See One, Do One?
Recently, an author commented that preceptors don’t take the time to directly role model or demonstrate patient care skills for learners as often as they should. Over the years, one of my work roles has been to review resident comments about their preceptors. I therefore reflect on the pros and cons of having a learner watch a task, versus letting them do it. On one side, I read many resident comments such as “Dr. X is a great preceptor because I got to do so much on my own, which built up my confidence”. I could easily understand the resident’s enthusiasm, and reaffirmation of the importance of learning by doing.
On the other hand, I frequently read comments such as “I learned so much from Dr. Y. She role modeled and demonstrated skills and attitudes that inspired me and clarified how I could practice high quality care.”
So, is there a problem? Despite the reality that each learner will have variable competencies dealing with diverse presenting problems, studies suggest that preceptors often adopt a fixed, non-adaptive style that uses the same amount of demonstration, or lack of demonstration, across all encounters. There are many factors that can influence our supervision choices. For example, a senior resident will typically and correctly value having more autonomy. Such an independent-minded resident may not recognize when an experienced demonstration could help their future performance.
Many learners are unaware how often a practitioner, who works within a “community of knowledge”, will seek out role-modeling and instruction from more skilled colleagues throughout their career.
Resident dissatisfaction seems easily triggered when they perceive an imbalance between opportunities for hands-on experience versus observation. Engaging the resident about this concern throughout the rotation is one way to empower learners to use a variety of learning strategies.
Here is a script I typically used while orienting new residents into my practice:
“As we work together we will be using several methods of supervision. A common one will be where you will encounter the patient on your own, and then we debrief after. Sometimes the debrief will happen right after, before the patient leaves, and sometimes at the end of a clinic, depending on our confidence. Another method will be when I directly observe you with the patient, during a part of the encounter, to give you more immediate, relevant and specific feedback. Finally, there are times when I will perform a task or see a patient myself so you can observe and identify potential future practice strategies. Patient preferences, learning agendas, and time management are all factors that will determine how we work. I’ll check with you regularly if the mix of styles is working well for you. Skillful learning in the workplace will be relevant throughout your career.”
The key for such a script is to review this with the resident on a periodic basis. The recurring conversations about skillful use of supervisory styles can empower a learner to actively engage with their learning and be part of their development of competencies and attitudes for being a life-long “guided self-directed learner”.
Dr. Michel Donoff is the recipient of the 2018 Ian McWhinney Family Medicine Education Award. After retiring earlier this year Dr. Donoff chose to continue working part time in the University of Alberta’s Department of Family Medicine, where he is a team member of the Competency-Based Achievement System.
