... 8,9 Learner issues, which require significant time to address, have also been recognized as a challenge for experiential education administrators in addition to concerns of expanding administrative responsibilities. 10,[12][13][14] Identifying and addressing learner challenges may provide efficiencies that would benefit preceptors, organizations, and experiential administrators. ...
Objective. To assess preceptor teaching challenges and development programming design preferences through a qualitative needs assessment of Doctor of Pharmacy student and resident preceptors.Methods. In 2018, 148 experiential education stakeholders across North Carolina (eg, preceptors, residency program directors, experiential faculty administrators, and practice site administrators) were invited to participate in a 60-minute semi-structured interview as part of a broad preceptor development needs assessment. Interview questions focused on: precepting challenges, positive and negative features of development programs, and preferences for program design. Interview transcripts were coded using thematic analysis.Results. Forty-two participants completed interviews, including preceptors from various rotation types, residency program directors, experiential faculty administrators, and institution administrators. Participants identified numerous teaching challenges related to learners, preceptors, and institutional level factors. Participants often noted there was inadequate time, resources, and support to effectively teach. Desirable preceptor development program features included practical strategies, collaboration with preceptors, delivery by education and practice experts, and topics specific to precepting experience. Participants identified live, on-demand, and webinar formats as acceptable if collaboration and engagement were included. Participants also desired unique training opportunities such as online platforms, coaching programs, and simulated learning environments.Conclusion. Preceptors for pharmacy students and residents face numerous challenges and require sufficient time, support, and resources to develop their skills. Participants requested training that included on-demand, frequent sessions delivered through various modalities, collaboration opportunities, a choice in topics and delivery formats, and sessions from educational and practice experts.
In the course of our supervisory work over the years we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By 'novice' we mean Master's students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of qualitative research papers. The first article provides an introduction to this series. The second article focused on context, research questions and designs. The third article focused on sampling, data collection and analysis. This fourth article addresses FAQs about trustworthiness and publishing. Quality criteria for all qualitative research are credibility, transferability, dependability, and confirmability. Reflexivity is an integral part of ensuring the transparency and quality of qualitative research. Writing a qualitative research article reflects the iterative nature of the qualitative research process: data analysis continues while writing. A qualitative research article is mostly narrative and tends to be longer than a quantitative paper, and sometimes requires a different structure. Editors essentially use the criteria: is it new, is it true, is it relevant? An effective cover letter enhances confidence in the newness, trueness and relevance, and explains why your study required a qualitative design. It provides information about the way you applied quality criteria or a checklist, and you can attach the checklist to the manuscript.
Objective:
To identify specific preceptor teaching-coaching, role modeling, and facilitating behaviors valued by pharmacy students and to develop measures of those behaviors that can be used for an experiential education quality assurance program.
Methods:
Using a qualitative research approach, we conducted a thematic analysis of student comments about excellent preceptors to identify behaviors exhibited by those preceptors. Identified behaviors were sorted according to the preceptor's role as role model, teacher/coach, or learning facilitator; measurable descriptors for each behavior were then developed.
Results:
Data analysis resulted in identification of 15 measurable behavior themes, the most frequent being: having an interest in student learning and success, making time for students, and displaying a positive preceptor attitude. Measureable descriptors were developed for 5 role-modeling behaviors, 6 teaching-coaching behaviors, and 4 facilitating behaviors.
Conclusion:
Preceptors may need to be evaluated in their separate roles as teacher-coach, role model, and learning facilitator. The developed measures in this report could be used in site quality evaluation.
The onboarding and retention of new graduate RNs continues to be a critical focus for both nursing as a profession and for health care organizations. A comprehensive residency program, with preceptor engagement playing a key role, is essential to the success of these new nurses in transition. With a focus on preceptor education, this article provides an analysis of the preceptor experience from the perspective of new graduate RNs and how their feedback provided the foundation for preceptor education. The article outlines opinions and recommendations for preceptor development, provided by a convenience sample of new graduate nurses from a multisite, postresidency evaluation survey. The purpose of the analysis was two-fold: (a) to identify preceptor skills and characteristics for presentation at the 2nd annual American Academy for Preceptor Advancement conference and (b) to ensure that the identified skills and characteristics provide the foundation for preceptor education in a national residency program. J Contin Nurs Educ. 2015;46(5):233-236.
