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Welcome Title Introduction of speaker(s)

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1 The “One Minute Preceptor”: Time Efficient Teaching in Clinical Practice
Welcome Title Introduction of speaker(s) [Materials needed for seminar: handouts for each participant: presentation slides, with space for notes pocket cards with the One Minute Preceptor microskills listed speaker notes laptop and projector, extension cord flipchart 2 thick markers -- dark colors masking tape]

2 Presentation based on materials included in the: Produced by : Supported by HRSA Family Medicine Training Grant # 1 D15 PE [Please include this Acknowledgement Slide]: This presentation is based on materials developed by the Mountain Area Health Education Center in Asheville, North Carolina, with a grant from the federal Health Research and Services Administration. [May wish to mention other aspects of the Preceptor Development Program which you are implementing or making available]

3 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, The One Minute Preceptor teaching model was developed at the Department of Family Medicine at the University of Washington several years ago, and it has been used in a variety of settings with a variety of learners.

4 The “One Minute Preceptor”
10 Minutes of “Teaching Time”... 3 Minutes Questioning Discussion 1 Minute First, a disclaimer: Is the “One Minute Preceptor” model going to help you do all your precepting in one minute? No. Studies have shown that the average teaching encounter takes 10 minutes: 6 minutes for the learner to present. 3 minutes for the preceptor to ask questions and clarify information. This leaves 1 minutes of discussion and teaching time. The One Minute Preceptor strategy still takes longer than a minute. But it provides a structure to the encounter that helps you maximize the amount of time for teaching. Presentation 6 Minutes

5 Teaching Styles Expert Socratic Others? “One Minute”
There are a lot of different styles of responding to case presentations. What’s your style? [Use some prop to indicate you’re becoming a learner] I’m a third year medical student presenting to you with the following case: “Mrs. Winkler is a 67 year-old woman who has come in today with a complaint of fever, cough, and shortness of breath. As you may know, she has a 30-year smoking history and carries the diagnosis of mild COPD. She began getting sick about 2 days ago with what she thought was a cold, but by yesterday she had more chest congestion and a temperature of 101 orally. She also noted that she was more winded than usual in her activities at home. Yesterday her cough was productive with whitish sputum, but by this morning it had become yellow to tan with streaks of blood. She noted chills this morning and her temperature was 100.5, and she called to come in. She has noted some increase in her wheezing but denies chest pain, except when she coughs. “She is on Capoten and HCTZ for high blood pressure. She uses an albuterol inhaler & has been using this about every 2 hours since last evening. She has no allergies, got a flu shot this year, and had the Pneumovax 2 years ago. “On physical she is working hard at breathing with wheezes heard without a stethoscope. HEENT is basically normal but her lung exam reveals diffuse expiratory wheezes and decreased breath sounds in the area of the right middle lobe…” At this point, I stop and wait for your response. How would you answer? [Discuss different answers. Expert: answer what you think is going on, ask questions about the patient. Socratic: ask questions of the learner.]

6 The 5-Step Microskills Method
Get a Commitment Probe for Supporting Evidence Reinforce What Was Done Well Give Guidance About Errors or Omissions Teach a General Principle The “One Minute Preceptor” strategy is based on 5 steps that build on each other. [read them]

7 Get a Commitment Why?… Encourages learner to process further and problem solve. Examples... “What do you think is going on here?” “What would you like to do next?” The first step is to get a “commitment” from the learner about what they thing is going on, what they think the plan should be, or how they think the case should be followed up. This commitment helps invest the learner further in the case. And it helps you assess their problem-solving skills. What you ask the learner to commit to depends on their level -- you want to encourage them to stretch beyond their current comfort level and problem solve.

8 Probe for Supporting Evidence
Why?… Helps you to assess the learners knowledge and thinking process. Examples... “What factors support your diagnosis?” “Why did you choose that treatment?” Step 2 is to probe the learner for supporting evidence of what they’ve just committed to -- explore the basis of their opinion. Was it a lucky guess, or was it a well-reasoned, logical answer? This step gives you insight into their clinical reasoning skills.

