Strategies pharmacy students can use to ensure success in an experiential placement

Experiential education is a key component of the curriculum for pharmacy students. Students value experiential placements (rotations) and genuinely appreciate the efforts of their preceptors in facilitating learning experiences. Similarly, preceptors do their best to help students achieve their goals and learning objectives. Despite these prevailing positive feelings and good intentions on the part of both the student and the preceptor, some students do not perform up to their own expectations in the clinical setting or fail to meet the expectations of the preceptor. There are many reasons this gap may exist, and the onus may rest to a variable extent with the student, the preceptor, various aspects of the preceptor-student interaction or the faculty, due to its role in preparing students for experiential placements. In this article, I offer a number of strategies that may help students enhance their success in an experiential placement.

Although this piece focuses on the student’s role, it is important to acknowledge the key role preceptors play in the student’s success. Preceptors facilitate the development of knowledge, clinical skills and professional attitudes in pharmacy through guidance, coaching, role modeling and personal development of the student. Preceptors also help to orient and socialize the student to the clinical environment to optimize learning. Therefore, students and preceptors are equally invested in the use of strategies that help students achieve their goals and be successful in their placement.

The strategies I propose are aimed at helping students take responsibility for their own success and are based on my observations over nearly 40 years as a preceptor for students of the Leslie Dan Faculty of Pharmacy at the University of Toronto. I have observed that students who exhibit certain behaviours and avoid others achieve a higher level of success and view their experiential training as more rewarding and fulfilling. The top-performing students consistently provide patient-centred care, perform to the best of their ability and exhibit a high level of professionalism. Given that success in an experiential placement is multifactorial, I offer these strategies in a spirit of goodwill and hope that students who are open to considering these behaviours and attitudes will find their experiential placements more successful overall.

Many of the strategies and attitudes presented here may already be known; nevertheless, due to the range of extant preplacement experience, personality types, motivation and self-directedness, some students may have more self-discovery to do to ensure their success in an experiential placement and will appreciate these suggestions. In addition, some of the proposed strategies will be more obvious than others based on the student’s formative experiences, and so I have chosen to list the strategies under 2 broad headings arbitrarily divided into the obvious and the not-so-obvious from my perspective (Table 1). However, no one strategy is more important than another, and the division is not critical.

Table 1.

Summary of strategies to ensure success in an experiential placement

The obvious strategies

The not-so-obvious strategies

• Understand and fully appreciate the syllabus. • Appear interested at all times and show that you value  this experiential opportunity. • Show enthusiasm for learning. • Demonstrate independence. • Show initiative and make contributions in the  experiential setting. • Share your knowledge to gain new insights. • Be ready to discuss patient care issues with your  preceptor. • Be inquisitive, but expect to answer (most of) your  own questions. • Do not fall behind with your assignments. • Never make anything up!

• Use clinical reasoning as the basis for your  contributions to care. • Integrate yourself into the placement environment  to optimize learning. • Discuss your observations with your preceptor. • Receive questions from the physician or other team  members with grace and appreciation. • Consider therapeutic recommendations carefully  because they will likely be put into action. • Embrace spontaneous learning experiences. • Be respectful of the clinical environment. • Use the mentorship and coaching skills of your  preceptor. • Be appreciative of the time and energy being invested  in you by your preceptor or other clinicians. • Consider your experiential placement as an extended  job interview.

The obvious strategies reflect what I perceive to be “expected” student behaviours. I mention them primarily for the benefit of those few students who lack self-awareness or who fail to approach the placement with the necessary importance. Making the obvious strategies explicit will serve as a review for the majority of students and a reinforcement of strategies that should be continued. The not-so-obvious strategies reflect what I consider to be “anticipated” student behaviours based on preplacement preparation. These behaviours may not be demonstrated universally simply because students are unaware of them or they represent areas for further growth. Regardless, these strategies are likely to be most helpful for students who fit any of the following descriptions: those who have little clinical experience, are reluctant to participate in care for whatever reason, have difficulty picking up on environmental or social cues, fail to see the applicability of their current experiential placement to future practice, are unaware that their behaviour is being monitored by everyone on the team and/or fail to appreciate the expertise of their preceptor. Making the not-so-obvious strategies explicit may be a revelation for those students.

The strategies presented here offer a practical view of conduct aimed at maximizing the experiential placement opportunity. They are part of being a professional and complement the traditional parameters of professionalism such as ethics, confidentiality, honesty, dependability, maintaining a high standard and placing the patient’s interests above one’s own.

