C hief R esident I mmersion T raining Landon Center on Aging University of Kansas School of Medicine...

Chief Resident Immersion TrainingLandon Center on Aging

University of Kansas School of Medicine

Clinical Teaching:The 1 Minute Preceptor

Mary McDonald, MDKUMC – Dept of Family Medicine,

Division of Geriatric Med and Palliative Care

Chief Resident Immersion TrainingLandon Center on Aging

University of Kansas School of Medicine

Chief Resident Immersion Training

Landon Center on AgingUniversity of Kansas School of Medicine

Types of TeachingPimpingLectureApprenticeshipMentorship

Venues for Teaching

Inpatient vs Outpatient



PimpingOften occurs on rounds

Both teacher and learner are active Patient-specific or hypothetical

Warning: Fine line between educational quizzing and emotional belittlement



LectureTeacher active but learner is passive



ApprenticeshipTeacher passive but learner activeCan occur on teaching rounds



PreceptorshipTeacher active and learner passiveOccurs in bedside teaching



Case PresentationPresenting in Front of the Patient

PROs CONs



Bedside Presentations*Patients reported:

Doctors spent more time with them (10 vs. 6 min) Perceptions of their care were slightly more

favorable Doctors were more likely to explain problems

adequately

*Lehman L, N Eng J Med 1997:336:1150



Bedside Presentations*Bedside presentation patients reported: Did not provoke worry (88%) The practice should continue (82%) Helped them understand their illness (51%) Too much confusing medical terminology (46%) Perceived that the purpose of rounds was to

teach and not to provide care (94%)




Improving Bedside Presentations* Patients should be given the opportunity to

say more All physicians in room should introduce

themselves Physicians should be more attentive to the

presentations There should be fewer physicians in the room




Improving Bedside Presentations* The physicians should respect the patients

privacy more Physicians should ask permission to present

at the bedside Physicians should be seated during the

presentation




How is teaching in an outpatient setting different?

1-8Chief Resident Immersion Training


Teaching in the Clinic

In-depth LecturesSeminarsFormal Educational SessionsExtensive Discussion

1-9Chief Resident Immersion Training


Efficient and effective ambulatory care teaching requires that both the student and preceptor accept the limitations of the outpatient setting.

Extensive discussions of differential diagnosis, pathophysiology and psychosocial problems are not possible nor necessarily desirable.



Pitfalls in Clinical Case-Based Teaching “Taking over” the case Inappropriate lectures Insufficient “wait-time”: 3-5 sec Pre-programmed answers

What do you think is going on? Could it be an ulcer?

Rapid reward Effectively shuts down the student’s thinking

Pushing past ability Persist in carrying the students beyond their understanding



The “One Minute Preceptor” teaching model was developed at the Department of Family Medicine at the University of Washington, Seattle.

See: Neher, J. O., Gordon, K. C., Meyer, B., & Stevens, N. (1992). A five-step "microskills" model of clinical teaching. Journal of the American Board of

Family Practice, 5, 419-424.



The One-Minute Preceptor

1. Get a commitment

2. Probe for supporting evidence

3. Reinforce what is right

4. Give guidance about errors or omissions

5. Teach general principles

6. Conclusion



Commitment Why?

Learner becomes more active in teaching encounter Allows you to assess how learner has processed

information presented Even if answer is incorrect, learning has occurred

Example What do you think is going on here? What would you like to do next?



Probe for Evidence

Why? Uncovers learners reasoning process for arriving

at the conclusion (Not a lucky guess)

Example “What factors support your diagnosis?” “Why did you choose that treatment?”



Reinforce What Was RightWhy?

Behavior specific feedback will promote and encourage desirable clinical behaviors.

Example “I liked that your differential took into

account the patient’s age, recent exposures, & symptoms.”



Give Guidance About Errors or Omissions

Why? Behavior specific constructive feedback

discourages incorrect behaviors and corrects misconceptions.

Example “During the ear exam the patient seemed

uncomfortable. Let’s go over holding the otoscope.”



Teach General RulesWhy?

Helps learner effectively generalize knowledge gained from this specific case to other clinical situations

Example “Remember 10-15% people are carriers of

strep, which can lead to false positive strep tests.”



ConclusionWhy?

Helps control time and sets clear agenda and roles for remainder of encounter

Example …“Let’s go back in the room and I’ll show

you how to get a good throat swab. Tell me when we have the results, and I’ll watch you go over the treatment plan.”



Adapted from Materials…… Effective Clinical Teaching, Rohan Jeyarajah, MD and Hari

Raja, MD Lehman LS,et.al. The effect of bedside case presentations on

patients’ perception of their medical care. NEJM 1997;336:1150.

The “One Minute Preceptor”:Time Efficient Teaching in Clinical Practice. Preceptor Development Program, developed by MAHEC. Funded by HRSA Family Medicine Training Grant # 1D15PD50119-01

The One-Minute Preceptor &The One-Minute Observation Effective & Efficient

Outpatient Clinical Teaching. JHUSOM Department of Neurology, December 21, 2006

C hief R esident I mmersion T raining Landon Center on Aging University of Kansas School of Medicine...

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