June 18, 2025 • 32 mins
In this episode, Kathy Schott sits down with Dr. Kate Smith, clinical faculty and pharmacy education expert, to explore one of the most critical and challenging aspects of training student pharmacists and residents: developing clinical reasoning skills. Drawing from over a decade of experience in both clinical practice and education, Dr. Smith discusses nuanced differences between clinical reasoning, critical thinking, and problem-solving and offers preceptors practical, classroom-tested strategies to support learners. From using patient cases and SOAP notes to applying the "One Minute Preceptor" model, this episode is a must-listen for any pharmacy educator or preceptor aiming to foster confident, capable, and patient-centered practitioners.
Host
Kathy Schott, PhD
Vice President, Education & Operations
CEimpact
Guest
Kathryn (Kate) Smith, PharmD, BCACP
Associate Professor of Instruction
University of Iowa College of Pharmacy
Get CE: CLICK HERE TO CPE CREDIT FOR THE COURSE!
CPE Information
Learning Objectives
At the end of this course, preceptors will be able to:
1. Differentiate clinical reasoning from critical thinking and problem-solving
2. Identify practical strategies to teach and assess clinical reasoning skills in student pharmacists and residents in experiential settings.
0.05 CEU/0.5 Hr
UAN: 0107-0000-25-215-H99-P
Initial release date: 6/18/2025
Expiration date: 6/18/2028
Additional CPE details can be found here.
The speakers have no relevant financial relationships with ineligible companies to disclose.
This program has been:
Approved by the Minnesota Board of Pharmacy as education for Minnesota pharmacy preceptors.
Reviewed by the Texas Consortium on Experiential Programs and has been designated as preceptor education and training for Texas preceptors.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Preceptor Practice Podcast.
I'm your host, Kathy Schott,and today we're diving into a
powerful and often misunderstoodconcept in pharmacy education
clinical reasoning.
What exactly is it?
How is it different fromcritical thinking or problem
solving and, most importantly,how can preceptors help students
and residents develop thisessential skill?
(00:22):
Joining me today is Dr KateSmith, a faculty member at the
University of Iowa College ofPharmacy, who brings over a
decade of experience in teachingand mentoring future
pharmacists.
Kate is passionate abouthelping learners transition from
knowing facts to making soundclinical decisions in real-world
settings.
So, whether you're a seasonedpreceptor or new to experiential
(00:43):
education, today's conversationis full of practical takeaways
that you can start usingimmediately.
Let's get started.
Well, welcome Kate.
Thanks so much for being herewith me today.
I had the pleasure of hearingyou speak at our Standard of
Care Institute here in Iowa afew weeks back Institute here in
(01:06):
Iowa a few weeks back and thenI found a paper that you had
published on clinical reasoning,and it aligned perfectly with
the topic that I'm hoping we canchat about today, which is
developing clinical reasoningskills in our student
pharmacists and residents.
So I'd love to start by havingyou just do a quick introduction
of yourself.
I know you were newer to Iowarecently and so share a little
(01:27):
bit about you and what you'repassionate about in this topic.
Speaker 2 (01:32):
Yeah, thank you for having me.
So I'm Kate Smith and I havebeen a faculty member at several
different institutions forcolleges of pharmacy.
I graduated from the Universityof Minnesota with my PharmD and
since then I've just reallybeen curious about how pharmacy
students learn to be pharmacists.
(01:53):
I know it doesn't just happenovernight, right.
There's a whole process behindit.
So how can we make it moreefficient?
How can we make it richer,right?
How can we make sure, when wegraduate pharmacy students and
send them out into practice,that they know what we need them
to know and they're ready tosolve the problems that they're
going to face?
So throughout my 11 years aspharmacy faculty, I've been kind
(02:17):
of exploring those problems indifferent areas.
So I've taught everything fromthe skills like the practical
lab part of class taught a lotof diabetes content, some
leadership content.
So I've been at the Universityof Iowa about a year and a half
now.
Speaker 1 (02:33):
Okay, time flies and already we've had you speak at
one of our state conferencesyeah, perfect.
Well, today the goal is reallyto provide preceptors
specifically with practicalstrategies to foster clinical
reasoning in students and inresidents.
So let's dig in to ourconversation here.
How would you define clinicalreasoning, and how does it
(02:56):
differ from problem solving orcritical thinking?
Speaker 2 (03:01):
Yeah, so this is such an important question and it's
also very challenging to answer.
So in 2020, some medicaleducation researchers looked at
how clinical reasoning wasdefined across the health
professions literature and theyfound over 100 different
definitions for clinicalreasoning.
So they kind of fell intosimilar buckets, right, but it's
(03:24):
obvious that it's a hard thingto define, right?
I actually want to start bytalking about critical thinking.
I think that's really thefoundation for all problem
solving that happens, right?
Can you look at what'shappening and make connections
and figure out a solution?
That's kind of their generalskill, and most of us have that
general skill, right.
But to be able to raise inclinically, you have to gain a
(03:47):
specific set of knowledgerelated to the area in which
you're going to's problemsolving right, general problem
solving.
But someone who's trained as apharmacist has the expertise and
(04:10):
the knowledge to fullyunderstand what that medication
is expected to do, how toevaluate the specifics of the
headache that the patient has,right, what are the risks and
benefits?
So, taking those things intoconsideration, that's the
clinical reasoning process,where it's much more detailed
and specific.
Speaker 1 (04:31):
Got it.
That makes sense.
So what I what my jotted downhere in my notes is that
clinical reasoning equalscritical thinking plus some
important foundational knowledge.
Yeah, and that's whatdifferentiates you from me.
When my family comes to me andasks me medication questions and
(04:51):
they think I'm going to know itbecause I work with pharmacists
, but I'm not one.
So I've got the criticalthinking skills and I can do the
research and you know and allthat kind of stuff, but not not
the you know, not thefoundational knowledge that
would allow me to go to thatnext step of clinical reasoning.
Is that a good metaphor?
Speaker 2 (05:09):
Yeah, and I think even as we move away from our
education right.
Different knowledge goes awayif we aren't using it right.
So I'm taking care of manydiabetes patients.
I can reason with those, but assoon as you put me in an
inpatient setting with someonewho's had sepsis, I am pretty
clueless, right.
So even your knowledge helpsdecide, or helps you know, what
(05:32):
you feel safe reasoning about,right.
Speaker 1 (05:35):
Right, yeah, yeah, I can also really appreciate the
idea that there's all thesedefinitions around clinical
reasoning and or clinicalreasoning and what kind of
challenge that poses In my ownresearch around professionalism
same issue.
Yes, you know a huge continuumof definitions of
professionalism and then we askstudents to be professional and
(05:58):
they're like, yeah, what doesthat mean to you?
Right so yeah, yeah, no, thatmakes sense.
Well, so we're starting to layfoundation, I think, for this
next question that I have foryou.
But what are some of the commonchallenges that you think
preceptors face when they'retrying to either teach or assess
clinical reasoning?
You know in their learners,whether they're working with
(06:18):
pharmacists or students orresidents.
Speaker 2 (06:21):
Yeah, so I think it's really that expert novice gap
that makes it so challenging toteach clinical reasoning we were
just talking about.
