Mentoring Matters

1
Mentoring Matters

• Marcia Docherty, RTNM, MA
• 2007 SAMRT Fall Conference

2
Overview

• Review of the preceptor model
• A preceptor framework
• Precepting techniques

3
The Preceptor Model

• Apprenticeship model
• Contributing to the work environment with
  learning as a secondary outcome (OMara, 1997,
  p.48)
• Preceptor model
• Neophyte works alongside an experience
  practitioner in a one-to-one relationship
• Clinical teaching model
• One clinical instructor teaching 8 to 10 students
  in the hospital setting

4
The Purpose of Preceptorship

• A variety of reasons exist for including a
  practicum in academic programs (Practicum Study
  for HPS, 2003, p. 5)
• A mandatory, prescribed length of experience for
  professional registration
• An opportunity to apply and develop classroom
  learning or theoretical concepts in work settings
• Opportunities to clarify or determine career
  directions
• Opportunities to identify and utilize the generic
  skills they are developing
• Opportunities to become work literate, to
  establish contacts, and to gain experience in the
  workforce

5
Preceptor Models

• Orientation Model
• Educational Model

6
Orientation Model of Preceptorship

• Used to orientate new hires, particularly in the
  field of nursing
• Developed in an attempt to improve recruitment,
  retention, and job satisfaction (Belcher, 1997,
  p. 119)
• The preceptor is accountable for thoroughly
  evaluating the skill set of the orientee and
  socializing them to the workplace
• Preceptors are selected and trained for the
  position
• Both preceptor and orientee are accountable to a
  manager

7
Educational Model of Preceptorship

• Barnum (1997) defines precepting as a subset in
  the instructing relationship that falls between
  teaching mentoring
• Teaching is about learning content and the
  personal relationship is secondary
• Mentoring is focused more on individual needs
  than content
• Precepting requires specific content,
  individualized for each student

8
Educational Model of Preceptorship
9
Challenges of the Educational Model

• Preceptors are automatically expected to function
  in this role without additional training or
  actual demonstration of aptitude or skill
• Placement with preceptors typically made on
  availability
• Logistical restraints rarely allow for consistent
  placement with one preceptor
• Preceptors do not work in isolation and require
  support from peers and administrators

10
Challenges of the Educational Model

• A students disposition to their learning will
  affect his/her perceptions of the experience
• Student satisfaction with the job does affect
  their performance proportionally
• Novices cannot be sure that their preceptor is
  competent
• Gender will influence the students perceptions
  of a preceptors abilities
• Positive preceptor characteristics far outweigh
  site characteristics

11
Challenges of the Educational Model

• Lack of linkage between academic staff and
  preceptors
• Faculty are rarely involved in the practicum
  experience
• Preceptors are often unaware how he/she fits into
  the educational sequence
• Practicum curriculum is developed for students
  often without input from the preceptors
• Preceptors unfamiliar with program curriculum
  cannot accept and internalize the programs
  values
• The effective integration of learning components
  results in a cohesive educational process
• CMA, 2001

12
Roles and Responsibilities of the Preceptor
evaluators
answers questions
teachers
guide
support system
facilitator
role models
mentor
student advocates
subject matter expert
liaisons
coach
supervisor
clinical educator
mediator
demonstrates best practices
experiential expert
13

• Working knowledge (the action knowledge used
  in the workplace) is qualitatively different from
  the knowledge of school
• Munby, Versnel, Hutchinson, Chin Berg (2002)
  p.1
• School knowledge is declarative while workplace
  knowledge is procedural

14
Requirements of a Preceptor

• Clinically competent
• Willing to share knowledge skills
• Willing to function as a preceptor
• Able to prioritize
• Great time management skills
• The art of precepting is knowing when to widen
  the experience to ensure student competency and
  when to set boundaries on the experience to
  reduce the risk of failure

15
The Role of the Preceptor

• Cooperating occurs when the preceptor initially
  determines with other technologists, faculty, the
  student and the program curriculum what learning
  needs to occur.
• Valuing happens next as the preceptor sets
  boundaries on the experience through observation
  and listening to the student.
• Task-oriented learning focuses on providing the
  student with hands-on experience of the job using
  a variety of techniques.
• Communicating focuses on articulating the roles
  and the profession as well as providing time for
  reflection.

