GENESEE COMMUNITY COLLEGE

RESPIRATORY CARE PROGRAM

CLINICAL PRECEPTOR GUIDE

 

PURPOSE OF THE CLINICAL PRECEPTOR PROGRAM

 

The purpose of the clinical preceptor program is to assist the student to make a smooth transition from the student role to the entry-level respiratory therapist role by improving patient care skills and reducing the probability of role conflict upon entry into practice.  In order to accomplish this, it is necessary to provide the student with a realistic clinical staff experience, to allow the student to:

-care for various types of patients in the clinical setting receiving different types of Respiratory Care (Oxygen therapy, Humidity and Aerosol therapy, Bronchial hygiene therapy, Volume expansion therapy, non-invasive and invasive ventilation, Cardiopulmonary Resuscitation, arterial blood gases, pulmonary function testing, etc.)

-practice treatments, planning and organization, decision making and priority-setting skills

-implement respiratory care procedures, develop patient management, and time management skills.

 

What is a preceptor?

 

PRECEPTOR

1.                  A teacher, an instructor. 

2.                  An expert or specialist, such as a physician, who gives practical experience and training to a student, especially of medicine.

 

A preceptor is a staff person who teaches, counsels, inspires, & acts as a role model. 

This person supports the growth and development of an individual (the novice) for a fixed and limited amount of time. 

The careful pairing of a novice with an experienced, precisely chosen staff therapist in the clinical setting provides an environment of nourishment and growth for the novice and of recognition and reward for the preceptor.

 

RC CLINICAL PRECEPTOR:  A staff respiratory therapist selected and prepared to allow a student to work with them as they do their normal patient care assignment.


CRITERIA FOR SELECTION OF PRECEPTOR:

The RT has an active New York license.

The RT is employed in the institution.

 

SKILL

The RT has demonstrated expertise in the delivery of respiratory care.  (As determined by the department administrator, clinical supervisors and/or GCC clinical educator).

 

ATTITUDE

The RT has expressed a desire to work with a student in the preceptor role.

 

COMMUNICATION

The RT has demonstrated ability to communicate effectively with patients, faculty, students, staff, and physicians.

 

 

GOALS OF PRECEPTOR PROGRAM

 

Goals for the student:

Complete clinical hours and competencies required by the State of New York and the Genesee Community College Respiratory Care Program.

Make a smooth role transition from student role to entry-level respiratory therapist role.

 

Goals for the Clinical Affiliate:

Contribute to the learning process of Respiratory Care Program students, which help ensure the preparation of competent graduate respiratory therapists.

Provide opportunity for selected staff respiratory therapists to gain experience in the role of preceptor.

Provide clinical learning opportunities for students to gain professional growth and accountability.

Assist in the transition that new graduates must make when entering the job market.

 

RESPONSIBILITIES OF THE CLINICAL AFFILIATE AND/OR CLINICAL PRECEPTORS:

  1. Provide clinical experience for selected student in the Respiratory Care Program.
  2. Collaborate with Genesee Community College in appointing the preceptors.
  3. Appoint alternate preceptor when needed, e.g. due to absence of assigned preceptor.
  4. Orient student to the unit and shift responsibilities.
  5. Direct student to clinical situations, which would provide student with opportunity to meet goals and objectives, increase skills and pass competency evaluations.
  6. Act as a clinical resource person for the student.
  7. Be a role model demonstrating responsible RT behavior.
  8. Feedback the student’s professional behavior through use of form provided by college (Clinical proficiencies and evaluation).
  9. Provide ongoing feedback to student regarding patient care and equipment use.
  10. Participate in beginning, midway and/or terminal conference with Genesee Community College faculty member and student.
  11. Confer with RC program Coordinator for Clinical Education about students experience and progress during clinical educator’s rounds.
  12. Consult with Genesee Community College clinical educator regarding observed student behaviors that are unacceptable for staff Respiratory Therapists such as:

-Content or skill weakness in a given area

-Inability to perform patient care procedures

-Lack of knowledge or inability to gain knowledge necessary for the implementation of patient care

-Lack of technical competence

-Any behavior, which is in the opinion of the assistance clinical instructor, is counter productive to the Respiratory Care Program process.

