Should I ask students about career goals?

Revisiting “Precepting 101” – Part 2
Should I ask students about career goals?

My short answer is Maybe. The real question I want you to be asking is “Why do I ask students about their career goals?” The motivation prompting this question can be associated with effective engagement with your learner, or it introduce In-Group-Bias into your relationship with your student. Or maybe you were just told at one point that this is what good preceptors do. I’m giving you permission to not ask this question if it isn’t helping you or your student.

Should you be worried about In-Group Bias when precepting?” The answer to that question is a resounding YES!

 What is "In-Group Bias" (IGB) and how may preceptors manifest it during a clinical rotation?

IGB is the tendency to favor those within a self-identified social group. This creates space for treating those who are out-of-group less favorably. Unlike other forms of identity such as race and gender, professional identity develops in the context of an emerging social identity in adulthood. Our career paths transform us from lay-person to student, student to entry-level practitioner, and many of us then choose to specialize within a passion area.  As we spend more time training and working alongside peers who share our professional identities, our sense of social identity within this professional group strengthens.

Bochatay et al. explains how this new professional social identity can overlay and intersect with other forms of identity, creating layers of potential biases that may shape social influence. As someone who has studied professional identity formation of health profession trainees, especially in the context of interprofessional education, I’m surprised I haven’t encountered as much discussion about the risk of IGB within professional groups. I feel strongly that IGB is a topic that deserves attention within the clinical learning environment. Now that I’ve become familiar with the concept, I can’t help but wonder if IGB explains why many preceptor-student relationship become more challenging than others. 

To be fair, IGB may manifest for many individuals in very positive ways. Many great practitioners engaging in clinical education today likely benefited from some form of IGB during their training. For example, IGB may influence would-be mentors to take an additional interest in a trainee who is pursuing similar training pathways as the preceptor. These mentors may develop a meaningful relationship with learners, creating opportunities for the younger professional. Meanwhile the younger professional develops a robust professional identity, feels welcome in the new social identity, and benefits from the psychological safety created by feeling integrated and supported in the learning environment.

How can In-Group Bias negatively affect the learning environment?

If we only trained individuals who are destined to follow the exact career path that led us to our professional identities, IGB would be a non-issue. Many of us may love this idea, but it’s simply not realistic for most clinical educators. Nearly every entry level health profession degree program has a prescribed set of core clinical training experiences. Medical students interested in primary care will do hospital clerkships. Pharmacy students wishing to pursue careers in the pharmaceutical industry will have to round on internal medicine rounds. Dental students wanting to work in public health are likely to spend time in a privately owned dental practices. In short, students need preceptors who can look past their own career path to ensure students receive equitable training, fair evaluations, and benefit from professional mentorship regardless of professional ambition.

What does In-Group Bias sound like to students?

"You're doing good enough considering you're not planning on doing residency."

"You're lucky - I usually only take students interested in critical care."

"I only want to work with students interested in pediatrics."

"I'm not sure how to help students who aren't focused on clinical pharmacy."

"Are you sure you don't want to do residency? You'd be great at it!”

When I was directing an experiential education program at a pharmacy school, students would often tell me they were bothered by statements like the ones above.  As a practitioner and preceptor myself, I often came to the defense of these preceptors because I knew they were well-intentioned and likely simply misunderstood. Perhaps I too was seeing this through the lens of preceptor IGB?

These examples stand out to me because they are often made in context of the most innocent of questions, “What do you want to do with your career?" There is nothing wrong with this question on its own. For preceptors, understanding why training is important to a learner, and being able to personalize new content and practice, is an effective and evidenced-based teaching strategy. However, as a thought experiment, imagine your newly assigned learner responds excitedly that they accepted a job in an area best described as "the last possible professional role I would ever choose for myself."  How do you feel? Are you excited for them? Are you anxious about your lack of understanding of that job? Are you concerned they may not value the job you do or what you may be able to teach them? Do you find yourself dismissing their goals because they don't align with the experience you are offering? Do you think creatively about how your rotation can support their career goals while meeting the required learning outcomes? Take a minute to reflect about your own perspectives on this question. If you’ve been precepting for any significant amount of time at all, you’ve likely been in this scenario.

 How do I address In-Group Bias as a Remediation Coach?

As a remediation coach, I work closely with students who have been unsuccessful at passing clinical rotations. While my students don't label IGB directly, they certainly describe it and ascribe to it reasons contributing to their failure. As a result, these students develop a strong desire to hide their true professional ambitions from future preceptors. Some assume they must portray an interest that aligns with their preceptor if they wish to be successful.  These students feel like their actual professional identities are a barrier, one best kept hidden in case it jeopardizes their ability to succeed once more. This is obviously a barrier to their eventual success. As their coach, I work with these students to navigate how to present their authentic selves and leverage their diverse perspective on a team. I want students to intentionally build the skill sets that overlap between their career goals and their out-of-group rotation. This isn't possible if they’re hiding their true professional ambitions.

Preceptor Advice

My advice to preceptors is to not let a student's career trajectory affect how they are perceived on rotation. Don't use their career interests as indicators of commitment, preparation, or aptitude.  Take the time to reflect on how you engage with learners regarding their career path and explore how this information can add to your learning environment. If a learner's professional path becomes an excuse to alter your rotation or expectations, then reflect on how necessary it is for you to know this information about your learner.