Part 4: Nuts and Bolts 202 - Clinical Learning

D. Developmental Stages of Precepting

The preceptor must be able to gradually release control of the management of patient care as the adult learner begins to take on that role. The preceptor must respect and encourage the student's growth. Differences in the learning style of the student and the preceptor can create a struggle over how much or how little control of patient management is appropriate.

There are four developmental stages in successful precepting that to some extent relate to how much clinical experience the student has had. However, just as in human psychological development, students (and preceptors) move in and out of the various stages in a non-linear fashion. (Armstrong, 1991).

Stage I: Supervision/Direction

At the earliest stage the preceptor is primarily responsible for the client's clinical care and for how much/how little the student participates in the care. The preceptor:

• Sets the goals for the student
• Takes responsibility for decision-making
• Closely supervises the student
• Gives specific instructions as needed
• Recognizes and praises good performance/uses specific teaching/modeling
• Provides a tight circle of safety for the student

Stage II: Instruction/Coaching

As the student progresses the preceptor begins to turn over more of the care and decision-making to the student. Together they decide on the amount of participation in care that the student will provide. The preceptor:

• Sets the goals jointly with the student
• Solicits input from the student on plans and decisions
• Takes responsibility for decision-making when the problem lies outside the student's experience
• Supports and encourages the work of the student
• Gives specific instructions as needed
• Evaluates the work at the end of the session
• Recognizes and praises good performance/ uses specific teaching/modeling
• Iincreases the circle of safety for the student

Stage III: Encouragement/Support

With progress, the student takes the lead. The preceptor:

• Lets the student set the goals
• Lets the student take the lead in plans and decisions
• Listens to and facilitates problem-solving and decision-making
• Shares the responsibility for decision making when outside the student's experience
• Supports and encourages the work of the student
• Redirects the student when necessary with specific teaching/modeling
• Evaluates the student's work with the student
• Recognizes and praises the student for successful planning and implementation of the management plan
• Enlarges the circle of safety

Stage IV: Entrustment/Delegation

By stage IV the preceptor trusts the student to identify the problem and accepts the student's plan, as long as it remains within the boundaries of safety. The preceptor:

• Lets the student define the clinical problem
• Lets the student develop the plan of action and control decision-making
• Accepts the student's decisions, within safety guidelines, and allows the student to be responsible for interventions within a widening circle of safety
• Allows the student to evaluate performance
• Recognizes and praises the student's ability to perform at a safe, beginning practitioner level
• Redirects the student - specific teaching is limited to new and complex situations

rev. 2/23/04

“Always listen to what your inside voice is telling you…trust in yourself…and always listen to what the woman is telling you.” - Susan Melnikow, CNM, North County Health Services, Encinitas, California

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