Preceptor Perceptions Research Articles

Perceptions of Nurse Managers and Nurse Preceptors: Are New Graduate Nurses Displaying Competency According to the New Graduate Nurse Performance Survey?

Assessing new graduate nurses' competency is an important outcome of the orientation and evaluation process. Nurse managers and nurse preceptors act as key stakeholders in the transition of new graduate nurses to professional practice and are often charged with the responsibility of assessing the competency of new graduate nurses. This article provides insight in regard to the perception of postorientation competency levels of new graduate nurses.

Analysis of the Perception of Interns, Residents, and Preceptors through the Mini-CEX Evaluation Method (Mini-Clinical Evaluation Exercise)

Abstract: Introduction: Mini-CEX is an evaluation method that covers the domains: anamnesis, physical examination, counseling, clinical judgment, organization, and professionalism. It has been tested and validated for use in any practice scenario. With its characteristic of providing feedback after a clinical assessment, the Mini-CEX can also be used as a training method to guide the professional development of students and teachers, promoting greater knowledge retention in undergraduate students and continuously providing information for students to realize how far they are from the desired objectives. The aim of this study was to assess the perception of interns, residents, and preceptors of Internal Medicine (IM) regarding the Mini-CEX instrument. Methods: Qualitative study, using the focus group technique, carried out from February to July 2017. Twenty interns, thirteen residents, and five IM preceptors participated. It consisted of six focus groups, two with interns, two with residents, and two with preceptors, using semi-structured questions that identified perceptions, through the methodology used, on the quality of the evaluation and possible repercussions for the teaching-learning process. Results: In the focus group of interns, the feedback moment of the assessment was considered essential for the learning process, although the bedside assessment was tense due to the preceptor’s presence. The residents reported that the evaluation was a valid one, as it led them to review some points in the medical literature, in addition to stimulating clinical reasoning in the face of a real situation. The preceptors validated the importance of the feedback for those who were evaluated and identified the bedside assessment as a moment for the best analysis of the individualities. Conclusion: Through the perceptions of the groups in focus, the mini-CEX was identified as a fundamental instrument for the teaching and learning process of all those involved and the need to structure the moment of feedback aiming to attain a more effective result. During the bedside assessment, the stimulus to clinical reasoning was identified as a positive point and the strangeness, anxiety, and tension as negative points.

Analysis of the Perception of Interns, Residents, and Preceptors through the Mini-CEX Evaluation Method (Mini-Clinical Evaluation Exercise)

Abstract: Introduction: Mini-CEX is an evaluation method that covers the domains: anamnesis, physical examination, counseling, clinical judgment, organization, and professionalism. It has been tested and validated for use in any practice scenario. With its characteristic of providing feedback after a clinical assessment, the Mini-CEX can also be used as a training method to guide the professional development of students and teachers, promoting greater knowledge retention in undergraduate students and continuously providing information for students to realize how far they are from the desired objectives. The aim of this study was to assess the perception of interns, residents, and preceptors of Internal Medicine (IM) regarding the Mini-CEX instrument. Methods: Qualitative study, using the focus group technique, carried out from February to July 2017. Twenty interns, thirteen residents, and five IM preceptors participated. It consisted of six focus groups, two with interns, two with residents, and two with preceptors, using semi-structured questions that identified perceptions, through the methodology used, on the quality of the evaluation and possible repercussions for the teaching-learning process. Results: In the focus group of interns, the feedback moment of the assessment was considered essential for the learning process, although the bedside assessment was tense due to the preceptor’s presence. The residents reported that the evaluation was a valid one, as it led them to review some points in the medical literature, in addition to stimulating clinical reasoning in the face of a real situation. The preceptors validated the importance of the feedback for those who were evaluated and identified the bedside assessment as a moment for the best analysis of the individualities. Conclusion: Through the perceptions of the groups in focus, the mini-CEX was identified as a fundamental instrument for the teaching and learning process of all those involved and the need to structure the moment of feedback aiming to attain a more effective result. During the bedside assessment, the stimulus to clinical reasoning was identified as a positive point and the strangeness, anxiety, and tension as negative points.

