Article Archive
November/December 2020

The Valuable Role of Preceptorships in Geriatric Education
By Lindsey Getz
Today’s Geriatric Medicine
Vol. 13 No. 6 P. 22

A time-honored tradition is more important now than ever.

Preceptors play a vital role in geriatric education. The general purpose of a preceptor program is to help preceptees develop confidence, critical thinking, and decision-making skills. Preceptors serve as guides and facilitators and help preceptees to gain essential clinical experience.

Brian Caldwell, MS, RN, AGPCNP-BC, is an adult geriatric nurse practitioner at St. Ann’s Community, an older adult living community, and serves as a preceptor at the University of Rochester’s School of Nursing. The program, he says, is an invaluable opportunity for students to hone their skills and learn how to care for this specific population—something that isn’t as easily done in the classroom or without hands-on support in the field.

“Clinicians need to be adequately trained, and I think preceptors help to promote better training in the field,” Caldwell says. “Participating in a preceptor program also helps to manage the complexities that we see in the older adult population by helping clinicians to really home in on patient- and family-centered care.”

According to Caldwell, who earned his gerontology degree in 2016, there are obviously many aspects of being involved in older adult patient care that don’t come to light in the classroom. Geriatric care, he says, can be “multifaceted” and there’s no substitute for learning in the field alongside someone who’s already trained and practicing.

David Hage, MSW, LCSW, ACSW, C-ASWCM, an assistant professor of social work and gerontology at Misericordia University in Dallas, Pennsylvania, and cofounder and practicing aging life care professional and consultant at Pathway Senior Care Associates, believes helping students better understand the current trends in the aging population—as well as the resources available to assist that population—is best achieved in the field. “A lot of people in general interdisciplinary fields may have more exposure to pediatrics and young adults than exposure to older adults, so having those important interactions gives them a real-world look at the unique issues this population may face. There are many age-related issues that older adults specifically encounter, and it helps to be exposed to those early on.”

James Siberski, MS, CMC, agrees there’s really no better way to learn than “out in the field,” and that’s what preceptoring is all about. “I really encourage students to be out in the community, because that’s a better teacher than me,” Siberski says. “They need to be in nursing homes and senior living communities, learning first-hand what they need to know. Preceptoring is about building a base—a foundation—of information.”

Audra Cave, DNP, FNP-BC, an assistant professor at Frontier Nursing University and a preceptor in Spindale, North Carolina, echoes the same views. When students work alongside a preceptor, there are new possibilities and opportunities for learning. “There is this amazing relationship that develops between the preceptor and the students,” Cave says. “But one of the surprising factors is just how much the patient gets out of it. They’re watching and [are] part of the experience—and they’re learning, too. Preceptoring is a really great way to include the patients in their own medical care.”

As we move more toward a model of patient-centered care with patients and their families being increasingly involved, preceptorships strongly support such a model. It can also provide substantial support for specialties, Cave says, which may have nuances that are best learned in the field.

Preceptors’ Role in Retention
It’s no secret that there has been an exodus of young medical professionals leaving the profession. The first few years of practicing can take a toll. With so much investment of time and money into education—and such a need for more skilled professionals—it’s a shame to lose anyone, particularly to unpreparedness.

But one potential reason for this trend may be the lack of clinical support and training received during their medical education and in those early years of practice. Even after nurses and young doctors begin formal practice, there’s often a learning curve to be overcome and, if they’re not supported during this time, they could fail.

With the need for more training and support, it’s been surmised that preceptoring could be an effective solution. A program such as this helps put supports into place that help young medical professionals feel more competent and prepared.

Solimar Figueroa, PhD, MSN, MHA, RN, P-PCA, a clinical collaborator for the American Academy for Preceptor Advancement (AAPA), says preceptorships are “the link between what students learn in the classroom and what they actually put into practice.” Preceptorships “are about promoting or enhancing learning and as a result it builds competence,” she explains. “The main reason that people leave is because they are not satisfied. But preceptorship improves satisfaction because they’re prepared—and that sets up them up for success.”

According to Figueroa, while there may be reluctance to invest in preceptorships, you have to think of the financial loss that will occur when new practitioners are unprepared. “For instance, when you bring in new staff and they have not been properly preceptored it’s not only a loss for that department but for the organization as a whole,” she says. “Remember the cost of advertising to attract new people and of the time and money spent in human resources. Preceptorship ensures a successful role transition in academic, administrative, leadership, and practice settings.”

Caldwell says preceptorships may be part of the solution to the gaps seen in health care as a whole. “The preceptor program also reinforces what we already know—that there is a gap in health care needs which are not being met,” she adds. “That’s not being made any easier by the decrease we’re seeing in our workforce and the increase that we’re seeing in the aging population. There’s a real need here and, frankly, there’s been a downward slope for clinicians who require more adequate training. But I think that preceptors are a powerful force in filling that gap.”

“Positive exposures to the older adult patient population are also important in driving more professionals into the geriatric profession in the first place, so, it’s not just about retention but recruiting, too,” Hage says. “There is already a demand for geriatric practitioners and as the baby boomer population continues to age, that need will increase exponentially,” he says. “Having these positive exposures with older adults will help demonstrate all of the beneficial aspects of this work. It may not be as flashy as something like a surgeon, but the demand is there. Providing opportunities for these positive exposures are more likely to make students choose geriatrics as a career choice.”

A Decline in Preceptorship Participation
Unfortunately, there’s concern about falling interest in preceptorships. Some research has explored the reasons for the decline in participation. A study published in Academic Medicine aimed to examine the perspectives from preceptors who had stopped preceptoring or decreased teaching time with students. The evolution of the health care system was cited as a reason, including the rise of electronic medical records (EMRs). According to the study findings, EMR implementation has affected provider efficiency, leaving preceptors with less time to accommodate student education.