As an expert in diabetes, Ihave the knowledge.
I've seen patients withdiabetes over and over again.
I can predict what the outcomesare going to be.
(06:42):
Right, I'm an expert.
It's pretty intuitive if I walkinto clinic.
Okay, this is how we're goingto do things today.
This is what I expect to happen.
Here's the meds that are right.
So I have this.
It's almost second nature,right, it happens fairly quickly
.
I've done it so many times.
So, as an expert.
But our novice learners right,their knowledge is a little more
(07:05):
shallow, right, and the numberof times they've seen these
types of problems is a lot less.
It's going to take them a lotof time to find the knowledge
that they need.
Fill those knowledge gapspotentially right.
I forget what kind of medicinethat is.
I forget how that works, right?
Or oh, I should look up thoseguidelines, right?
It's going to take them time.
(07:26):
And then they have all thisinformation.
How do they pick whatinformation is important, right?
So the novice it takes.
It takes that extra time, Ithink, as an expert, it's so
easy for us, as preceptors, toforget what it was like to be a
novice right and and how maybepainfully slow it is to kind of
(07:46):
reason through these problems.
I think that gap makes itchallenging to teach our
students clinical reasoning.
It's easy to say, well, youjust, I just know that, right,
well, our students don't justknow it.
So how can we catch?
Speaker 1 (08:02):
them up, right, right , right, because you're really
teaching them.
You're you're teaching themclinical expertise.
At the same time, you're tryingto teach them this additional
layer of reasoning and judgment,and all of that.
So it's kind of two separateskills really.
Speaker 2 (08:20):
Yeah, I think the thing.
Another thing that came up whenI was thinking about this
question was how so much of ithappens in our head.
So we, we know what we want,but it's really hard to explain
to someone out loud what we want, right?
Like not only are there so manydefinitions when we say
clinical reasoning, but likewell, I just, I just do it, it's
(08:40):
just second nature, right?
It's happening in your head andyou, as the preceptor, may not
know what's happening in thelearner's heads, so you just
know their output.
Whatever they decided on waswell, that is wrong, right?
So clearly something went wronginternally in their clinical
reasoning process.
But what exactly can bechallenging to get at?
Speaker 1 (09:01):
Right, right, and you may make incorrect assumptions.
Right, about what that gap isabout.
Right, yeah, can you give anyexamples, kate, of some you know
techniques, some teachingtechniques that have worked well
for you to foster some of thisclinical reasoning, taking into
(09:22):
account, you know, this sort ofexpert novice gap that we're
talking about?
Speaker 2 (09:28):
So I think the first thing that comes to mind I do.
I do more teaching in theclassroom these days than I do
in the clinical setting so Iwanted to share one classroom
example, and that's usingpatient cases, and there's good
ways to do that and bad ways todo that.
But I think one of the waysthat I've really seen be
successful to help buildclinical reasoning is to give
(09:50):
the students a patient case andthen I give them four reasonable
answers.
Right, Something that wouldpossibly make sense, but I'm not
sure.
Right, the student isn't surewhether it's the exact right
answer.
So, and as we know, in practicethere are many times when
there's more than one rightanswer.
So I, when I give the studentsthe cases and these potentially
(10:14):
correct answers, I ask them topick and then defend their
answer, Like why did?
you pick A over B.
B looks pretty good to me,right Like, or what are the
differences there?
And why did you feel A over B?
B looks pretty good to me,right Like, or what are the
differences there?
And why did you feel that thisanswer was more appropriate or
better to go with first than oneof these other answers?
I think when we expect ourstudents kind of have this
(10:36):
open-ended like, you could doanything that can be
overwhelming to learners.
So giving them specific answersto look at and then defend can
help them put together.
Okay, this is the rationalebehind my choice, or the
evidence that I'm using to pickA over B right.
And I think that practicing thatin the classroom really sets
(10:57):
them up well for rotations wherethere is no multiple choice
right, right, right.
Speaker 1 (11:02):
Yeah, I mean I can also see that sort of activity
working in the experiential site, though, especially early on,
right Early on with a newpractice.
You know practice area orspecialty or focus or whatever,
yeah, where they maybe aren'tcoming to the table with as much
clinical knowledge on thisspecific thing, whatever it is.
(11:23):
But you know, but giving them,and so then are you kind of,
you're kind of helping them backinto the the, you know the
thinking that that they use toget to A, b or C or D right,
right Okay.
Yeah, yep, no, makes sense.
Speaker 2 (11:40):
Helping them.
I think explain why is reallyimportant.
Right, so they're taking examsoften that they don't have to
explain.
Right, it's a multiple choiceexam.
You just pick one and you'reeither right or wrong.
Well, explain why, Tell me why.
So it does take some investmentand some time to not only
develop these cases and answers,but also to listen to the
(12:02):
students' answers.
Speaker 1 (12:03):
Right, right, well, and you know, in the
experiential setting, I think it, it it.
Obviously it takes time to dothis.
You know to have theseinteractions, but you also have
the ability to look at thepatient in front of you and say,
well, we could do this or wecould do that.
Talk me through.
Speaker 2 (12:20):
You know these options and you know, talk
through it out loud.
Yeah.
So there's a great tool wherethey kind of took all what we
just talked about and kind ofcondensed it into something
called the one minute preceptorand it's it's really a nice
short, quick thing that can beused, you know, between patients
on rounds or between patientvisits at the clinic setting
(12:43):
Right.
So I explained that to a littlemore in the article, but really
it's just there's five microskills.
You ask the student first okay,what are you going to do right
For this patient?
You've had time to look it up,what are you going to do?
And then you ask the studentwhy you get that supporting
evidence right, that supportingevidence right.
Then as the preceptor, you canreinforce what's done right and
(13:09):
correct their mistakes, and thenyou can just teach general
rules.
So, for example, in diabetesclinic, right, I could say, well
, what do you want to do forthis patient?
Well, I think it's time tostart basal insulin, okay, well,
tell me why, right.
And then they have somerationale.
I can say, okay, so I like thispart of the plan.
I think we have to wait on thispart of the plan because of
(13:31):
these risks.
In general.
What I do is.
I make sure that any patientswhose A1C is over 10, I'm
definitely thinking about thatbasal insulin.
So I that's the general rulewe're going with here Right?
So it can be really nice andshort and succinct and get a key
pearl for your practice areaacross to the student.
Speaker 1 (13:53):
What other examples I mean?
Do you find that it's effectiveto sort of share your own
thinking, like processing outloud, especially in some of
those earlier learningexperiences?
Speaker 2 (14:05):
Yes, and I again.
If we go back to the fact thatas clinical pharmacists, you
know, as experts we're doingthis all the time really quickly
.
So you don't have to make theteaching of clinical reasoning
complex.
You can literally just talkaloud what you are doing while
you're making the decisionsright, and it's going to depend
on your context.
(14:26):
So I noticed this patient's A1Cwas over 10.
So I'm going to start lookingat basal insulin and what is
covered by their insurance andwhat other risks they might have
, right?
So instead of just sitting atyour computer and making
decisions right or talking tothe patient and then making
decisions, just taking thatextra few minutes to say aloud
to the student your rationalefor the decisions that you're
making related to the patientand then making decisions just
(14:47):
taking that extra few minutes tosay aloud to the student your
rationale for the decisions thatyou're making related to the
patient, that's something that,even as a preceptor, it helped
me reinforce my own knowledgeand evidence base for the
decisions that I was making.
