This past week I walked in to work on a dreary Monday, still half-caffeinated, and a chipper young medical resident walked right into my office and introduced herself as the resident working with me today. I tried to hide my startled look, as no one had told me I would be charged with the learning of a resident that day.
Surprise! You’re a preceptor!
Well, shit, I thought to myself. I barely feel like I know what I’m doing half the time, and they want me to supervise and teach another whole person about this stuff?
I thought back to my time as a student, and all the things that I wish that preceptors had done for me, how I wish they had had me learn, the autonomy that I wish they had given me, because I knew in my heart that I was capable of doing the job. I had wished that they had asked me what I wanted to do, what my goals were for that day, what my strengths were, my weaknesses, things I wanted to work on, see, learn about.
I wish my preceptors had taken the time to let me think it through, to let me look under the microscope and talk through what I was seeing before my preceptor would tell me what they saw.
I wish that they had asked me what they were teaching me in school, and update their practice with the newest evidence.
But most of all, I wish they had given me constructive feedback, and told me when I had done something well. Finally gotten it right. When they had seen improvement from one visit to the next.
I held in my heart all of the completely awful experiences I had as a student and vowed to make the day a really fun one with the resident. To give her the independence that I know she is capable of (as student midwives we’re not yet licensed, medical residents are already doctors, but are still having some supported learning and training, something I would have given my left arm for).
But I also felt this slight trepidation as I sent the resident in with a patient with urinary tract infection symptoms. Will she check her temperature? Will she make sure she doesn’t have a kidney infection? Will she give her all the warning signs that the patient should look out for and when to return to care?
And all of a sudden, in that moment, I understood so much more about my preceptors. Why they wanted to have me just watch sometimes. Why they nit-picked my charting down to the last word. Why they wanted to be in the room with me, even though it made me nervous.
I knew that this resident, capable and smart, already in her nearly third year of practice was doing all the right things, and yet, deep down I had a gut feeling that I didn’t trust her seeing my patients as far as I could throw them. Why did I have this reaction? On one level, its because I take great pride in the care I give my patients, but at the end of the day, I now understand what my preceptors meant when they said to me, “it’s my name on that chart.” Should something happen, should something go wrong, should a test be overlooked, it’s my name at the top of the visit summary for that day. Each of those patients, even if I don’t see them directly, are technically under my care.
I’m sure it will take a while to learn to trust a student, and I’m sure if I had a chance to work with this resident again, my fears would be more alleviated, and we would learn to trust each other and develop a really solid relationship. Unfortunately, as a float clinician, I will probably never see this resident again.
This resident, in my opinion, had all the right attitudes about watching another provider. One of my favorite things when I started work was observing other midwives and nurse practitioners. Learning how they talked to patients about different forms of birth control, how they talked to women about breast exams, how to talk a tearful woman through her decision to have an abortion.
I am constantly out on my own now, and very rarely get to observe another clinician discuss these things with a patient, and I miss it dearly. So what was the one thing the resident wanted to do that day? Get a really good birth control schpeil down. And that’s the one thing that is the most difficult while you’re learning. You know the hand skills, you know the science, you know this birth control pill from that one, but how do you explain it to patients? How do you take a history quickly and get the whole picture of what’s going on? Those things come with time, practice, and observing someone else do it, over and over and over.
Sometimes, I don’t always have fun doing my job. Sometimes I’m frazzled. Sometimes I feel like I don’t know what I’m doing, but after spending a day working with a resident, I felt re-invigorated. I understand, in some small way why we’re encouraged to take students. Not only is it absolutely vital to train the next generation of providers, but suddenly, I remembered why I take such joy in my work. Why I love talking to women about family planning. Why I love talking women through their first pelvic exams. Why what we are doing is so necessary and important.
I left work that day feeling invigorated, helpful, and like I had helped a learner deepen not only her knowledge of gynecologic care, but also gave her some pearls to make practice a little easier (unfolding your sterile gloves on the tray under the patient to make a mini-sterile field during IUD inserts changed my life, and I’m guessing the residents’ too by the giant grin she gave after I showed her).
I still feel a little self conscious, and know that learning how to precept is a skill, and a difficult one to learn when you’ve only been in practice for such a short period yourself, but it’s one I can’t wait to practice again
Students and new-to-practice grads, what do you wish your preceptors had done with you? What great experiences did you have with your teachers? What not-so-great experiences do you think you learned from?