Preceptor Development Program (PDP)

Lessons Learned in Developing and Implementing a Preceptor Development Program

The following lessons learned are offered to faculty developers who plan to start their own faculty development project from scratch or would like to adapt and use these Preceptor Development Program materials.

The lessons learned are organized according to stages of PDP program development:

• Literature Search
• Developing Materials
• Collaboration
• Implementation
• Training 
• Dissemination

Literature Search

1. Conduct a literature search to identify existing strategies for teaching and to serve as a basis for developing training materials. We searched Medline, HealthStar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and ERIC (the major education literature database). 
   
   In Medline and HealthStar, there are several major subject headings for health science student education:
   For educational programs and process:
   Education, Medical
   Education, Medical, Continuing
   Education, Medical, Graduate
   Education, Medical, Undergraduate 
   Clinical Clerkship
   Internship and Residency
   Education, Nursing
   Education, Nursing, Associate
   Education, Nursing, Baccalaureate
   Education, Nursing, Continuing
   Education, Nursing, Diploma Programs
   Education, Nursing, Graduate
   Nursing Education Research
   (And similar groups for dental and pharmacy education)
   
   For types of students:
   Students, Health Occupations
   Students, Dental
   Students, Medical
   Students, Nursing
   Students, Pharmacy
   Students, Premedical
   
   For precepting:
   Preceptorship
   
   There isn’t a specific heading for community-based education, so a search will usually retrieve a mix of campus-based education and community-based education.
   
   CINAHL has similar headings, but with more detail for allied health education.
   
   Strategy for ERIC: There is an entire group of terms for education, which includes the headings above, as well as a number of others, such as Teaching, Curriculum, and Problem-Based Learning.


2. To keep track of the literature, enter articles in a database as they are received.
   We chose ProCite, a database program designed for citation information. There are several other programs in this family. For a comparison of software programs, see "Bibliography Formatting Software: An Evaluation Template" at: http://www.burioni.it/forum/ors-bfs4/ors-bfs.htm, or Chorus at http://www-writing.berkeley.edu/chorus/eresearch/index.html. 
   
   It is also helpful to annotate each article as it is read. We labeled each article according to which topic it was most closely related, and then filed articles in a 3-ring binder by category.

Developing Materials

1. Make training materials concise with many clinical examples. Community-based teachers told us they appreciate specific, concise materials with lots of clinical examples. The non-physician author drew from clinical examples observed while video-precepting medical students and sought physician help for developing cases, identifying medical mneumonics, and providing a “reality check” regarding what teaching processes were appropriate to recommend given the time constraints of patient care. We also received community-based preceptors’ feedback on the modules.
2. Develop templates for each format early on. Develop templates for each format early on. This saves a lot of time and is particularly helpful when there is more than one author because it reduces inconsistencies caused by different writing styles. We found it easier to write the monograph of a given topic first, get the content down, and then adapt it for each format before moving on to the next topic. Given that most preceptors were not going to be exposed to all nine topics, we tried to overlap the topics to give each preceptor exposure to the central concepts of the series.
3. Keep your web site user-friendly. A lesson we have learned the hard way is that a web site that is not very user-friendly will not be used. We intentionally limited graphics and other items that would require fast computers and modems to access our page. However, the many steps required to download software and read our online training modules seemed to create a barrier to their use.
4. Use professionals to script, act in, and produce videotapes. Poor quality in any of these aspects is very distracting!
5. Establish clear guidelines for awarding CME. he Preceptor Development Project sought CME hours for each topic in each in depth format, i.e., monograph, videotape, web-site module, and seminar. The monographs, videotape and web-site modules are defined as enduring materials and require a different type of CME application process from the live seminars. All formats were based on the same content for each curriculum topic, (e.g. Setting Expectations), so all CME applications for the various formats used the same learning objectives, faculty, and evaluation forms developed for the specific topic.
   CME credit for the enduring materials was awarded for a 3 year period; credit for each seminar was awarded per activity and depended on which combination of topics were presented for each seminar. To facilitate the seminar approval process, a " fast track CME" procedure was developed whereby the paperwork documentation required for each specific topic was pre-approved and could be quickly combined into a specific seminar for final approval with a minimum of time and paperwork.
   For the curriculum topics to qualify for CME credit, staff documented the effectiveness of preceptor training as supported by the literature (needs assessment), developed specific learning objectives for each topic, identified faculty for each topic and developed standard evaluations for each topic. Enduring materials modules also required the development of post-tests, the successful completion of which was required before CME hours could be awarded to the learner. Each format of every curriculum topic was approved to award CME hours to physicians, physician assistants and nurse practitioners.
   Because MAHEC is a state-approved CME sponsor, only practitioners in North Carolina and contiguous states could earn Category 1 hours. However, any physician who views the material may self-select it for Category 2.

