What Clearer Preceptor Leadership Could Mean for Residency Training

Pharmacy residency programs often rely on preceptors to take on critical leadership responsibilities without defined roles, expectations, or recognition. According to Lisa Modelevsky, PharmD, BCOP, this lack of structure creates widespread inefficiencies — from overextended residency program directors (RPDs) to residents receiving inconsistent guidance. In this interview, she outlines why professional organizations and institutions should prioritize clearer leadership pathways and how even small programs can implement them effectively.

Q: You describe preceptor leadership roles as “undefined and underutilized.” From your experience, what are the most common consequences of that lack of structure — for the preceptors themselves, for residents, and for the overall quality of residency programs?
Lisa Modelevsky, PharmD, BCOP: So I will say, without having a structure or built-out model for these lead preceptor roles, often what I see is that the residency program director (RPD) themselves, they're really taking on all of the burden. So especially for a new RPD not being aware of the possibility of creating these lead roles, this is really going to add up on them. They're going to carry more on their shoulders. And then, without guidance on creating these structured roles as you try to build them out, preceptors themselves sometimes are reinventing the wheel. That can be very time-consuming. It's not clear to them how their success is going to be measured. So being able to give that guidance about the leadership skills that they can build, or how they can measure success, is invaluable for helping that preceptor be successful.

You mentioned residents as well. So if people are reinventing the wheel around them, it's not always clear to preceptors exactly what their expectations are. The residents feel it. So often for them, maybe they're not sure if they're on the right track or who they can reach out to for more support. There's a trickle-down effect of—I don't want to say confusion—but there just could be more structure to keep everyone on track and have better, more effective management of their time as a result.

Q: The RPD role has a well-established framework through American Society of Health-System Pharmacists (ASHP) accreditation standards, but roles like the residency program coordinator (RPC) and advisors do not. What do you think has historically prevented professional organizations from standardizing these roles, and is that starting to change?
Modelevsky: Certainly. So the ASHP standards really are meant for programs to follow in order for them to obtain accreditation. So in a way, it does make sense to me that the standards do not also flush out the details of a lead role, because you're not being surveyed on those lead roles. However, I do think it would be helpful for ASHP or other organizations to put out maybe a how-to guide or some type of resource explaining other lead roles that they've seen through surveys going across the country. What lead roles have really been effective for supporting an RPD in addition to an RPC, or if there are multiple RPCs, what do those different roles look like? So I don't think in the future this will be in the standards, but it could be in conjunction with the standards, sure.

Q: Your session presents proposed pathways to expand and formalize preceptor leadership opportunities. What does a realistic, structured pathway look like for a preceptor at an institution with limited administrative support or a small residency program — is this scalable beyond large academic medical centers?
Modelevsky: So during our presentation, we had a slide illustrating the framework of what we see these lead roles looking like. So starting with the RPD role, then RPC, supported by or potentially supported by the residency advisory committee (RAC). Beneath those roles, we had created 16 distinct lead preceptor positions. So for a program that is small, that could sound daunting — you don't have 16 preceptors for each position. So you could potentially have single preceptors taking on multiple roles. However, it might be more effective to even have multiple RPCs instead, if there's going to be more weight to that title and more ability to reward and recognize that preceptor for taking on lead roles with that title.

Q: Recognizing and rewarding preceptors for leadership contributions is easier said than done in environments where clinical productivity is the primary metric. What are the most practical and creative strategies you've seen institutions use to formally acknowledge preceptor leadership without relying solely on financial incentives?
Modelevsky: I've come to learn that the most effective and easiest solution is incorporating precepting into career ladders. Career ladders can drastically vary depending on the role of the pharmacist who is filtering into that career ladder — where the specialist or pharmacist is practicing, as well as the size of the program. But still, I think the managers need to take an individualized look, a keen eye, at that career ladder to make sure that points for these additional roles — like leading or being an advisor on a research project, advising a medication use evaluation (MUE), whatever it might be — that those accomplishments are recognized as points that feed into a career ladder for promotion or bonus, whatever recognition comes as a result of moving up in that career ladder.

For institutions that don't have career ladders, we learned from other programs that there are opportunities for bonuses, if that might be an option; a Preceptor of the Year award that's recognized amongst peers; maybe that's showcased on the social media for the program as well. So some type of peer recognition, if a financial incentive isn't available.

Q: Many preceptors take on coordination or advisory responsibilities informally, often absorbing significant workload without title or credit. How do you recommend preceptors advocate for themselves in the current environment, and what language or data are most persuasive when making the case to pharmacy leadership?
Modelevsky: Okay, so I think there are multiple layers to this answer. First, I think that in certain circumstances, managers are unaware of what preceptors are actually doing in these roles. I think the lead roles can come across as task-oriented: Did the resident complete the task? Yes or no. But there's so much involved to get that resident to completing the project — everything that the preceptor is learning in that process as well. I don't think managers are always aware of all of that hard work and time that's going into that. So I think that's step one: transparency with what we're actually doing.

And then we've learned from other institutions that they have built protected time into full-time equivalents (FTEs). For example, my colleague who was presenting with me, Hori at Dana-Farber, one day per week is an admin day for their pharmacists to actually work on preceptor-related activities. But that all, of course, starts with a conversation — understanding the needs of the staff, knowing that preceptors really need to be putting this time in in order for us to maintain ASHP accreditation as well, and then managers being able to give that time to them to do those activities.

Q: For a preceptor or RPD attending this session, what is the one structural change you most want them to leave motivated to pursue at their own institution — and where should they start?
Modelevsky: The structural lead that I want them to take away from this presentation is the slide illustrating an example framework with those 16 distinct roles. If an RPD doesn't have 16 different preceptors taking on these roles, they can understand which types of advisorship positions maybe can be bundled together and distributed fairly amongst multiple RPCs.

Q: Is there anything you’d like to add?
Modelevsky: I think a key takeaway after the presentation is that managers and RPDs — we do really want to know what our preceptors are doing, and it really takes the preceptor to advocate for themselves and let us know the time, effort, contribution, the milestones that they've accomplished with the resident and within themselves. Without them communicating that to us, we're not always aware. And we want to know about all of these great things that our preceptors are doing. So I just want to say a big thank you to all of the preceptors who are out there working hard, taking on multiple lead roles. We see you. You deserve rewards and recognition for what you're doing, and we hope you shed more light within your institutions to help get you there and get what you deserve.