Speaker 1 (14:59):
So yeah, yeah, that makes sense.
Yeah, so lots and lots oftransparency.
Yeah, yeah, so lots and lots oftransparency.
Yeah, yeah, any other?
Any other important strategiescome to mind that you've used?
Speaker 2 (15:11):
So I think another strategy that's used both in the
classroom and in theexperiential setting can be soap
notes.
So I think there's the dangerof students wanting to put every
single thing they know aboutevery guideline, about every
possible thing that might happen, into a soap note.
So I, when I use soap notes, Itry to provide the students with
(15:32):
an example of what I expect,and then I always explain to the
student.
Look, this example is only onepage long, so you can't go on
forever.
But when you turn in your soapnote, let's make sure that we're
discussing it so that you cangive me your rationale.
The student will then have theor the learner will then have
the opportunity to talk aloudwhat their process was.
(15:55):
They couldn't write it all downon the paper right, but they can
still have that opportunity toshare that with me.
I'm not just grading or lookingat the outcome right, what drug
did they pick?
But I'm also thinking aboutthat process that they are using
to make the decision of whatdrug to use for the patient.
Speaker 1 (16:17):
Right, right, okay, so that's a good transition into
talking about assessment, Ithink.
So.
What would you say are some ofthe most common barriers
preceptors face in assessingclinical reasoning?
Speaker 2 (16:33):
Yeah, I think going back again a little bit to the
fact that it happens a lot inthe student's head or in the
learner's head and it's hard toget it out on paper, can make it
hard to assess how they arereasoning right, right, how they
are making the decisions.
And then I think the other onetoo, is is just not as
(16:57):
preceptors Well, I'll know itwhen I see it.
Again like professionalismright.
Well, I will know it when I seeit.
But I have a hard timeexplaining what I'm really
looking for, right, so it it cantake some work, I think.
I think experiential officescould help lead some of that
work of like.
When we say clinical reasoning,what do we mean, right?
(17:18):
When we say our student, well,so we talk a lot about
entrustment.
Do I trust this student to carefor patients in this setting,
right?
Yes or no?
And part of that is I trustthem because they've made good
decisions over and over again,right?
Speaker 1 (17:33):
Right, right, yeah, so what's so?
What are the strategies for fordoing that assessment of their,
of their skills in this, inthis way?
Speaker 2 (17:43):
Yeah.
So again, I think soap notescan be a tool, but with some,
maybe, addition of a discussionaround that right.
You could also have the studentsdo a more formal case
presentation or something shortand sweet like that one minute
preceptor where it's.
(18:03):
It's just just a quick little.
Here's what I decided and whyright.
And so either one of those canwork, depending on your time.
I think having the student in areal life setting and watching
them right, that's going to bethe most realistic.
So you know, we might dosomething like OSCEs at the
college right, where it's astandardized patient, it's
(18:25):
pretty controlled.
But as soon as they get out atthe college right where it's a
standardized patient, it'spretty controlled.
But as soon as they get out onexperiential right, that's where
we're going to see not only canthe student make a good
clinical decision, but can theyroll with resistance or can they
deal with distractions right,like all those things kind of go
into being able to reasonclinically in the real world.
Speaker 1 (18:46):
Right, right, right.
Well, and that makes me thinkof sort of another angle.
I mean, does clinical reasoningencompass understanding the
patient in front of you?
Beyond, you know how they'representing from a clinical
standpoint, like what barriersmight they have to affording
medications?
What health beliefs might theyhave?
(19:06):
You have, what are all theother factors?
Is that all part of this too?
For the learner, definitely.
Speaker 2 (19:12):
Yeah, definitely I think, because as pharmacists,
we've made a commitment to carefor patients right, and we keep
our patients at the center ofeverything we do.
We can't make decisions thattotally ignore our patient's
ability to access the medicationor understand the medication or
the device or things like that.
So yeah, so clinical reasoningand that's why it's so complex
(19:34):
to assess is because there's somuch to take in, right.
I think, starting with thosemore controlled situations, can
be helpful to say, oh youtotally missed this one thing
that I set up in this case foryou to, you know, really catch
and you missed it.
But then once we get out intopractice or into experiential
(19:55):
right, there's so many differentnuances and so I think, talking
with the student, having themtalk aloud of, like what are the
three biggest things that youtook into consideration with
this patient and maybe it isthree clinical things, but maybe
it's two clinical things andsomething else, right, social
determinants of health or accessissues, things like that.
(20:15):
So just more practice is goingto help our students and our
learners make better decisionsover time, right?
Speaker 1 (20:22):
Right, right, yeah, with all of the patient factors
in mind.
Yeah, this might be backing upa little bit, but it's.
It's in my mind because youknow when, when you were here in
Iowa, you presented at thestandard of care symposia on the
patient, pharmacist, patientcare process.
Where does that fit into all ofthis from a critical, you know,
(20:42):
a clinical reasoningperspective?
Speaker 2 (20:45):
Yeah, that's a great question.
I think the pharmacy educationinitially, that pharmacist
patient care process model was acollaboration between
practitioners and payers andeducators, right?
How do we set up a model forwhat pharmacists are doing in
practice?
Right?
So there's, you know the fivesteps.
(21:06):
They're collecting information,assessing that information,
making plans, implementing thoseplans and then following up to
make sure the plans are safe andeffective.
So the so pharmacy educationuses the pharmacist patient care
process kind of as a model forwhat the pharmacist is doing.
I think it's the assessment stepand the planning step are
(21:28):
really where the clinicalreasoning occurs, the what's
happening with this patient,what's the problem here, and
then what are all these optionsfor medications, potentially
that I have to fix it right,whether it's starting a
medication, stopping it,changing it to something else.
So it's a good framework, Ithink, for our early learners.
(21:49):
I totally understand how, onceyou're in practice, the thinking
process is not always as linearas the PPCP might make it look
right.
But I think if the studentshave a good foundation of here
are the things I'm going to lookthrough and decisions that I
have to make as a pharmacist,then once they get into practice
(22:10):
, it's okay if things are alittle less structured, right.
I think pharmacists are oftendoing the things that are listed
in the PPCP they might not justcall it that by the same right.
It goes back again todefinitions, having clear
definitions of what we mean whenwe say assess the patient for
(22:30):
something.
I think, also, a morestructured process works well
for people who haven't done thisbefore, right, those novices,
so.
And then again, when we'reexperts, we may not need all
that scaffolding that ourlearners do.
The only other thing is, Ireally do feel like the process
is a good stepwise process forbeginning learners, but it still
(22:54):
doesn't necessarily get at likeokay, but how do you make that
decision?
The final decision, right, howdo you make that decision, the
final decision, right, becausethe process is great for
collecting every piece ofinformation from the patient,
right, or even identifying whatthe problem might be.
But then there's still thislike leap that we have to make
(23:14):
of like okay, so this is whatI'm going to do for the patient
and why and I don't think thePPCP teaches that right, right,
right, right.
So we still have have that kindof leap of faith almost to take
.
