Watching Your Baby Birds Fly: Precepting Residents

Since switching to working in the same clinics on a consistent basis I have had the simultaneous pleasure/horror of working with first and second year family practice residents every week.

I precept them like I was precepted in school. I teach them the resources I use and the important parts of of exam techniches. We talk about how to discuss screening, tips and techniques for IUD insertions and Nexplanon insertion and removal.

Medical residencies are intense and fulfilling and prepare physicians to do an incredibly difficult job, and I would have given my left arm for a residency. I try to be the preceptor I rarely had. The supportive presence available in the office, never judgemental or scolding, always letting them ask for help instead of jumping in during procedures.

In the office, I walk them through all the trial and error that I have endured through this past year.

I recently had a resident, who after I told her about using a q-tip to see the mark on the sound to measure the uterus during IUD insertions, respond quickly, “Oh, yes. I’ll do it that way next time.”

I was perplexed for a moment. What I was sharing as a helpful tip, my resident was taking as an instruction that that was how she must do IUD insertions when I was precepting her. I had some preceptors who insisted on this practice, instead of letting me explore what felt right and develop my own style. I quickly clarified, and the resident told me that it was common practice for attendings to all insist that you practice the way they do, and remember what each attending wanted.
Jesus, I thought to myself, that sounds exhausting. I have long thought that interdisciplinary learning is one of the most important things that we can all engage in. Many of the residents that I have worked with remind me of myself as a student. They are slightly awkward with patients, still uncertain of their counseling points, but sharp and full of all the latest research.

I feel such pride as they integrate my counseling into their exams and procedures, feel more confident with their skills, and grow in the few weeks I see them. Medical residency rotations are short, and I see these residents for four to six weeks total.

Most of the time, I love resident days. They are excited to learn and love coming in. Sometimes though, we catch residents on bad days. Uninterested, disrespectful of nurse practitioners in general and me specifically. These residents come few and far between, but make me nervous for their future practice.

I love precepting, and sometimes I think to myself, “you’re a midwife on the inside,” because midwifery isn’t just the practice of caring for pregnant women and catching babies; it’s an outlook on practice.

I recently worked with a lovely resident for four whole weeks. She was competent and kind and incredibly thorough. And now she’s moving on to her pediatrics rotation.

Today, we have a new resident. Will she be like the last resident? Will she not be interested in GYN? I can only imagine what my midwifery school preceptors would wonder as I walked, bright eyed, nervous and very very green, into their offices.

I’m still in my first year of practice and feel an odd pull between recent experiences as a student and learning how to be a teacher. I’ve scoured the internet and many journals, and there is little in the way of research on clinical teaching. Midwives, preceptors, and other learners, what did preceptors do to teach and nurture with you? How did you learn best?

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