Ok, then that is a bit different did that preceptor give you anything constructive to work on.Without what knowing what they specifically told you my first thought is it a confidence issue? Do you turn to your preceptor and ask them questions on everything you do not know? That maybe a cause for lower marks because they want you to look up an answer/try to formulate something yourself before turning to them. Never make something up to tell a patient if you do not know but if it is between you and your preceptor sometimes it is better to give an answer, that may not be entirely correct, with good reasoning behind it than to say I don't know. They want you to be more self sufficient and looking for answers to your questions rather than turning to them all the time. Did they sit down with you one on one and talk through what deficiencies they saw? If they didn't try to get them to talk with you openly about what they think you need to improve and take it to heart.
Also are you on a rotation with other students? Are you letting them take the spotlight or comparing yourself to them too much? I knew before going into one of my rotations that I was paired against one of the more extroverted people in my class and it made me really nervous. Luckily for me I was also paired with another more low key student like myself and we were able to balance the other student's outspokenness but it was still intimidating. The bottom line though is make sure you are shining through too. You do not have to be the most outspoken but make sure your voice is heard. Even if your answer is not always correct make sure you are providing one, this is your last chance to be wrong and it be ok so take advantage of that.
Also if this is a faculty preceptor know that they are notorious for being harder on their students because they know a lot of the outside preceptors will often just give straight passes as long as there is nothing genuinely wrong with the student. I know that because the only ones that I ever received below a pass on our midpoint evaluations was with faculty preceptors. One of the ones that did this to me was on my last block and I was panicking so I asked him to sit down one on one and discuss it. He basically told me that he was going to pass me in the end regardless, I was not truly deficient, he just basically said I think you have more in you than you give yourself credit for. And it worked. Honestly I didn't think that I had it in me to really do any better than I was doing but by the end I even came up with something on rounds that he hadn't thought of, and this man by all accounts and purposes is a genius. So if it was a faculty preceptor just know that in general they are known for being harder on their students.
Counseling probably won't be that much on an issue in the hospital setting unless your acute care is vastly different than my experience. Typically in most instances I think that involves rounding on patients with your preceptor and maybe medical students. So more of the knowledge will be on lab work, drug interactions, and infectious disease. I am not sure what they wanted you to review in preparation but I would think they would want you to brush up on your anti-infectives and their spectrums of activity. Disease states that you will see everywhere and are just good to review are: diabetes, heart failure, and hypertension. Knowing the treatment guidelines for these will be a major help. So if you wanted something to review disease state wise that is probably what I would stick with. Plus whatever else they wanted you to review.
Although you probably won't counsel on an acute care rotation 5 counseling tips in general. 1. Make sure you tell the patient what the medication is typically used for, stressing that they maybe using it for something else. (This is a good thing to always do because for example if the patient is prescribed Gabapentin and goes home and reads about it first thing they will probably see it is for is seizures. Naturally they are going to freak out and call you saying you gave them the wrong medicine.) 2. How should they take it? Morning/evening. With food or without.Also if it cannot be taken with something such as vitamins/supplements. If a device how do they take use it. 3. Any specific storage instructions? 4. Most common/severe side effects and how to deal with them should they occur/how to prevent them. For example Levofloxacin you would want to tell them about possibility of tendon rupture( prevent avoid strenuous activity and if occurs call their doctor right away) also may make them more sensitive to the sun(prevent by wearing sunscreen outdoors). You will never be able to tell a patient every side effect or you will not get anything else done all day. 5. Answering any questions/concerns they have. If it is something that you do not know the answer to look it just say, "Let me double check the answer on that...." and look it up. If on rotation looking it up does not answer your question then and only then ask your preceptor. And whatever you do DO NOT MAKE UP AN ANSWER! I have met students that do this and it only results in a bad time for everyone. Also I normally end counseling telling patients to read the provided information and call back to talk to us if anything concerns them.
I hope some of this helped at least a little.