So I think when I've had fourthyear students on rotation they
say, oh, I haven't ever, Ihaven't had a lot of practice
picking the one therapy that I'mgoing to do with.
(23:36):
The dose and the frequency andthe duration right, oh,
interesting.
And the frequency and theduration right, oh, interesting.
Okay, that decision right, thatcan be a leap to take that
right.
So the more opportunities wecan give them to do that before
they get to rotations, I thinkthat'll help them build up their
confidence.
Speaker 1 (23:55):
Right, you just took the words out of my mouth
because I was going to say wehelp make them confident, but
they also need the confidence tomake that, to make those
decisions and move forwardconfidently with the next step
or the plan or, you know,whatever it is setting is that
our students really are in.
Speaker 2 (24:14):
They're almost in a playground of like I can do
stuff here and mess stuff up andmy, my preceptor is going to
keep me safe.
Right, I'm not gonna.
I'm not gonna totally bomb thisrotation without getting some
feet, you know.
But I think they, we, we needto create that safe environment
(24:37):
where it's okay to mess up, andpart of that is giving them rich
feedback, right Like you pickedthe right drug, but here's why
the dose is not correct, right.
Or at this hospital that we'reat today, we have this on
formulary and not that, sothat's why I picked this other
drug.
There's no other good reason topick it other than because it's
(24:58):
on formulary, right.
Or maybe there is a really goodreason to pick something
different, right, and you haveboth options.
So I think that conversation ispart of what I love about being
an educator is that it's a lotof back and forth.
There's a lot of learning thathappens as we're talking through
things.
So I think that feedback is ina safe learning environment is a
(25:22):
really important part ofhelping our students not only
figure out how to be morecompetent, right, identify gaps
in their thinking, but also tobe more confident of like hey, I
love how you went aboutthinking about this problem.
Here's here's one part where wecan fix next time, right, right
right.
Speaker 1 (25:37):
So yeah, yeah, no, that that's good.
Anything else you can add tothe?
You know that create, create.
Speaker 2 (25:44):
We are shifting how we evaluate students on rotation
and other states have as wellas the new accreditation
(26:10):
standards for pharmacy educationhave come out, but they're
asking us, as preceptors, todecide how much we trust our
learners right and there aregoing to be learners where
you're like.
Oh, I do not trust this studentto make decisions about these
patients on my critical carefloor right.
But if they went to a communitypharmacy.
I would totally trust them tomake decisions there.
Right?
That goes back to theirknowledge base, how you know
(26:32):
their clinical thinking in thatsetting.
So I think, as preceptors, whenwe think about our student like
our learners is, do I trustthem?
It's a different approach toteaching than do they know what
they need to know to be okayhere.
Right, right right.
Because you're almost more of apartner in.
Can I teach you what you don'tknow, so that we can be working
(26:56):
together right, more than I'mhere to punish you for what you
don't know, right?
Yeah, it's a different mindsetas preceptors some preceptors
you know what they're doing.
Speaker 1 (27:08):
Yeah, almost a little more like collegial, in a way
like how?
Do I bring you along from hereto there.
Yeah, under this sort offramework of trust, which is
perfect timing, because theprior episode is all about EPAs
and what those look like.
So, yeah, perfect, perfecttiming to bring that up, and it
(27:30):
does change the feedbackconversation too.
Speaker 2 (27:33):
Yes, yeah, when it's more of a.
I care about your growth anddevelopment as a pharmacist and
I want you to get better at this, which is why I'm giving you
hard feedback, right, Rightright, right, yeah, exactly,
exactly yeah.
Speaker 1 (27:48):
Anything else on the feedback front, before we kind
of move toward wrapping up?
You know this obviously plays apretty huge role in developing
these clinical reasoning skills.
Any other tips for preceptorson the feedback front?
I think?
Speaker 2 (28:04):
when you have a student start or a learner start
a rotation with you, you cansay to them hey, I care about
your development, which meansI'm going to give you a lot of
feedback.
So let's talk about what to dowhen you get hard feedback,
right?
How do you think you can reactto that?
Or you could even ask thelearner like would you rather I
(28:24):
send you feedback by email soyou have some time to think
about it before we talkface-to-face, or would you like
me to just come out with it whenwe're face-to-face?
Right?
Maybe having, you know, settingup an intentional time with
your learner?
I imagine most preceptors dothis anyways, but let's make
sure at the end of week one wetake 30 minutes to discuss how
(28:44):
the first week went, how it wentfrom my perspective and your
perspective.
Right, I think it's a lot of.
It is like basic human decency.
Speaker 1 (28:52):
Right, right, yeah, yeah, exactly Good point.
Speaker 2 (28:55):
A good point, we all would appreciate that right, but
I think being intentional aboutit is important and just making
it clear to the student that,as a preceptor, part of your job
is to give them feedback, andit might not all be grades and
numbers like they're used to,but it's going to be a Lots of
great thoughts and ideas.
Speaker 1 (29:14):
Kate, I really appreciate your perspective on
all of this.
You know, I think preceptorsare doing these things, probably
often without even thinkingabout it, but you mentioned the
(29:35):
importance of intentionality.
So for preceptors, who you know, want to be a little bit more
intentional about focusing onthese clinical reasoning skills
just versus getting through theday and yes, that was a great
recommendation that one wasterrible.
Let's move on.
What's one little thingpreceptors can start doing today
(29:57):
to be more intentional aboutfostering these, you know,
really important clinicalreasoning skills in their, in
their learners?
Speaker 2 (30:07):
Yeah, so I think I would go back to the thing where
you don't have to make itcomplicated.
You can do what you normally do, but just talk it aloud.
Right and I think, when yourlearner is sitting next to you,
listening to you talk aloud,they're going to pick up so much
stuff, right?
So if you don't want to add awhole lot to your plate, that's
where I would start, yep, andthen I imagine that will blossom
(30:30):
into better conversation withyour learners and you know more
again, solidifying your ownknowledge and evidence base.
Speaker 1 (30:36):
Yeah, yeah absolutely , yeah, absolutely, and also
just demonstrating yourwillingness to share and be
transparent, I think would behelpful in making students and
residents comfortable sharingtheir thought process when they
see you doing it right, Even ifit's not something they feel
super comfortable you know doing.
I mean, students have a rangeof communication skills right,
(30:58):
or communication comfort.
Speaker 2 (30:59):
So, and I think, as a preceptor, there have been
times where I've said I'm notsure what to do here.
I need to go talk to my clinicpartner or the medical director,
or let me read another articleabout this type of patient that
I haven't seen before.
Right.
So I think, admitting that,like man, or like modeling, what
(31:22):
you do when you don't know, Ithink is a really powerful step
too.
Speaker 1 (31:26):
Right, absolutely.
That's why you're a pharmacist,so you can think through these
issues and not just check thebox out of a playbook.
Right?
Yeah, definitely, yeah, yeah.
Well, kate, this was a pleasure.
Thank you so much for joiningme.
I am especially during springbreak, yeah really grateful.
(31:48):
So thank you, kathy.
We'll talk again soon.
Thanks so much for listening intoday.
There were many practicaltakeaways as part of today's
conversation, but I'll justhighlight a few that stuck with
me.