PROFESSIONALISM IS PRIORITY FOR MACAO CLINICAL NURSING STUDENTS: FOCUSED ETHNOGRAPHY OF PRECEPTORS

Clinical preceptors are primary mentors as well as important role models for nursing students who are learning skills, knowledge and critical decision-making in clinical practice. However, little is known about how the preceptors perceive nursing students during their practicum in a Chinese society. The study used a focused ethnography to explore clinical preceptor perceptions of nursing student performance in professional attitudes, knowledge, theory, and nursing skills. The preceptors were from critical-care, surgical, and medical units of hospitals, health-care centers, and nursing homes. Twenty clinical preceptors participated in 30-60 minute interviews that were transcribed and analyzed. One principal theme that emerged from the study was the need for greater professionalism. The nursing professional demeanor of students theme includes subthemes of active behaviors, having ?heart? or attitude intent to learn to do the work of nursing, and demonstrating a professional image. If nursing students show these attributes during clinical experiences, it was believed that all other learning would take place easily. Academic educators and clinical preceptors are in the best position to foster student development and expressions of professionalism.

Development and evaluation of physician-precepted advanced pharmacy practice experiences (APPEs) within an accountable care organization (ACO)

Background and purposeThe American Council of Pharmaceutical Education (ACPE) standards emphasize that pharmacy graduates should be “practice- and team-ready,” and the American Society for Health-System Pharmacists (ASHP) Task Force on accountable care organizations (ACOs) states that curricula at pharmacy schools should be evaluated and reworked to prepare students to practice effectively as members of the health care team within ACOs. The objective of this study was to describe the development of an ACO-based advanced pharmacy practice experience (APPE) rotation block, clinical activities and interventions completed by students during the experience, and perceptions of students, patients, and physician preceptors regarding the experience. Educational activity and settingThe rotation block was within outpatient ACO offices and consisted of a four-week rotation with one pharmacy faculty, immediately followed by a four-week elective experience in a different office with a physician serving as primary preceptor. FindingsEight students completed the rotation block between August 2017 and April 2018. Students documented a total of 1299 clinical activities and 65 interventions. Medication reconciliation and recommendations to initiate a medication were the most commonly completed activities and interventions documented. The experience was positively perceived among surveyed students, patients, and physician preceptors. SummaryThe rotation block was successfully implemented with a positive response from students, patients, and physician preceptors. As a result, the program has expanded in accordance with ACPE Standards to create “practice- and team-readiness” among graduates and expose students to interdisciplinary care within ACOs and other settings.

Reorientação do estágio de Odontologia no SUS subsidiada pela criticidade de preceptores

O preceptor de estágio exerce influência chave na formação profissional e pessoal do estagiário. Uma vez que o preceptor está grande período de tempo em contato com o acadêmico, este pode auxiliar na identificação das principais limitações do estágio curricular de Odontologia no Sistema Único de Saúde (SUS). O objetivo deste estudo foi expor percepções críticas de cirurgiões-dentistas preceptores de estágio no SUS, com enfoque no processo de reestruturação curricular de um curso de graduação em Odontologia. Realizou-se pesquisa exploratória e descritiva com abordagem qualitativa junto a cirurgiões-dentistas preceptores de estágio (n=8) do referido curso. A apreensão das informações se deu por meio da técnica em entrevista de Grupo Focal e os dados foram transcritos e categorizados por meio da Análise de Conteúdo Temática. Da análise emergiram quatro dimensões: Estrutura Organizacional, Perfil do Estagiário, Serviço de Saúde e Atuação do Orientador. Os preceptores investigados assumem a importância do estágio para a integração entre academia e serviço. Todavia, sua percepção encontra-se arraigada no modelo biologicista, o que sugere um enorme desafio às políticas públicas atuais e em especial à mudança curricular do curso de Odontologia, centrada na integralidade da atenção humana e na abordagem humanista, crítica e reflexiva em saúde.

