Arianna Johnson, PharmD, BCPP
Though the introduction of telehealth into modern medicine was inevitable given recent technological advancements, the COVID-19 pandemic forced a health care system-wide change to prioritize telehealth care modalities to minimize health and safety risks for patients and providers alike. This dramatic shift led to lasting changes in patient care delivery models and, as a result, impacted trainee/learner rotations. Telehealth, along with hybrid or fully virtual rotation models, are here to stay. This new reality comes with its own hurdles for preceptors to navigate in order to ensure successful rotation experiences.
Beyond the technological difficulties and varying competencies regarding telehealth use, the preceptor must address the challenges the challenges of establishing good communication, building rapport between preceptor and student, and conveying appropriate empathy in virtual interactions to ensure successful virtual rotation experiences. Here are some suggestions on how to address these barriers to success.
Establishing Good Communication
Make sure to set very clear expectations during the start of your rotation regarding standards and communication ground rules. I recommend providing visual guides on how to use your system’s telehealth platforms and walking through examples. Learners should know when to log into visits with you, how they should introduce themselves to patients, and in what situations the preceptor may interject during the appointments. Establish when the learner should touch base with you right after interventions versus at the end of the day. Emphasize that because of the rotation format, it is appropriate for the learner to discuss a difficult case and provide a callback to the patient if they are unsure about next steps based on information presented during the appointment.
How does the student like to receive feedback? During a visit, would they prefer you correct them via instant messaging or by speaking up within the appointment? How do they prefer to receive feedback on their notes and their performance? It is best to prioritize providing feedback regarding the learner’s soft skills, “webside manner,” and overall rotation performance by video call and limit delivering feedback in writing or audio call only. Tone can be easily misinterpreted in written or telephonic communication, so feedback over video is important to provide tone and nonverbal cues to contextualize your comments.
Building Rapport
A common barrier of virtual rotations is less-frequent communication and/or less rapport between learner and preceptor, which can lead to an unfulfilling or unenjoyable rotation. It is easy for a busy day to pass by without a dedicated meeting with your learner, especially if the learner is independent and efficient. It is important to set aside time during the day to meet with the learner for feedback, briefs/debriefs, topic discussions, and informal discussions. Make sure to go out of your way to ask the learner how they are doing or what they did over the weekend. Have a lunch once per week with your learner where anything but the rotation itself is discussed. These activities help build rapport and may provide insightful information regarding your learner's overall goals and personality. Building rapport is overall easier in an in-person setting, as physical proximity can facilitate more informal discussions during the downtime between visits. Since co-locating is not possible in virtual rotation settings, preceptors should dedicate more time to bridging the “virtual gap.”
Conveying Appropriate Empathy
This section ties in all the information above. Making sure you are setting clear communication expectations and clarifying preferences early in the rotation, meeting regularly using both audio and video when possible, and building in time to informally connect with your learner are all steps to help learners feel more comfortable in a virtual rotation setting. Integrating these concepts with the “Four Pillars of Empathetic Communication” can support a more successful rotation experience. The four pillars to remember are: Being Present, Taking the Patient’s (or learner’s) Perspective, Empathetic Listening, and Acknowledging Feelings.1 Incorporating these into your interactions with learners, just as you do with your patients, is a great way to make sure they feel heard.
Virtual precepting presents unique challenges. However, with a little extra effort and the tips above, you can make your virtual rotation just as fulfilling as an in-person one!
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