helping our students and preceptors succeed - c.ymcdn.com · helping our students and preceptors...

76
Helping Our Students AND Preceptors Succeed Doctor Frank J. Tornetta Memorial Lecture

Upload: vannhi

Post on 02-Jul-2018

223 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Helping Our Students AND Preceptors Succeed

Doctor Frank J. Tornetta

Memorial Lecture

Page 2: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Contact Information

• John O’Donnell

[email protected]

• Michael Kost

[email protected]

Page 3: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Our Discussion Plan

• The stakes – Why CRNA preceptors and SRNAs should care

• The teaching-learning environment – Today’s perioperative environment

• Parallel priorities – Safe patient care combined with student success

• A review of educational best practices – Moving from theoretical principles to practical

principles

Page 4: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Learning Objectives

• Describe current processes in preparing preceptors and statements for their roles

• Review environmental and situational factors that determine an effective teaching/learning environment

• Analyze trigger videos and clinical vignettes to identify problems and potential solutions

• Reiterate practical applications to the clinical area

Page 5: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Developing Agreement

• Are all NAPs and their students alike?

• What is the main job of a preceptor?

• How to individualize to students?

• Are SRNAs truly adult learners?

• How do patient care priorities impact clinical precepting?

Page 6: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Ex: Student vs. Preceptor Expectations Medication Preparation

Page 7: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Why is Precepting Challenging?

• Stressors of student role

• Stressors of the faculty role

• Production pressure

• Complex patients

• Mismatch of student level to case/situation

• Remediation student

Page 8: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Importance of Preceptor Education

and Preparation for the Role

Page 9: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

How Do We Align Expectations

Page 10: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Focus: Precepting Best-Practices

• Interactive learning

• Review of educational best practices for clinical precepting

• Mostly expert consensus, from other professions or taken out of the simulation world

– Ex: Loading (Power/load, cognitive load), feedback, pre-brief/debrief, reflective learning, novice to expert development process

• Provide practical approaches/techniques to improve the teaching-learning environment

Page 11: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Baseline Clinical Vignette

KPSAN Baseline Video

Page 12: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Baseline Video Group Discussion

Page 13: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

3 Key Precepting Skills (among others)

for signs of stress, anxiety, overload and ‘gaps’ Observation

• This will allow you to intervene when students become overloaded

• Often useful to identify a task or function they CAN do

Expectations and objectives clearly Communication

• This will reduce SRNA confusion about what is expected and….

• Set the stage for deeper understanding of their performance

Coaching, prompting and cueing Use of

Techniques

• Being mindful about which techniques are most effective for students at different levels of ability is critical

• For example: more novice students or those under stress may require that you use more direct instruction as compared to more advanced students

Page 14: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Careful Preceptor Observation

Identifying & Closing ‘Gaps’

Performed well

Performed well

Performed poorly

Performed poorly

Feels good

Feels bad

Feels bad

Feels good

GAP

CRNA Preceptor:

Observation of performance SRNA:

Perception of performance

Knowledge

Skill

Behavioral

14 Adapted from: Phrampus P.E. and O’Donnell J.M. ‘Debriefing: Using a Structured and Supported Approach’ in The Science and Art of Health Care Simulation (Ed.) Levine A.L., Bryson E.O., DeMaria S., Schwartz A.D. Springer and Springer (2013)

Page 16: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Common Precepting Techniques

• Active instruction- do – Coaching

• Directing, instructing and training …..aim to achieve some goal or develop a specific skill

– Prompting • Well….what was our plan?

– Cueing (more experienced) • Giving more subtle clues- verbal non-

verbal that are designed to trigger an action

• Passive instruction- show

– Modeling- demonstrating effective behaviors that you want students to emulate

Directly Instruct

Facilitation

Page 17: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Importance of Preceptor Use of

Educational Best Practices

17

Personalized experience

Making didactic information come to life

Transfer of knowledge and skill

Serving as a positive role model

Page 18: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Clinical Vignette #1

Video 1

Page 19: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Video 1 Group Discussion

Page 20: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Video 1: Effective Planning Practical Application

• Educational Time Out (ETO) – Pre-briefing

– Occurs at the beginning of the day BEFORE beginning of the first case or a few minutes prior to the case

Easton A., O’Donnell J.M., Morrison S., Lutz C. Development of an Online, Evidence-based CRNA Preceptor Training Tutorial (CPiTT): A Quality Improvement Project. AANA Journal. (in press- scheduled for publication Summer 2018)

Page 21: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Prebrief Assess SRNA Level and Experience

Page 22: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Prebrief

Page 23: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Prebrief

“This is my fourth day in the O.R.”