A Retrospective Study of the Clinical Capstone Experience on Perceptions of Practice Readiness in Associate Degree Student Nurses and Preceptors

This Student Transitional Experience into Practice (STEP) study explored differences in perceptions of practice readiness expectations between associate degree student nurses and their preceptors after a clinical capstone experience. The STEP study is a quantitative, retrospective design, secondary data analysis using a practice readiness survey delivered to associate degree nursing students and their nurse preceptors. Student and preceptor perceptions of practice readiness varied significantly across skill competency domains.

A Comparison of Student Outcomes Between Longitudinally and Traditionally Placed Advanced Pharmacy Practice Experiences

Objective. To compare performance outcomes of students completing a longitudinal pharmacy practice experience at a single site with those of students completing advanced pharmacy practice experiences (APPEs) at a variety of practice sites. Methods. Performance data and other meaningful outcomes from a cohort of students completing a six-month experience within a single health system (longitudinal group) were compared to data from a group of students completing six months of similar APPEs at multiple health systems (control group). Results. Motivators for participating in the longitudinal program varied, with students in the program identifying practice interest alignment, schedule simplification, and desire to do a residency; and students choosing to not participate in identifying schedule flexibility and experience at a variety of practice sites. The 16 longitudinal students differed from the 20 control students at baseline in grade point average and the number of scheduled community pharmacy APPEs. Performance measures for longitudinal students and control students did not differ significantly, but the difference between students' self-perceived effort and preceptor perception of student effort was significantly different for control students compared to longitudinal students. Residency match rates and number of students receiving recognition for high academic performance were similar in the two groups. Conclusion. Students participating in the longitudinal program had different motivators but comparable outcomes to students who completed similar APPEs at a variety of practice sites.

An immersive clinical experience to create sustainable clinical learning opportunities for nurse practitioner students.

A significant increase in nurse practitioner program enrollment has resulted in a critical need for committed preceptors willing to offer clinical learning opportunities for students. Academic practice partnerships have been proposed as a strategy to address the preceptorship crisis. This project evaluated the impact of a longitudinal immersive clinical experience designed for nurse practitioner students in collaboration with two federally qualified health centers and an underserved clinic within an academic health center. The study used a pre- and postsurvey method to determine the impact of an immersive clinical experience on preceptor perceptions of benefits and rewards, support, and commitment to the role. A statistically significant increase in preceptor perception of support was noted in three areas. Participants reported increased opportunity to share information with other preceptors, improved support from nursing faculty to help identify students' performance problems, and greater clarity in faculty responsibilities related to the preceptor role. Increases in perceptions of benefits and rewards and commitment to the preceptor role did not reach statistical significance. Immersive clinical experiences have the potential to improve the levels of preceptor support, commitment, and perceived opportunities for benefits and rewards, which may facilitate the development of high-quality, sustainable clinical learning opportunities for nurse practitioner students.

Improving Retention of Home Health Nurses

Home healthcare plays an increasingly vital role in contemporary postacute healthcare. Staffing instability and lack of perceived organizational support is a stimulus for nursing attrition from the organization with far-reaching impact on staff morale, patient care, agency budgets, and relationships with other healthcare settings. The purpose of this article is to describe a redesign of an agency's nursing orientation and the development of a mentorship program for newly hired home healthcare nurses within a large Midwestern integrated health system. During this time frame, 154 nurses completed the newly designed orientation program and, of those, 91 participated in the mentorship program. In this article, we evaluate 1-year new-hire nursing retention rates over a 4-year period, examine new-hire job satisfaction and perceptions of preceptors and mentors during their first year, and discuss issues of outcome sustainability. Agency-wide turnover rates for all home healthcare nurses decreased from 15.4% in 2016 to 10.1% in 2018, demonstrating the associated impact of these initiatives on staffing stabilization.