Another reason for a decline in preceptorship participation was cited as “personal barriers”—time being one of the largest.

According to Cave, time can definitely be a challenge. “It can be difficult to precept if you are counting on production,” she says. “But like anything that’s difficult, once you put time and effort into it, you can really start to make it work for you. In the beginning, it does take a lot of time to teach as you go, but you’ll see that your preceptees will become more and more independent—and honestly, they’re very helpful.”

Some providers simply may be uncomfortable with the idea of being a preceptor. It can also be difficult for preceptors to deal with giving difficult feedback to students—even though it’s beneficial in the long run, Cave says. “It can feel critical and challenging—but when posed as a learning experience it’s always beneficial to have those tough conversations with students.” After all, it’s better for students to make mistakes and be corrected now rather than down the road when it can be truly detrimental.

Of course, it can’t be overlooked that the COVID-19 pandemic has also become a barrier to preceptorships. As education was halted or moved online in some cases, some preceptorship programs were put on hold. As some restrictions eased, Caldwell says it was on a case-by-case basis that universities and colleges allowed their students to come in and finish clinical hours.

“Obviously, first and foremost, it was important to ensure both students and patients were safe,” he says. “There has been a lot of concern over exposure and there have been some changes to preceptorship programs to help them adapt to the new protocols.”

It’s important for universities and teaching hospitals to get “as creative as possible” in finding ways that students can still have in-person learning experiences—or ‘simulation experiences,’ which is a close second,” Hage says. “Finding ways to safely introduce students to older adults is important,” he continues. “Many are shifting more toward a remote care model and there can be opportunities there. I’m also involved in simulation activities that are helping to fill a gap where in-person training may not be possible.”

Caldwell adds that preceptor burnout is another concern—and he wonders whether it could lead to less participation in these types of programs. He’s found preceptorship to be thoroughly rewarding and worth overcoming challenges. But sometimes, preceptors do need some time off.

There are also potential challenges in recruiting preceptors. In addition, not all colleges and universities have a program. “We’re fortunate to have a larger university teaching hospital with people who are dedicated to helping match students to preceptors,” Caldwell says. “But that’s probably not always the case. If students have to go out and find their own preceptors, that would be quite challenging.”

While there is no single answer why it may be happening, Siberski worries that the decline in preceptorship programs will negatively affect the education of future medical providers. Older adults, he says, end up getting the “short end” of that reality. “The fact that we don’t see enough of these formalized programs really does ultimately have a negative impact on the older adult population,” he says. “Less hands-on training and less support isn’t ideal for students—but it’s not great for older adults, either. We’re seeing that aging literacy is poor. Students are not well prepared to work with this population and that’s a major problem. The answer is getting more students out with patients and doing that hands-on work while they’re still learning. There’s really no substitution for that experience.”

Considering a Preceptorship
Finding more providers who are willing to participate in preceptorships is imperative, according to Siberski. “Simply put, we just need more people out there, building up a program, so that we can place more students,” he says. “To just take them from classroom into practice without that base of support is not setting them up for success.”

Involvement in a preceptorship is no small undertaking, but those who serve as preceptors say it’s exceptionally fulfilling. Caldwell became a preceptor to be able to give back. He considers it an honor and a privilege. “My profession is one that I love and hold so highly and dearly, and I love that I’m able to not only give back to this profession but to my university,” Caldwell says. “It really is a rewarding experience.”

Cave agrees. “We all remember those that made an impact on us—and being a preceptor is a way to now help make an impact,” she says. “Still, I find that I learn as much from my students as they learn from me and in that sense, I really benefit from it, too. I think it’s an opportunity for all of us to be better.” Her best advice to anyone who might be considering preceptoring is to find a training course and read more about what’s involved. “I think that there is this common misconception that being a preceptor just means someone tagging along with you—but there’s really a lot more to it than that,” she says. “That mindset can actually end up creating frustration on both ends so it’s best to understand what you’re getting involved with. There are a lot of tools out there that can help make the process easier. You can find actual instructions to follow that will teach you how to precept.”

Figueroa believes the AAPA can be a valuable resource as well. She adds that it’s important people see the difference between preceptorships, mentorships, and coaching—three things that are often mistakenly referred to as interchangeable when in fact they are all unique. In order to continue to elevate the value of becoming a preceptor—what Figueroa calls a “true expert in one’s field”—it’s important to keep this terminology separate.

Unlike mentorship, which is often informal, preceptorship is an official relationship, designed to evaluate new practitioners and offer feedback within a limited time to help them gain competence, Figueroa says.
“Not everyone can be a preceptor—you might be the best there is clinically, but not a good teacher, and preceptors need to be good teachers,” Figueroa says. “It’s important to remember that preceptorship is a specialty in and of itself. Preceptors should receive training. There is a scope and a standard of practice created by the AAPA and you can become certified by portfolio. A certified preceptor is a specialist.”

Caldwell adds that preceptoring can be a great learning opportunity and he would encourage others to consider it.

“Even though we’re set up as the leaders or the mentors, as preceptors we learn a lot from our students and that leads to professional growth and development for us,” he says. “It’s something that forces us to be looking at policies and procedures on a daily basis—something that we probably wouldn’t do if we weren’t in that role. It also just opens up a lot more dialogue and discourse for people to have one-on-one patient and family conversations about the care being provided and what’s needed. I think it leads to improvements all around.”

In addition, Caldwell says, it supports “nonstop learning,” a concept that all medical professionals should take to heart. “There are always new evidence-based practices and new things to learn, and being part of a preceptorship program helps to keep you in that cycle of nonstop learning,” he says. “You should never become stagnant in the medical field.”

— Lindsey Getz is an award-winning freelance writer in Royersford, Pennsylvania.