13.  Participate with Genesee Community College faculty in the evaluation of the preceptor program.

 

 

RESPONSIBILITIES OF THE GENESEE COMMUNITY COLLEGE RESPIRATORY CARE STUDENT:

1.                  Perform patient care under the supervision of a preceptor assuming an increasing level of responsibility on a daily basis.

2.                  Monitor their competency list, discuss competency list with clinical preceptor.

3.                  Identify competencies yet to be completed and discuss with clinical preceptor.

4.                  Notify clinical affiliate, clinical preceptor and CCE if going to be tardy or absent in a timely and appropriate manner.

5.                  Adhere to the Genesee Community College Respiratory Care student dress guidelines when in a clinical facility.

6.                  Review necessary theory and clinical content to maximize safety and performance.

7.                  Consult with Genesee Community College Coordinator of Clinical Education weekly and PRN.

8.                  Participate in beginning, midway and terminal conference with preceptor and Genesee Community College faculty.

9.                  Participate in the evaluation of the preceptor program.

10.              Conform to all policies and procedures particular to the clinical facility.

 

THE CLINICAL EDUCATOR-CLINICAL PRECEPTOR—STUDENT INTERACTION

All three of the parties involved will have some insecurities and discomfort as we begin this experience and develop working relationships between us.

The progression of the workload that the student can handle is a mutual negotiation and assessment between the student, CP and the CCE.

To help us develop realistic expectations the following is offered as to how the roles may work on a practical level:

 

THE CLINICAL PRECEPTOR’S (CP) ROLE:

The CP functions as a role model for delivering effective Respiratory Care to patients.

The CP facilitates the student’s progress towards accepting more and more of the patient care assignment and the development of good time-management skills to facilitate the education of capable graduate therapists.

The CP will treat the student as an adult learner in a teacher-learner relationship.

The CP must countersign all students charting.

The CP makes a conscious effort to develop relationships with students that is:

                        -relaxed and trusting;

                        -mutually respectful;

                        -informal and warm;

                        -collaborative and supportive.

 

THE STUDENT’S ROLE:

The student has the greatest changes to make in her/his method and means of communication and interpersonal interaction to become socialized to the health care industry and the Respiratory Care profession culture.

The student is on time for the start of shifts and end of breaks.

The student must learn to communicate directly with the CP about patient care; this is done to encourage the student to learn how to develop a peer support system within the clinical facility.

The student is increasingly self-directed and enthusiastic about performing respiratory patient care.

The student follows all HIPPA rules with respect to patient confidentially and not use patient names or ID numbers if writing notes or preparing for a case presentation.  In addition, students will be very careful not to discuss specifics about patients or their care in public places where they can be overheard by third parties.

The student makes a conscious effort to develop a relationship with the CP that is:

                        -relaxed and trusting;

                        -mutually respectful;

                        -informal and warm;

                        -collaborative and supportive.

 

The student is responsible for entering observations and competency data into the clinical book.  Patient care time is never to be forfeited in order to enter clinical book while the student is at the clinical facility for a patient care shift.

Students MAY NOT make any changes in the prearranged clinical schedule without the approval of the facility CP and program faculty (clinical and program director).

The students should make contact with the preceptor before the start of the shift and introduce themselves.  If a problem arises before or after identifying and making contact with your preceptor, notify the facility CE or other program faculty immediately.

The facility CP and other program faculty must be notified and appropriate hospital incident reports completed if indicated, if any incidents occur to either patients and/or students. An incident in which a student may sustain some injury may require that the hospital treat you.  If this happens, you must complete the form “Report of Accident or Illness.”  Without this form, the student is financially responsible for any medical bills that may be forthcoming.

 

Clinical Instructors

The utilization of the personnel resources of the College and its clinical affiliates for the clinical education phases of the Respiratory Care Program is based upon a clear differentiation of the nature and type of the clinical contact provided to the students.  The types of clinical contact provided are defined thusly:

 

Clinical Instruction:  the organization and implementation of purposeful, planned and systematic learning experiences based upon specifically identified performance objectives and including direct one-to-one and group instruction, detailed evaluation and assessment of clinical performance.

