The cliché says that we learn through our mistakes, and in many professions that is probably true. But in any health-care field, mistakes can have very serious or even deadly consequences. Learning on the job, therefore, is often not an option.
In many medical professions, internships and residencies offer opportunities for intensive, supervised on-the-job training. The School of Health Professions, however, relies primarily on dozens of preceptors—professionals working in each of the disciplines who serve as teachers and mentors to SHP students, giving them the guidance and experience they need before they enter the workforce.
With the school’s broad range of health professions, the role of a preceptor can vary widely from one department to the next, depending on the nature and needs of each profession, but for all their variety, preceptors are a vital part of every SHP student’s education. “If you’re looking for one all-encompassing definition, you could say our preceptor system provides oversight of the student experience by someone who is typically not a member of the paid faculty,” says Harold P. Jones, Ph.D., dean of the School of Health Professions. “You wouldn’t think of having even a minor surgical procedure performed by someone who had never done the operation before; surgeons have years and years of training and operating under supervision of experienced mentors. But students in our professions are expected to be able to perform their responsibilities immediately when they enter the workforce, so our preceptors help them to gain the training and experience they need as part of their education.”
Leaving the Classroom
“When students come to us, they are usually very green,” says Glenn Pippen, a respiratory therapist at UAB Hospital. “They come here with a semester’s worth of classwork under their belt, so on their first clinical rotation, we’re usually going over the things in the hospital that they learned in the classroom. No matter how well prepared you are in class, there is still a connection you have to make between what you learned and what you have to do on the job.”
Ben Jones, a respiratory therapist at Princeton Baptist Medical Center, agrees, saying that classroom experiences cannot possibly cover the entire range of possibilities that can arise on the job. “In school, you go through a curriculum and you learn a lot of the background and the steps you have to take to do a job,” says Jones, who has been serving as a preceptor since 1989. “But you can’t write a script about what is going to go on during the course of a day at the hospital. We may work with as many as 20 patients in a given day, and each one will be unique with an entirely different set of challenges.”
In respiratory therapy, students are with preceptors for two weeks at a time, working eight-hour shifts in intensive-care units as well as on the hospital floor. “They don’t have a lot of experience, but they come in here and get comfortable in the hospital environment, and then they are expected to rise to the occasion and get hands-on experience performing all the responsibilities associated with their position,” says Ben Jones. “A lot of that is just prioritizing, evaluation of situations, and performing the necessary tasks.”
“There is no way within the walls of the university that we can simulate what it’s like to be dealing with patients or the situations that come up every minute of the day in a professional practice,” agrees Harold Jones. “We can prepare students with the background they need to recognize certain situations, but there is no substitute for the actual experience.”
Duty or Calling?
In most cases, preceptors work with students from several different universities, and in virtually all cases, they do so on an unpaid, volunteer basis. In 15 years with the Birmingham Veterans Affairs Medical Center (VA), nutrition-sciences preceptor Jodie Bilbrey says working with students has been an almost daily part of her routine throughout her career, as she conducts two-week rotations with them from August through July. “I take UAB students, diatetic interns from the Tuscaloosa campus, and occasionally students from Auburn or Montevallo,” she says. “In my case, being a preceptor is part of my job description. But even if it weren’t a job requirement, I would volunteer. The students keep me up to date with what is being taught in the classroom, and it challenges me to have that dialogue with them when they ask questions and I have to explain or defend the methods and habits I’ve developed over the years.”
Bilbrey is the dietician for critical care at the VA. After spending time with her, students will do rotations in other areas of the hospital, though some opt to spend more time in a particular area. “I have had probably close to 20 preceptors,” says Haley Westbrook, a UAB nutrition-sciences graduate student who recently worked under Bilbrey. “The preceptors we have had are well known in the nutrition field and are very active in national organizations, so you’re working with people who are at the forefront of their field. That has been a big motivator for me to keep going in my own education.”
In addition to the motivation, Westbrook’s relationship with her preceptors has had a more practical benefit, since she learned through one of them about a fellowship that allowed her to spend additional time at Children’s Hospital. But the benefits aren’t all onesided. “The goal is for students to become as proficient as any professional dietician, so as they become more comfortable in the work environment, the preceptor’s role becomes more of a supervisory role,” Bilbrey says.
“We were at UAB Hospital for a total of 10 weeks working under different preceptors,” says Westbrook. “After the first couple of weeks, the preceptors can see that we know what we’re doing, so they will let you do the work and they will check on you. I think there is a fine line between providing guidance and letting someone learn how to do the things on their own. It’s important for preceptors to find that line so that their students are getting experience and learning from the experience instead of just following directions.”
