Precepting

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.