The obvious strategies

Understand and fully appreciate the value of the syllabus provided by the faculty

The experiential placement syllabus will help you take charge of your learning and, along with preparation you received from your faculty, will help to ensure that you meet rotation goals and requirements. The syllabus is intended to foster self-directedness and independence so that the student is not completely reliant on the preceptor for direction. This allows preceptors to maintain their own work pace while guiding the self-directed learner in the pursuit of real-world experiences. Consider your learning objectives carefully and use them to guide the rotation, establish expectations and keep your learning on track.

Appear interested at all times and show that you value this experiential opportunity

Show up for work well rested, alert and attentive to learn. Take responsibility for your behaviour to demonstrate independence and maturity, necessary traits for any workplace. Do not make excuses for being tired, unprepared, late for appointments or failing to let your preceptor know your whereabouts. However, do notify your preceptor if specific accommodation is required. If there is a lapse in behaviour or you miss completing a task, apologize immediately and initiate corrective action.

Show enthusiasm for learning

Take initiative in addressing your learning objectives and demonstrate self-directedness, but ask for direction if needed. Demonstrate your ability to carry your learning forward to the next day.

Demonstrate independence

Students who take charge of their learning and demonstrate independence are progressing toward the goal of becoming a competent practitioner. Some of the ways students demonstrate independence include initiating contact with patients and the health care team, taking responsibility for monitoring outcomes of therapy, advocating on the patient’s behalf, justifying their recommendations and handing off care to the next responsible person when appropriate. By the second week of the placement, you should be aware of routines, work flow and expectations and be able to set your own agenda to accomplish your identified learning needs. Students who need to have the next day’s agenda continually spelled out in detail demonstrate a lack of organizational skill and situational awareness. Students who are not aware of what needs to be done are not developing as expected. This situation can become exhausting for the preceptor and can lead to unproductive student-preceptor interactions such as inefficient use of time, unmet learning objectives and lack of personal growth by the student. As a remedy, the student should proactively offer to review the plan for the next day with his or her preceptor.

Show initiative and make contributions in the experiential setting

Rotations are a wonderful opportunity to engage in the various aspects of patient-centred care. Students should be motivated to provide care and contribute to their full scope of practice. Students who show initiative and are open to new experiences have a more rewarding rotation, have a bigger impact on patients and the team and receive more praise. Similarly, students who get involved in various rotation activities fit in faster, acquire more skills, pick up clinical pearls more easily and feel more confident.

Students are encouraged to look for opportunities to be involved in care. Too much observation can slow the pace of skill development and maturation. Students who seem unaware of how they can be useful in the clinical setting or fail to show initiative may believe their behaviour is normal, consistent with their personality or preferred learning style, or that they are deferring to the preceptor as a way to show respect. Such a student is missing the point of the experiential placement, which is to gain experience in performing clinical skills, with emphasis on performing or active learning.

To gain experience, you must do necessary work. Doing and observing are separate learning experiences. Do not lapse into an “auditing” frame of mind. Focus more on action and less on observation. Do not let rigidity in your preferred learning style create barriers to learning from others or prevent you from engaging in a variety of learning experiences. Some suggestions to consider include offering to do what is needed to meet the needs of the patient and the team, clarifying the activities that are meaningful and beneficial to patients and are consistent with the priorities of the pharmacy department at the site, and using your preceptor as a role model.

Share your knowledge to gain new insights

You are expected to demonstrate your knowledge but are not expected to know everything. An experiential rotation is an opportunity to consolidate your knowledge by applying what you know to real-life situations, to gain new or greater insights into the use of medications and to gain new knowledge and skills through exposure to patients and practising clinicians. By describing the thought process underlying your therapeutic recommendations, you consolidate knowledge and enable new learning.

In discussions with your preceptor, offer your own assessment as a starting point. For example, consider using phrases such as, “The mechanism of action is . . . therefore . . .,” “Due to the slow onset of action, monitoring should occur . . .,” “In my reading I found . . .,” “I know this, therefore. . . .”

Inadequate core knowledge will slow the pace of learning but is not an excuse to avoid engaging in the learning process. Knowledge gaps can be overcome if an individual commits to a structured learning program and uses his or her time wisely.

Be ready to discuss patient care issues with your preceptor

Use your available time to achieve your learning objectives and be prepared for discussions with your preceptor or the team. Read any assigned material and complete patient workups in a timely manner. Be knowledgeable about your patient’s issues by seeking input from the patient and using the other information sources available to you, including the medical chart, nursing notes, nurse’s observations and notes written by medical consultants or other health care professionals. To obtain the greatest yield from a patient interview, use your knowledge of the disease, its natural course and the impact of medications in terms of efficacy and side effects to guide questioning in order to fully understand the patient’s experience.

