The concept of teaching as reflection-in-action refers to the preceptor's thinking about the teaching/ learning process or problem-solving teaching/learning situations while directly engaged in teaching.  You demonstrate effective reflection-in-action when you change your teaching approach after recognizing that your approach is not working.  That sounds pretty obvious, and yet many teachers and preceptors keep plugging away with the same approaches even though they are not satisfied with the results--an echo of that popular saying, "If you continue to do what you have always done, you will continue to get the same results you have always obtained."

While you are explaining a case to the student, you see the student's eyes glaze over and you readily see that the student is no longer actively engaged.  But it is not always so obvious when an approach is not working.  Even when the student is exhibiting my-eyes-glaze-over (humorously called MEGO), a preceptor might fail to notice and continue to drone on.

Seek feedback from the student frequently.  Not by asking questions which can be answered "Yes" or "No," such as, "Did you get that?" or "Do you understand?" or "Do you see the relationship between … and …"  Instead, ask the student to tell you what he or she got out of an explanation or ask, "What did you think was most important in what I just told you?" or "If you had to summarize this case in 60 seconds, what would you say?"

Validate your perception that your present approach is (or is not) working.  Validate often so that you do not waste valuable time pursuing an ineffective approach.  Validate the effectiveness of your teaching approaches with students just as you validate the effectiveness of treatment plans with patients.  Remember the learning vector concept and its implication that students benefit differentially from teaching approaches depending upon their level of development.  At a given time, a student may learn best from a collegial approach in some aspects but at the same time need a very directive, didactic approach in aspects that are entirely new.

By taking a holistic approach, Advanced Practice Nurses offer patients a unique approach to primary care.  The student needs to practice comprehensive patient care, but at times in the learning process, the student may benefit from repetitive practice of a narrow aspect of care in order to master a skill.  For example, if you assess a weakness in the student's skill in history taking, you might assign the student to taking and documenting histories for that day.

Keep your flexible stance, practice the techniques included in this section, and seek feedback from the student to validate the effectiveness of your approaches.