Starting Well

Studies show that without orientation, learners take about two weeks to work out how to function in the office. Investing 30-60 minutes in orientation can prevent a lot of frustration and inefficiencies for you, the student, patients and office staff.

Orientation must be well-timed and focused – the "good start" on which the experience can be built. Consider developing a Student Folder (paper or electronic) for:

• Orientation checklist-include all areas where the student will engage;
• Office staff list and duties-include staff in orientation;
• Expectations

Timing

Verify with the course director or coordinator when to expect the student in your practice. Plan to schedule 30-60 minutes for orientation as soon as the student arrives. Immediate, personal orientation by the preceptor is the ideal. If this is not possible consider:

• Ask the student to come earlier. Some preceptors meet the student in a more informal session before the first clinical day.
• Have the student shadow you for all or part of the first session, then incorporate what they observed about your practice into the orientation.
• Arrange for a staff member to orient the student to the practice site, patient flow, personnel and possibly major policies and procedures but ensure this information is reinforced in your personal orientation with the student.

Focus

The purpose of orientation is to set the framework for the experience in your office and start building the teacher-student relationship. Arrange to have uninterrupted time in a private area for orientation.

Plan to cover:

• learning objectives;
• general expectations;
• operational issues (schedules, logistics, etc.);
• final assessment.

Learning objectives

There are specific learning objectives for the course. These usually follow the "knowledge, skills, attitudes/behaviors" (KSA) format to articulate how the student is expected to perform by the end of the experience.

These are specific, clear items that can be measured reliably and are the basis for the student's evaluation so they must be clear from the beginning. Ask the course director very early if you have any questions about what the student is supposed to achieve in your practice.

At orientation, go over the course expectations and what will be included in the final assessment with the student.

Prioritize a few key objectives to achieve while the student is with you. These should be based on the formal objectives for the course, plus the personal learning needs of the learner, and your priorities as the teacher. In addition to the formal course objectives, the student may have specific needs or interests, and you may be aware of special learning opportunities or important items that can best be learned in your practice.

Develop 2-5 specific objectives with your learner. Emphasize that these will be taken seriously and revisited during the experience. Above all, emphasize that the responsibility to achieve the objectives belongs to the student.

Some preceptors find a written learner contract" helpful:

Course name:
Student name:
Preceptor/supervisor name:
My learning objectives are (2-5 specific objectives):
My strategies for achieving these objectives are (specific action steps for each objective):
Student signature/date:
Preceptor/supervisor signature/date:

Objectives keep the learning on track, even when patient care gets very busy. To help ensure the objectives are useful, aim for ones that are SMART:

Use learning objectives to describe what the student will know or be able to do by the end of the experience. For example, by the end of the rotation, the student will be able to:

• Describe (or list) the most common reasons for change in cognition in an elderly patient (a knowledge objective)
• Perform a targeted physical examination on a primary care adult patient presenting with a headache (a skills objective)

Attitudes are more difficult to express in objectives and often address very personal and sensitive areas such as ethics, confidentiality and personal interactions with patients. Attitudinal objectives are often not objectively measurable and may rely on your subjective assessment of student behaviors. Common items include treating patients with respect and empathy, or maintenance of confidentiality.

Setting up realistic and practical objectives at the beginning of the experience and revisiting them frequently during the rotation provides structure in teaching and helps learners appreciate how they are progressing.

Resource

Using Learning Objectives to Plan Teaching Activities
Virginia Apgar Academy of Medical Educators Teaching Tip

General expectations

How should the student behave?

Medical students spend a lot of effort in trying to work out what supervisors want from them and frequently complain that they do not know what is expected. In addition to learning objectives, experienced teachers use orientation to explain "ground rules" and priorities to the learner.

These are highly individual and the environment in your practice may be very different from their previous learning experiences. To identify key areas consider:

• What do you want to ensure they do?
• What might be obvious to you but not to a newcomer to your practice?
• If you previously had a really outstanding learner, what did they do that you wish every learner copied?