One Minute PreceptorEffective Teaching in the
Clinical Setting Dr. Paul Ogden
Office of Medical Education
2004
Goals
• Learn and Apply 5 Microskills of the One Minute Preceptor
• Learn to diagnose the learner
• Understand the concept of standardized evaluation of learners
Clinical Instructional Reasoning
5 Microskills-One Minute Preceptor
1. Ask for a Commitment
2. Probe for Underlying Reasoning
3. Teach General Rules
4. Provide Positive Feedback
5. Correct Errors
Diagnosing the Learner
• Question Learner to determine their understanding of the case
• Determine Learner’s strengths and weaknesses based upon answers
• Determine Teachable Moment based on responses
• Determine Learner’s Level based upon defined standards
Ask for a Commitment
• Use open-ended questions and not yes/no questions.
• Avoid jumping in with your opinion of what is going on.
• Be patient.• Wait a few seconds for a response
and ask for elaboration.
Ask for a Commitment
• What do you think is going on?
• What other types of information do you feel are needed?
• What is your working diagnosis for this patient?
Probe for underlying reasoning
• Probe for evidence that supports the diagnosis.
• Have the learner think out loud so you can analyze his or her thought process.
• Do not take over the case, and remember that probing for evidence is different from grilling.
Probe for underlying reasoning
• What were the major findings that led to your conclusion?
• What else did you consider? What kept you from that choice?
• Why would you choose that particular medication
Evaluation StandardsThe RIME System
• Reporter– M3, Can do H&P well, report findings
• Interpreter– M4, Interprets case and labs well– Well-developed differential diagnosis
• Manager– Intern, Can manage the case
• Educator– Upper resident to staff, Can determine teaching points
and educate the team.
RIME and Grading
• Students and residents should be at expected level
• 1 level below is a concern
• 2 levels below may be a reason for failure
• 1 level above is above expected or near honors
• 2 levels above is outstanding or honors
Teaching in One Minute
1. Teach General Rules
2. Provide Positive Feedback
3. Correct Errors
Teach General Rules• Create “rules of thumb” that can
be applied to other patients. • Correlate this patient with
previously seen patients. • Think out loud. • Tell “war stories” or use
hypothetical situations to make the point more memorable.
Teach General Rules
• If the patient only has cellulitis, incision and drainage is not possible. You have to wait until the area becomes fluctuant to drain it.
• Patients with cystitis usually experience pain with urination, increased frequency and urgency and they may see blood in their urine.
Provide positive feedback
Reinforce what is done right• Be specific and explicit to reinforce
desired behavior.
Provide positive feedback Reinforce what is done right
• “You didn’t jump in to solving her presenting problem but kept open until the patient revealed her real agenda for coming in today. In the long run, you saved yourself and the patient a lot of time and unnecessary expense by getting to the heart of her concerns first. Nicely done.”
Correct Errors
• Be specific and descriptive, not personal and judgmental.
• Concentrate on fixable problems.
Correct Errors
• “You may be right that this patient’s symptoms are probably due to a viral URI. But you can’t be sure it isn’t otitis media unless you have properly examined the ears.”
In Summary
Ask for a Commitment
Probe for Underlying Reasoning
Diagnose the learner for teaching and evaluation
Apply standards to the evaluation process (RIME)
Teach General Rules
Provide Positive Feedback
Correct Errors
Use this method to teach and give feedback in a busy clinical practice.
References
• Neher JO, Gordon KC, Meyer B, Stevens N. A five-step “microskills” model of clinical teaching. J Am Board Fam Prac. 1992:5:419-424.
• Sarkin, R. The One Minute Preceptor: Microskills of Clinical Teaching. http://www.im.org/facdev/…/Strategies%20Tampa%20Sarkin.ht
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