First, clinical reasoningcombines critical thinking with
foundational knowledge.
It's essential for effectivepatient-centered care.
Bridging the expert-novice gaprequires patience and
intentional teaching.
(32:09):
Tools like the one-minutepreceptor and modeling your
thought process can help makereasoning visible and teachable,
and creating a safe space forfeedback encourages growth and
helps build confidence in yourlearners.
As always, remember to checkout previous episodes of
Preceptor Practice and don'tforget to visit the full library
(32:29):
of Preceptor by Design coursesavailable for you on the CE
Impact website.
Be sure to ask yourExperiential Program Director or
Residency Program Director ifyou are a member so that you can
access it all for free.
And if you are a member, don'tforget to claim your CE.
Thanks again for listening andfor the work you do to shape
future pharmacy leaders.
(32:50):
I'll see you next time onPreceptor Practice.
Welcome to the Preceptor Practice Podcast.
I'm your host, Kathy Schott,and today we're diving into a
powerful and often misunderstoodconcept in pharmacy education
clinical reasoning.
What exactly is it?
How is it different fromcritical thinking or problem
solving and, most importantly,how can preceptors help students
and residents develop thisessential skill?
(00:22):
Joining me today is Dr KateSmith, a faculty member at the
University of Iowa College ofPharmacy, who brings over a
decade of experience in teachingand mentoring future
pharmacists.
Kate is passionate abouthelping learners transition from
knowing facts to making soundclinical decisions in real-world
settings.
So, whether you're a seasonedpreceptor or new to experiential
(00:43):
education, today's conversationis full of practical takeaways
that you can start usingimmediately.
Let's get started.
Well, welcome Kate.
Thanks so much for being herewith me today.
I had the pleasure of hearingyou speak at our Standard of
Care Institute here in Iowa afew weeks back Institute here in
(01:06):
Iowa a few weeks back and thenI found a paper that you had
published on clinical reasoning,and it aligned perfectly with
the topic that I'm hoping we canchat about today, which is
developing clinical reasoningskills in our student
pharmacists and residents.
So I'd love to start by havingyou just do a quick introduction
of yourself.
I know you were newer to Iowarecently and so share a little
(01:27):
bit about you and what you'repassionate about in this topic.
Speaker 2 (01:32):
Yeah, thank you for having me.
So I'm Kate Smith and I havebeen a faculty member at several
different institutions forcolleges of pharmacy.
I graduated from the Universityof Minnesota with my PharmD and
since then I've just reallybeen curious about how pharmacy
students learn to be pharmacists.
(01:53):
I know it doesn't just happenovernight, right.
There's a whole process behindit.
So how can we make it moreefficient?
How can we make it richer,right?
How can we make sure, when wegraduate pharmacy students and
send them out into practice,that they know what we need them
to know and they're ready tosolve the problems that they're
going to face?
So throughout my 11 years aspharmacy faculty, I've been kind
(02:17):
of exploring those problems indifferent areas.
So I've taught everything fromthe skills like the practical
lab part of class taught a lotof diabetes content, some
leadership content.
So I've been at the Universityof Iowa about a year and a half
now.
Speaker 1 (02:33):
Okay, time flies and already we've had you speak at
one of our state conferencesyeah, perfect.
Well, today the goal is reallyto provide preceptors
specifically with practicalstrategies to foster clinical
reasoning in students and inresidents.
So let's dig in to ourconversation here.
How would you define clinicalreasoning, and how does it
(02:56):
differ from problem solving orcritical thinking?
Speaker 2 (03:01):
Yeah, so this is such an important question and it's
also very challenging to answer.
So in 2020, some medicaleducation researchers looked at
how clinical reasoning wasdefined across the health
professions literature and theyfound over 100 different
definitions for clinicalreasoning.
So they kind of fell intosimilar buckets, right, but it's
(03:24):
obvious that it's a hard thingto define, right?
I actually want to start bytalking about critical thinking.
I think that's really thefoundation for all problem
solving that happens, right?
Can you look at what'shappening and make connections
and figure out a solution?
That's kind of their generalskill, and most of us have that
general skill, right.
But to be able to raise inclinically, you have to gain a
(03:47):
specific set of knowledgerelated to the area in which
you're going to's problemsolving right, general problem
solving.
But someone who's trained as apharmacist has the expertise and
(04:10):
the knowledge to fullyunderstand what that medication
is expected to do, how toevaluate the specifics of the
headache that the patient has,right, what are the risks and
benefits?
So, taking those things intoconsideration, that's the
clinical reasoning process,where it's much more detailed
and specific.
Speaker 1 (04:31):
Got it.
That makes sense.
So what I what my jotted downhere in my notes is that
clinical reasoning equalscritical thinking plus some
important foundational knowledge.
Yeah, and that's whatdifferentiates you from me.
When my family comes to me andasks me medication questions and
(04:51):
they think I'm going to know itbecause I work with pharmacists
, but I'm not one.
So I've got the criticalthinking skills and I can do the
research and you know and allthat kind of stuff, but not not
the you know, not thefoundational knowledge that
would allow me to go to thatnext step of clinical reasoning.
Is that a good metaphor?
Speaker 2 (05:09):
Yeah, and I think even as we move away from our
education right.
Different knowledge goes awayif we aren't using it right.
So I'm taking care of manydiabetes patients.
I can reason with those, but assoon as you put me in an
inpatient setting with someonewho's had sepsis, I am pretty
clueless, right.
So even your knowledge helpsdecide, or helps you know, what
(05:32):
you feel safe reasoning about,right.
Speaker 1 (05:35):
Right, yeah, yeah, I can also really appreciate the
idea that there's all thesedefinitions around clinical
reasoning and or clinicalreasoning and what kind of
challenge that poses In my ownresearch around professionalism
same issue.
Yes, you know a huge continuumof definitions of
professionalism and then we askstudents to be professional and
(05:58):
they're like, yeah, what doesthat mean to you?
Right so yeah, yeah, no, thatmakes sense.
Well, so we're starting to layfoundation, I think, for this
next question that I have foryou.
But what are some of the commonchallenges that you think
preceptors face when they'retrying to either teach or assess
clinical reasoning?
You know in their learners,whether they're working with
(06:18):
pharmacists or students orresidents.
Speaker 2 (06:21):
Yeah, so I think it's really that expert novice gap
that makes it so challenging toteach clinical reasoning we were
just talking about.
As an expert in diabetes, Ihave the knowledge.
I've seen patients withdiabetes over and over again.
I can predict what the outcomesare going to be.
(06:42):
Right, I'm an expert.
It's pretty intuitive if I walkinto clinic.
Okay, this is how we're goingto do things today.
This is what I expect to happen.
Here's the meds that are right.
So I have this.
It's almost second nature,right, it happens fairly quickly
.
I've done it so many times.
So, as an expert.
But our novice learners right,their knowledge is a little more
(07:05):
shallow, right, and the numberof times they've seen these
types of problems is a lot less.
It's going to take them a lotof time to find the knowledge
that they need.
Fill those knowledge gapspotentially right.
I forget what kind of medicinethat is.
I forget how that works, right?
Or oh, I should look up thoseguidelines, right?
It's going to take them time.
(07:26):
And then they have all thisinformation.
