In the past 6 months, I precepted two students, one in the clinic and one on labor and delivery. I also got to be a participant of student care with my recent home birth. Both experiences gave me some time to reflect on being a preceptor and being a patient that receives care from a student.
I’ve long loved precepting and teaching. I adore students and am passionate about pouring into them as much as possible. I believe that each preceptor has a duty to help students develop a strong foundation of midwifery expertise and skills.
I also am humbled by how much there is to learn within the art of obstetrics and midwifery. And you can’t teach a student everything they need to know in school.
To that end, I’m sharing 4 tips today to help students. These may sound simple, but each tip goes a long way.
Tip #1: Sit down when you are talking to clients/patients.
This might be a no brainer for some people, but once you start to watch providers, you’ll notice how some lean on the counter during the patient interview or simply stay standing up throughout the visit. This act is the same to me as the provider that ends a visit with holding the door handle. These are all nonverbal signs to the client that you’re in a hurry.
Wouldn’t it be strange if the patient stood up the whole time? It would…and any provider I know would think “Why is the patient standing?!”
Try sitting down. Sitting down offers an atmosphere of relaxation to you and the client.
It’s hard to get students to sit down sometimes because they spend so much time following their preceptor around. I strategically let the student enter the room first so they can start the introduction and I find myself a seat on the extra chair (often times the trash can…) so the student can conduct the interview sitting down on the stool/provider chair and I’m also sitting down…but am not the center of the interview.
For some of the visit, you may need to stand (I usually perform belly assessments for fetal heart tones and fundal heights standing). In this case, either start your visit with sitting, then move to standing and back to sitting for the final “Do you have any other concerns or questions today that we didn’t cover?”
Extra tip: If you find your clinical site doesn’t have enough chairs, trying getting to the site early and putting an extra stool in each room you’ll be using. You’ll get used to sitting down in no time!
Final bonus….It’s easier to take notes during your interview when you are sitting. #winning
Tip #2: Introduce yourself confidently and don’t forget to say your role.
This is a small tip but it comes with a huge payout in the respect and mannerisms categories.
Ask yourself this: Last time you went to a hospital or clinic, how many people introduced themselves by name and role in a manner that you could remember their name and understand their role?
It doesn’t happen as often as you’d think!
From the student side, it’s simple. “I’m Jamie and I’m a student nurse midwife working with Susie, a certified nurse midwife, in the clinic today.”
In the birth setting, it’s the same thing, but you can end with “…on labor and delivery today and will be assisting with your labor care and birth.”
(Preceptors – I like to introduce the student and myself as your “midwife team.” I find this is really well received from the mama stand point about who is helping with the birth and specifically, how they willbe helping.)
You know you did the intro right when the patient walks to the front desk and says “Is Jamie available for my next appointment?
Tip #3: Practice briefing and debriefing.
Oh this is a goody. But very few students or preceptors do this well. In truth, I didn’t do this skill well until I’d been in the military for a few years. As a military midwife, you either learned the brief/debrief process or it made your life miserable.
I’ll walk you though this one.
Before you get to clinic, think about what goals you want to try and accomplish that day, week or month. Take these goals for example:
- Are you working to complete a history and physical by yourself?
- Are you trying to place 20 IUDs before graduation?
- Are you looking for more menopause management?
- Are you trying to manage triage independently?
Take those goals and share them with your preceptor.
Here’ are some examples on how to present goals to your preceptor:
- This week I’d like to work on placing contraception. My goal is to place 20 IUDs before graduation. Does your schedule have some IUD placement opportunities?
- This month I’d like to complete a well woman exam by myself with little guidance. What do you suggest I work on to fine tune this visit?
- This week I’d like to go over how to review labs and you call/notify your patients. My school doesn’t really teach us how to do this. Would you build some time in this week to review how you manage your in basket with me?
Then to the debrief…
I like to start with two questions: What went well today? What didn’t go well today?
Those questions are the tip of the iceberg but should steer you nicely towards the follow up questions you need. For example, if you wanted to improve your well woman exam and you’d stumbled through the history part, you could say “I think the physical exam went well but I always forget to ask about family and surgical history.” This should lead into a review of the items asked during a history and those particular to a well woman exam.
For students and preceptors, I don’t often find you have a student and a preceptor that do a brief and debrief well. My advice would be to do it anyways – you’ll both get better with practice. But don’t despair either if you feel it’s a one sided conversation. You (the student) will be better just by developing goals and asking probing questions about how to improve.
(Last note: Some people may have no idea was a brief is, but most people know what a debrief is; just think of the two as the opposite of each other!)
Tip #4: Be in the building 15 minutes before start time and in your seat 5 minutes before start time.
You read it right. Just be on time to your clinicals. There are a few things that happen when you show up early.
You’ll hear the labor and delivery nurses run the labor board and it will give you all sorts of insights as to the day you’re going to have.
You’ll be able to hear midwives or the obstetrics team discuss all the ins and outs of the work – the newest evidence, the latest guideline the clinic adopted, the crazy triage story from last night or a recap of an emergency.
You’ll be able to review patient charts before you get report. (Wonder what to review? I always look at the history and physical, the labs and the care coordination note or whatever the practice uses as the “sticky note” for patient care. In the clinic, I look at the last visit’s note, the main problems/ICD-10 codes on the chart and the reason for the visit today.
Lastly, you won’t feel rushed at the start of the deck shift or clinic day because you built in extra minutes to go to the bathroom, grab a cup of coffee, listen to conversations and to review some charts.
That’s it for tips! I hope these are helpful to students. Maybe to preceptors as well?? Share this post with a fellow student you know!
If you love these tips, you’ll find even more in The Successful Student Midwife PDF I put together at the beginning of this year. Find out more here.
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