 

Clinical Supervision:  the facilitation of skills acquisition, development and refinement by supervised work experience selected to correspond with the general performance objectives detailed for a course unit or clinical rotation.  The degree of supervision varies with the course/rotational sequence and the prerequisite instruction.  It includes selection of relevant work assignments, delegation of work responsibilities, provision of procedural assistance, and (where necessary) procedural remediation and the observation and reporting of student clinical performance in basic, advanced or intensive and subspecialty areas.

 

Clinical Instructor Selection and Evaluation

Qualifications and Selection of Clinical Preceptors:

In arrangement (and by recommendation of) each of the clinical affiliate Directors of Respiratory Care, affiliate staff members interested in assuming student supervisory roles are screened by the department according to the following differential criteria (*Note: each affiliate may have criteria which, if higher than Program requirements, will take precedence over the following):

 

 

INSTRUCTOR QUALIFICATIONS

 

INSTRUCTOR

Role:  General Therapeutics

Qualifications:  Must meet one of the following:

(1)    CRTT

(2)    Graduate of AMA accredited training program for respiratory therapy technicians with one-year full-time experience (under medical supervision) after formal training

(3)    By prior training or experience have competence in the specialty area to which students are assigned, and substantiation by Clinical Education Coordinator which fulfills JCAHO requirements (1995); and holding a New York State License in Respiratory Therapy by virtue of a “grandfather clause”

(4)    RRT with a minimum of two-years full-time experience after formal training, one of which must be in the area to which the students are assigned

(5)  CRTT with a minimum of four years full-time experience two of which must be in the area to which the students are assigned.

 

Integration

Integration didactic and clinical curricular elements and providing for sequence and continuity of students’ learning activities requires careful organization of the clinical experience and appropriate utilization of the Respiratory Care learning laboratory as an integral element in the overall curriculum design.  A concurrent patterning of didactic/clinical curriculum organization (in which a portion of each week is devoted to didactic instruction matched with a related clinical component) with a full time clinical assignment at the end of each semester (Clinical Practice II, III, IV) is employed at the Genesee Community College Respiratory Care Program.  This organization serves the multiple purposes of facilitating the transfer of learning between curricular elements; providing frequent practice and reinforcement for skills development and mastery; maintaining and promoting the students’ interest and reinforcement for skills development and mastery; maintaining and promoting the students’ interest in learning; and providing for the integration, continuity and sequence among and within curricular components.  These components, in turn, are organized in the Genesee Community College Respiratory Care Program into three identifiable, but not exclusive clinical stages: orientation and observation and learning and reinforcement of basic modalities, application of advanced modalities and supervised work experience, and finally, advanced clinical areas and subspecialties in a minimally supervised setting (refer to Table 1).

 

Teaching/Learning Strategies

The teaching/learning strategies employed in the clinical practices of the Respiratory Care Program represent the logical extension of the clinical mastery sequence described in PART C of this Section.  The basic premise underlying the selection and utilization of the clinical resources of the Program is the belief that the clinical affiliate(s) must provide: (a) student learning activities which are fully integrated with the didactic and laboratory experience, and (b) opportunities for developing the higher level cognitive and performance skills requisite to assuming the role of the entry level respiratory care practitioner.

 

The nature and type of learning strategies employed in the clinical setting are contingent upon the particular phase (or particular clinical practice) of clinical education that the student is assigned.  Based upon the four Clinical Practices (or phases) identified in this section (and Table 2), the following teaching/learning strategies are implemented.


 

TABLE 1 – Integration of the Clinical Components of the Respiratory Care Program

 

            SEMESTER               COURSE NUMBER                         CLINICAL PHRASE

                SUMMER I                                           RCP 106                                 Orientation/Observation

                                                                                                                                                Patient Assessment

                                                                                                                                                Written/Oral Communication

                                                                                                                                                Basic RC Modalities – Introduction and Reinforcement

                                                                                                                                                (Closely Supervised Work Experience)

                                                                                                                                                Advanced Modalities – Introduction

               

FALL II                                                  RCP 215                                 Advanced Modalities – Learning and Reinforcement

                                                                                                                                Subspecialty Rotations

                                                                                                                                (Supervised Work Experience)

 

SPRING II                                              RCP 206                                 Advanced Clinical Areas and Subspecialties