Page 24: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Prebrief Plan and set achievable goals…

• “Just want to let you know that you will be receiving an unsatisfactory clinical evaluation on one of your students. Really has to work on room turnover and anticipating events in the O.R…”

Page 25: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Patricia Benner Stages of Clinical Competence

Page 26: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Dreyfus Model of Skill Acquisition

• Stuart Dreyfus

– Mathematician and systems analyst

• Hubert Dreyfus – Philosopher

• Developed a model of skill acquisition based on the study of chess players and airline pilots.

• Benner applied it to nursing practice Dreyfus, S. & Dreyfus, H. (1980). A five stage model of the

mental activities involved in directed skill acquisition. Unpublished report supported by the Air Force Office of Scientific Research (AFSC), USAF. University of California at Berkley.

Page 27: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

The 5 Levels of Nursing Practice

NOVICE ADVANCED BEGINNER

COMPETENT

PROFICIENT EXPERT

27

Page 28: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill
Page 29: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

The Expert Practitioner

“Experts are always made, not born.”

-Ericsson, Prietula, & Cokely

29

Novice 10,000 hours Expert

Page 30: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill
Page 31: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

I. Novice

Page 32: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

The Novice SRNA

Characteristic

The SRNA has the theoretical knowledge

of anesthesia from their didactic study but little

practical application

CRNA Preceptor Role

Discuss your expectations for the SRNA and his/her

responsibilities before beginning patient care

Read the care plan and discuss it with the

SRNA while imparting any knowledge you have about the case

32

Page 33: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

I. Novice Expectations

• SRNA

– No experience

– Should not be expected to ‘perform’

– Behavior in the clinical area is inflexible and limited

Page 34: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

I. Novice Expectations

• CRNA Preceptor

– Understands not ‘all’ didactic course work initiated

– Observation days are utilized by some programs

• 2 to 3 days early in program

– Initial clinical assignments

• Assign ‘routine, reasonable’ clinical cases

• If possible, assure student has case assignment prior to clinical day

– Extremely stressful

• SRNA does ‘not know what they do not know’

Page 35: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

I. Novice Expectations

Page 36: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill
Page 37: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill
Page 38: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill
Page 39: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill
Page 40: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill
Page 41: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Clinical Vignette #2

Video 2

Page 42: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Video 2 Group Discussion

Page 43: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Video 2: Effective Evaluation Practical Application

Page 44: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Forms of Student Evaluation

Formative Summative Responsibility of CRNA preceptor or

anesthesiologist Responsibility of the Clinical Coordinator

Critiques the SRNAs performance for the day

Reflects the SRNA’s performance at the end of a rotation

Verbal feedback should be offered to SRNA when possible

Clinical coordinators should review with the SRNA if possible

Unsatisfactory performance should be discussed with SRNA and documented on

the daily evaluation

Clinical Coordinator should be made aware

Unsatisfactory performance should be discussed with the SRNA’s advisor

44

Page 45: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Effective Evaluation

Timely

Non Judgmental

Private

Objective

Page 46: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

SRNA Expectations

• Preceptor has working knowledge of:

– Principles of adult education and adult learning

– Learning styles

– Planning and implementing learning experiences

– Principles of providing objective clinical evaluations and providing constructive feedback

– Resources to problem solve

Page 47: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Ideal Characteristics

• Overall, they agree that critical requirements of the effective clinical preceptor include:

– Sound interpersonal skills

– Able to provide timely feedback

– Are clinically competent

– Function as good role models

– Encourage mutual respect C. Kelly (2006) Student’s perceptions of effective clinical

teaching revisited. Nurse Education Today, 27, 885-892.

