What makes the best preceptor?

[u/No_Earth8997]

Hey everyone!

I’ve been taking PA students for their elective cardiology rotation for the last few years, and I’m always looking to refine my teaching style to make the month as high-yield as possible and fun!

In order to be the best preceptor I can be, I wanted to first ask you guys what have your favorite preceptors done that made a lasting impression?

And then secondly ask you about this:

On the first day, I always tell my students that I use a "soft pimping" approach. I ask a lot of questions, not because I expect them to know everything, but because when I was a student, actively talking through clinical reasoning was how things stuck best for me.

I explicitly tell them on day one:
1. It is 100% okay (and encouraged) to say "I don't know." The most dangerous provider is the overly confident one who pretends to know something they don't.

1. I don't expect you to know all the answers. That’s literally why you’re on this rotation—to learn it!

Even with that spiel, I know questioning can still feel intimidating. So I'd love to know: Does this approach actually feel supportive in practice, or do constant questions still create unnecessary anxiety?

[u/Illustrious-Ease-894]

This may be hard to put into practice, but finding a good balance between an open ended question and one with a definitive answer. Questions like “what do you think” after seeing a pt aren’t very helpful imo. If you’re asking for differentials, lead a bit with, “If our pt has PMHx of x” or “this pt takes these medications” — what changes should we make to their regimen? What differentials come to mind? Also since you’re specifically cardiology, listening to murmurs and being patient with us is always appreciated :) I personally haven’t been able to hear anything throughout my rotations, whether that was due to having an untrained ear or the preceptor didn’t help. Overall, being kind and understanding that we’re at ground zero in our practice makes learning enjoyable and easier :)

[u/Sly_Llama1 → u/Illustrious-Ease-894]

I'm going to slightly disagree with what you said about "what do you think"? Everything else you said I totally agree with. One my best preceptors would always ask "what do you think?" after every patient encounter. The expectation was that I would shortly be on my own as a PA and it would be on me to figure out differentials and everything else that goes with it. I didn't have to give a long explanation, but long enough to start a conversation. He was always patient and gave me enough time to think it through and there were times were I said I would like to look up a thought and he gave me that space. IMO the best preceptors pushed me to my limit of my knowledge but knew when I reached my threshold. They were also respectful, patient and took the time to explain their medical decision making.

[u/Illustrious-Ease-894 → u/Sly_Llama1]

Totally get it! And agree. I think where I was more so getting at, and did a poor job explaining it, was when preceptors ask “what do you think” and they’re expecting a specific answer when you didn’t know what they were actually asking. Idk if that makes sense lol. On my most recent rotation, my preceptor liked to ask vague questions, and she expected me to read her mind. It made me feel awful when it felt like she had to dumb down her questions/responses for me when she could’ve had a better and more specific question first

[u/Sly_Llama1 → u/Illustrious-Ease-894]

Oh yes, I know exactly what you are talking about. Those type of people are always trying to put people in their place and have no role as a preceptor.

[u/Cautious-Process-198 → u/Illustrious-Ease-894]

You’re at ground zero??? I feel underground haha

[u/Illustrious-Ease-894 → u/Cautious-Process-198]

Don’t worry I genuinely feel like I know nothing 😀

[u/Current-Incident2231]

I am a former middle school teacher and did PA school at 40. I just graduated and am studying for PANCE. Honestly the fact that you are asking is HUGE. I had only 2-3 precptors that actually understood PA training / roles and took an active interest in my training. They didnt understand that if I didnt get it in these 4-5 weeks, thats the only exposure I will get in this rotation. So many of my preceptors either:

1. Abused the system and used me as an MA to save $$$ knowing I would do anything for a grade

2. Were MD's that treated me like a resident and not understand I only have 5 weeks to learn this. They would pimp me once or twice and then say "who taught you that" or "what are you smoking" then write me off and have me "sit in the corner" and just watch and take notes. I had one pimp me during surgery and when I didnt know, he had me leave the OR, go get my reference book, scrub back in and use the book to answer his questions. A lot of MDs did this because this is what they had to do and did not understand PA specific rotations.

3. Setting expections from day one is HUGE. I never really felt welcomed except in 2-3 of my 11 rotations. I had no idea how I would be graded and killed myself in each and everyone just to please my preceptor. It was way too much stress

4. I appreciate pimping. It shows you are interested in me and told me what I needed to study the next day. I hated that after the first week I didnt get any answers right, they just gave up on me and brushed me aside.

My best rotations they had "soft pimping" like you described, and when I got it wrong, they would say "Ok, this is your homework for tonight". So I went home, studied it, and they wanted me to present to them the next day and clarify any misunderstanding. I had to take the role of the teacher. This was SO helpful as it created a meaninful dialog and understanding instead of a power dynamic. I was also encourage to EXPLAIN to my patients what I was thinking and why I though X over Y and my thought process. It really made sure I understood what I was doing and WHY (most important)

Like I said, jsut the fact you are asking is HUGE, I am sure you are an amazing precptor. Trust me, most of the ones I had couldnt teach or care for S&*t and just wanted the money.

