For pharmacy preceptors, the challenge is rarely just identifying when a student is struggling; it’s knowing how to respond in a way that supports the learner while upholding professional standards.

A team of experts, including from the UCSF School of Pharmacy, has developed “The Preceptors’ Toolkit for Working with Struggling Pharmacy Students,” that offers a structured path forward.  

“Preceptors are often navigating these situations in real time, without a clear roadmap,” said Tram Cat, PharmD, BCPS, associate dean of student affairs at the UCSF School of Pharmacy and among the paper's authors. “This toolkit is designed to bring structure and confidence to what can otherwise feel uncertain.”

The toolkit was published in Pharmacy, an international, peer-reviewed, open-access journal by MDPI in Switzerland, affiliated with the Academy of Pharmaceutical Sciences,  that focuses on pharmacy education and practice. 

A common challenge, often faced alone

Preceptors have dual roles in teaching and patient care, yet many report feeling underprepared to manage underperforming students — especially when challenges involve mental health, learning differences, or disability accommodations.

“Supporting a struggling student starts with understanding what’s driving the difficulty,” said Cat, whose work centers on student success and well-being. “This paper acknowledges that working with struggling learners can contribute to burnout, particularly when expectations are unclear and support systems are limited.”

Looking beyond performance gaps

A central message of the toolkit is that no two struggling students are the same.

Preceptors are encouraged to assess gaps in knowledge, clinical skills, and professionalism, while also considering contributing factors such as mental health challenges, substance use, and learning disabilities. The authors of the paper describe such external stressors as “social determinants of learning.”  

Because students may hesitate to disclose these issues, early communication and trust-building are essential. Clear expectations, alignment with program competencies, and early assessments help distinguish between correctable deficits and more complex barriers.

Starting early and intervening often

The authors of the toolkit emphasize that intervention should begin before a rotation starts. Pre-rotation questionnaires, orientation discussions, and clear goal setting help create psychologically safe learning environments, especially in clinical settings.

Once a rotation is underway, timely, specific feedback is critical. Structured approaches, such as regular check-ins and models like “Stop, Start, Continue” help guide productive conversations.

“In more difficult discussions, timely, clear feedback can change the trajectory of a student’s experience,” Cat said. “Focusing on observable behaviors keeps feedback actionable.”

Navigating mental health and accommodations

Supporting students with mental health challenges or disabilities is one of the most complex aspects of precepting.

The toolkit emphasizes that accommodations should be based on appropriate diagnoses and developed collaboratively among students, preceptors, and disability offices. While preceptors may make informal adjustments when needed, formal processes help ensure equity and legal compliance.

Creating space for open communication — through tools like pre-rotation surveys — can also encourage students to seek support earlier.

“We’re seeing more students navigating significant stress and mental health challenges,” Cat said. “Building that into how we teach is vital.”

Documentation and difficult decisions

The paper provides practical guidance on documentation and formal intervention strategies, including individualized education plans that are specific, measurable, and developed with student input.

Despite early support, not all students will meet competency thresholds. In those cases, preceptors may need to recommend extending or repeating rotations, or, when necessary, dismissal from rotation in alignment with school policies. The authors also address the persistent issue of “failure to fail,” where students advance without meeting standards.

“Preceptors play a critical gatekeeping role,” Cat said. “Ensuring students are practice-ready is fundamental to patient safety.”

Support for preceptors

Focusing on shared responsibility and offering clear frameworks for guiding learners through challenges, while staying focused on strengthening the preceptor role, helps ensure that UCSF upholds its mission of delivering safe, effective patient care.

“Preceptors remain essential, and shouldn’t feel like they’re navigating these situations alone,” Cat said. “This guidance reflects the pharmacy profession’s commitment to supporting students with intention while maintaining rigorous standards for practice.”