Page 48: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Practical Approaches to Evaluation

• Production/Patient Care Pressures

• Practical and easy to use approaches – Plus - Delta

– One minute preceptor

– Newspaper review

– GAS

Page 49: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Plus/Delta

What did you do effectively?

What would you

do next time?

Page 50: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

One Minute Preceptor

• Described by Neher, Gordon, Meyer and Stevens in 1992

• Beneficial when ‘teaching moments’ are very short.

• Effectiveness evaluated in several studies

– (Aagaard, Teherani & Irby 2004)

Page 51: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

One Minute Preceptor

Plus/Delta

Page 52: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

‘End of the Day Newspaper Review Technique’

• End of the day review that focuses on: • Learning goals achieved

• Clinical tasks accomplished

• Student perception of clinical day

• What worked

• What did not work

• Identification of ‘clinical corrections’ for next clinical day

Plus/Delta

Page 53: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

GAS Tool

Goal: Listen to the SRNA to understand what they think & how they feel

GA

THER

25%

Actions: Have the SRNA fill out this portion of the evaluation form. Review this portion of the evaluation with the SRNA

Sample Questions: How do you feel the clinical day went? Were your goals achieved?

Page 54: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

GAS Tool

Goal : Facilitate the SRNA reflection on & analysis of their actions

AN

ALY

ZE

50%

Actions: You complete this portion of the evaluation – include narrative about things that stuck out in your mind during the clinical day.

Report observations (correct & incorrect steps)

Reveal the SRNA’s thinking processes

Reflect on performance

Sample Questions: “Tell me more about…”

“What were you thinking when…”

“I understand, however, tell me about “X” aspect of the case…”

“Let’s refocus… what’s important is not who is right but what is right for the patient…”

Page 55: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

GAS Tool

Goal: Facilitate identification & review of lessons learned

SUM

MA

RIZ

E

25%

Actions: The SRNA identifies positive aspects of his/her performance along with areas of improvement

Summary of comments or statements

Sample Questions: “List two actions or events that you felt were effective or well done”

“Describe two areas that you think you need to work on…”

Page 56: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Summary: Using the GAS Model

Gather: Student impression

Analyze: Base on goals/ case detail

Summarize: Went well/ Need for improvement

Preceptor

Preceptor & Student

Student

Page 57: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Clinical Vignette #3

Video 3

Page 58: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Video 3 Group Discussion

Page 59: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Video 3: The ‘Safe’ Learning Environment

• Assignments match the clinical objectives

• Environment is viewed as ‘safe for learning’

• Student feel comfortable and ‘free to ask questions’

Page 60: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Objective Evaluation

• Objective assessment of

– Basic knowledge application

– Assessment skills

– Technical skills attainment

– Time management

– Critical thinking

– Communication

Page 61: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill
Page 62: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Safe = Factual

Page 63: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Safe = Fair

Page 64: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Family

Educational

Rights and

Privacy Act (FERPA)

64

Privacy of Student Education Records

SRNA Clinical Evaluation Forms

http://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html

Safe = Legal

Page 65: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Clinical Vignette #4

Video 4

Page 66: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Video 4 Group Discussion

Page 67: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Video 4: Practical Application

Page 68: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

CRNA’s and Clinical Sites are Program Partners

Page 69: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Student as Consumer

Page 70: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

SRNA = Our Consumer

Page 71: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill
Page 72: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Health Care Benefits Pharmacy Benefits Meals

Page 73: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Tuition and Fees

Page 74: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

NAPs

Clinical Sites

Students

Academic Institution

CRNA Perspective

• What is the ROI for having students?

– Service

– Professional rewards- teaching, satisfaction

– Recruiting opportunities

– Exposure to the latest thing

Page 75: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

Achieving Balance

Page 76: Helping Our Students AND Preceptors Succeed - c.ymcdn.com · Helping Our Students AND Preceptors Succeed ... improve the teaching-learning environment . ... Dreyfus Model of Skill

FINAL COMMENTS/DISCUSSION