Optimizing differentiation of human pluripotent stem cell-derived cytotrophoblast into extravillous- and syncytio- trophoblast.

The American Council of Pharmaceutical Education (ACPE) standards emphasize that pharmacy graduates should be “practice- and team-ready,” and the American Society for Health-System Pharmacists (ASHP) Task Force on accountable care organizations (ACOs) states that curricula at pharmacy schools should be evaluated and reworked to prepare students to practice effectively as members of the health care team within ACOs. The objective of this study was to describe the development of an ACO-based advanced pharmacy practice experience (APPE) rotation block, clinical activities and interventions completed by students during the experience, and perceptions of students, patients, and physician preceptors regarding the experience.The rotation block was within outpatient ACO offices and consisted of a four-week rotation with one pharmacy faculty, immediately followed by a four-week elective experience in a different office with a physician serving as primary preceptor.Eight students completed the rotation block between August 2017 and April 2018. Students documented a total of 1299 clinical activities and 65 interventions. Medication reconciliation and recommendations to initiate a medication were the most commonly completed activities and interventions documented. The experience was positively perceived among surveyed students, patients, and physician preceptors.The rotation block was successfully implemented with a positive response from students, patients, and physician preceptors. As a result, the program has expanded in accordance with ACPE Standards to create “practice- and team-readiness” among graduates and expose students to interdisciplinary care within ACOs and other settings.

Student perceptions of the value they bring to APPE sites

IntroductionPartner institutions invest much time and effort into educating pharmacy students, and ideally students should be viewed as valuable to those sites. Prior studies have demonstrated the perceptions that preceptors and administrators have about the value of students at their sites. However, students' perceptions of their own value at practice sites have not been described. Students do have perceptions about their own value to sites, and such information could be useful in learning about potential areas in which students perceive they are making an impact on patient care. MethodsFive hundred qualitative student responses to an evaluation question regarding perceived value were analyzed from a United States pharmacy school. Nineteen categories of value were extracted. Responses fit into multiple categories, resulting in 783 data points for analysis. The categories were analyzed overall and with respect to advanced pharmacy practice experience (APPE) type (acute care, community, hospital, ambulatory care, and elective). Descriptive statistics were used. ResultsProviding patient counseling (15.7%) and therapeutic recommendations (14.7%) were the highest perceived values. In adult acute care and hospital APPEs, “providing therapeutic recommendations” (24.4% and 19.1% respectively) were rated highest. In community, ambulatory care, and elective APPEs, “providing patient counseling” (25%, 23%, and 13.8%, respectively) was highest rated. ConclusionsStudents perceive they are valuable to practice sites in several ways. These results demonstrate that students' self-reported perceptions of the value they bring to their sites are consistent with other literature reports based on perception of preceptors regarding student value to patient care.

Assessing Preceptor Use of Cognitive Apprenticeship: Is the Maastricht Clinical Teaching Questionnaire (MCTQ) a Useful Approach?

Construct: The authors investigated the utility of the Maastricht Clinical Teaching Questionnaire (MCTQ) to assess preceptor use of cognitive apprenticeship teaching methods. Background: The MCTQ is an instrument first studied in medical and veterinary education; it was shown to produce valid and reliable data when evaluating how well preceptors engage in cognitive apprenticeship. Additional validity evidence, however, is needed to determine if the MCTQ is useful and applicable in other healthcare professions, such as pharmacy. Approach: Student pharmacists and pharmacy residents at a large academic medical center completed the MCTQ to evaluate pharmacist preceptors. A confirmatory factor analysis (CFA) was used to determine how consistent the data were with the 5-factor structure of the cognitive apprenticeship teaching methods (e.g., modeling, coaching, articulation, exploration, and safe learning environment). A structural equation model (SEM) was used to evaluate the relationship between the 5 factors. Preceptor and student perceptions were also collected to evaluate the response process and potential consequences of using the instrument. Results: Thirty-eight learners (2nd-year and 4th-year student pharmacists and pharmacy residents) submitted 157 evaluations. The CFA showed appreciable fit with the 5-factor structure of the cognitive apprenticeship framework after 2 modifications (removal of 1 item and moving 1 item to a different factor). The SEM had poor model fit compared to previous studies, and an exploratory analysis suggests that there is a complex relationship between the various teaching methods. Preceptors and students highly agreed that the instrument was valuable for providing feedback. Conclusion: The MCTQ has additional validity evidence that supports it as a viable instrument to assess preceptor engagement in teaching methods consistent with the cognitive apprenticeship framework. Additional research is warranted to explore the relationship between components in the cognitive apprenticeship framework to determine how preceptors can best focus their efforts to improve clinical teaching.

