Studies show that without orientation, learners take about two weeks to work out how to function in the office. Investing 30-60 minutes in orientation can prevent a lot of frustration and inefficiencies for you, the student, patients, and office staff.
Orientation must be well-timed and focused--the "good start" on which the experience can be built. Consider developing a Student Folder (paper or electronic) for:
- Orientation checklist-include all areas where the student will engage;
- Office staff list and duties-include staff in orientation;
Timing: Verify with the course director or coordinator when to expect the student in your practice. Plan to schedule 30-60 minutes for orientation as soon as the student arrives. Immediate, personal orientation by the preceptor is the ideal. If this is not possible consider:
- Ask the student to come earlier. Some preceptors meet the student in a more informal session before the first clinical day.
- Have the student shadow you for all or part of the first session, then incorporate what they observed about your practice into the orientation.
- Arrange for a staff member to orient the student to the practice site, patient flow, personnel and possibly major policies and procedures but ensure this information is reinforced in your personal orientation with the student.
Focus: The purpose of orientation is to set the framework for the experience in your office and start building the teacher-student relationship. Arrange to have uninterrupted time in a private area for orientation. Plan to cover:
- learning objectives;
- general expectations;
- operational issues (schedules, logistics etc);
- final assessment.
Learning objectives: There are specific learning objectives for the course. These usually follow the "knowledge, skills, attitudes/behaviors" (KSA) format to articulate how the student is expected to perform by the end of the experience.
These are specific, clear items that can be measured reliably and are the basis for the student's evaluation so they must be clear from the beginning. Ask the course director very early if you have any questions about what the student is supposed to achieve in your practice.
At orientation, go over the course expectations and what will be included in the final assessment with the student.
Prioritize a few key objectives to achieve while the student is with you. These should be based on the formal objectives for the course, plus the personal learning needs of the learner, and your priorities as the teacher. In addition to the formal course objectives, the student may have specific needs or interests, and you may be aware of special learning opportunities or important items that can best be learned in your practice.
Develop 2-5 specific objectives with your learner. Emphasize that these will be taken seriously and revisited during the experience. Above all, emphasize that the responsibility to achieve the objectives belongs to the student.
Some preceptors find a written "learner contract" helpful:
My learning objectives are (2-5 specific objectives):
My strategies for achieving these objectives are (specific action steps for each objective):
Objectives keep the learning on track, even when patient care gets very busy. To help ensure the objectives are useful, aim for ones that are SMART:
Use learning objectives to describe what the student will know or be able to do by the end of the experience. For example, by the end of the rotation, the student will be able to:
- Describe (or list) the most common reasons for change in cognition in an elderly patient (a knowledge objective)
- Perform a targeted physical examination on a primary care adult patient presenting with a headache (a skills objective)
Attitudes are more difficult to express in objectives and often address very personal and sensitive areas such as ethics, confidentiality and personal interactions with patients. Attitudinal objectives are often not objectively measurable and may rely on your subjective assessment of student behaviors. Common items include treating patients with respect and empathy, or maintenance of confidentiality.
Setting up realistic and practical objectives at the beginning of the experience and revisiting them frequently during the rotation provides structure in teaching and helps learners appreciate how they are progressing.
Using Learning Objectives to Plan Teaching Activities
Virginia Apgar Academy of Medical Educators Teaching Tip
General expectations: How should the student behave?
Medical students spend a lot of effort in trying to work out what supervisors want from them and frequently complain that they do not know what is expected. In addition to learning objectives, experienced teachers use orientation to explain "ground rules" and priorities to the learner.
These are highly individual and the environment in your practice may be very different from their previous learning experiences. To identify key areas consider:
- What do you want to ensure they do?
- What might be obvious to you but not to a newcomer to your practice?
- If you previously had a really outstanding learner, what did they do that you wish every learner copied?
Common items in general expectations include:
Responsibility for learning. Emphasize that the learning in the office will be focused on solving patient problems and there is little time to give mini-lectures or stop to read about the clinical issues. This requires that students "read up" in non-clinic time. Emphasize that you will help direct their reading/private study and will coach them on how to use it in patient care but that you will expect them to study without being specifically instructed to do so.
Regular feedback. Explain that the office experience will be like "coaching". You will be providing continuous feedback to help them improve as well as more formal feedback at set times during the experience. Encourage the learner to ask you for feedback and to help you keep it specific, timely, and focused on behaviors that can be improved.
Punctuality and time management. Because of patient flow and other issues, time management is much more acute in the office than in the teaching hospital. The learner may not fully appreciate that the office team depends on each person managing time well. Be specific about when the learner has to be in the office and about time spent on specific activities.
Appearance and professional behavior. The learner is a very visible part of the team. Although the medical school gives guidance about appearance and professional behavior, provide specific expectations for your office.
Communications. Preceptors differ in how they wish learners to be involved in charting, answering telephone messages, or communicating with patients. As regulations change, check with the course director about legal issues concerning students or residents making entries in patient charts.
Operational Issues: Where, who, how, when?
This very practical aspect of orientation can often be conducted by staff and many items can be addressed in a student folder. It covers everything the learner needs to know to function in the office.
Where? Items are often covered during a tour of the facility and emphasize the student work area, parking arrangements, location of equipment, and layout of the patient rooms.
Who? Includes introductions to key staff and explanations of their roles and expected interactions with the learner.
How? Can cover many aspects of dictation, records and communications systems as well as computer and library resources. Security and building access may also be an issue. This area can also cover major policies that are important to the learner such as confidentiality, expected conduct with staff and patients, and management of medications.
When? In addition to schedules, this should cover "special events" and arrangements to handle unexpected occurrences such as when a student is unable to attend a clinic session or the preceptor is unexpectedly unavailable for teaching.
The bottom line A short individualized orientation that establishes what the student aims to learn and how they are expected to use the time and resources of the office establishes a firm foundation for successful teaching.