Preceptor Pearls

Nadia Pasha, MD

Inpatient Medicine Physician, Duke Raleigh Hospital

Why did/do you decide to precept Duke PA students?

I have been involved in PA teaching at Duke Raleigh Hospital for over 6 years and I truly enjoy it! I took on a leadership teaching role 4 years ago because I have a passion for teaching and find it extremely rewarding. It’s an amazing feeling to see how you can positively impact young brains and mentor them to become great clinicians. You have the ability to mold them and teach them what you feel could have been done better when you were a learner. It’s a great way to pay forward and educate those who will probably be taking care of us and our loved ones.

How do you orient students to your practice setting?

Typically 2 weeks prior to their rotation, students receive an email with FAQs and details on student & preceptor expectations. These have also been shared with the preceptors so there is role clarity. I also orient students in person whenever possible. I always give them my cell phone number and they know they can reach out to me anytime. Recently I am working on a short orientation video so I can further improve this process and students can have something to refer back to, whenever needed.

How do you integrate students into your clinical workflow of seeing patients?

Hospital Medicine can be a very busy & fast paced service with acutely sick patient. Each student meets with their provider and continues to work at their own pace depending on where they are in their rotation. They may see anywhere between 2-4 patients and help in managing the patients including placing orders in a supervised environment. They are encouraged to take ownership of their patients as they will be providers within the next year. They sometimes present their patients at Multi D rounds. We have also successfully advocated for a slightly lesser work load for the teaching service. This provides students with extra one on one time with their preceptor and they are able to discuss cases they saw in details. I teach students small tips and learning points as we go along and round.We provide students with IPE experience as they spend one day with each service- DPT/ ICU rounding RN and IR. Students also observe procedures on their patients including EGD, Cath and Bronch. We are working on innovative ways to add more to this experience.

How do you make time to assess students’ knowledge and observe clinical skills?

Students meet with their preceptor in the morning and are assigned patient. They go and see their patients and meet with their preceptor later in the day to discuss the case with special emphasis to their assessment and plan. I have found that this is the part students struggle with the most. Preceptors ask questions which helps them identify and assess the learner so they can build on the student’s knowledge base. They give them feedback in real time and students are expected to read up on what they learned. They are encouraged to ask questions. To help our preceptors become better educators, we constantly work on tips ,techniques , lectures and workshops to help them improve. As mentioned previously, our precepting provider has a decreased work load which gives them extra time to teach.

 What is your approach to providing constructive feedback to students?

In my experience the best way to give feedback is to first ask the students on what they feel is going well and what is work in progress. Students are usually very critical of themselves. I always encourage them and compliment them on what they are doing good. This boosts their moral and motivates them to work harder. Ask them how they think they can do better and then add recommendation to their ideas. Set some clear goals for the upcoming week and then circle back. I always ask them how we can support them and make this rotation better for them and for others. This creates an environment of collegiality and helps us improve as well. They walk away with a positive experience.

In very rare cases, if you feel a student is not engaging or lacking in their basic knowledge, I recommend reaching out to the PA program and letting them know ASAP so everyone can work towards the same common goal- helping the students become better clinicians.

What advice would you give a clinician new to precepting?

Just like different learners have different learning styles, different educators might have a different teaching style and that’s ok. Identify what works for you and how you can use this to teach your students. Ask your students for feedback and it is empirical that this is done in a safe environment and the students don’t feel intimidated. Make sure you let them know that your goal is to help them and support them. They can help you by telling you what works and what doesn’t. Self-reflect and stay open minded. Over time you will become more confident and understand what are good teaching techniques for you and your learners.

Is there anything else you would like to share about your experience as a preceptor?

Teaching can be great experience if we continue to evolve and change according to the needs of our students and patients. Students feel that they fit in if they are given tasks during their rotation. Do not hesitate to tell them to call and co-ordinate care with other health professionals for their patients or have them update and teach their patients. This gives them a sense of fulfillment. Be sure to support them I they have any questions during this process.

It gives me great pleasure to write LORs for my students and see how they grew in their professions. It will feel very rewarding to you too.

Preceptor Pearls

Michael Steigerwald, PA-C

Emergency Medicine PA-C, Lead Advanced Practice Clinician

Maria Parham Medical Center- Duke Lifepoint Hospitals, Henderson, NC

Why did/do you decide to precept Duke PA students?

I felt it was important for PA students to experience emergency medicine in the community setting, as it often dramatically differs from academia. It is an experience I wish I had as a student.

How do you orient students to your practice?

First, students will receive a welcome letter with FAQ’s, expectations, procedural expectations, and logistical information. The first half of day 1 consists of an ED tour and shadowing, in order to become comfortable in the often chaotic environment.

How do you integrate students into your clinical workflow of seeing patients?

Typically, the student will go see a patient first unless they are critically ill. They will begin writing a note, create an appropriate differential, then we will discuss the patient. Due to the constantly changing patient flow dynamics in the ED, sometimes we will need to deviate from this model.

How do you make time to assess students’ knowledge and observe clinical skills?

I have found that asking questions related to the particular case we are discussing both allows me to assess student knowledge and simultaneously reinforce specific teaching points.

What is your approach to providing constructive feedback to students?

First, I always try to let them know when they have done an excellent job on a particular case or procedure. If a case or procedure did not go as well as expected, we will discuss what could have gone better, but in a way as to not solely focus on the negatives. During the mid and end of rotation discussions, I have found it helpful to start by asking the students how they feel their performance was. Students tend to be their own toughest critics.

What advice would you give a clinician new to precepting?