Implementing a peer-learning approach for the clinical education of respiratory therapy students.

IntroductionWith recent clinical placement demands exceeding supply, the University Health Network (UHN) Respiratory Therapy (RT) department implemented a 2:1 student-to-preceptor model where a focus on peer learning (PL) becomes a key component of program success. PL can be defined as students learning from and with each other in both formal and informal ways. The shift towards facilitative student-directed models in other health care professions can be seen globally with the literature suggesting that 2:1 models not only support increases in student capacity but also improve the student learning experience through PL strategies. The aim of this study was to explore the perceptions of RT preceptors and students regarding the 2:1 model as an educational strategy in the context of their clinical experience. The study further explored experiences of PL to understand how learning is enabled in RT practice-based education, particularly within 2:1 models.MethodsA qualitative descriptive study using single-episode semi-structured interviews with RT preceptors (n = 10) and students (n = 10) was conducted during the 2015–2016 RT student clinical year. Twelve open-ended interview questions were designed to draw out study participants’ PL experiences and exploration of issues using a 2:1 model in the context of their clinical experience. Data were recorded, transcribed verbatim, and analyzed using thematic analysis.ResultsThe content analysis resulted in two broad themes with respect to the RT 2:1 educational model: “enablers” and “barriers” to a PL approach. The 2:1 model was preferred by students and preceptors early on in the clinical training due to the benefits of PL, whereas opportunities to showcase independent practice was preferred towards the end of their clinical year. Furthermore, careful planning, resources, and supports need to be implemented to augment benefits and diminish potential disadvantages of using a 2:1 model structure.ConclusionParticipants felt that a 2:1 model strongly contributes to a supportive learning environment and can have a positive influence on the RT student clinical experience at UHN. Along with the improved critical thinking and student engagement opportunities that a 2:1 model offers, increased placement numbers are also supported.

Nurse Preceptor Perceptions of Nursing Student Progress Toward Readiness for Practice.

New nurses are often perceived as not meeting expectations for safe nursing practice. Nurse educators need to identify student learning and professional development needs as students progress toward practice. The purpose of the study was to determine the strengths and weaknesses of senior-level nursing students related to readiness for practice before graduation. Using a descriptive, exploratory design, nurse preceptors evaluated the degree to which their assigned senior nursing student was meeting expectations for readiness for nursing practice. Survey items were organized into affective, cognitive, and psychomotor domains and general readiness. This evaluation occurred at the beginning of the final practicum to assess student progress toward readiness for practice. Students scored highest in professional attributes but lowest in time management, prioritization, management of multiple patients, and pharmacology knowledge. Results can be used to inform teaching strategies, strengthen academic-clinical partnerships, and promote readiness for entry-level practice.

Preparation for Practice in Newly Licensed Registered Nurses: A Mixed-Methods Descriptive Survey of Preceptors.

This descriptive study assessed current registered nurse (RN) preceptor perceptions of professional competencies in new nursing graduates. Strengths in caring and compassion were observed by preceptors, in addition to deficiencies in time management and prioritization. Inasmuch as deficiencies observed by RN preceptors may be functions of time and experience, it is recommended that academic nurse educators and residency program educators explore and develop means to improve students' skills in prioritization and time management.