                                                                                                                                (Minimally Supervised Work Experience)

 

        PHASE OF CLINICAL EDUCATION                                                             TEACHING/LEARNING STRATEGIES

               

                Orientation/Observation                                                                                     Facility Orientation

                and Basic Modalities                                                                                           Observation/Assessment/Reporting

                (Initial Exposure)                                                                                                  Oxygen Therapy

                                                                                                                                                ***CPR

                                                                                                                                                Some Basic Competency Evaluations

                                                                                      Clinical Logbook and Care Plans

                                                                                                                                                Formative and Summative Evaluations

                                                                                                                                                Computer Assisted Instruction

 

                Learning/Reinforcement                                                                                     Demonstrations as necessary

                (Basic Modalities)                                                                                                Clinical conferences as needed

                                                                                                                                                Supervised Procedural application and practice

                                                                                                                                                Case Studies and Presentations

                                                                                                                                                Interaction with Physicians (Incidental/Planned)

                                                                                                                                                Basic Therapeutic Modalities with Competency

                                                                                                                                                Evaluation

                                                                                                                                                Clinical Log

                                                                                                                                                Formative and Summative Evaluations

                                                                                                                                                Computer Assisted Instruction (Simulations)

 

                Reinforcement/Advanced Modalities                                                              Advanced Therapeutics with Competency

                (Supervised Work Experience)                                                                          Evaluations

                                                                                                                                                Case Studies and Presentations

                                                                                                                                                Interaction with Physicians (Incidental/Planned)

                                                                                                                                                Clinical Logbooks

                                                                                                                                                Introduction to the ICUs

                                                                                                                                                Formative and Summative Evaluations

                                                                                                                                                Computer Assisted Instruction (Simulations)

 

                Advanced Clinical Areas/Subspecialties                                                         Minimally Supervised ICU

                (Minimal Supervision)                                                                                         Neonatal/Pediatric ICU

                                                                                                                                                Cardio Pulmonary Rehabilitation

                                                                                                                                                Cardiac Rehabilitation

                                                                                                                                                Home Care

                                                                                                                                                Interaction with Physician

                                                                                                                                                Case Studies and Presentation

                                                                                                                                                Maintenance of Clinical Logs

                                                                                                                                                Clinical Competency Evaluations

                                                                                                                                                Formative and Summative Evaluations

                                                                                                                                                Computer Assisted Instruction (Simulations)

TABLE 2 –Teaching and Learning Strategies with the Respiratory Care Program

 

Evaluation

Philosophy and Rationale:  The clinical evaluation methodology employed at Genesee Community College to assess students’ procedural proficiency and behavior has been formulated to reflect a competency-based, student centered philosophy of the Program; the faculty maintain that it is only through the implementation of reliable and valid measures of students’ clinical performance and proficiency that the ultimate goal of the program of learning, i.e., the training and provision of competent clinical practitioners capable of successfully assuming the roles and functions requisite to the delivery of quality respiratory care, can be realistically achieved.

 

Bases for Implementation:  The policies and procedures upon which the evaluative system is built are consistent with the philosophy, goals, and grading policies of the College and are based upon the principle of equivalent clinical experience within the Program curriculum.  The criteria utilized to assess learning outcomes have been derived from the current delineation of the roles and functions of the entry-level respiratory therapist.

 

Integration of the Evaluative System within the Curriculum:  The evaluative system has been designed to provide documentation, assessment, feedback and remediation, which are relevant to the three key phases of the students’ clinical education.  The various evaluative approaches and assessment/documentation tools utilized are summarily described, according to the pertinent clinical phase of the Program during which they are employed in Table 3:

 

                PHASE OF CLINICAL                       EVALUATIVE                                                      METHODS UTILIZED

                EDUCATIONS                                     APPROACH

 

                Orientation/Observation                     Attitudinal Self-Appraisal                                  Student Maintained Clinical Logbook

                and Basic Modalities                           Clinical Competency                                            Preceptor's Evaluations

                (Initial exposure)                                  Formative/Summative                                          Clinical Competency Check-offs

                Learning and Reinforcement              Performance Evaluations                                    Proficiency Evaluation Forms

                (Basic Modalities)                                Formative Attitudinal Evaluations                    Computer Assisted Instruction (Simulations)

