Coaching the Preceptor and Student when the Student is not Meeting Expectations

There are many reasons that students may not meet preceptor and faculty expectations in their precepted experiences.  The preceptor’s expectations may be inappropriately high.  The student may lack a good foundation of knowledge, may be too anxious to perform at their best, may be unable to apply didactic learning, or may be distracted by work and family responsibilities.  Faculty can intervene to help make the experience a positive one for the preceptor and to assist the student in meeting the goals of the program.

Characteristics of students who are potentially failing have been documented for pre-licensure students and seem applicable to nurse practitioner students as well.  Students with difficulties lack both competence and insight into their lack of competence.  They may show a failure to improve when given feedback.  They may show poor professional behaviors and boundaries.  Finally, the preceptor may have an intuitive sense that the student just isn’t “getting it”.  That intuition should be taken seriously by faculty.

Faculty can coach both preceptor and student to move the student forward in meeting expectations of the program.  Faculty need to help the preceptor and student define the problem and establish specific objectives for the student to meet.   Faculty may also help the student to structure remedial work or other activities which will help the student meet the goals which have been set.

Multiple clinical teaching strategies exist which may help students who are struggling.  Useful strategies include focused half days, preceptor modeling of patient care activities for the student to observe, case discussion, thinking aloud methods, assigning directed readings, the One Minute Preceptor model which fosters critical thinking, and video precepting.

When a student fails a clinical experience, it is tremendously stressful for preceptors and students.  Faculty need to support preceptors in this decision-making process.  Faculty need to help preceptors document the student’s failure to meet objectives using specific examples and focusing on behaviors.  Faculty will also need to help students decide how to move forward from this experience.