How do they pick whatinformation is important, right?
So the novice it takes.
It takes that extra time, Ithink, as an expert, it's so
easy for us, as preceptors, toforget what it was like to be a
novice right and and how maybepainfully slow it is to kind of
(07:46):
reason through these problems.
I think that gap makes itchallenging to teach our
students clinical reasoning.
It's easy to say, well, youjust, I just know that, right,
well, our students don't justknow it.
So how can we catch?
Speaker 1 (08:02):
them up, right, right , right, because you're really
teaching them.
You're you're teaching themclinical expertise.
At the same time, you're tryingto teach them this additional
layer of reasoning and judgment,and all of that.
So it's kind of two separateskills really.
Speaker 2 (08:20):
Yeah, I think the thing.
Another thing that came up whenI was thinking about this
question was how so much of ithappens in our head.
So we, we know what we want,but it's really hard to explain
to someone out loud what we want, right?
Like not only are there so manydefinitions when we say
clinical reasoning, but likewell, I just, I just do it, it's
(08:40):
just second nature, right?
It's happening in your head andyou, as the preceptor, may not
know what's happening in thelearner's heads, so you just
know their output.
Whatever they decided on waswell, that is wrong, right?
So clearly something went wronginternally in their clinical
reasoning process.
But what exactly can bechallenging to get at?
Speaker 1 (09:01):
Right, right, and you may make incorrect assumptions.
Right, about what that gap isabout.
Right, yeah, can you give anyexamples, kate, of some you know
techniques, some teachingtechniques that have worked well
for you to foster some of thisclinical reasoning, taking into
(09:22):
account, you know, this sort ofexpert novice gap that we're
talking about?
Speaker 2 (09:28):
So I think the first thing that comes to mind I do.
I do more teaching in theclassroom these days than I do
in the clinical setting so Iwanted to share one classroom
example, and that's usingpatient cases, and there's good
ways to do that and bad ways todo that.
But I think one of the waysthat I've really seen be
successful to help buildclinical reasoning is to give
(09:50):
the students a patient case andthen I give them four reasonable
answers.
Right, Something that wouldpossibly make sense, but I'm not
sure.
Right, the student isn't surewhether it's the exact right
answer.
So, and as we know, in practicethere are many times when
there's more than one rightanswer.
So I, when I give the studentsthe cases and these potentially
(10:14):
correct answers, I ask them topick and then defend their
answer, Like why did?
you pick A over B.
B looks pretty good to me,right Like, or what are the
differences there?
And why did you feel A over B?
B looks pretty good to me,right Like, or what are the
differences there?
And why did you feel that thisanswer was more appropriate or
better to go with first than oneof these other answers?
I think when we expect ourstudents kind of have this
(10:36):
open-ended like, you could doanything that can be
overwhelming to learners.
So giving them specific answersto look at and then defend can
help them put together.
Okay, this is the rationalebehind my choice, or the
evidence that I'm using to pickA over B right.
And I think that practicing thatin the classroom really sets
(10:57):
them up well for rotations wherethere is no multiple choice
right, right, right.
Speaker 1 (11:02):
Yeah, I mean I can also see that sort of activity
working in the experiential site, though, especially early on,
right Early on with a newpractice.
You know practice area orspecialty or focus or whatever,
yeah, where they maybe aren'tcoming to the table with as much
clinical knowledge on thisspecific thing, whatever it is.
(11:23):
But you know, but giving them,and so then are you kind of,
you're kind of helping them backinto the the, you know the
thinking that that they use toget to A, b or C or D right,
right Okay.
Yeah, yep, no, makes sense.
Speaker 2 (11:40):
Helping them.
I think explain why is reallyimportant.
Right, so they're taking examsoften that they don't have to
explain.
Right, it's a multiple choiceexam.
You just pick one and you'reeither right or wrong.
Well, explain why, Tell me why.
So it does take some investmentand some time to not only
develop these cases and answers,but also to listen to the
(12:02):
students' answers.
Speaker 1 (12:03):
Right, right, well, and you know, in the
experiential setting, I think it, it it.
Obviously it takes time to dothis.
You know to have theseinteractions, but you also have
the ability to look at thepatient in front of you and say,
well, we could do this or wecould do that.
Talk me through.
Speaker 2 (12:20):
You know these options and you know, talk
through it out loud.
Yeah.
So there's a great tool wherethey kind of took all what we
just talked about and kind ofcondensed it into something
called the one minute preceptorand it's it's really a nice
short, quick thing that can beused, you know, between patients
on rounds or between patientvisits at the clinic setting
(12:43):
Right.
So I explained that to a littlemore in the article, but really
it's just there's five microskills.
You ask the student first okay,what are you going to do right
For this patient?
You've had time to look it up,what are you going to do?
And then you ask the studentwhy you get that supporting
evidence right, that supportingevidence right.
Then as the preceptor, you canreinforce what's done right and
(13:09):
correct their mistakes, and thenyou can just teach general
rules.
So, for example, in diabetesclinic, right, I could say, well
, what do you want to do forthis patient?
Well, I think it's time tostart basal insulin, okay, well,
tell me why, right.
And then they have somerationale.
I can say, okay, so I like thispart of the plan.
I think we have to wait on thispart of the plan because of
(13:31):
these risks.
In general.
What I do is.
I make sure that any patientswhose A1C is over 10, I'm
definitely thinking about thatbasal insulin.
So I that's the general rulewe're going with here Right?
So it can be really nice andshort and succinct and get a key
pearl for your practice areaacross to the student.
Speaker 1 (13:53):
What other examples I mean?
Do you find that it's effectiveto sort of share your own
thinking, like processing outloud, especially in some of
those earlier learningexperiences?
Speaker 2 (14:05):
Yes, and I again.
If we go back to the fact thatas clinical pharmacists, you
know, as experts we're doingthis all the time really quickly
.
So you don't have to make theteaching of clinical reasoning
complex.
You can literally just talkaloud what you are doing while
you're making the decisionsright, and it's going to depend
on your context.
(14:26):
So I noticed this patient's A1Cwas over 10.
So I'm going to start lookingat basal insulin and what is
covered by their insurance andwhat other risks they might have
, right?
So instead of just sitting atyour computer and making
decisions right or talking tothe patient and then making
decisions, just taking thatextra few minutes to say aloud
to the student your rationalefor the decisions that you're
making related to the patientand then making decisions just
(14:47):
taking that extra few minutes tosay aloud to the student your
rationale for the decisions thatyou're making related to the
patient, that's something that,even as a preceptor, it helped
me reinforce my own knowledgeand evidence base for the
decisions that I was making.
Speaker 1 (14:59):
So yeah, yeah, that makes sense.
Yeah, so lots and lots oftransparency.
Yeah, yeah, so lots and lots oftransparency.
Yeah, yeah, any other?
Any other important strategiescome to mind that you've used?
Speaker 2 (15:11):
So I think another strategy that's used both in the
classroom and in theexperiential setting can be soap
notes.
So I think there's the dangerof students wanting to put every
single thing they know aboutevery guideline, about every
possible thing that might happen, into a soap note.
So I, when I use soap notes, Itry to provide the students with
(15:32):
an example of what I expect,and then I always explain to the
student.
