1. Wisconsin Indianhead Technical College The Paramedic Preceptor

2. Thank you for agreeing to serve as a preceptor for the WITC Paramedic Program. You will play a key role in the lives of our paramedic students, as they acquire the knowledge and skills to perform the job of a paramedic in our community. We value your dedication to the medical field and your contribution to the success of our paramedic students. Thank you for agreeing to serve as a preceptor for the WITC Paramedic Program. You will play a key role in the lives of our paramedic students, as they acquire the knowledge and skills to perform the job of a paramedic in our community. We value your dedication to the medical field and your contribution to the success of our paramedic students. The purpose of this orientation is to familiarize you with: The purpose of this orientation is to familiarize you with: The Preceptor The Preceptor Clinical Training Clinical Training How to provide feedback How to provide feedback How to evaluate students How to evaluate students Welcome

3. You were once but a learner; now you are the master. The Effective Preceptor What are the characteristics of the effective preceptor? As a health care professional you strive to maintain and improve your knowledge and skills in order to provide the highest quality of care possible. For many of you, this passion for excellence spills into other areas of your lives and professional work, and the evidence is seen in the high quality of teaching you provide as a preceptor. What are the characteristics of the effective preceptor? As a health care professional you strive to maintain and improve your knowledge and skills in order to provide the highest quality of care possible. For many of you, this passion for excellence spills into other areas of your lives and professional work, and the evidence is seen in the high quality of teaching you provide as a preceptor.

4. The Effective Preceptor The effective preceptor communicates their clinical knowledge clearly to the learner while remaining open and respectful. Specific concepts are expanded to general principles. Careful listening indicates respect for the learner. Goals and expectations are defined and clearly communicated, and a pleasant and stimulating learning environment is fostered using humor and enthusiasm. The effective preceptor communicates their clinical knowledge clearly to the learner while remaining open and respectful. Specific concepts are expanded to general principles. Careful listening indicates respect for the learner. Goals and expectations are defined and clearly communicated, and a pleasant and stimulating learning environment is fostered using humor and enthusiasm.

5. The Effective Preceptor Possesses and demonstrates broad knowledge Possesses and demonstrates broad knowledge Explains the basis for actions and decisions Explains the basis for actions and decisions Answers learner questions clearly and precisely Answers learner questions clearly and precisely Open to conflicting ideas and opinions Open to conflicting ideas and opinions Connects information to broader concepts Connects information to broader concepts Communicates clear goals and expectation Communicates clear goals and expectation Captures learners attention Captures learners attention Makes learning fun Makes learning fun

6. Communication and the Effective Preceptor Possesses and demonstrates broad knowledge Possesses and demonstrates broad knowledge Explains the basis for actions and decisions Explains the basis for actions and decisions Answers learner questions clearly and precisely Answers learner questions clearly and precisely Open to conflicting ideas and opinions Open to conflicting ideas and opinions Connects information to broader concepts Connects information to broader concepts Communicates clear goals and expectation Communicates clear goals and expectation Captures learners attention Captures learners attention Makes learning fun Makes learning fun

7. Communication and the Effective Preceptor Clear communication of goals is vital to effective precepting. Too often teachers do not define the specific observable behaviors that are desired. When clear expectations are set and communicated the learner is better able to focus his or her energies and efforts. Developing goals for what you wish learners to achieve while working with you can assist you in measuring your own effectiveness. The environment in which teaching takes place has a major effect on the transfer of information. For example, the preceptor’s body language and tone of voice has a significant effect on communication with the patient. Likewise, learners remember more when a preceptor who can capture their attention and make learning fun. This can be accomplished by using humor, dramatic case examples, suspense and enthusiasm. Clear communication of goals is vital to effective precepting. Too often teachers do not define the specific observable behaviors that are desired. When clear expectations are set and communicated the learner is better able to focus his or her energies and efforts. Developing goals for what you wish learners to achieve while working with you can assist you in measuring your own effectiveness. The environment in which teaching takes place has a major effect on the transfer of information. For example, the preceptor’s body language and tone of voice has a significant effect on communication with the patient. Likewise, learners remember more when a preceptor who can capture their attention and make learning fun. This can be accomplished by using humor, dramatic case examples, suspense and enthusiasm.

