Leadership Blog Series – Preceptorship

Preceptorship

Tips from a fourth year naturopathic medical student

Docere-doctor as teacher. It is one of our main principles of naturopathic medicine. Most commonly, we associate this aspect of nature cure with patient education; empowering individuals with the knowledge to help them heal themselves. But docere, in its fullest form, also plays an important part in the education and mentoring of students and new naturopathic doctors, as well as in the preservation and continuation of the profession as a whole.

Preceptorship is an educational aspect of most regulated healthcare provider programs, in some form or another, but it is a central part of the AANMC/CNME accredited ND programs’ curriculum criteria. Starting in Year 1, students are required to obtain a certain number of hours shadowing healthcare providers each year as part of their clinical education. The preceptorship experience is diverse for naturopathic medical students. Some students are quite eager at the prospect of observing clinicians in their private practices and are able to make valuable professional contacts and opportunities for networking through this process. But for many, preceptorship is daunting, mired in feelings of self-consciousness and worries of rejection. It requires the student taking the initiative to carry out this aspect of their education independently, external to their already busy on-campus school lives and personal lives. To compound this further, there seems to be a growing number of students who are struggling to find preceptors who will accept them.

There does seem to be a number of NDs who originally started their careers accepting all students for preceptorship and have limited or restricted this involvement as they have matured in the profession. A lot of this can be the result of one (or multiple) previous negative experiences with students that have caused the practitioners to re-evaluate their openness to bringing them into their practice. This is unfortunate, but understandable, and emphasizes the importance of students needing to respect the opportunity for clinical observership and recognizing the responsibility they take on of representing future prospective students in these situations, not just themselves. There are also numerous practical and logistical reasons for why preceptorship can interfere with patient care, and so, ultimately, some clinics are just not conducive to this type of teaching environment. All of this being acknowledged, there are still a large number of NDs who openly take on all inquiring students for preceptorship. There is a need to better inform and encourage students in this aspect of their education to destigmatize the unpleasant reputation preceptorship is gaining among some bodies of students.

Having reached out to the North American ND community regarding this, we have received a generous amount of feedback, leading us to summarize the following notes and recommendations when it comes to navigating the preceptorship process for students:

One of the most important things to remember when sourcing potential preceptors is to not get discouraged or offended when refused. NDs (and any other potential preceptor you contact) have the right to refuse your request for preceptorship and they may be basing this off of many reasonable defenses; the patient population they treat could be potentially sensitive to issues concerning privacy, or their practice may be either too busy or not busy enough to provide you with what they feel would be the appropriate experience from preceptorship, as some examples. You’ve got to keep at it and eventually things will come through for you, especially if you approach this experience with genuine passion and interest! However, do not expect convenience: anticipate that you may have to travel outside of your city, or approach preceptors in areas outside of where you intend to practice, to find a willing practitioner.  

When you reach out to a potential preceptor, provide some background information on yourself and why you are interested in preceptorship with them (what do you want to learn from them, what types of patients do you want to see, what treatment modalities are you interested in having more exposure to, etc.). Personalize the e-mail, so that it doesn’t give the impression that you are mass-sending the same generic message. Give them a reason to want you to come observe at their clinic. Citing the close proximity of their clinic to you, or that you’ve heard that they accept students for preceptorship, are not the best ways of justifying your reasoning for reaching out to them.

Plan well in advance. Whatever stage in your education you are at, your preceptorship requirements at that time will likely involve you needing to arrange multiple shifts (not just one day of observation). As such, you need to accommodate for the amount of time it will take you to complete the requirements before their submission deadline. Spacing things out evenly throughout a semester will put a lot less stress on you than waiting to the last month to get started. Also, inherently, there will always be other students trying to complete these requirements last-minute as well, which often results in a student inundation for popular preceptors near the end of semesters when these requirements are due. This potentially maxes out these preceptors’ schedules so that there is just no availability for all the inquiring students. It also looks much better on you professionally to be contacting potential preceptors well in advance of deadlines than to be citing a soon-approaching deadline as the reason for why you need to get in with them quickly.

Try not to get yourself in the mindset of completing preceptorship hours just for the sake of getting them done. Take advantage of this learning opportunity (and chance for professional networking) by pursuing preceptorship with practitioners who focus in a particular area that you are interested or who deal with things you are potentially not exposed to in your program.