Öhrling Hallberg, 2001, p. 539
16
Precepting Techniques

• Sheltering the Students When Learning

17
Cooperating

• Setting learning goals with the student, other
  technologists, faculty program curriculum
• Conflict management styles
• Complete the questionnaire and score

18
Conflict Management Styles

• A - competing
• B - collaborating
• C - compromising
• D - avoiding
• E - accommodating
• The higher your score in a specific area, the
  more likely you are to use that conflict
  management style.

19
Conflict Management Styles

• Each style has a role to play in the workplace,
  but the best conflict management approach is
  collaboration.
• Only collaboration can lead to problem solving
  and true conflict resolution.
• Consider any patterns that
• may be evident in your score
• and think about how to better
• handle conflict.

20
SOAP Approach to Conflict Resolution

• Subjective
• What do you/others think and say?
• Objective
• What are the specific behaviours that are
  observed?
• Assessment
• Your differential diagnosis of the problem.
• Plan
• Gather more data/intervene/get help

21
Valuing

• Setting boundaries on the experience

22
Emotional Learning

• Emotional learning anchors knowledge
• If I am activated appropriately, I will be able
  to react
• If I am overloaded, I will freeze up
• When learning in highly activated states
• Knowledge is recalled when similar states are
  invoked
• Anchors mastery under stress
• Knowledge tends to be indelible

23

• How do we create an environment in which the
  student feels simultaneously challenged and
  psychologically safe enough to engage in
  learning?

24
Debriefing

• A means to improve professional effectiveness
  with the student
• A process that helps students recognize and
  resolve pressing clinical and behavioral
  situations raised by the experience and the
  judgment of the instructor.
• The act of reviewing a real or simulated event in
  which participants explain, analyze and
  synthesize information and emotional states to
  improve performance in similar situations.

25
Three Stages of Debriefing

• Reactions - Clear the air and set the stage for
  discussion feelings
• Understanding - Understand what happened and
  explore deeper meaning
• Summary Review what was learned and ensure the
  single scenario is put into a larger context

26
Dirty Questions

• Not all questions are created equal!
• Advocacy That was really stupid?
• Inquiry What the were you thinking?
• Cleaning questions is a learned
• skill

27
Advocacy-Inquiry Approach

• Advocacy I noticed you had the patient lying
  prone on the bed/table?
• Inquiry Can you tell me why you chose to do
  that?

28
Debriefing

• Advocacy Statements use I
• I noticed that you were
• It seemed to me
• I thought our policy was to
• I observed you getting
• Inquiry Statements keep them short
• I am curious to know how you got there?
• I wonder why?
• I wonder what happened?
• I didnt see you wash your hands after that
  patient. Did I miss that?
• I didnt see you introduce yourself. Why do you
  think you didnt?

29
Debriefing

• Use good judgment
• People make mistakes
• Assume they meant to do the right thing
• Believe they were prepared, care about doing
  their best, want to improve . . . OR . . .
• Entertain the 5 chance that there is a
  legitimate reason
• You have valuable expertise and insight you are
  paid to be discriminating

30
Example Exercise

• Dirty Question
• Advocacy
• Inquiry

31
Precepting Techniques

• Facilitating the Students Learning

32
Task-Orientated Learning

• Provide hands-on learning
• Think about the last time you learned something
  new. How many of you . . .
• prefer doing and experiencing?
• prefer observing and reflecting?
• prefer to learn the underlying concepts and
  reasons?
• prefers to try things to see if they work?

33
Perception Continuum How we think about things
Processing Continuum How we do things
34
Learning Styles

• Whats your preferred learning style?
• Complete the questionnaire
• Circle the best response
• Total each column

35
VAK Learning Styles

• Visual learning style involves the use of seen or
  observed things, including pictures, diagrams,
  demonstrations, displays, handouts, films,
  flip-charts, etc.
• Auditory learning style involves the transfer of
  information through listening to the spoken
  word, of self or others, of sounds and noises.
• Kinesthetic learning involves physical experience
  - touching, feeling, holding, doing, practical,
  hands-on experiences.