Copyright 2015, SLACK Incorporated.
Objective:
To qualitatively analyze free-text responses gathered as part of a previously published survey in order to systematically identify common concerns facing pharmacy experiential education (EE) programs.
Methods:
In 2011, EE directors at all 118 accredited pharmacy schools in the US were asked in a survey to describe the most pressing issues facing their programs. Investigators performed qualitative, thematic analysis of responses and compared results against demographic data (institution type, class size, number of practice sites, number and type of EE faculty member/staff). Expert and novice investigators identified common themes via an iterative process. To check validity, additional expert and novice reviewers independently coded responses. The Cohen kappa coefficient was calculated and showed good agreement between investigators and reviewers.
Results:
Seventy-eight responses were received (66% response rate) representing 75% of publicly funded institutions and 71% of schools with class sizes 51-150. Themes identified as common concerns were site capacity, workload/financial support, quality assurance, preceptor development, preceptor stipends, assessment, onboarding, and support/recognition from administration. Good agreement (mean percent agreement 93%, ƙ range=0.59-0.92) was found between investigators and reviewers.
Conclusion:
Site capacity for student placements continues to be the foremost concern for many experiential education programs. New concerns about preceptor development and procedures for placing and orienting students at individual practice sites (ie, "onboarding") have emerged and must be addressed as new accreditation standards are implemented.
A comprehensive evaluation and remediation program is an essential component of any residency program. The evaluation system should identify problems accurately and early and allow residents with problems to be assigned to a remediation program that effectively deals with them. Elements of a proactive remediation program include a process for outlining deficiencies, providing resources for improvement, communicating clear goals for acceptable performance, and reevaluating performance against these goals.
In recognition of the importance of early detection and prompt remediation of the struggling resident, we sought to develop a multifaceted approach to resident evaluation with the aim of early identification and prompt remediation of difficulties. This article describes our comprehensive evaluation program and remediation program, which uses resources within our radiology department and institutional graduate medical education office.
An effective evaluation system should identify problems accurately and early, whereas a proactive remediation program should effectively deal with issues once they are identified.
Decisions about recruitment of clinical teachers and about the content of clinical teacher training programs are complex. This article aims to identify core components that reflect the characteristics of effective clinical teachers and effective clinical teaching in the ambulatory setting. These are grouped into four thematic categories--personal attributes, educational theory and principles, core clinical teaching skills, and mentored instructional activities.
Situation
The evolution of practices in healthcare and the content and delivery of pharmacy education have generated new challenges for practitioners and academicians. Fittingly, pharmacy education research in the academic setting has grown rapidly to provide innovative solutions to these challenges. One approach for addressing these challenges includes the collection and analysis of qualitative research (QR). Though a useful methodological tool, many pharmacy educators are not trained to appropriately conduct QR and present the findings of their work.
Methodological literature review
QR offers many advantages for pharmacy education researchers. However, prior to delving into QR projects it is important to understand the key distinctions of the approach, role of the researcher, and the significance of situating the study so that the research question, data collection techniques, and analysis procedures are aligned.
Recommendations
We provide recommendations for several key components for conducting QR, articulating the process, and presenting and contextualizing the findings.
Implications
This article serves as a primer on QR methods, offering relevant background information, ways to apply this approach in pharmacy education research, and recommendations for presenting qualitative findings. Employing rigorous qualitative approaches in pharmacy education and appropriately presenting the procedures and findings will increase the visibility of QR and provide an opportunity for scholars to become familiar with the approach.
Introduction
Priority #3 of the Canadian Experiential Education Project for Pharmacy provided evidence-based guidance for the design and implementation of a national approach to preceptor development. In this first article (of three), findings from the project and recommendations to achieve a high-quality preceptor development program (PDP) are presented.