Collaboration

1. When staff who design and implement the program cut across organizational lines, have a mechanism in place that facilitates communication and establishes accountability for tasks.
   This project involved family medicine faculty, student program staff, librarians, Web developers, CME administrators, and evaluators. Staff on this project came from six different departments in three separate divisions. Keeping track of the various components of the program was a challenge.
   Oversight meetings, held every four months, enhanced communication and helped maintain accountability among key players from different departments in MAHEC.

Implementation

1. Have realistic expectations for rate of participation.
   Expect low participation rates if your preceptor development is part of a voluntary program. Conversely, if you want high participation rates, you will need to require participation. In our case, the rates of community-based rotations in North Carolina have increased so dramatically in the last few years, and community preceptors are feeling so squeezed by managed care productivity pressures, that we cannot afford to lose the preceptors that would drop out if we required participation.
   Conduct a survey or needs assessment of your targeted preceptors. Be clear about what you want to get out of your assessment and time it accordingly. At the start of the program, preceptors were mailed a close-ended survey about their interest in preceptor training, their preference of topics and how they would like the training to be delivered. They were also asked their preference for length and time of day for training. An open-ended survey at the start of the program might have been more helpful in assessing whether we were on the right track with our proposed set of topics and formats. This close-ended survey would have been more helpful closer to the time we sent out the materials, so that interest in the program generated by the survey would be promptly addressed, and the data about specific topic interests would have been more current.
2. Make preceptor training as user-friendly as possible, and integrate it into other activities.
   Take advantage of “teachable moments”: A portable training kit was assembled for program staff to take along on site visits to preceptors. During site visits, staff inquired about preceptors’ teaching experiences and tied in relevant topics. We went over the thumbnail of the topic, and then distributed the corresponding monograph or scheduled the corresponding office-based seminar.
   Tie into other training or activities. In our region, librarians are providing office-based Internet training to preceptors, so together we organized seminars that cover both Internet use and preceptor development.
   For the online modules, we looked for a computer-based instruction development software program that would be low-tech, inexpensive, and user-friendly. We found low-tech and inexpensive software, which we used to convert our Word monographs into computer-based modules. We mounted these modules on the MAHEC web site and preceptors’ test scores were reported via FTP to our web server.
   Unfortunately, the software we used requires the end user to download and install a separate reader software program. This created a major obstacle for preceptors. The reporting of scores via FTP instead of email was also not very user-friendly for faculty developers, because someone had to remember to look at the ftp site, rather than getting the scores in their email box. Finally, the software we used did not allow us to include survey questions, which could be used for gathering feedback about the materials. 
   
   We are currently looking at other software which could help us design more seamless Internet training materials.
3. Give preceptors feedback on their precepting.
   
   We planned to send training materials to preceptors when they received low student ratings on student feedback forms. We have found that discretion is helpful, however, in determining how receptive the preceptor will be to preceptor development.
4. Have a system in place to track preceptor training activities.
   
   We use an Access database to track preceptor interests and program participation. When a preceptor received CME for a monograph or web-based module, we then sent them another module on a different topic. The database also helped us evaluate the program.
5. Consider combining preceptor development training with Internet training.
   
   Our preceptors have access to a number of Internet information resources, such as Ovid Medline, Cochrane Database of Systematic Reviews, Best Evidence, MD Consult, and several hundred full-text journals. Preceptors mentioned their desire for enhanced training opportunities in how to use these resources.

Disseminating PDP Materials to Other Faculty Developers

This program was funded by a federal grant and the resulting materials are public domain. We disseminated our materials to other faculty developers by presenting the program at conferences, through our web site, and through word of mouth. We have received the loudest praise for this aspect of our program. 

1. Conferences: Conference participants greatly appreciate the free sharing of materials.
2. Weblinks: We registered the PDP web site with the major search engines. We also searched for related sites and asked that those sites link to us. 
   
3. The following pages have useful advice about how to get your website listed with search engines.
   Search Engine Submission Tips, from Search Engine Watch
   Checking Your URL, from Search Engine Watch (how to see if your site is included by searching on its URL)
   Submit-It!'s Search Engine Tips (contains useful information about how to get your page listed)

These are a few of the lessons we have learned in developing and implementing the Preceptor Development Program. We are eager to hear your experiences with these materials and with your own. Please share your lessons learned, Tell Dr. PDP.