Community, hospital and industry preceptor perceptions of their role in experiential placements- the need for standardization of preceptor responsibilities and evaluations on students

Introduction: Appropriate evaluation processes are important in experiential placements. With the growing diversity between placements, consideration for standardization of some of these processes would be beneficial, particularly for those skills that are transferable regardless of the placement type. The objectives of this study was: (1) to explore the experiences, evaluation strategies, and feedback processes of Australian preceptor pharmacists from three primary experiential areas (community, hospital, and industry) in providing student placements; and (2) to inform the future development of the current local experiential program and future extended international experiential programs.Methods: A qualitative, exploratory study with three preceptor focus groups (community, hospital, and industry) were conducted, recorded, and transcribed verbatim. Data were analyzed using Bazeley's "describe – compare – relate" method for thematic analysis.Results: There were a total of 16 participants. Four themes emerged: (1) motivation and purpose of being a preceptor; (2) expectations of students and the university; (3) organizational planning and conduct of experiential placements; and (4) importance of appropriate evaluation and feedback processes to include evaluation of interpersonal skills, which were considered by all focus group members as highly desirable for future employability.Conclusions: The need for standardized processes across different experiential placements, although difficult given the diversity, is important particularly with respect to evaluation and feedback. As interpersonal attributes are transferable and desirable for all types of experiential settings including rural and international environments, standardizing the evaluation of students to include these could be beneficial and applicable for students on local experiential placements and/or cross globally on international experiential placements.

Preceptor perceptions: Standardizing evaluation and feedback processes for experiential placements

Incorrect medication administration risks errors and patient harm. The aim of this study was to test the reliability of the newly developed medication administration evaluation and feedback tool.An observational, fully crossed design using recorded scenarios in a simulated environment was used to test reliability and agreement of an evaluation tool for nurses administering medications.Intrarater and inter-rater reliability observed agreement overall were 84% and 82% with Fleiss Kappa coefficient 0.72 and 0.68, respectively. Overall intrarater and inter-rater reliability of the tool rated as good.The medication administration evaluation and feedback tool is reliable in a simulated environment.

Host clinical preceptors' perceptions of professionalism among learners completing global health electives.

ObjectivesThis study aims to gain an understanding of the perceptions of host clinical preceptors in Malawi and Lesotho of the professionalism exhibited by short-term learners from the United States and Canada during short-term global health electives. MethodsFocus group discussions were conducted with 11 host clinical preceptors at two outpatient pediatric HIV clinics in sub-Saharan Africa (Malawi and Lesotho). These clinics host approximately 50 short-term global health learners from the United States and Canada each year. Focus group moderators used open-ended discussion guides to explore host clinical preceptors’ perceptions of the professionalism of short-term global health learners. Thematic analysis with an inductive approach was used to identify salient themes from these focus group discussions. ResultsEleven of the 18 possible respondents participated in two focus group discussions. Adaptability, eagerness to learn, active listening, gratitude, initiative, and punctuality was cited as professional behaviors among short-term global health learners. Cited unprofessional behaviors included disregard of local clinicians’ expertise and unresponsiveness to feedback. Host clinical preceptors described difficulty providing feedback to short-term global health learners and discrepancies between what may be considered professional in their home setting versus in the study settings. Respondents requested pre-departure orientation for learners and their own orientation before hosting learners. ConclusionsBoth host clinical preceptors and short-term global health learners should be aware that behaviors that may be considered best practice in one clinical setting may be perceived as unprofessional in another. Future studies to develop a common definition of professionalism during short-term global health electives are merited.

Preceptor Perceptions of Team Quality Improvement Projects Conducted With the Educating Pharmacists in Quality Program

Preceptor Perceptions of Team Quality Improvement Projects Conducted With the Educating Pharmacists in Quality Program