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Discussion

Preceptor

Just curious to those who are doing or have done clinicals, what was the expectation of your preceptor, did you follow her/him, or did you just jump in. My preceptor wants me to just jump right in on my own the first day, I am already nervous and this is kind of adding to my stress level.:mad:

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if you are only 1st or 2nd semester you can just say I would really like to shadow you at least a few shifts since I have never done this before.

I think it is good if they make you come out of your comfort zone, but that is usually a little much the first semester.

its hard when you get to the end and they ONLY want you to shadow and you really want to do everything for practice!

Neelia

Both of my preceptors so far have allowed me to shadow for a few patients but then threw me to the wolves and made me independent. When I didn't feel comfortable with something (like my first pap) I asked her to stay in the room with me for the first one.

Your preceptor should always follow through with your assessment and plan so don't feel like you have to have the answer to everything the first day! :)

Best of luck!

Adding to the wisdom everyone else has said ~

At most sites the first day I shadow in the morning and then start doing H&P on my own in the afternoon. All of my preceptors have thrown me in fairly quickly. If it's a CC I've never dealt with before I check in with my preceptor first: "So I'll ask about x, y, z is there anything else I should do?". Part of it is learning your preceptor's style. Everyone is a little different.

Never fear, if you forget something you can always go back in the room. No one expects you to know everything or be perfect.

And if you don't have a clue say "I'm going to go talk with my preceptor then we'll come and take a look together."

Wash your hands, smile, you'll do great :nuke:

Are you referring to school clinicals or your actual first job? I'm in my second semester of school clinicals and so far I have just shadowed and took notes.

Are you referring to school clinicals or your actual first job? I'm in my second semester of school clinicals and so far I have just shadowed and took notes.

I'm referring to school clinicals.

I am in my first clinical, which started in March. I am following a hospitalist group with a primary and a secondary preceptor. The first day, I followed them around, listened to chests, etc...when they said "listen here" etc. Day 2, I was given 3 pts. left to fly on my own. Got lost many times, felt out of sorts, but ended up getting three soap notes done, hooking back up with my preceptor, following him with more patients then reviewing mine. I have gradually grown to about 6-8 pts/day and sometimes the other hospitalists call me if they have an exciting patient. It's been a good experience. I do clinicals about 3 days/wk. My clinical instructor has been on site once and met with the 2 preceptors and so far just continue as is...and develop comfort in writing the notes. I have intubated, put a central line in and admitted to ICU, all with the help of my preceptors. So I think the opptys have been good. I do feel though my assessments are sound...but I lack depth at a number of clinical scenarios. I will let you know how things progress.

Tracey

In my experience, it all depends on if the preceptor has had students before and what their experience has been with them. For example, my very first clinical was with an FNP who has had many students before. I shadowed her the first day and after that, she had me see patients, do the H&P, and go over my findings with her where we would both come up with diagnoses and plans. She would go in and see the patients after I did just to make sure her findings went along with mine.

The next clinical I had was with an MD who never precepted an NP student before, so both of us would go to see the patients together. Initially, he did everything at first, then he gave me a little more freedom - he would interview the patients and I would do the physical exam while he was in the room. Eventually, after he became much more familiar with my experience and comfort level and after I let him know that I would like to see patients on my own, he allowed me to do that and I only consulted with him - and would have him just come in to see the patient after I was done just to make sure I was on track with my findings.

Another preceptor was an NP who just threw me to the wolves the first day and had me seeing my own patients - which I didn't mind - depending upon what they were there for. If it was something I was unsure of, I would have my preceptor come in and talk with and examine them, also. Mostly, she trusted my findings and would briefly talk with the patients after I was done seeing them.

My current clinical experience is with an NP and she comes in the room with me all the time because she is very protective of her patients since she had a bad experience with a student several years ago - which I completely understand. This is my women's health rotation so I am doing numerous internal exams daily, so I actually like having her there with me as an extra pair of hands to hand me things and also to double-check if I have a hard time finding a cervix. I also find that the patients actually enjoy having the both of us there talking with them and providing education.

To sum all of this up, I think what you need to do is to ask your preceptor if they have had students before, and if they did - how did they typically go about seeing patients. I typically let my preceptors know that for the first day, I would prefer to follow them around so that I get an idea of how the facility is run and where supplies are, etc., and then I let them know that I would like to start seeing patients on my own after that if they are comfortable with it. I also will try and talk with them when there is time and give them an idea of what my nursing background has entailed, and how many years of experience as an RN I have - just so they can somewhat guage what I can handle on my own. Most times, they typically ask me this when I call them to set up my hours.

I feel that having open communication with your preceptor about what you would like to do and experience is the best approach - and that sometimes you (general you) need to speak up a little bit if you feel that you are not getting enough - or are getting too much - freedom with regards to what you are allowed to do in clinical.

  • Experts

Something not mentioned so far is what does the institution ALLOW students to do? For me, that was a very real issue. In one hospital (where I was employed as an RN), I had much more lattitude in what I could do. However, in another hospital, I wasn't even allowed to look at the computer screen for vitals. It all had to do with liability.

  • Author

Thanks to everyone who responded now one more question, how many patient's a day should I be expected to see on my own at first. If any one remembers I had started clinicals earlier, and it was not a good fit and she had me going in to see 20 patients a day, honestly by the time my day was done my brain was mush, :banghead:

  • Experts
Thanks to everyone who responded now one more question, how many patient's a day should I be expected to see on my own at first. If any one remembers I had started clinicals earlier, and it was not a good fit and she had me going in to see 20 patients a day, honestly by the time my day was done my brain was mush, :banghead:

When we precept PA students we usually do it in four week blocks. Usually the first week is mostly observational. Seeing how things run, maybe scrubbing some surgery. The second week we have them do some inpatient notes. Usually I give them 1-2 patients that will be there most of their rotation so that they can see continuity in action. We add more each week both in what we expect out of the plan and what we have them document. At the end of four weeks I would expect 3-4 very good notes on each inpatient they are seeing. I would never give them more than 1/2 the patient population. I also try to involve them in as many procedures as possible.

In the clinic we tend to grab the next patient up. Again I stress a good complete note. When I worked private practice, I would have the patient see every other patient. 2 patients an hour so that worked out to eight patients a day at the most (this was mostly outpatient consults). If we were early in the clinical year, I might have them do one patient per hour or one patient per two hours. However, I would expect them to use that time to look up unfamiliar conditions and present a good consult.

I did my FP rotations in a busy practice. The patients were scheduled every 15 minutes. In the beginning I saw one patient out of four. This allowed the PA to keep up while allowing me to look up any unfamiliar conditions. Eventually as the rotation to progressed I saw every other patient or 16 per day. This in my mind should be around the maximum that a student should see during a day, and only a student with some experience in clinical who already has a good grasp of a focused visit and how to document it.

Realistically a student should not be seeing every patient unless they are in their final rotations and want the experience of a high throughput clinic. The purpose of clinicals is not to let the student do your work. It is to provide them with a good learning experience. This means that the preceptor has to properly assess where the student is in their clinical experience and help them move to the next level. It also means being on the look out for good cases and unusual presentations. Providing learning materials is also helpful.

Unfortunately there are any number of preceptors that regard a student as an excuse to sit back and take it easy. Ideally the program uses student ratings to eliminate these preceptors. I precept because I enjoy teaching and because it makes me think.

Good luck

David Carpenter, PA-C

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