For Liseli Mulala, RPh, PhD, MPH, being a preceptor is more than teaching clinical skills. It’s about shaping how future pharmacists see and serve their patients.

At Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG), where she serves as the transitions of care pharmacist, Mulala trains UCSF School of Pharmacy learners to counsel patients preparing for discharge, often navigating complex medical and social needs.

“Before I get started, I ask patients, ‘What questions do you have?’” she said. “It changes everything.”

That approach is at the heart of Mulala’s teaching philosophy and her work in cultural competence and cultural humility, an area she has developed in recent years and now integrates deeply into both her clinical practice and precepting.

Expanding the role of preceptor

Mulala’s path to pharmacy began during her undergraduate studies in pre-med. She found herself drawn to pharmacology, and completed what was then a 5-year pharmacy degree program in 1993. Her career began in retail pharmacy, where she also started precepting students.

Over time, she realized she wanted to influence health outcomes on a broader scale. She went on to earn a Master of Public Health, followed by a PhD in public health, focusing on community-based participatory research and medication adherence.

Throughout, teaching remained a constant. “I’ve always wanted to share what I’m learning with my students,” she said. “And it has always been a two-way street.”

ZSFG, she added, is an ideal setting to practice not just clinical decision-making, but communication grounded in respect and curiosity.

From competence to humility

Mulala’s focus on cultural competence sharpened in 2020. She felt a growing responsibility to move beyond representation and take more concrete action and began developing presentations for professional organizations including the California Pharmacists Association (CPhA) and the California Society of Health-System Pharmacists (CSHP), as well as for UCSF Health Pharmacy Grand Rounds and her own students. Over time, her approach evolved.

“I try not to just focus on disparities,” she said. “I want to talk about what’s working — what’s actually helping us improve care.”  

Rather than framing cultural competence as an abstract concept, she added, she grounds it in practical, everyday interactions. “It’s about respect, and listening to patients, understanding their perspective, and not making assumptions.”

Teaching through practice

One of the key tools Mulala shares with students is a framework for relationship-centered communication sometimes referred to as the “Four C’s.” It includes understanding what a patient believes about their condition, what they think caused it, how they cope, and what concerns them most.

Students report that starting with questions and letting patients use their own words helps build rapport more quickly, surfacing more meaningful conversations that uncover deeper insights, like barriers to care.

“When patients feel heard, they’re more likely to share their experiences,” Mulala said. “That can include challenges they’ve faced in the health care system. And once you understand that, you can respond in a more thoughtful way.”

Real-world impact

Mulala’s commitment to culturally responsive care extends beyond teaching into program development. When she joined Zuckerberg in 2017, she identified a gap to leadership, who then supported her initiative to launch a pharmacist-led inpatient diabetes education and transitions of care program.  

Since then, the percentage of patients receiving diabetes counseling before discharge has risen from 5 percent to 75 percent.

But improvement wasn’t immediate. "We noticed that some groups were actually having higher readmission rates, even after receiving education. That told us something wasn’t working,” Mulala said.

Deeper analysis revealed that educational materials for certain populations were outdated and not culturally relevant. By updating and translating those materials — for example, incorporating culturally familiar foods into dietary guidance — the team was able to reverse that trend.

“Now we’re seeing improved outcomes,” Mulala said. “And you can see it in the moment, too. When patients recognize themselves in the materials, it makes a difference.”

People-centered pharmacy

For Mulala, these experiences reinforce the broader lesson she hopes students carry forward, that pharmacy is as much about people as it is about medications.

“The box is as big as you make it,” she said. “There isn’t just one way to be a pharmacist.”

As a preceptor, she encourages students to continuously reflect on their own assumptions and adapt their approaches.  

“Cultural humility is an ongoing practice,” she said. “It’s something that helps not just in patient care, but in how we interact with everyone."