Be inquisitive, but expect to answer (most of) your own questions

Inquisitiveness demonstrates enthusiasm for learning, allows you to express your therapeutic thought process, drives productivity and personal development and reflects engagement and independence. However, inquisitiveness is only virtuous to the extent that it inspires self-directed learning and fosters self-discovery.

Do not fall behind with your assignments

Fulfilling rotation expectations according to the schedule set out in the syllabus is important because it enables formative feedback. For example, feedback on your pharmacy care plans provided in one week can be incorporated into the care plans you will prepare in the following week. Submitting several written assignments all at once in the third week of the rotation is disadvantageous for the student and preceptor. Students should establish expectations with the preceptor on day 1 of the rotation.

When responding to your preceptor, or interacting with a patient or any other care provider at the site, never make anything up!

Offering a vague or inaccurate generalization to a clinical question is not useful and may be construed as trivializing the situation. At worst, your response may be put into action and result in patient harm. However, it is perfectly acceptable to engage in a discussion with your preceptor regarding material that you are unsure of to identify the learning needs.

Students are encouraged to offer their existing knowledge as a starting point or look up the information and agree on a timeline for the response. If possible, review material prior to discussions with your preceptor. Prepare in advance for planned interactions with other health care professionals or patients. When speaking to a patient or another health care professional, only provide information you are certain is correct to avoid damaging your credibility. In other words, do not be afraid to say, “I don’t know but will find out.”

The not-so-obvious strategies

Use clinical reasoning as the basis for your contributions to care

Clinical reasoning involves the amalgamation of inputs such as core knowledge and cognitive processing using the pharmaceutical care thought process. It requires analysis and synthesis of information and reflects your understanding and will be the basis of your expertise. Students should not confuse expertise with looking up information. Experiential placements offer you an opportunity to use your knowledge base, refine clinical reasoning skills and incorporate multiple inputs into clinical decisions. Make the most of this opportunity by engaging in the therapeutic thought process. Speak with confidence in what you know, but with humility because there is more to learn. In discussions with your preceptor, offer your own assessment as a starting point. For example, consider using phrases such as, “My understanding is . . .,” “I am aware of . . .,” “I know this . . ., therefore . . .,” “The urgency for action is . . .” and “These are the points I plan to raise during my interview with the patient. . . .”

Integrate yourself into the placement environment to optimize learning

Integrating yourself into the learning environment enables personal growth. Despite the preceptor’s efforts to help students feel comfortable in the clinical setting, some students do not integrate quickly into their new team. Students who are reserved, reticent, quiet, shy or feel intimidated by the environment need to put these personal feelings aside so that academic performance is not compromised. Students should feel they are welcomed by the preceptor and the clinical team, their work is valued and that their presence enriches the clinical environment. If you are slow to fit in, the surest remedy to employ is to simply do your best work.

Discuss your observations with your preceptor

Reflect on your learning or on an interaction you have had at the site to gain further appreciation for the significance of events. Reflection and debriefing are powerful learning tools. The significance of the clinical experience is magnified when issues are discussed or pointed out.

Receive questions from the physician or other team members with grace and appreciation

The highest compliment another health care professional can pay you is to invite you into the circle of care by seeking your contribution. Treatment-related questions directed to you represent an invitation to participate in the patient’s care. Your response to these questions is part of your contribution to patient care and teamwork and reflects positively on you, the faculty and the profession of pharmacy. Always clarify the timeline for your response, since the urgency for providing a response will vary with each clinical scenario.

Consider therapeutic recommendations carefully because they will likely be put into action

Relationships among health care professionals in the clinical environment are built on trust and respect. Such environments allow students to feel safe and foster the development of clinical skills. Be aware that that the health care team will assume your treatment recommendations are accurate and have been endorsed by your preceptor; therefore, they will likely be accepted. However, this is not a place for a cavalier attitude. Remember, the team will expect you to emulate the diligence and professionalism exhibited by your preceptor.

Embrace spontaneous learning experiences

You must be “present” in routine clinical encounters to gain experience. Each interaction with a patient or physician or other health care professional is unique and has something to contribute to your development. Presence in the environment enables you to participate in care decisions and follow up on outcomes. You will be able to observe how other care providers apply their clinical skills and interact with patients and colleagues—yielding valuable lessons in teamwork.

