The One-Minute Preceptor

The ONE-MINUTE PRECEPTOR: Using Microskills to Shape the Teaching-Learning Conversation

Linda L. Carr, Ph.D. CEO, Faculty Ed Solutions, LLC

Know Do

Learning Objectives

 Know the 5 steps of the One Minute Preceptor (OMP) Teaching Model.



Appreciate how OMP allows you to identify knowledge gaps for any level of learner.

 Based on identified gaps, learn to select one microskill for each learner each day.

 Facilitate self-directed learning using the OMP.



Microskills Teaching Model

A 5-step approach to structure effective precepting encounters that last 5- minutes or less OR address problems that arise during teaching sessions.

 Validated in teaching medical students and residents.

5 Microskills

① Get a commitment

② Probe for supporting evidence

③ Teach general rules

④ Reinforce what was done right

⑤ Correct mistakes

At first, focus on one microskill at a time. The order can be modified to fit the need.

The OMP …

 Used when learners are presenting a patient case.

 Fosters learner ownership of the clinical problem.

 Allows preceptor to identify gaps in learner’s knowledge base and focus teaching on learner needs.

Neher, J.O., et al (1992). A Five-Step “Microskills” Model of Clinical Teaching, Journal of the American Board of Family Practice, 5(4):419-423.

Get a Commitment

Examples:

“What do YOU think is going on with this client/patient?”

“What would YOU like to accomplish?”

“Why do YOU think the client/patient has been noncompliant?”

“Can YOU tell me more?”

Non-example:

“This is obviously a case of pneumonia.”

Get a Commitment

Difficulty or unwillingness … could be due to:

 Incomplete or contradictory data

 Knowledge gaps or errors obscuring clinical picture

 Passive, immature learning style

 Fear of making mistakes or exposing weakness

 Fear of you!!

Probe for Supporting Evidence

You can do this by asking …

 WHAT factors make this diagnosis likely?

 WHY do you suggest getting this test first?

 WHICH medications are available for this condition?

 HOW did this prognosis emerge as the most probable?



Probe for Evidence

Non-examples:

“What are the possible causes of congestive heart failure?”



“I don’t think this is gout. Do you have any other ideas?”

 “This seems like a classic case of ….”

Remember: This is not a grilling session!



Teach General Rules

Examples:

“Patients with plantar fasciitis usually experience pain when first getting out of bed in the morning and after rest.”



“In older patients with headache, it is important to consider glaucoma and temporal arteritis as well as the primary headaches.”

 “This rash is not typical of any common conditions. The best reference is … if we don’t solve the problem by looking at that, we need to call …”

Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the Teaching Conversation. Family Medicine 35(6):391-3.

Teach General Rules

Non-example:

It is not an unsupported, idiosyncratic approach.

“I’m convinced the best treatment for diarrhea with salmonella enteritis is still a liquid or soft diet.”

Remember:

 It is not imperative that the teacher “teach something” every time.

 Keep it brief and focused on identified issues.

 Avoid anecdotes and idiosyncratic preferences.

 Keep it to 1-3 general rules at most.

Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the Teaching Conversation. Family Medicine 35(6):391-3.

Tell Them What They Did Right

Example:

“You didn’t jump into solving her presenting problem but kept open until the patient revealed her real agenda for coming in today.”

 Make your comments to the student specific and focused.

Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the Teaching Conversation. Family Medicine 35(6):391-3.

Tell Them What They Did Right

Non-examples: It is not general praise!

“You are absolutely right. That was a wise decision.”

“Great job!”

Remember:

 Competencies must be repeatedly rewarded and reinforced.

 Build upon the learner’s professional self-esteem.

 Focus on specific behaviors.

Correct Mistakes (gently)

Ask learner to self-assess first.

As soon after a student mistake as possible find an appropriate time to discuss what was wrong and how to correct the error in the future.

Example:

“You may be right that the child’s symptoms are due to a viral upper respiratory infection, but you can’t be sure it isn’t otitis media until you’ve examined the ears.”

Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the Teaching Conversation. Family Medicine 35(6):391-3.

Correct Mistakes (gently)

Non-example: Avoid vague, judgmental statements.

“You did what?!”

Remember to:

Find an appropriate time and place—best done in private.

Ask learners to critique their own performance first.

Focus on how to correct the problem or avoid it in the future.

Offer specific resources.

Agree upon an action plan.

Using Microskills Strategies in Difficult Teaching Situations

In the three clinical scenarios that follow:

① Identify possible reasons for the learners’ behavior.

② Identify the ONE microskill that would be most appropriate for the situation.

Harold Hasty

Harold:

I have a patient that is coming in today with a headache. I have not seen the patient yet but it is probably a migraine. I plan to use Imitrex. Is that O.K. with you?

How would you handle this?

http://wichita.kumc.edu/preceptor/difficult.html

Abby Absolutist

 Preceptor: So you think the patient has poison ivy? How do you plan to treat her?

 Abby: I plan to give her a Medrol dose pack.

 Preceptor: The way you describe this area it sounded small and was not weeping. Have you considered using something topical?

 Abby: When I did my dermatology rotation with Dr. DeMarco, he always used oral steroids so that is what I plan.

How would you handle this?

http://wichita.kumc.edu/preceptor/difficult.html

Al Arrogant

Al Arrogant: I want to check out this patient. He is coming in with an upper respiratory infection. Same old, same old. Is that O.K.?

Preceptor: I noticed on the chart, he is a smoker.

Al: Yeah, all of the patients in our clinic smoke.

Preceptor: I don't know about that, but have you talked with this patient about quitting smoking?

Al: It won't do any good.

Preceptor: It especially won't do any good if you don't try it. What do you know about smoking cessation?

Al: I know about the nicotine patches.

Preceptor: Maybe there are some things that you need to learn about smoking cessation.

Al: (Laughing) I doubt Cecil's has anything to say about that.

How would you handle this?

http://wichita.kumc.edu/preceptor/difficult.html

Tips on Using the Microskills

 Clarify expectations – yours and the learners.

 Don’t interrupt the student during his/her patient presentation.

 Make learner commit to a diagnosis or plan and give the rationale for these decisions before critiquing the presentation.

 Teaching includes indicating resources as well as telling the answers. Neher,

Tips on Using the Microskills, cont.

It’s okay for either preceptor or learner to say

“I don’t know”, as long as the next step is to actively address the problem (e.g., by seeking the missing knowledge, re-analyzing the situation) and actively learning from the situation.

 Reinforce positive actions and provide constructive correction of mistakes or misconceptions.

Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the Teaching Conversation. Family Medicine 35(6):391-3.

One Minute Preceptor In Action

2-Minute Video of the One Minute Preceptor In Action

Diane Mar, MSIV

Dr. Ivan Lopez

University of Nevada School of Medicine

Enhance your teaching and your trainee’s learning by using one or more microskills during each patient encounter.

Summary

Spencer, J. (2003). Learning and teaching in the clinical environment. BMJ, 326, 591-4.

LEARN – REFLECT - TEACH

What will you keep the same?

What will you do more of?

What will you do less of?

What will you stop doing?

What will you do differently & how will you do it?

What will you add?