Whereas some preceptor models, such as the one used by the Department of Nutrition Sciences, involve a number of relatively short rotations, others such as occupational therapy require a longer period with one preceptor. “Our terminology is slightly different from other departments in that rather than preceptors, we use fieldwork educators,” says Chris Eidson, an assistant professor in the Department of Occupational Therapy. “These are people who are usually only affiliated with the university through a contract for fieldwork education, so they’re not on faculty. They are therapists with at least one year of experience who have agreed to take on students.”
In occupational therapy, Eidson explains, a minimum of 960 clinical (or fieldwork-education) hours is required. Students typically do a pair of 12-week rotations, working 40 hours per week with a fieldwork educator. “The accreditation body for occupational therapy programs allows up to four rotations, but traditionally students will do two 12-week rotations,” he says. “Each facility will have a fieldwork coordinator who secures the fieldwork educators for the students. Typically the educators rotate, but in this profession, this role is generally viewed as the minimal professional obligation, so everyone takes on students at some point.”
Eloisa Narvaez, an occupational therapist at UAB’s Spain Rehabilitation Center, serves as the fieldwork coordinator for the SHP Department of Occupational Therapy. With 12 weeks of full-time work, Narvaez says a dramatic change is usually evident over the three-month period. “The rate that a student progresses obviously varies, depending on the student, but overall, you do see a big change from the beginning of the rotation to the end,” she says. “Our role as fieldwork educators is to bring them along slowly until they’re capable and comfortable doing the job on their own. At the beginning, the licensed therapist typically does most of the work with the student present. By the end of six weeks, we expect our students to be able to treat four to five patients with our supervision, and then by the end of the rotation, they should be able to treat them independently.”
The skills that occupational therapists use to treat patients aren’t the only things that must be honed before a student enters the workforce. Virtually all disciplines taught in the School of Health Professions require graduates to work as part of a team of health-care professionals. So while their experience with patients is invaluable to their training, the ability to communicate effectively with health-care workers from other disciplines is equally important. “Our students have to learn to work well and coordinate their efforts with doctors, nurses, physical therapists, speech therapists, and any other professionals who are a part of a particular team,” says Narvaez. “Getting a feel for those relationships and the needs of those disciplines is something that can only be learned if the student is on the job and is a part of those teams, so that is another critical aspect of their fieldwork training.”
Preceptors such as Bilbrey view their role as a career-long responsibility; new students coming in every two weeks is simply a part of her job. Others may serve as preceptors for a relatively short time, but the effects may have the same lasting impact. “The most obvious benefit for a preceptor is when the preceptor uses it as an opportunity to recruit students to his or her facility,” says Harold Jones. “You get a sense of who the student is and what kind of employee that person will be, so you can use this method to ensure that the student coming to your facility has the skill set that you would like them to have and that they’re doing things the way you would like them to be done.
“But the more important benefit may be the relationships that are built through this process. Virtually everyone in each of these professions owes part of their professional development to being precepted by someone else—hundreds of years of professional development of people mentoring other people.”
To illustrate his point, Jones points to former preceptors such as Jon Vice, the president and CEO of Children’s Hospital and Health System in Milwaukee. “Jon went through and was mentored, and then he served as preceptor for Jim Schmerling,” he says. “Jim is now head of Children’s Hospital in Denver, and the two of them still talk about career decisions and dealing with different administrative problems. These preceptor-student relationships often continue well beyond the short-term mentoring, and even when careers take people far away from one another physically, there still tends to be this connection.”
Vice has been serving as a preceptor since 1977, taking one or two students each year at the Children’s Hospital corporate offices in Milwaukee. “They do a lot of administrative tasks for the operating vice president, and they do work on billing issues and human resources issues, but we also have them shadow nurses, residents, and physicians,” says Vice. “We want them to be exposed to as much as possible in their time here.”
Vice says the hospital tends to keep these students on after they graduate, but their experience at Children’s also prepares them for work at other types of hospital. “We have a large ambulatory program and a large primary care program out in the community, so it’s a good training program for them,” he says.
As students move on in their careers, Vice says he has stayed close to many of them, such as Schmerling, but that the mentoring relationship often evolves over the years to one of mutual benefit. “Over time, the roles will often flip-flop, or at least become equal,” he says. “With my own mentor, as well as with students I have mentored, you see the relationship becoming more like one between peers, where professional questions and opinions are offered back and forth.”
Vice can recite a long list of former students he has precepted who have moved on to positions of leadership in a variety of hospital environments, and he says he is proud of how his role as a preceptor has led to so many lifelong friendships.
“After all,” he laughs, “I might be looking for a job one day.”