Look, this example is only onepage long, so you can't go on
forever.
But when you turn in your soapnote, let's make sure that we're
discussing it so that you cangive me your rationale.
The student will then have theor the learner will then have
the opportunity to talk aloudwhat their process was.
(15:55):
They couldn't write it all downon the paper right, but they can
still have that opportunity toshare that with me.
I'm not just grading or lookingat the outcome right, what drug
did they pick?
But I'm also thinking aboutthat process that they are using
to make the decision of whatdrug to use for the patient.
Speaker 1 (16:17):
Right, right, okay, so that's a good transition into
talking about assessment, Ithink.
So.
What would you say are some ofthe most common barriers
preceptors face in assessingclinical reasoning?
Speaker 2 (16:33):
Yeah, I think going back again a little bit to the
fact that it happens a lot inthe student's head or in the
learner's head and it's hard toget it out on paper, can make it
hard to assess how they arereasoning right, right, how they
are making the decisions.
And then I think the other onetoo, is is just not as
(16:57):
preceptors Well, I'll know itwhen I see it.
Again like professionalismright.
Well, I will know it when I seeit.
But I have a hard timeexplaining what I'm really
looking for, right, so it it cantake some work, I think.
I think experiential officescould help lead some of that
work of like.
When we say clinical reasoning,what do we mean, right?
(17:18):
When we say our student, well,so we talk a lot about
entrustment.
Do I trust this student to carefor patients in this setting,
right?
Yes or no?
And part of that is I trustthem because they've made good
decisions over and over again,right?
Speaker 1 (17:33):
Right, right, yeah, so what's so?
What are the strategies for fordoing that assessment of their,
of their skills in this, inthis way?
Speaker 2 (17:43):
Yeah.
So again, I think soap notescan be a tool, but with some,
maybe, addition of a discussionaround that right.
You could also have the studentsdo a more formal case
presentation or something shortand sweet like that one minute
preceptor where it's.
(18:03):
It's just just a quick little.
Here's what I decided and whyright.
And so either one of those canwork, depending on your time.
I think having the student in areal life setting and watching
them right, that's going to bethe most realistic.
So you know, we might dosomething like OSCEs at the
college right, where it's astandardized patient, it's
(18:25):
pretty controlled.
But as soon as they get out atthe college right where it's a
standardized patient, it'spretty controlled.
But as soon as they get out onexperiential right, that's where
we're going to see not only canthe student make a good
clinical decision, but can theyroll with resistance or can they
deal with distractions right,like all those things kind of go
into being able to reasonclinically in the real world.
Speaker 1 (18:46):
Right, right, right.
Well, and that makes me thinkof sort of another angle.
I mean, does clinical reasoningencompass understanding the
patient in front of you?
Beyond, you know how they'representing from a clinical
standpoint, like what barriersmight they have to affording
medications?
What health beliefs might theyhave?
(19:06):
You have, what are all theother factors?
Is that all part of this too?
For the learner, definitely.
Speaker 2 (19:12):
Yeah, definitely I think, because as pharmacists,
we've made a commitment to carefor patients right, and we keep
our patients at the center ofeverything we do.
We can't make decisions thattotally ignore our patient's
ability to access the medicationor understand the medication or
the device or things like that.
So yeah, so clinical reasoningand that's why it's so complex
(19:34):
to assess is because there's somuch to take in, right.
I think, starting with thosemore controlled situations, can
be helpful to say, oh youtotally missed this one thing
that I set up in this case foryou to, you know, really catch
and you missed it.
But then once we get out intopractice or into experiential
(19:55):
right, there's so many differentnuances and so I think, talking
with the student, having themtalk aloud of, like what are the
three biggest things that youtook into consideration with
this patient and maybe it isthree clinical things, but maybe
it's two clinical things andsomething else, right, social
determinants of health or accessissues, things like that.
(20:15):
So just more practice is goingto help our students and our
learners make better decisionsover time, right?
Speaker 1 (20:22):
Right, right, yeah, with all of the patient factors
in mind.
Yeah, this might be backing upa little bit, but it's.
It's in my mind because youknow when, when you were here in
Iowa, you presented at thestandard of care symposia on the
patient, pharmacist, patientcare process.
Where does that fit into all ofthis from a critical, you know,
(20:42):
a clinical reasoningperspective?
Speaker 2 (20:45):
Yeah, that's a great question.
I think the pharmacy educationinitially, that pharmacist
patient care process model was acollaboration between
practitioners and payers andeducators, right?
How do we set up a model forwhat pharmacists are doing in
practice?
Right?
So there's, you know the fivesteps.
(21:06):
They're collecting information,assessing that information,
making plans, implementing thoseplans and then following up to
make sure the plans are safe andeffective.
So the so pharmacy educationuses the pharmacist patient care
process kind of as a model forwhat the pharmacist is doing.
I think it's the assessment stepand the planning step are
(21:28):
really where the clinicalreasoning occurs, the what's
happening with this patient,what's the problem here, and
then what are all these optionsfor medications, potentially
that I have to fix it right,whether it's starting a
medication, stopping it,changing it to something else.
So it's a good framework, Ithink, for our early learners.
(21:49):
I totally understand how, onceyou're in practice, the thinking
process is not always as linearas the PPCP might make it look
right.
But I think if the studentshave a good foundation of here
are the things I'm going to lookthrough and decisions that I
have to make as a pharmacist,then once they get into practice
(22:10):
, it's okay if things are alittle less structured, right.
I think pharmacists are oftendoing the things that are listed
in the PPCP they might not justcall it that by the same right.
It goes back again todefinitions, having clear
definitions of what we mean whenwe say assess the patient for
(22:30):
something.
I think, also, a morestructured process works well
for people who haven't done thisbefore, right, those novices,
so.
And then again, when we'reexperts, we may not need all
that scaffolding that ourlearners do.
The only other thing is, Ireally do feel like the process
is a good stepwise process forbeginning learners, but it still
(22:54):
doesn't necessarily get at likeokay, but how do you make that
decision?
The final decision, right, howdo you make that decision, the
final decision, right, becausethe process is great for
collecting every piece ofinformation from the patient,
right, or even identifying whatthe problem might be.
But then there's still thislike leap that we have to make
(23:14):
of like okay, so this is whatI'm going to do for the patient
and why and I don't think thePPCP teaches that right, right,
right, right.
So we still have have that kindof leap of faith almost to take
.
So I think when I've had fourthyear students on rotation they
say, oh, I haven't ever, Ihaven't had a lot of practice
picking the one therapy that I'mgoing to do with.
(23:36):
The dose and the frequency andthe duration right, oh,
interesting.
And the frequency and theduration right, oh, interesting.
Okay, that decision right, thatcan be a leap to take that
right.
So the more opportunities wecan give them to do that before
they get to rotations, I thinkthat'll help them build up their
confidence.
Speaker 1 (23:55):
Right, you just took the words out of my mouth
because I was going to say wehelp make them confident, but
they also need the confidence tomake that, to make those
decisions and move forwardconfidently with the next step
or the plan or, you know,whatever it is setting is that
our students really are in.
Speaker 2 (24:14):
They're almost in a playground of like I can do
stuff here and mess stuff up andmy, my preceptor is going to
keep me safe.
