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their clinical , they occasionally forget important concepts that they learned earlier in the didactic portion of their program . We give them this document with educational topics to review including drugs , tubing volumes per foot , cardioplegia types , and unique cardiac surgical procedures that we perform at our institution that may not have been covered in school . Less review is needed by the preceptors and director since providing the body of knowledge sheet . This is mentioned based on observation and consensus only , however the change was very noticeable .
The clinical program director will assign students to preceptors . Ideally , the assignments are for a week at a time . These assignments are made after looking at who is available based on position in preceptor rotation and vacation time off . All students spend one week each with the program director as a preceptor . In most instances , each student spends one week with a preceptor but no more than two weeks with the same preceptor . This allows the students the ability to see and work with as many preceptors as possible . We currently have 24 perfusion preceptors at our center .
Another area that is covered during rotation at our institution is the ability to give students time to lead a biweekly education hour in which two topics are chosen . These are typically focused on special cases such as sickle cell anemia , cold agglutinins , pregnancy , and others . Students select topics , find articles that promote evidence-based practice ( EBP ), and review the most important parts of topics for perfusionists to think about or plan out how to deal with the topic . EBP for practicing perfusionists has been reported on in a low sample size study . It showed that higher education level and work status at an academic center increased EBP [ 15 ]. The goal of these sessions is to promote problem-based learning ( PBL ) and have the students construct mental models of the perfusion world . Students lead the discussion with questions and are aided by the program director to provide PBL scaffolding to make some support and connections for the learners to further their own ideas . The program director also prompts the students to think about what the most critical areas are that a perfusionist should think of for these topics . The students then take the lead in answering and incorporating their own thoughts . The program director then offers clinical input on the topic . The goal of these interactions is for students to develop skills and the ability to look for quality articles that would be viewed as the best articles for developing EBP guidance for a perfusionist . We also ask that the students not refer to our institutional guidelines or look at the references in those guidelines , as that amounts to getting the cliff notes on the topic and defeating the goal of the education hour . Over the course of having students rotate the topics are usually repeated , but not with the same students present .
By partnering with multiple programs , the starting dates of students are staggered . This allows for previous students who have already started to obtain experience before we receive more students . This allows the new students to participate in less intense and more straightforward cases , thus giving the experienced students the more difficult , challenging cases that they have attained the ability to perform . Similar processes have been used successfully with nursing students [ 16 ]. The best analogy for this is using an escalator as a model . Students enter at the bottom of the escalator and work their way up to the higher level . This allows more students to get on at the bottom . The escalator does not stop , but as students leave the escalator ( rotation ) it is filled with more students . The mid-level students taking over as senior students ( top of escalator ) that have the most experience are able to assist the newer students and provide helpful tips .
With a large number of preceptors and rotating students at our institution , utilizing a level system was identified as a way to provide students goals to reach and preceptors an idea of the student ’ s aptitude . There are three levels , labeled numerically : 1 , 2 , and 3 . All students start at level 1 with the goal of reaching level 3 by the end of their rotation . Ideally , students in level 1 are given more straightforward cases like coronary artery bypass grafting and valve-only cases . As students move up levels the cases get more complex . Level 2 cases may include redo sternotomy and complex valve cases . Level 3 cases are the most difficult and may involve deep hypothermic circulatory arrest with retrograde or antegrade cerebral perfusion ( Table 1 ). The amount of assistance from the preceptor is expected to decrease as student levels increase . Assessment for promotion up the levels is done by the program director with feedback from the students and their recent preceptors .
In order to make evaluations more student-centered instead of preceptors filling out the evaluation the student takes the lead on this endeavor . This is not to lessen the preceptor ’ s responsibilities but rather designed to make the evaluation and the learning points “ stick ” for the student . The student completes their full required didactic programs evaluation including the grading areas for individual tasks . The student then adds in at least three areas where they learned something new , did a task well , or need to improve on a task . Each of these areas is required to be expanded upon with a minimum of three sentences . The goal is that the subject will be identified , framed , and a conclusion formed within these sentences . By doing this the student has completed a mini-reflection three times . At this point , the preceptor reviews the whole evaluation with the student . If additions or changes in grading areas are needed the preceptor will discuss this with the student and the student will make the changes . These evaluations are also done immediately following the case , usually while waiting for the bypass circuit tubing to be handed back . This is done at least 30 min after the arterial cannula is removed and after chest closure . If the preceptor is relieved during the case , then the relieving preceptor is responsible for completing the evaluation with the student . The preceptor being relieved will give a report on how the student has been doing on the case verbally or via a paper copy of the student ’ s evaluation . In any case , timely feedback and completion of the student ’ s evaluation are critical for their improvement and information retention .
Clinical student learning would not be possible without preceptors . For preceptors to be as effective as possible some baseline education and common practice benefit both the student and preceptor . At our institution , the program director makes a yearly education module to touch on an educational approach or theory for the preceptors to review . These include a podcast and additional website material from the medical center ’ s school requiring about 1 h of the preceptor ’ s time . Incorporating and adapting our medical center ’ s established content to meet our needs prevents us from having to invent