Don’t restrict yourself to just NDs either-observing a diverse range of healthcare provider professions during your preceptorship training is a great way to understand how other types of practitioners run their business and treat their patients, helping to foster more integrative care and team-based approaches to patient health.

Always remember to represent yourself professionally. Correspond with the practitioner in a polite manner. Do not assume or demand preceptorship; inquire about it. Do not leave correspondence unanswered. If a preceptor offers to meet with you, be sure to respond back to them in a timely manner. Be courteous and respectful of the practitioner’s decision. Whether you end up observing the practitioner or not, be sure to end your interaction positively. Their impression of you may impact their future interactions with other students!

For The Day Of:
Understand your role. Different practitioners may have varying levels of comfortability in what they will allow you to do with regards to patient interactions in visits at their clinic. You should always assume that you are only there to observe and to speak only when you are spoken to directly in an appointment with a patient. You are not there to give your opinion or advice; these are not your patients and this is not your clinic. In the case that a preceptor is more open to you getting more involved in patient interaction, ensure that you first fully understand the preceptor’s exact expectations regarding this and it is still advisable to air on the side of caution when you find yourself in a position where you might be asked for your opinion or for advice by the patient. Be conscious of how even passive comments might be interpreted (or misinterpreted) by patients that could create problems for the practitioner.

Offer assistance. Be proactive during this time with the preceptor. Express your willingness to help them out with anything during the shift, if they need it. Things like room set-up, collecting supplies and paperwork may all be tasks that you could do to make the practitioner’s workday that much more easier and they will likely remember you and appreciate you for it. Avoid isolating yourself, taking multiple “breaks” and not engaging/being present outside of patient visits. You have come there to do work-stay busy, no napping!

Come prepared. In advance of your observation day, create a list of questions or points of discussion you would like to have with the practitioner. Preceptors may often ask you throughout the day if you have any questions and actually having a response other than “…I don’t know…” will encourage your mutual interaction.

Talk to everyone. Introduce yourself to reception when you arrive and any other practitioners that are part of the practice. So long as it is not interfering with their work, it is encouraged to ask these other members of the clinic about their experience as well. This can provide you with some great insight into practice management and clinic-related business and also fosters a lasting, positive impression of you on the whole clinic staff, not just the preceptor.

How To Make This Process Better:
Most schools keep a record of preceptors who regularly accept students. This contact information should be available to you through your institution’s office of clinical education and can be a good resource to start with if you’re feeling overwhelmed as to where you should even begin. Preceptorship can count towards CE credits for NDs, so there is incentive for practitioners to be a part of the preceptorship program other than for the altruistic benefit of the profession.

Talk to your colleagues, TAs, professors and supervisors. They can all be great sources for leads, referrals and advice regarding this process!

There have been suggestions and even previous attempts by schools to implement an integrated “match” program for preceptorship. Such an endeavour would potentially involve online profiles for students and preceptors that could cross-reference and match practitioners to students based on a number of different criteria (such as schedules/availability, interests, areas of focus, etc.). If this is an initiative you would be interested in bringing to your institution, reach out to your local NMSA Chapter Executive to start the collaboration with your school!

— Maxwell Crispo, CCNM Chapter President

About the Author:

Maxwell Crispo is a 4th-year clinical intern at the Canadian College of Naturopathic Medicine (CCNM) and the current NMSA Chapter President for CCNM. He also serves as the clinic and academic representative for his cohort, a position he has held since his first semester at CCNM. Max is looking forward to another successful year of the NMSA bringing opportunities to naturopathic medical students that are not available to them through their regular school programs. He is excited to work with a local and international leadership team, passionate about advancing the collaboration of naturopathic medical students and progressing the cultivation of future naturopathic doctors.”

Max received undergraduate degrees in Nutritional and Nutraceutical Sciences and Ethics in the Life Sciences from the University of Guelph, where he also completed a certificate in Food Science. During this time, he became certified as an Integrative Yoga Therapy teacher and studied Ayurvedic Medicine through the American Institute of Vedic Studies. He worked as a real estate professional before attending CCNM and was the manager of a natural health product dispensary until this past year.

Image retrieved from:
Porter, Sheri . “Family Physician’s Passion Catches Students by Surprise.” American Academy of Family Physicians. 29 Jun. 2015.<http://www.aafp.org/news/education-professional-development/20150629preceptor.html>

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