Right, I'm not gonna.
I'm not gonna totally bomb thisrotation without getting some
feet, you know.
But I think they, we, we needto create that safe environment
(24:37):
where it's okay to mess up, andpart of that is giving them rich
feedback, right Like you pickedthe right drug, but here's why
the dose is not correct, right.
Or at this hospital that we'reat today, we have this on
formulary and not that, sothat's why I picked this other
drug.
There's no other good reason topick it other than because it's
(24:58):
on formulary, right.
Or maybe there is a really goodreason to pick something
different, right, and you haveboth options.
So I think that conversation ispart of what I love about being
an educator is that it's a lotof back and forth.
There's a lot of learning thathappens as we're talking through
things.
So I think that feedback is ina safe learning environment is a
(25:22):
really important part ofhelping our students not only
figure out how to be morecompetent, right, identify gaps
in their thinking, but also tobe more confident of like hey, I
love how you went aboutthinking about this problem.
Here's here's one part where wecan fix next time, right, right
right.
Speaker 1 (25:37):
So yeah, yeah, no, that that's good.
Anything else you can add tothe?
You know that create, create.
Speaker 2 (25:44):
We are shifting how we evaluate students on rotation
and other states have as wellas the new accreditation
(26:10):
standards for pharmacy educationhave come out, but they're
asking us, as preceptors, todecide how much we trust our
learners right and there aregoing to be learners where
you're like.
Oh, I do not trust this studentto make decisions about these
patients on my critical carefloor right.
But if they went to a communitypharmacy.
I would totally trust them tomake decisions there.
Right?
That goes back to theirknowledge base, how you know
(26:32):
their clinical thinking in thatsetting.
So I think, as preceptors, whenwe think about our student like
our learners is, do I trustthem?
It's a different approach toteaching than do they know what
they need to know to be okayhere.
Right, right right.
Because you're almost more of apartner in.
Can I teach you what you don'tknow, so that we can be working
(26:56):
together right, more than I'mhere to punish you for what you
don't know, right?
Yeah, it's a different mindsetas preceptors some preceptors
you know what they're doing.
Speaker 1 (27:08):
Yeah, almost a little more like collegial, in a way
like how?
Do I bring you along from hereto there.
Yeah, under this sort offramework of trust, which is
perfect timing, because theprior episode is all about EPAs
and what those look like.
So, yeah, perfect, perfecttiming to bring that up, and it
(27:30):
does change the feedbackconversation too.
Speaker 2 (27:33):
Yes, yeah, when it's more of a.
I care about your growth anddevelopment as a pharmacist and
I want you to get better at this, which is why I'm giving you
hard feedback, right, Rightright, right, yeah, exactly,
exactly yeah.
Speaker 1 (27:48):
Anything else on the feedback front, before we kind
of move toward wrapping up?
You know this obviously plays apretty huge role in developing
these clinical reasoning skills.
Any other tips for preceptorson the feedback front?
I think?
Speaker 2 (28:04):
when you have a student start or a learner start
a rotation with you, you cansay to them hey, I care about
your development, which meansI'm going to give you a lot of
feedback.
So let's talk about what to dowhen you get hard feedback,
right?
How do you think you can reactto that?
Or you could even ask thelearner like would you rather I
(28:24):
send you feedback by email soyou have some time to think
about it before we talkface-to-face, or would you like
me to just come out with it whenwe're face-to-face?
Right?
Maybe having, you know, settingup an intentional time with
your learner?
I imagine most preceptors dothis anyways, but let's make
sure at the end of week one wetake 30 minutes to discuss how
(28:44):
the first week went, how it wentfrom my perspective and your
perspective.
Right, I think it's a lot of.
It is like basic human decency.
Speaker 1 (28:52):
Right, right, yeah, yeah, exactly Good point.
Speaker 2 (28:55):
A good point, we all would appreciate that right, but
I think being intentional aboutit is important and just making
it clear to the student that,as a preceptor, part of your job
is to give them feedback, andit might not all be grades and
numbers like they're used to,but it's going to be a Lots of
great thoughts and ideas.
Speaker 1 (29:14):
Kate, I really appreciate your perspective on
all of this.
You know, I think preceptorsare doing these things, probably
often without even thinkingabout it, but you mentioned the
(29:35):
importance of intentionality.
So for preceptors, who you know, want to be a little bit more
intentional about focusing onthese clinical reasoning skills
just versus getting through theday and yes, that was a great
recommendation that one wasterrible.
Let's move on.
What's one little thingpreceptors can start doing today
(29:57):
to be more intentional aboutfostering these, you know,
really important clinicalreasoning skills in their, in
their learners?
Speaker 2 (30:07):
Yeah, so I think I would go back to the thing where
you don't have to make itcomplicated.
You can do what you normally do, but just talk it aloud.
Right and I think, when yourlearner is sitting next to you,
listening to you talk aloud,they're going to pick up so much
stuff, right?
So if you don't want to add awhole lot to your plate, that's
where I would start, yep, andthen I imagine that will blossom
(30:30):
into better conversation withyour learners and you know more
again, solidifying your ownknowledge and evidence base.
Speaker 1 (30:36):
Yeah, yeah absolutely , yeah, absolutely, and also
just demonstrating yourwillingness to share and be
transparent, I think would behelpful in making students and
residents comfortable sharingtheir thought process when they
see you doing it right, Even ifit's not something they feel
super comfortable you know doing.
I mean, students have a rangeof communication skills right,
(30:58):
or communication comfort.
Speaker 2 (30:59):
So, and I think, as a preceptor, there have been
times where I've said I'm notsure what to do here.
I need to go talk to my clinicpartner or the medical director,
or let me read another articleabout this type of patient that
I haven't seen before.
Right.
So I think, admitting that,like man, or like modeling, what
(31:22):
you do when you don't know, Ithink is a really powerful step
too.
Speaker 1 (31:26):
Right, absolutely.
That's why you're a pharmacist,so you can think through these
issues and not just check thebox out of a playbook.
Right?
Yeah, definitely, yeah, yeah.
Well, kate, this was a pleasure.
Thank you so much for joiningme.
I am especially during springbreak, yeah really grateful.
(31:48):
So thank you, kathy.
We'll talk again soon.
Thanks so much for listening intoday.
There were many practicaltakeaways as part of today's
conversation, but I'll justhighlight a few that stuck with
me.
First, clinical reasoningcombines critical thinking with
foundational knowledge.
It's essential for effectivepatient-centered care.
Bridging the expert-novice gaprequires patience and
intentional teaching.
(32:09):
Tools like the one-minutepreceptor and modeling your
thought process can help makereasoning visible and teachable,
and creating a safe space forfeedback encourages growth and
helps build confidence in yourlearners.
As always, remember to checkout previous episodes of
Preceptor Practice and don'tforget to visit the full library
(32:29):
of Preceptor by Design coursesavailable for you on the CE
Impact website.
Be sure to ask yourExperiential Program Director or
Residency Program Director ifyou are a member so that you can
access it all for free.
And if you are a member, don'tforget to claim your CE.
Thanks again for listening andfor the work you do to shape
future pharmacy leaders.
(32:50):
I'll see you next time onPreceptor Practice.
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