By Riley D. Bowers, PharmD, BCPS
Why am I writing this? What credibility do I have on this topic?
I am not special. I am not an expert in the world of pedagogy, nor a seasoned preceptor, but I do have personal experience. I was the student you don’t want to be. I was an entitled learner, and I eventually realized it halfway into my final year of pharmacy school. All it took was two rotations with mentors who introduced me to the way I should approach clinical practice, a pivotal moment that shaped my career. The information I had memorized didn’t have meaning or relevance until I learned how important the six principles described below were to my success. Reflecting back, these mentors didn’t use the terminology “deliberate practice,” yet this is exactly what was occurring. Now, I emphasize these principles as part of a deliberate practice framework for my own and my students’ professional growth.1-2
Ask (good) questions
As a student, I never asked questions. Now, I love it when my students ask “good” questions. Asking questions shows me that a student is invested. It’s also a key step in deliberate practice because it creates feedback.,2 Don’t be shy to ask questions, just be sure to make sure they are “good” questions (see Figure 1).
Figure 1: “Good” Questions 3
Don’t be afraid to fail
Not to minimize your importance, but patients generally don’t die if you get something wrong as a student. You have the safety net of a preceptor. This is your opportunity to provide your hypothesis, with rationale and potential outcomes, before pulling out your iPhone. This fact, once realized, impacted me greatly as a student. Working systematically through this thought process fits within the deliberate practice framework, because it is mentally demanding and purposeful.2 You will learn more in healthcare from your mistakes than your successes. This is the time to make them. Once you’re a practicing pharmacist, you can’t guess.
Develop your own process
I will not hold your hand, literally or metaphorically. Although it would be easier on both of us, you won’t learn and we both fail. As a student, I didn’t like this. As a preceptor I have found the best students can utilize and build upon their existing knowledge, even if they don’t have the highest GPAs. The best students develop an efficient patient care process and time management skills. How did they do it? They focused on their process early on, found what works, and repeated it regularly.1-2 They asked themselves questions like “Where do I struggle?” and “What is taking up most of my time?” From my own experience, you do NOT need to write everything down; rather, write the “right” things down.
Reflect, evaluate, and grow
Part of being a self-directed learner is being able to reflect on your current level of skills and knowledge.4 However, to become a better practitioner, reflection alone will not suffice. You must identify areas for improvement; then actions to make improvements. Do you need to develop a skill, work on your process, or are you lacking foundational knowledge? To improve, you must identify the cause. The practice strategy must match up with the deficiency, a key component of deliberate practice.1-2
Communication is key
There have been plenty of occasions where I have seen students who successfully tell me about their patients, come up with excellent recommendations, then freeze during rounds. All the knowledge in the world couldn’t help them because they were poor communicators. Don’t feel bad, this happens to all of us. Communication is a vital component of being a trusted healthcare professional and improves patient care. A “good” student can take what they know and share it in ways others can understand. Practice is the only way to develop this skill.
Have a positive attitude
I believe that nobody is born with an innate ability to be a great clinician. This takes effort, practice, and long hours. However, if you’re an entitled learner, like I was, your attitude will eventually become a problem. Entitlement is a funny thing. If everything goes your way, you feel that you are “deserving”, and your attitude is fine. However, when things go poorly, your problems become far larger than anyone else’s, and you believe everyone should halt to fix the problem. Regardless of the cause, if things go poorly, it is your responsibility to decide how you handle it. Maintaining a positive attitude will get you further than being knowledgeable but negative. So, remember this core concept of deliberate practice: it is mentally challenging and not usually fun.2
The concept of deliberate practice provides a great framework for learning, especially in an experiential environment.1-2 This concept is further explained in the book Talent is Overrated.2 Just know that becoming a “good” pharmacy student only begins with knowledge base.
I would like to thank my preceptors and RPDs, who are now my colleagues, for providing a great example of where I wanted to be and the feedback on how to get there.
- Ericsson KA. Deliberate practice and acquisition of expert performance: a general overview. Acad Emerg Med. 2008;15(11):988-94.
- Colvin G. Talent is Overrated, What Really Separates World-class Performers from Everybody Else. Penguin; 2010.
- Flynn J. Yes, Some Questions ARE Stupid: Your elementary school teacher lied to you. Available at: http://livinglifefreelancing.blogspot.com/2015/03/yes-some-questions- are-stupid-your.html. Accessed June 13, 2018.
- Daily JA, Landis BJ. The journey to becoming an adult learner: from dependent to self-directed learning. J Am Coll Cardiol. 2014;64(19):2066-8.
Riley Bowers is a Clinical Assistant Professor of Pharmacy Practice at the Campbell University College of Pharmacy & Health Sciences. Educational scholarship interests include simulation-based learning, utilizing educational frameworks to develop experiential experiences, and leadership & professional development. In his free time, Riley enjoys playing golf, outdoor activities, and traveling.
Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning
A good communicator must be an active listener first. As a full time academic and part time hospital pharmacy preceptor I always emphasise my students to carefully listen to patients and other healthcare professionals and then visualise with mindfulness their know how and awareness followed by careful analysis before putting into verbal communication.
I am sure that Prof Riley is an excellent preceptor for his students
Thanks for the post. There is not enough attention paid to deliberative practice in pharmacy education. This is more than repetition or practicing with an intense focus. DP involves developing a better understanding of the task, deconstructing it and reconstructing it in order to get better performance. Are we helping our students to isolate the parts of a task that they are finding difficult and understand it better? Are we avoiding arrested development by setting new goals and higher performance standards that require students to increase speed, accuracy and control of their actions? I have found Chapter 3 (Work on the Hard Parts) in Making Learning Whole (Perkins) to be great food for thought!