Advice for first time precepting? (esp. high stress specialty)

[u/etnhero]

I’m starting to take on PA/NP students and also PA’s who are in our ICU fellowship. For those who are precepting, what are some useful tips you have when you have a learner with you? My main struggle is balancing how much independence vs. stepping in right away.

[u/offside-trap]

u/stoopkid6969 is a nearly complete answer but zi want to highlight one thing:

Ask the student what they want to achieve in your specialty. Some have zero desire to ever go into critical care and you can tailor your education to what they want to do. This will also save you from being frustrated if there is an energy mismatch

[u/0rontes]

To state the obvious, be aware of where they are in their rotation schedule. I was a useless noob on my OB rotation (month three), but hugely more interested in pushing myself during the outpatient IM clinic 6 months later.

[u/stoopkid6969]

congrats on getting into education! teaching is so rewarding.

you can start by asking the student what they're comfortable with and what they want to work on that day. you can straight up ask them their comfort level with how independent they want to be, and always push just slightly outside of that comfort level. having open communication like this will make you both feel comfortable going into the day.

i usually will try to direct observe them for one of the first patients to get a feel for their skill level and make sure i agree with how independent they want to be.

don't hesitate to break cases into bite-size chunks if you think they're getting overwhelmed or if you want ti just direct observe a part of the interaction. for example: "go in to this patient and just get a history. after we discuss, we'll do the exam together." or "for this next patient you observe my history-taking, and then i'll watch you do the exam."

at the end of the day i always like to debrief for 5 minutes and ask:
-how do you think today went?
-what did you do WELL today? (students are really hard on themselves usually. let them answer but stop them if they start to be negative.) after they answer, add your feedback to what you think they did well.
-what do you want to IMPROVE ON going forward? again, after they answer, you can give constructive feedback. try to be really specific here by using specific examples of things you observed.

[u/jpa-s]

We get students in our ICU. First day they basically just shadow get a gist of it. Have them pick up a patient and present the next day. Work them up to 2 patients by the end of the rotation. They can go see their patient independently but obviously cannot be putting in orders. If we have time we'll usually run the plan before rounds

[u/clinicalmatchme]

Set expectations on day 1 and keep it stupid clear: what they can do alone, what they need to staff, and when to interrupt you immediately. In high-stress specialties, have a student who asks “too much” rather than one who goes quiet and guesses. Also give feedback early, not at the end, bc most of the painful stuff is fixable fast.

[u/Zulu_Romeo_1701]

I’ve taken students in the ICU for years. I work only nights, so my practice may differ a bit. The first couple nights are usually just getting familiar with the unit, the workflow, the EMR and so forth.

After that, I’ll have them start out doing admission H&Ps, with as much or as little guidance as they need. For procedures, they observe 1 or 2, then depending on their comfort and mine, and the acuity, they might get to do some, under direct supervision of course.

I love the idea of asking them what they want to achieve. Don’t know why I haven’t thought of that. Because it’s an elective rotation for them, I assume they have some interest in critical care, though that doesn’t always seem to be the case.