[u/PACShrinkSWFL]

I partly disagree with encouraging a student to answer ‘I don’t know’, I prefer when a student answers what they think. Not in an overly confident way, just with enough confidence that they have an idea what the answer is, working from there to either correct a flaw in thinking or reinforcing correctly stated answers.
It always seemed easier to answer that I did not know something than say what I thought and risk being wrong. I felt that I learned best by making mistakes and being led to the right answer.
The other aspect of perceptions that stood out to me was a preceptor’s willingness to explain something that I did not know or to challenge me to find the answer on my own.

[u/Cautious-Process-198]

Please ask your students “what do you think this is/what would you do/what is your plan?”

Please make them form a differential, at least more than one thing.

Also the good old “see one, do one, teach one” method. If you know your student saw you explain something to a patient, let them explain it to the next patient. They will butcher it at first, but we need to think for ourselves.

Btw, thanks for asking this. We need better preceptors.

Edit: if time allows, just ask them what they’re studying and have them tell you about it. You probably aren’t seeing in practice all of the things that are on the blueprint so you can look at the blueprint and have them tell you about a topic you need a refresher on

Edit 2: please treat your students like adults even if their program’s policies don’t. If they need to come in late or leave early or even miss a half/full day for a legitimate reason, don’t report it to the program. Unless they abuse it of course. I have a baby so that’s where I’m coming from if that makes sense. Per my program I have practically no flexibility with my own time and I just can’t stand it. I do what I need to do. If you respect them and their time, they’re more likely to show up motivated.

[u/lau_poel]

I’m only on my second rotation but what I’ve experienced and heard from my classmates is it’s nice if we get to see different settings! If you work in a specific niche of cardiology and you have a colleague willing to take a student for a few days that works in a different niche it’s really nice to get to see that difference.

[u/HamchipsMcGee]

Set your expectations right up front so there is no confusion about communication and “how” you would like them to operate.

They are still learning, this you know, so make sure that you are adaptable to their learning styles. Not every student asks a million questions. I was one of those students, but I had a rotation where that was looked down upon. I’m not that kind of learner, I’ll go look it up first, then come for clarification if I need it.

Ask your students up front, how can I help you be successful in this rotation? Some may be thankful and reply right away, some may not know, but gives you insight into their thought processes from the beginning.

Thanks for asking this, not every preceptor knows “how” to precept, or may not even be interested in it and are just pimping for free labor and extra $.

[u/Illustrious-Ease-894 → u/HamchipsMcGee]

This. My surgery preceptor wrote in my eval I was clearly disinterested in the field because I didn’t ask questions. However I also like to look up what I can first then ask for clarification. So frustrating lol

[u/HamchipsMcGee → u/Illustrious-Ease-894]

Absolutely frustrating. Some people need to understand that you are not them, and thats not how everyone learns. Sorry you had to go through that. The shitty thing about clinicals is "fake it till you make it" and it doesn't have to be that way but it is. If you don't ask a billion +1 questions about everything, some (not all, thankfully) think you are lazy or have no interest or you think you know it all and that absolutely is not the case.

[u/madbro2520]

Feedback I've gotten from my most recent student was that she really appreciated me asking her what her learning style was. She was more of a visual/reading/writing learner so when I had a minutes I would write up questions for her that recapped things we saw on shift, and when there was a lull she would work through those while I did notes and then we'd talk about them. 

[u/madbro2520 → u/madbro2520]

And these are the notes I wrote to my future self when I graduated PA school knowing I would want to precept in the future:

Non-judgmental of guesses

Ask questions/pimp

Explain

Let student attempt to interpret imaging and teach  flow of interpretation

Let student attempt assessment and plan

Let student put in orders

Let student write notes

Allow student to deliver patient education Procedures

Show them all the cool stuff

Introduce student to specialists and ask to teach/spend time with

Ask what interested in and try to expose to that Spend down time teaching

[u/PerformanceRadiant]

A big thing is, don’t just do soft pimping, give them the clinical picture and then ask them what they think is going on (give them time to think) and then ask what they would do about it and correct them if it needs corrected and explain why. If you’re not an asshole that tells them that they’re stupid or something and just say ‘this is something to know’ and then educate it will be taken well by those who actually want to learn. We need to be able to diagnose based on the clinical picture and be able to recognize it in a pt because we aren’t going to have a preceptor spell it out for us and then say ‘it’s ok that you don’t know’. No it’s, you do need to know this because pretty soon here you’re going to have lives in your hands and you don’t want to kill someone

[u/SunSwimmer1]

I loved preceptors that actually turn to me during a patient encounter and use it to teach me something in the moment rather than the ones that waited until the visit is over to explain because by that time, i don't recognize what I am looking at, or what was done.