Methods
A multi-method approach including detailed semi-structured interviews, classic literature review, and advisory committee feedback was employed. The research team performed an integrated analysis of all data to achieve the objectives of Priority #3.
Results
Fifteen formal interviews, 167 articles and two stakeholder meetings informed findings. Experiential Education programs exhibited commonality in content and usually delivered programs online using modules or live lectures. Not all programs required preceptor education despite it being mandated by academic accreditors. Academics’ perceptions varied regarding pharmacists’ baseline knowledge, skills and attitudes prior to engaging in the preceptor role. A national approach to a PDP was desired if jurisdictional content was accommodated. Copious interprofessional literature of generally fair quality did not identify superior preceptor development approaches although there were numerous descriptions of interventions. Only 29 articles measured educational outcomes. Outcomes included satisfaction rates, self-efficacy and perceived knowledge, skill retention, skill implementation and participation rates.
Discussion and conclusions
Twelve recommendations were identified to guide successful development of a national PDP. In the absence of good evidence, adult educational theory provided a basis for an effective PDP. Findings from Priority #3 may be relevant not only to pharmacy in Canada but other health professions and counterparts in other western nations with similar approaches to professional education.
Recognizing indicators and risk factors for burnout and addressing these issues on systemwide and professionwide levels may help to mitigate professional pressures and improve healthcare provider satisfaction and fulfillment. Mechanisms for coping with professional stress and pressures are imperative for those involved with professional and postgraduate training. The onus for implementing strategies to prevent burnout and for reenergizing pharmacy practitioners in their work lies with employers, institutions, businesses, schools of pharmacy, hospitals, and health systems. The influence of burnout on patient safety and quality of care cannot be ignored and demands attention. Copyright © 2018, American Society of Health-System Pharmacists, Inc. All rights reserved.
The practice of pharmacy is highly influenced by the training pharmacy clinicians receive through experiential education (EE) programs, for it is within this “total practice immersion” that their skills are shaped, honed, and refined.[1][1] However, not all rotation experiences are positive for
Objective. To provide an overview of the current status of advanced experience program as colleges and schools transition into the era of the PharmD as the sole professional degree. Methods. A survey of advanced clinical experience programs was conducted. Data from the American Association of Colleges of Pharmacy (AACP) Institutional Report Series, AACP Professional Experience Program surveys, and published literature in the field were obtained. The areas addressed included organization, administration, teaching faculty, financial support, and the most pressing issues facing program administrators Results. Of the 74 colleges and institutions with advanced experience programs in pharmacy, 27 had only students who were pursuing their first professional degree, 16 had only post-baccalaureate PharmD students, and the remaining 31 had students from both degree programs in their advanced experience program. Instructors were primarily full-time faculty members; however, joint and part-time faculty members, as well as adjunct faculty members, were involved in teaching, particularly in larger institutions. Of greatest concern was the shift in responsibility for experiential training programs from more experienced faculty members to younger, non-tenure-track faculty members. Conclusion. As colleges and schools of pharmacy begin offering the PharmD as the sole professional degree, the role of the advanced experience program in producing confident and competent pharmacy professionals becomes even more critical. A commitment must be made to develop and support highly skilled, experienced faculty members to develop and support the advanced experience programs.
INTRODUCTION
There is no widely accepted structured, evidence based strategy for the remediation of clinical reasoning skills.
AIM
To assess the effectiveness of a standardized clinical reasoning remediation plan for medical learners at various stages of training.
SETTING
Learners enrolled in the University of Colorado School of Medicine Remediation Program.
PROGRAM DESCRIPTION
From 2006 to 2012, the learner remediation program received 151 referrals. Referrals were made by medical student clerkship directors, residency and fellowship program directors, and through self-referrals. Each learner’s deficiencies were identified using a standardized assessment process; 53 were noted to have clinical reasoning deficits. The authors developed and implemented a ten-step clinical reasoning remediation plan for each of these individuals, whose subsequent performance was independently assessed by unbiased faculty and senior trainees. Participant demographics, faculty time invested, and learner outcomes were tracked.
