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How to CRAFT an effective preceptor-learner relationship

With the advent of postgraduate competencybased medical education (CBME), the preceptorlearner relationship is in the spotlight. The focus on defined outcomes (outcome targets), learnercentric delivery, and direct observation, with an emphasis on formative assessment,1 has demanded a preceptor-learner relationship in which both the preceptor and the learner have key roles. For preceptors, demonstrating high-quality care and being a good clinical role model are crucial to addressing the importance of patient safety and developing credibility as a teacher. Second, attending to the teaching relationship fosters the learner’s receptivity to feedback2 and sets the stage for negotiating useful goals to advance learning. Third, with the inception of programmatic assessment, contributing to formative (low-stakes) assessment through good-quality feedback3 can create a portrait of the learner advancing to competence. Finally, knowing what roles, habits, or skills residents need to achieve and what outcome targets relevant to a preceptor’s specific context look like are critical. For example, frameworks such as CanMEDS–Family Medicine,4 sentinel habits,5 and skill dimensions6 articulate roles, habits, and skills, respectively, that need to be developed and assessed. Outcome targets, often described in terms of entrustable professional activities, core learning activities, or similar, are broad descriptions of the activities that residents will be able to do by the end of their programs. They reflect their competence to enter and adapt to independent practice. The role of the resident has shifted from a passive recipient of experience to an active learner engaged in their education and assessment. Specific skills for this role include setting goals, seeking feedback and coaching through direct observation, integrating coaching guidance into practice, reflecting on assessment information, and planning learning to address identified gaps.7 Think of this as a personal quality improvement cycle for professional development. Preceptors want to teach effectively and avoid confusion. New preceptors may wonder what skills they need and may ask themselves, “Am I ready to teach?” Experienced preceptors face the challenge of the shift to CBME, which requires more direct observation, attention to and skill in giving feedback (coaching), and documentation of low-stakes assessment. What residents require to engage deeply in their learning and assessment are explicit teaching and modeling of reflective, self-directed, self-regulated learning and to incorporate these skills as part of their professional development.8