9 Reinforce What Was Done Well
Describe specific behaviors and likely outcomes Why?... Behaviors that are reinforced will be more firmly established. Example… “I liked that your differential took into account the patient’s age, recent exposures, & symptoms.” Starting with step 3, you can give the learner some feedback. Start with positive feedback, and reinforce what was done well. Skills and positive behaviors need repeated reinforcement to become firmly established. With a few sentences, you increase the likelihood that these behaviors will be incorporated into further clinical encounters. Describe specific actions the learner took (“good job” is too vague), and describe the likely outcomes of these actions. What are some examples of positive reinforcement you could give me on my presentation of Mrs. Winkler? [Wait for a response]

10 Guide Errors/ Omissions
Describe what was wrong (be specific), what the consequence might be, and how to correct it for the future Why?… Corrects mistakes and forms foundation for improvement. Example… “During the ear exam the patient seemed uncomfortable. Let’s go over holding the otoscope.” Step 4 is correcting the learner’s mistakes or omissions. Again, describe specific actions and potential negative outcomes. It’s important to also suggest ways the learner can improve. Think about your wording -- if you focus on actions and ways of changing, and avoid negative labels such as “bad” or “poor”, the learner is less likely to feel judged and more likely to see the criticism as constructive. It’s important to notice and provide feedback to the learner on both the things they do well and the areas they need to work on. What are some examples of constructive criticism you could give me about my case presentation of Mrs. Winkler? [Wait for a response]

11 Teach a General Principle
Symptoms, treatment options, or resources to look information up Why?… Allows learning to be more easily transferred to other situations. Examples… “Remember 10-15% people are carriers of strep, which can lead to false positive strep tests.” The fifth step is teaching a general principle. One of the most important and challenging tasks for the learner is to take information from an individual situation and accurately generalize it to other situations. This can be about how a symptom usually manifests, treatment options, what resources are available in your community -- or what references to look something up in. This isn’t a major teaching session -- but 1or 2 statements can have a significant impact on the learner. (This microskill can be skipped if the learner has performed well and you have no new information to add.) Examples you could use with me about Mrs. Winkler’s case? [Wait for a response]

12 Conclusion Why?... Limits Time. Directs remainder of the 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.” The concluding step is to wrap up the teaching session with directions to the learner about what is needed to resolve the case. Time management is a critical function of clinical teaching, and it’s helpful to signal the end of the interaction so that you can move on to the next patient. The learner’s and preceptor’s roles may need definition at this point. In some cases you may wish to observe as the learner performs the physical or reviews the treatment plan with the patient. In other cases, you may wish to go in an confirm physical findings and then review the case with the patient yourself. In either case, it helps the learner to know what is expected of them once you go in to see the patient together.

13 “5” Step Microskills Method
Get a Commitment Probe for Supporting Evidence Reinforce What Was Done Well Give Guidance About Errors or Omissions Teach a General Principle To help you remember the steps of this model, here are cards that you can keep in your pocket during a rotation. [Distribute cards] Let’s apply this model to another case. A nurse practitioner student is in your office and has just seen a patient of yours for a follow up visit. Here is her presentation: “I just saw Mrs. Bodman for a 2-month follow up visit for her diabetes. She is a 60-year-old woman who has had Type 2 diabetes for 5 years. She states she has felt well except for a cold that she just got over. She tests her blood sugar at home about twice a week and says her fasting sugars have been between 120 and She didn’t bring in her logbook, though. She denies polyuria and polydypsia, but says she has gained some weight because she went on a cruise last month. She did have one episode of shakiness and sweating which got better when she ate. “Her current regimen is glyburide 5mg BID and glucophage 500 mg BID. She also takes an occasional dose of 25mg hydrochlorothiazide about once a week for foot swelling. Other meds are calcium and Premarin. “On physical, her weight is 165 (up from 160 last time), BP is 140/80, pulse is 84 and temp is normal. Her fundi were hard to see but looked normal to me. Lungs are clear, heart regular without murmur and abdomen slightly obese but normal. She had a blood sugar checked when she came in and it was 180 but she had lunch two hours ago.” Learner pauses and waits for your comments. So, the first step is getting a commitment from the learner. What kinds of questions might we ask to get a commitment in this case? [Go through all 6 steps]

14 What makes sense in your practice?
Now that we’ve gone over the model, think about it in the context of your practice and teaching. What of this model would work in your teaching? The 5 skills can be used separately -- how can you fit them in? [Encourage individuals to describe their particular settings and application of the model] The One Minute Preceptor strategy is designed to maximize efficiency and effectiveness of teaching about an individual patient encounter. It should be used in conjunction with your other teaching strategies. Thank you for all of your precepting. We hope this model and this seminar is helpful in integrating teaching into your practice. [Have participants complete evaluations and any necessary CME paperwork]

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