36
Learning Styles

• Be inclusive of other learning styles
• Vary your approach
• Experience, watching, thinking, doing
• Visuals, lectures, activities

37
The One Minute Preceptor

• Get a commitment
• Probe for supporting evidence
• Reinforce what was done well
• Give guidance about errors and omissions
• Teach a general principle
• Conclusion
• http//www.oucom.ohiou.edu/fd/monographs/microskil
  ls.htm

38
The One Minute Preceptor

• We have a patient with L-Spine pain/tumours. What
  protocol should we follow?
• Why do you think this?
• You were right to suggest . . .
• But what about the theory behind . . ?
• When I have patients with L-spine pain/tumours I
  consider . . .
• Lets get the patients history and make a final
  decision on the protocol.

39
Communicating

• Reflective Practice
• The discipline of examining the values,
  assumptions, and knowledge-base that drives ones
  own professional practice
• Making sense of the way we actively filter,
  create and perceive our environment
• Reflective practitioners who learn to scrutinize
  their taken-for-granted assumptions and mental
  routines are able to self correct and improve
  their professional skills (mastery)
• The simple act of reviewing the event with the
  preceptor helps the student analyze and
  synthesize the information

40
Communicating

• Values
• The basic notion/conviction of what is right and
  wrong
• Primarily genetic, can also be influenced by
  national culture, parents, teachers, friends, and
  other environmental factors
• Differ between generations, regions, cultures
• Fairly stable over time
• Influence attitudes and behaviours

41
Communicating

• Value Systems
• Ranking an individuals values in terms of
  intensity
• Rokeach Value Survey
• Terminal values are the end-state we hope to
  achieve in life
• Instrumental values are means of achieving these
  terminal values

42
Rokeach Value Survey

• To complete the survey, number all the terminal
  values from 1 to 18 in order of importance
• Repeat with instrumental values
• TODAY Take 5 minutes and pick
• your top choices on both sides

43
Communicating

• In groups assess how the following people might
  react/behave in this scenerio based on their
  values
• You are working the late shift and for the 3rd
  day in a row, the physician has asked you to stay
  late again (overtime) and do another stat
  patient.
• I value an exciting life
• I value freedom
• I am ambitious
• I am honest
• How would you react in this situation? How does
  your reaction align with your values?

44

• If you want to understand a persons behavior,
  you must understand his/her values.

45
Conclusion

• Education model of preceptorship
• formative vs summative feedback
• Preceptor framework
• Shelter the student when learning
• Conflict management
• Debriefing
• Facilitate the students learning
• Learning styles
• One minute preceptor
• Values reflective practice

46
Mentoring Matters

• The role of mentoring rather than imparting
  information is very challenging

47
References

• Barnum, B. S. (1997). Precepting, not mentoring
  or teaching Vive la différence. In J. P. Flynn
  (Ed.), The role of the preceptor A guide for
  nurse educators and clinicians (pp. 1 14). New
  York Springer Publishing Company, Inc.
• Belcher, A. E. (1997) Beyond preceptorships
  Internships and externships, fellowships/apprentic
  eships and mentorships. In J. P. Flynn (Ed.), The
  role of the preceptor A guide for nurse
  educators and clinicians. (pp. 119 137). New
  York Springer Publishing Company, Inc.
• Canadian Medical Association. (2001). Program
  assessment report. Ottawa CMA.
• Debling, G. (1999). Skill retention and decay An
  extract from the report of a project conducted on
  behalf of the College of Physical Therapists of
  BC. Unpublished manuscript.
• Driscoll, M. P. (2000). Psychology of learning
  for instruction. Boston Allyn and Bacon.
• Munby, H., Versnel, J., Hutchinson, N. L., Chin,
  P., Berg, D. H. (2002, April). Workplace
  learning and the metacognitive functions of
  routines. Paper presented at the annual meeting
  of the American Educational Research Association,
  New Orleans, LA.
• Öhrling, K., Hallberg, I. R. (2001). The
  meaning of preceptorship Nurses lived
  experience of being a preceptor. Journal of
  Advanced Nursing, 33(4), pp. 530-540.
• OMara, A. M. (1997). A model preceptor program
  for student nurses. In J. P. Flynn (Ed.), The
  role of the preceptor A guide for nurse
  educators and clinicians (pp. 47 74). New York
  Springer Publishing Company, Inc.
• Practicum study for health and public safety.
  (2003). Calgary, Canada HSS-Health Service
  Solutions.
• Wilson, M. A. (2002). Dietetic preceptors
  perceive their role to include a variety of
  elements. Journal of the American Dietetic
  association, 102(7), pp. 968-975. Retrieved from
  ProQuest February, 25, 2005.

48
Questions?