For your first few students, you will be learning about your teaching style almost as much as the student is learning medicine. Always approach your methods of teaching with the thought, ‘Would I have learned from this method when I was a student?’.

Is there anything else you would like to share about your experience as a preceptor?

Helping to shape future clinicians has been one of the most rewarding aspects of my career thus far. For those that are on the fence regarding becoming a preceptor, I highly recommend that you dive right in. You will not regret it!

Preceptor Pearls

Tami Lee, MHS, PA-C

Roxboro Family Medicine, Roxboro, NC

How do you approach orienting a student to your practice if it is their first clinical rotation?

Over the last few years I have developed a multi-page orientation handout regarding rotating at Roxboro Family Medicine.   It covers everything from where to park to what to brush up on before arrival…. There are pointers in there regarding what we expect in terms of attendance, professionalism, patient care, documentation, etc.  The document is sent out in advance of them coming to Roxboro. On their first day, we try to have them arrive 30 minutes early so we can review this document in detail.  If it if their first clinical rotation, I have them shadow for a couple of hours before seeing patients independently.  I touch base at the end of every day and then a formal sit down at the end of week one.

What steps do you take to learn about students’ prior experiences and goals for their rotation with you?

Informal process in terms of prior experience – just ask them in conversation at the beginning of rotation.  I also ask what they hope to gain from the rotation in primary care at the beginning and then also at the official mid-term review.

What are your top priorities for students in their early clinical phase compared to students who are near the end of the clinical training?

Fairly similar in that we want them to have a broad based understanding of primary care issues, health maintenance, and how to promote health and well-being for a wide spectrum of patients.  Initially in training, they are often getting comfortable with talking to and touching people, as well as documenting those activities.  I find that there are a lot more medical questions from students in the first half of their clinical year.  At the end of training, I focus a lot on making sure they are prepared for how to approach the job search and negotiations.

How do you communicate your expectations to students? Are these expectations different for students early in their clinical training?

Most of my expectations are summarized in the aforementioned document.  I verbally review these with students on day one and also on an as needed basis.  I find that using daily examples of areas for improvement makes a lot more sense than saving it up for the mid-term review.  I provide daily feedback so they can go ahead and implement best practices.   Students early in training do get a little more hand holding I would say but still, by the end of week two, I expect that they are fairly up to speed in getting the needed information out of a patient visit.  I work with them the entire rotation on expanding differential diagnosis and developing evidence based treatment plans.

How do you convey feedback to students? How do you let them know this is feedback?

Feedback is given orally at the end of presentations when appropriate.  I also provide oral feedback at the end of the day, end of first week, end of first month, and at the end of the rotation.  Additionally, I send inter-office “flags” pertaining to certain cases to given positive feedback as well as constructive criticism.  ( in confidence, I have had one student in the last few years that required numerous emails but this was an anomaly so likely not helpful to include.)

Why do you continue to precept Duke PA students?  

I enjoy the feeling that I am giving something back to Duke.  It is fun to help shape future PA leaders and hopefully it keeps me on my toes.

Preceptor Pearls

Poonam Sharma, MD

Hospital Medicine, Duke University Hospital, Duke Regional Hospital


“Being a preceptor is one of the most engaging and fun things about my job.”

Why did/do you decide to precept Duke PA students?

I have been involved in PA education since I started on faculty 7 years ago and took over the role of site preceptor from Dr. Belcher who had crafted a very successful rotation at DRH. I was excited about the opportunity to get more involved in PA education!

How do you orient students to your practice?

An email goes out 2 weeks ahead of time with lots of practical information and tips that prior students have added. When I am available, I try to meet students early in the rotation as well to provide a face and name to go to if any issues arise. I always provide by cell phone number in case issues arise when I am off site.

How do you integrate students into your clinical workflow of seeing patients?

The work flow of a hospitalist is very fluid and each day can vary. On rounding days, I usually assign students 2-3 patients to start and let the student interview and examine the patient while I go see the other patients on my list. Then we meet, go see the patient together, and get a plan in place for each patient the student has. On admitting shifts, the students go see patients in the ER and develop their own assessment, then we again meet up, and go see the patient together. I usually have the student present the H&P in the room with the patient and then we can finalize the plan. Then the student can work on the orders and write up before tackling the next case. Some days are very fast paced and you get to see lots of patients. Slower days are good opportunities to go see procedures like upper and lower endoscopies, cardiac caths, stress tests, etc.

How do you make time to assess students’ knowledge and observe clinical skills?

On the hospitalist service the students work closely with attendings, PAs, and NPs who are passionate educators and used to quickly figuring out how to help advance a learner’s skills. If a student can proactively share with the clinician what the student wants to work on, that helps too!

What is your approach to providing constructive feedback to students?

I try to make it timely and supportive. My goal is to make each student an excellent clinician, and every student in the Duke PA program can get to that point with support. Part of that support is getting feedback. I also ask for feedback on my own skills as an educator and feedback about the rotation. No matter where you are in your career, you should want to get better. With this in mind, I think feedback is a gift!

What advice would you give a clinician new to precepting?

Ask students what they want to learn about, take interest in their career aspirations and what they have previously learned about (including in their prior clinical experience). Push students to be engaged in patient care – next year the students will be PA’s, so this the time for students to be in the driver’s seat as much as possible…with the clinician for backup, support and feedback!

Is there anything else you would like to share about your experience as a preceptor?

Being a preceptor is one of the most engaging and fun things about my job. I love working with PA students. Working with students forces us to not only teach, but to be mindful of our practice patterns and stay up to date on the literature. Students also can spend a lot of time counseling patients in smoking cessation and other interventions. In so many ways, having a student can lead to better patient care.