As I have mentioned, I LOVED my January rotation. I could go on and on about why I liked my preceptors, the facility, and the other staff I got to work with. But I'll refrain for now. There is something I noticed though. What didn't strike me as obvious at the time, but I'm quickly realizing, is that a big difference in these rotations is in the perspective from which you are taught/treated. I now realize that the difference between finding annoyance or reward in an experience has more to do with that perspective/attitude than the tasks you actually do (though that can have a big effect, too, if its a major deficit).
Two of my inpatient rotations were at places that don't do any formal teaching. There's no residents (for the most part) and there are traditionally fewer students, also in part due to their locations. I took it for granted at the time, but I was treated more as a colleague than a student. I had plenty of oversight and opportunity to get help when I needed it, but I got an attitude of more "we don't have as many students, I don't exactly know what to do with you, so you can do the things we do." That was, for me, much more enjoyable and educational. Of course, at first I got a lot more guidance and direct supervision but I was left more to do my assigned tasks and to check in with questions or approval before taking action.
The alternative is what I have experienced at a facility that DOES do formal teaching. There is a lot more hand-holding and I don't feel like I am viewed as someone who is at the level in education that I am. I don't like being asked if I have questions every ten minutes. I am an adult, almost a doctor (which I say with the highest level of humility...just making a point) it should be assumed that if I have questions, I'll ask them, which I frequently do.
Here's another difference: it is very common for preceptors to ask students questions ("grill" them). But there comes a point when that is overkill. Sure, for most things it is worthwhile to discuss the underlying basics as part of the topic, but I don't think it's necessary to explain EVERYthing. A specific example is asking me: are you familiar with dosing of alteplase for ischemic stroke? If I say yes, that I did a presentation on stroke protocols and dosing, I would expect that the pharmacist trust my response and confidence, and not make me regurgitate "0.9 mg/kg total up to 90 mg with 10% as an IV bolus followed by the rest as an infusion over an hour." I'm not saying it's not reasonable or useful to "grill" the student, but the manner in which you do it makes a huge difference. It probably sounds like I'm just whining about minor things, and its difficult to articulate what I mean, especially when non-verbal cues play a role, but the issue I have is when I feel like I'm answering things for the sole reason of proving I know them instead of as a piece in basing or facilitating a discussion on the topic.
While appropriate for a first experience too much of these things in a more advanced rotation make for a little bit of "arrested development" and feels like a huge slow-down in my development of the clinical skill-set I've been so excited about lately.
I can think of a couple possible reasons for these differences. One was immediately apparent when I compare these more formal-teaching rotations to school (you know, that three-year period I just hated for these exact reasons...?) and all those "educational methodologies" they beat to death. You can tell pretty quickly if someone is a newer graduate that bought into that stuff. The other reason I see is that the majority of students aren't like I am when it comes to interpersonal skills and confidence. I am a pretty independent and non-soft-spoken person, especially compared to some of my classmates. If you give me a task, I can do it on my own and wouldn't hesitate to ask for help if I need it, or speak up if I don't know something. I'm not afraid of talking to people (calling patients, discussing issues with physicians, etc). The fact that many students need this excessive hand-holding is probably why it happens. I guess teaching hospital preceptors are so used to doing it that it's become the standard.
(So am I implying that the school accepts a whole bunch of people who don't possess the confidence, independence, and communication skills that are necessary for a pharmacist to have? Hmm... )
Now I'm making this conclusion pretty early, so nothing says it won't change over time. My point, though, is that students at this level should be held to a high standard. If they are new to something, guide them through it and build trust in their skills and judgment as you get to know them and as they become more comfortable - that's part of teaching. But also realize when you can skip the hand-holding and treat the student as less of a child (a little harsh, but that's how it feels sometimes) when they prove their competency right away. Someone that asks questions a lot doesn't need to be asked if they have more. And someone quick to admit they don't know or remember something shouldn't be questioned every time they say they do (vs. if they dodge questions or try to pull answers from their backside). If you can bypass the more elementary concepts, there's way more time to go into things you wouldn't otherwise get to. It can be more educational for the student as well as less monotonous for the preceptor.
This realization in the difference in teaching styles of smaller vs. large/teaching hospitals is very valuable for my job searching as well as (and more importantly) my possible residency prospects. It's something I'll have to look at closely to determine if a particular residency would be a year of being like a CIT of pharmacy or, the way it should be, as a graduate who is almost a colleague and just gaining experience in a more structured setting than OTJ training. In situations like this, I just have to plug away, go along with their methods, and hope that enough of proving I can be treated like an adult will result in exactly that. If not, I'll still have learned something at the end, even if it was not as much as I could have and was through a process of baby steps and extra hoops to jump through.
When it comes down to it, I am still just a student. All responsibility lies on the preceptor when the student is gone or if/when something goes wrong, but tailoring the experience to each student's personal and clinical abilities and knowledge in order to find a point between holding their hand and totally throwing them off the deep end is important at this point in professional education. It can still be done with sufficient oversight, effective teaching, and appropriate guidance and, while it may be impossible for those students whose skills are lacking, will make a very meaningful difference for those who can handle it.
(If only everyone was as confident, responsible, and able to communicate as the Camp Parsons Staff...)
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