2007 Preceptor of the Year: Mary (Himlin) Dimo, PharmD’93

Aclinical pharmacist on the University of Michigan trauma-burn service since 1998, Mary (Himlin) Dimo, PharmD’93, knows that her practice specialty isn’t on most students’ career checklist.

So rather than attempt to turn the six to eight U-M PharmD students she precepts each year into clones of herself, she focuses her teaching on reinforcing the clinical skills that are applicable to all areas of pharmacy practice: critical thinking, problem solving, organization, communication, empathy.

“I can’t make beginner pharmacists into trauma-burn clinical specialists in four weeks, but I can make them better pharmacists than they were when they arrived on my service,” Dimo states. “What I expect is for them to be interested. If they are interested and motivated, they will do their best, and we will have a foundation for learning.”

Her ability to match clinical content to the diverse needs and interests of students was a major reason Dimo was selected the College’s 2007 Preceptor of the Year.

The U-M trauma-burn service includes a 10-bed intensive-care unit, an eight-bed step-down unit, plus general-surgical care floors. Patient load ranges from 20 to 30 acutely-ill individuals whose therapies require a multidisciplinary approach involving consulting medical services, dedicated physician assistants, nurses, nutrition specialists, respiratory, physical, and occupational therapists, and, of course, pharmacists.

Dimo begins each P-4 rotation cycle with an orientation. She then interviews students to find out what previous rotations they may have had, the extent of their work-related experience, students’ career goals, and their clinical strengths and weaknesses. All this helps her to tailor students’ learning experiences by placing them in structured, skill-building situations.

Describing her teaching style as “supervised independence— leading from behind,” Dimo insists that students get involved and take responsibility to the best of their ability.

Because trauma-burn cases are clinically complex, students are inundated with a vast amount of detailed information in a short span. This can result in information overload, at least initially, until students learn how to sort it out, Dimo says. In addition, the expectations of medical team members are exacting and immediate, and everyone, including student pharmacists, is expected to perform at a high level.

Faced with such demands, some students would prefer to let Dimo act while they watch. That’s not an option in Dimo’s playbook.

“I try to coax students out of their comfort zones,” explains Dimo. “I expect them to respond to the questions that arise on rounds or from nurses. I expect them to answer the pages I get from interns about the pharmaceutical care of the patients they are following. I expect them to talk to patients or family members about issues related to pharmaceutical care. We discuss beforehand how they will respond to a question and what the recommendations will be, but my approach is to stand back and let students work their way through clinical situations. I’ll catch them if they fall, but I want them to carry the initiative and to develop confidence in their ability to perform under pressure.

This approach provides “teachable moments” for Dimo to give feedback about the effectiveness of each interaction, and how students might improve their performance next time. Dimo also makes herself available to students outside of scheduled meeting times, to help them manage issues that come up throughout the day.

Sometimes, her interventions with students are of a non-academic nature.

“The critical care environment is frightening for many students, what with all the machinery and monitors, ventilators, and IV bags,” Dimo acknowledges. “Despite our best efforts, we have patients who die because of the severity of their injuries. That can really impact a student, especially if they’ve been monitoring the patient and have been helping to tailor the medication regimen.”

Asked if she models her teaching style after any preceptor she had as a student, Dimo replies, “Definitely. I had an amazing group of preceptors and mentors such as Lynda Welage, Peggy Carver, Sally Guthrie, and Leslie Shimp who helped shape who I am today. They all had a disciplined, straightforward, practical approach to patient care. They gave students a lot of responsibility, raised the bar high, and challenged you to reach it. The great thing is that all the outstanding preceptors I had are still inspiring students today.” E-mail: dimo@umich.edu.