PROGRAM EVALUATION
Prevalence of clinical reasoning deficits did not differ by level of training of the remediating individual (p = 0.49). Overall, the mean amount of faculty time required for remediation was 29.6 h (SD = 29.3), with a median of 18 h (IQR 5–39) and a range of 2–100 h. Fifty-one of the 53 (96 %) passed the post remediation reassessment. Thirty-eight (72 %) learners either graduated from their original program or continue to practice in good standing. Four (8 %) additional residents who were placed on probation and five (9 %) who transferred to another program have since graduated.
DISCUSSION
The ten-step remediation plan proved to be successful for the majority of learners struggling with clinical reasoning based on reassessment and limited subsequent educational outcomes. Next steps include implementing the program at other institutions to assess generalizability and tracking long-term outcomes on clinical care.
Objectives:
To identify factors associated with preceptor excellence as rated by student pharmacists and to assess the correlation of excellent ratings with years as pharmacist, specialty certification, and faculty appointment status.
Methods:
A retrospective analysis of student pharmacist evaluations of preceptors from May 2009 to May 2012 was completed to determine factors associated with preceptor excellence.
Results:
Preceptors who showed an interest in teaching, related to the student as an individual, encouraged discussion, were accessible, provided feedback, served as a role model, were organized, and/or spent increased time with students were more likely to be rated excellent.
Conclusion:
Serving as role models and showing an interest in teaching demonstrated the strongest association with being an excellent preceptor. Identifying factors students associate with preceptor excellence may result in enhanced preceptor recruitment, development, and training.
To identify deficit types and predictors of poor academic outcomes among students, residents, fellows, and physicians referred to the University of Colorado School of Medicine's remediation program.
During 2006-2012, 151 learners were referred. After a standardized assessment process, program faculty developed individualized learning plans that incorporated deliberate practice, feedback, and reflection, followed by independent reassessment. The authors collected data on training levels, identified deficits, remediation plan details, outcomes, and faculty time invested. They examined relationships between gender, training level, and specific deficits. They analyzed faculty time by deficit and explored predictors of negative outcomes.
Most learners had more than one deficit; medical knowledge, clinical reasoning, and professionalism were most common. Medical students were more likely than others to have mental well-being issues (P = .03), whereas the prevalence of professionalism deficits increased steadily as training level increased. Men struggled more than women with communication (P = .01) and mental well-being. Poor professionalism was the only predictor of probationary status (P < .001), and probation was a predictor of other negative outcomes (P < .0001). Remediation of clinical reasoning and mental well-being deficits required significantly more faculty time (P < .001 and P = .03, respectively). Per hour, faculty face time reduced the odds of probation by 3.1% (95% CI, 0.09-0.63) and all negative outcomes by 2.6% (95% CI, 0.96-0.99).
Remediation required substantial resources but was successful for 90% of learners. Future studies should compare remediation strategies and assess how to optimize faculty time.
Clinical reasoning serves as a crucial skill for all physicians regardless of their area of expertise. Helping trainees develop effective and appropriate clinical reasoning abilities is a central aim of medical education. Teaching clinical reasoning however can be a very difficult challenge for practicing physicians. Better understanding of the different cognitive processes involved in physician clinical reasoning provides a foundation from which to guide learner development of effective reasoning skills, while pairing assessment of learner reasoning abilities with understanding of different improvement strategies offers the opportunity to maximize educational efforts for learners. Clinical reasoning errors often can occur as a result of one of four problems in trainees as well as practicing physicians; inadequate knowledge, faulty data gathering, faulty data processing, or faulty metacognition. Educators are encouraged to consider at which point a given learner's reasoning is breaking down. Experimentation with different strategies for improving clinical reasoning can help address learner struggles in each of these domains. In this chapter, various strategies for improving reasoning related to knowledge acquisition, data gathering, data processing, and clinician metacognition will be discussed. Understanding and gaining experience using the different educational strategies will provide practicing physicians with a toolbox of techniques for helping learners improve their reasoning abilities.
