It was a challenging transition, when I shifted from
being a medicine resident to supervising medicine residents. There is much to be said about this shift
(and similar shifts of ever-increasing responsibility at various stages of
doctors’ training). The aspect on my
mind at the moment is the role of clinic preceptor.
When I was new to the role and new to the clinic, I was paired
with a more experienced preceptor. He
showed me the practical details: how to do the billing sheets, how to use the
computer system, where things were located, which clinic staff could help with
different problems. He also modeled how
to structure a visit: the resident goes in to see the patient, comes out and
reports to the preceptor, then they go back in together.
This was practical guidance in the sense of figuring out
how to use the time, keep up with multiple residents, and incorporate teaching
into a high-pressure environment. But it
went beyond what to do, pointing at why to do it a certain way. There were attitudes and, in fact, a
philosophy to it. For example, he
encouraged the residents to do their presentations in the patients’ presence
because he believes in including the patients in decision-making.
There are so many delicate balances in precepting. How to give residents the right amount of
autonomy versus support. How to tell
what they know and what they don’t know.
How to teach them the answer but more importantly how to find the answer
and how to handle situations in which the answer is not established. Making sure that the patient is well cared
for and the resident is too. I observed
him navigate these waters with insight, subtlety, and integrity. I could tell how deeply he cared about
getting to know patients as people and about instilling those values in the
residents.
The residents’ clinic can be an overwhelming place. Patients usually have multiple serious
medical problems and a host of psychosocial problems, which make management
even more difficult. Residents are torn
between their clinic and hospital duties and other competing demands. However, it is also a setting that allows for
more continuity than inpatient rotations and gives residents a chance to be
people’s primary doctor. There is
potential for empowerment, fulfilling relationships, and a lot of
learning.
What I had not realized before was that this potential
extends to the preceptors as well. The
endless variety of humanity and ever-changing field of medicine allow us to
learn something new every day, even when we’re the “senior” supervisors. In addition, we have the privilege and
delight of observing the residents over time, as they develop in their
professional roles. Having a
co-preceptor to debrief with can make us more aware of these processes and
mindful of both the residents’ growth as doctors and our own growth as their
teachers.
