Section 1: Basic Principles of Precepting

These principles are essentially universal to all optometry schools in terms of expectations of students and preceptors in the clinical setting.

Precepting students in a clinical environment is a mutually beneficial learning environment for the doctor, the student doctor and the patient.  To ensure that everyone gets the most out of the time together, the learner must feel comfortable to make mistakes, ask questions and push themselves to become more independent clinicians.  The doctor must nurture an environment for growth, encourage independence and critical thinking.  Hopefully this is achieved with minimal effort with all student interns and clinical preceptors, but in the event more effort is needed, please use this toolkit as a resource to enhance the clinical experience for all members of the learning team.   

Basic Principles for a Preceptor:

  • Teach by example.
  • Create a supportive learning environment.
  • Create a safe environment for students. 
  • Encourage students to ask questions.
  • Give informative balanced feedback.
  • Heighten student’s understanding and practice of cultural and linguistic competency.
  • Demonstrate the development of physician-patient relationship and communication.
  • Follow through.
  • Model “Patients First” mentality. 
  • Be on time for your patient care sessions. 
  • Move the patient flow along to ensure good time management for patients and students.

Part 1. Preceptor Expectations:

  • Review clinical policies and practice specifics early on.
    • Protocol for emergencies–whom do they contact, and what is the protocol for safety and reporting?  
    • What if they have something that requires immediate attention, what is the protocol?  
    • If they have a question or concern when not in the office, what is the preferred method of contact and all the players involved in that communication tree?
Preceptor Pearl: Students take in only a part of what they learn in orientation, just because there is a lot to take in. Have important points in written form so that they can refer to these elements later. 
  • Establish and review learning objectives with each student early on.  Make sure that everyone is on the same page and helps one another to feel like you are working towards the same goal. For example, if you are concerned with efficiency and they are concerned with accuracy, those two items may not be mutually exclusive in the beginning of clinical learning.
    • What are you hoping they learn over the course of the clinical rotation
    • What are they hoping to learn over the course of the clinical rotation
  • Coordinate student’s educational activities (student schedules), patient assignments, patient presentation styles and required components and desired flow when presenting clinical findings.
    • Set up your expectations of the student early to help them start to think clinically. Presentation of clinical findings and clinical thinking is a learned skill that takes time to develop.
Preceptor Pearl: Some students do best by watching the best practice modeled for them.  Others need to see the general flow in writing. Try to meet them in the way that is most effective for them, as presenting cases to a new preceptor can be nerve-wracking at first. 
  • Discuss specific expectations of oneself and of the student learner.
    • What if they don’t understand something, or need assistance, what is the preferred approach?
    • When should they be prepared for the clinical session? 15 minutes before patient care? 
    • Do they need to check in before picking up a patient?
    • When should a student check in with you?
    • Can they dilate a patient without consultation with you?
    • What testing is absolutely necessary on each patient?
    • How will you provide feedback to the student?
  • Lead discussion of clinical cases asking open ended questions.  
    • Ask thought provoking questions to see where they learner may have a learning gap.
    • Provide appropriate guidance to assist the learner and help them arrive at the best final outcome 
    • Encourage independent decision making and afford clinical externs the opportunity to formulate diagnosis and patient management plans.
  • Allow students different ways to respond to questions, i.e. in real time in the exam room, after some time to think on their own or to look up answers.  Not all students respond well to direct questions in the exam room or with peers within earshot.
    • Lack of feedback or feedback that is provided well past the learning opportunity impedes the learning
    • Allow the student a chance to remediate mistakes and foster an environment that creates mutual respect.
    • No feedback or lack of holding students accountable hinders the students success moving forward as this may create a false sense of ability that does not allow the student to know where to focus their efforts.
    • Be sensitive that students are sometimes under immense pressure inside and outside the classroom. If you suspect that a learner is struggling, ask for help from others or let other faculty know so that they can also discuss it with them
Preceptor Pearl: Provide Feedback that is consistent. Verbal feedback should match written feedback. 
  • Complete all grading in a timely manner. Discuss areas of strengths and weaknesses to foster an environment of back and forth dialogue.
  • Finish charting promptly and provide feedback to students as appropriate.

Part 2. Student Expectations:

  • Students should be familiar with policies, clinical hours and procedures to follow
  • Arrive on time, have all equipment necessary and be ready for patient care
  • Communicate any and all questions immediately for a quick resolution
    • Clarify expectations 
    • Complete assignments in a timely manner
    • Communicate goals for the rotation and areas for increased abilities
    • Communicate any misunderstandings early
    • Preceptors have the best intentions for your success.  If there is another way to better communicate with you, let them know that.  
  • You are a student who is integrating yourself into a busy practice. Understand that you are a part of a healthcare team and all members are expected to be present and deliver high quality patient care at all times
    • Any absence from the clinic should be taken very seriously and all individuals must be notified as early as possible especially if patient care is impacted.
  • Understand that you will be making mistakes in your learning process. It is your job as a student intern to remediate mistakes as quickly as possible and prevent similar mistakes from happening again
    • Ask questions
    • Be a self starter
    • Defensiveness, if a large internal barrier, can impede progress
  • Clinical requirements for patient care 
    • Identify, record and analyze pertinent history and problems presented by the patient
    • Demonstrate the necessary skills to examine and evaluate the patient to arrive at a rational diagnosis
    • Independently formulate a treatment and management plan and understand the implications of various treatment and management options
    • Provide preventative care, patient education and counseling to a level of understanding by the patient
    • Recognize when it is necessary to obtain a consultation and to coordinate care provided by healthcare providers and/or other professionals
    • Demonstrate knowledge of professional, ethical, legal, practice management, and public health issues applicable to the delivery of optometric care
    • Effectively communicate orally and in writing with other professionals and patients