Clinical teachers often work with students or residents whom they perceive as a "problem". For some, it is a knowledge deficit that first alerts them to a problem; for others it is an attitudinal problem or distressing behaviour . And in some cases, it is difficult to know if the learner is, indeed, presenting with a problem. The goal of this Guide is to outline a framework for working with "problem" learners. This includes strategies for identifying and defining learners' problems, designing and implementing appropriate interventions, and assuring due process. The potential stress of medical school and residency training will also be addressed, as will a number of prevention strategies. Identifying learners' problems early - and providing guidance from the outset - can be an important investment in the training and development of future health professionals. It is hoped that this Guide will be of help to clinical teachers, program directors and faculty developers.
Remediation of residents is a common problem and requires organized, goal-directed efforts to solve. The Council of Emergency Medicine Residency Directors (CORD) has created a task force to identify best practices for remediation and to develop guidelines for resident remediation. Faculty members of CORD volunteered to participate in periodic meetings, organized discussions and literature reviews to develop overall guidelines for resident remediation and in a collaborative authorship of this article identifying best practices for remediation. The task force recommends that residency programs:
Resident remediation is frequently necessary and specific steps may be taken to justify, document, facilitate, and objectify the remediation process. Best practices for each step are identified and reported by the task force.
ACADEMIC EMERGENCY MEDICINE 2010; 17:S95–S103 © 2010 by the Society for Academic Emergency Medicine
Internal medicine residency training is demanding and residents can experience a wide variety of professional and personal difficulties. A problem resident is defined by the American Board of Internal Medicine as "a trainee who demonstrates a significant enough problem that requires intervention by someone of authority." Data are sparse regarding identification and management of such residents.
To gain more understanding of the prevalence, identification, management, and prevention of problem residents within US internal medicine residency programs.
Mailed survey of all 404 internal medicine residency program directors in the United States in October 1999, of whom 298 (74%) responded.
Prevalence of problem residents; type of problems encountered; factors associated with identification and management of problem residents.
The mean point prevalence of problem residents during academic year 1998-1999 was 6.9% (SD, 5.7%; range, 0%-39%), and 94% of programs had problem residents. The most frequently reported difficulties of problem residents were insufficient medical knowledge (48%), poor clinical judgment (44%), and inefficient use of time (44%). Stressors and depression were the most frequently identified underlying problems (42% and 24%, respectively). The most frequent processes by which problem residents were discovered included direct observation (82%) and critical incidents (59%). Chief residents and attending physicians most frequently identified problem residents (84% and 76%, respectively); problem residents rarely identified themselves (2%). Many program directors believed that residents who are from an underrepresented minority, are international medical graduates, or are older than 35 years are at increased risk of being identified as a problem resident (P<.05). Program directors believed that frequent feedback sessions (65%) and an assigned mentor for structured supervision (53%) were the most helpful interventions.
Nearly all internal medicine residency programs in this sample had problem residents, whose presenting characteristics and underlying issues were diverse and complex. JAMA. 2000;284:1099-1104
The University of Maryland School of Pharmacy has systematically implemented professionalism assessment to establish expectations in experiential learning and to create a mechanism for holding students accountable for professionalism. The authors describe their philosophic approach to the development and implementation of these explicit criteria and also review the outcomes of applying these criteria. In 2001, 3 professionalism criteria were developed and applied to required intermediate and advanced pharmacy practice experiences (APPEs). Students were expected to achieve 100% acceptable ratings to pass the rotations. The criteria were subsequently enhanced and by 2005 applied to all experiential courses. Most students exhibited professional behavior; however, 9 students did not meet the established criteria. Strategies used in remediation and further professional development are discussed. The use of professionalism criteria has promoted a culture of professionalism throughout the School.
Diagnosis and management of clinical reasoning difficulties: part 1. Clinical reasoning supervision and educational diagnosis
- Audetat
Early steps in analysis
- Miles