                                                                                                                                                                Formative and Summative Evaluations

                                                                                                                                                                Presentations

 

                Advanced Modalities                         Clinical Proficiency                                              Clinical Proficiency Check-offs

                                                                                Evaluations                                                           Student Clinical Notebook

                                                                                Formative Attitudinal                                          Case Studies and Presentations

                                                                                Evaluations                                                           Formative and Summative Evaluations

 

                Advanced Clinical Areas                    Clinical Competency                                            Proficiency evaluation

                                                                                Check-off Evaluations                                         Student Clinical Notebook

                                                                                Formative Attitudinal                                          Case Studies and Presentations

                                                                                Evaluations                                                           Formative and Summative Evaluations

                                                                                NBRC SAE Examination

TABLE 3 – Clinical Education Evaluative Mechanism Used in the Respiratory Care Program

 

During the learning and reinforcement phases of the clinical education (RCP 106 Summer), the clinical mastery sequence is actually initiated.  Competence is assessed in the College laboratory by discrete skills evaluations utilizing a “workbook” mastery of skills and observation.  A checklist/rating scale approach may also be utilized as these are contained within the utilized clinical performance rating scales.  All performance elements, whether performed in the College laboratory or in the clinical affiliate site, is maintained on file in the Respiratory Care Program student files.  Depending upon the student’s performance of the skill and comprehension of the procedure, a status recommendation is made by the evaluator and recorded on the Performance Rating Scale.  Additional assessment of the student’s clinical performance made by the College faculty during the learning and reinforcement phase, as well as the advanced modalities/supervised work phase and the advanced clinical/subspecialty phase (minimal supervision) include Formative Behavioral Scale and an assessment of the students clinical logbook at the end of each semester by the Director of Clinical Education (DCE).

 

Entry into the advanced modalities phase (supervised work) experience of the clinical education phase (RCP 215 Fall 2nd year) is contingent upon the student’s successful demonstration of proficiencies in all requisite skills and procedures.  It is during this phase that a majority of the actual clinical evaluation takes place.  The same form utilized for evaluation of procedural proficiency is employed for the clinical evaluations and status of the evaluators are recorded in the same Summary Performance Record in the “Clinical Column”.  For each assigned rotation during the Clinical Practicum(s), students must satisfactorily complete all proficiency evaluations applicable to that rotation and demonstrate a satisfactory or better rating on each of the behavioral scales.  Progress to subsequent rotations is dependent upon the status report made by the applicable Director of Clinical Education and Clinical Instructor/Preceptor.

 

Entry into the final clinical phase (RCP 206 Spring 2nd year) requires documentation of the student’s logbook, which summarizes, on a daily basis, procedures performed, pertinent observations, and physician contact.  In the final clinical practicum, the students work under minimum supervision in intensive care areas as long as the Clinical Instructors/Preceptors in conjunction with the Director of Clinical Education substantiate the student as competent and ready.  In the subspecialty rotation(s), student will have to provide written product (case study), as well as the student clinical logbook with satisfactory attitudinal and behavioral assessments.

 

Entry into the application and work experience (supervised working and minimal supervision) phases of the clinical education is contingent upon the student’s successful demonstration of proficiency in all previous skills and procedures.  It is during these two Clinical Practicum’s (RCP 215and RCP 206) that a majority of the actual clinical evaluations take place.  At times, the same form utilized for pre-clinical evaluation of procedural proficiency is employed for clinical evaluations and status recommendations of evaluators are recorded in the same Summary Performance Record.  For each assigned rotation during each clinical practicum, students must satisfactorily complete all proficiency evaluations applicable to that rotation and demonstrate a satisfactory or better rating on each of the behavioral rating scales.  Progress to subsequent rotations is dependent upon the status report made by the applicable Clinical Instructor/Preceptor in conjunction with the formal and/or informal discussions with the Director of Clinical Education.  Documentation of student experience is accomplished by a student-maintained logbook, which summarizes, on a daily basis, procedures performed, pertinent observations and physician contact.  Upon completion of all clinical rotations, a composite student attribute rating can be estimated to provide a rationale for offering honor grades (for exemplary clinical performance beyond that necessary for safe and effective practice).