Be respectful of the clinical environment

Be cautious when using handheld electronic devices when in the presence of the team. It is unprofessional to be answering texts or emails while interacting with the health care team. Clarify the culture at the site regarding use of handheld electronic devices or ask permission if unsure. Observe how others make use of handheld electronic devices.

Be aware of space limitations at the site that affect how people position themselves in the space during discussions or rounds. Space limitations may require that you move adeptly during rounds to accommodate movement of team members. This may mean you need to give up your chair or find another chair as the situation dictates. Be especially careful to not monopolize the computer or desk space required by staff to do their work.

Use the mentorship and coaching skills of your preceptor

The preceptor-student interaction is dynamic and no 2 preceptor-student relationships are identical. Regardless, preceptors have much to offer their students, and students have much to gain. Mentorship and coaching are 2 important benefits that preceptors provide for their students. Mentors pose thoughtful questions that enable students to evaluate their options and formulate their own decisions. Coaches help their students to refine their skills, experience new things, learn in new ways, expand their capacity, think creatively and grow in confidence. This process sometimes takes a student out of his or her comfort zone, but the resulting growth is rewarding and fulfilling.

Feedback on performance contributes significantly to your personal growth. Consider feedback a gift. By providing feedback, preceptors demonstrate that they care about your development. Acknowledge and accept feedback with grace and implement recommendations into your practice or offer alternative solutions. Continuously monitor your own progress relative to your learning objectives, the syllabus, your understanding of professionalism and norms for behaviour at the site. If unsure whether the quality of your work meets expectations, check with your preceptor. At the time of scheduled evaluations, the preceptor’s assessment of your performance should be a recap, not a surprise.

Be appreciative of the time and energy being invested in you by your preceptor or other clinicians

All professions and trades devote considerable effort to grooming the next generation of practitioners. Students should think carefully about their learning objectives for each rotation and be sure they accomplish those objectives while the responsibility is shared with a mentor. After graduation, ongoing learning will become almost completely self-directed.

Exposure to physicians and other health care professionals either on an individual basis or in a team setting will enrich your experience by offering insight into the provision of collaborative care. For example, physicians may share their insights with you or describe the thought process behind a decision, or other health care professionals may describe the value of a particular assessment tool they commonly use.

Acknowledging the time invested by others in your development by expressing thanks demonstrates maturity and promotes further investment. Expressing appreciation in the moment demonstrates respect for others and increases acceptance on the team, creates a positive impression and solidifies relationships that may be helpful to you in the future. For example, when appropriate, consider using phrases such as, “This discussion was helpful,” “Thank you for demonstrating that skill,” “Thank you for explaining that concept,” “That’s good feedback” or “Is there anything I can look up to contribute to the team’s knowledge?” Upon completion of your experiential placement, be sure to formally thank anyone who contributed to your learning in any way.

Consider your experiential placement as an extended job interview

While the student is focused on completing academic requirements, work colleagues are evaluating the student’s attitude, behaviour and work quality. Ensure that your conduct will enable the preceptor to consider you for employment or provide a good reference. Be sure to demonstrate your flexibility to accommodate various situations that arise in the workplace. Offer suggestions to overcome challenges and demonstrate your ability to accept responsibility. The relationships you develop during the placement will be helpful to you in your career.

Conclusion

The strategies presented here can be valuable to students, preceptors and administrators within pharmacy education as guidance for ensuring student success in experiential placements.

While this list of strategies is neither comprehensive nor a formula for success, awareness of these behaviours can help students perform to the best of their ability. I believe there is value in making certain behaviours explicit for new learners. Students can then self-monitor their behaviour and make adjustments so that they feel in control of their learning outcomes. These strategies alone do not describe the behaviour of an ideal student (although these behaviours tend to be demonstrated by top performers), nor do they characterize the personality traits of an idealized student. In fact, I have tried to stay away from making comments about personality because I do not believe it should be the prominent driver of performance in a clinical placement. All students have their own skill sets, talents and personality and express themselves in their own way and to the best of their ability, and this makes them unique. Attempting to change aspects of someone’s personality to affect his or her performance in a placement leads to frustration for all parties and can be a source of conflict. I advise against this type of thinking.

For each student, there is room for growth, and seeing this growth is personally gratifying for the preceptor. If students or their preceptor find at least one strategy here that helps students achieve their learning objectives or facilitates their socialization to the team, I will have accomplished my goal. ■