8. ANALYSIS OF THE LEARNER The most skillful clinical interview and physical examination is useless if the clinician is not able to analyze the information and use it to assist the patient in his or her problem. The effective preceptor analyzes the data obtained from his or her interaction with the learner and uses this information to benefit the learner through assessment, feedback and evaluation. The most skillful clinical interview and physical examination is useless if the clinician is not able to analyze the information and use it to assist the patient in his or her problem. The effective preceptor analyzes the data obtained from his or her interaction with the learner and uses this information to benefit the learner through assessment, feedback and evaluation. In order to accurately assess the learner's performance the effective preceptor observes that performance directly as often as is possible. Often a preceptor's observations tend to be second hand – based on presentations or write-ups. It is important to directly observe those vital history-taking and physical exam skills in order to give the necessary guidance to the learner. In order to accurately assess the learner's performance the effective preceptor observes that performance directly as often as is possible. Often a preceptor's observations tend to be second hand – based on presentations or write-ups. It is important to directly observe those vital history-taking and physical exam skills in order to give the necessary guidance to the learner. Feedback is highly valued by learners; It is the mechanism by which the effective preceptor promotes the positive behavior and skills and works to modify those areas where improvement is needed. Feedback is highly valued by learners; It is the mechanism by which the effective preceptor promotes the positive behavior and skills and works to modify those areas where improvement is needed. Evaluation is a key function of the effective preceptor. Through clear goals and expectations, ongoing assessment of the learner, and continuing feedback to guide progress, the preceptor has integrated the evaluation process into the entire rotation. The final evaluation is the culmination of an ongoing process and is more relevant and valuable as a result. Evaluation is a key function of the effective preceptor. Through clear goals and expectations, ongoing assessment of the learner, and continuing feedback to guide progress, the preceptor has integrated the evaluation process into the entire rotation. The final evaluation is the culmination of an ongoing process and is more relevant and valuable as a result.

9. ANALYSIS OF THE LEARNER Accurate assessment of learner's knowledge attitudes and skills Accurate assessment of learner's knowledge attitudes and skills Uses direct observation of the learner Uses direct observation of the learner Provides effective feedback Provides effective feedback Performs fair and thoughtful evaluations Performs fair and thoughtful evaluations

10. Skill in Teaching and Practice The demonstration of skill is important in clinical practice and in clinical teaching. Students value the demonstration of skillful clinical practice and effective role modeling. Clinical teaching is more than telling someone what to do and how to do it – the effective preceptor not only “talks the talk” but also “walks the walk.” In the close quarters of the teaching relationship, true role modeling involves being consistent in what you say and do in your relations with patients, staff and learners. The demonstration of skill is important in clinical practice and in clinical teaching. Students value the demonstration of skillful clinical practice and effective role modeling. Clinical teaching is more than telling someone what to do and how to do it – the effective preceptor not only “talks the talk” but also “walks the walk.” In the close quarters of the teaching relationship, true role modeling involves being consistent in what you say and do in your relations with patients, staff and learners.

11. Skill in Teaching and Practice The effective preceptor recognizes that, when appropriate, he or she must relinquish some of the control in the clinical area to the learner. Shadowing can be a useful introduction to clinical care, but this technique alone grows old after several days of following the preceptor. Learners value appropriate increases in responsibility coupled with careful oversight and guidance. With careful ongoing analysis, the effective preceptor can balance the educational needs of the learner with the needs of the patients and the office.. The preceptor must not only have knowledge and skill but must be able to share it in a way that is useful and interesting to the learner. Learners also value an organized approach to teaching. Organization and clarity are important in the impromptu teaching in your practice as well as in a formal lecture. What should the learner focus on with this next patient? How do you want the next case presentation to be different? Actively directing the learning will create small individual goals that will build into greater accomplishments. The effective preceptor recognizes that, when appropriate, he or she must relinquish some of the control in the clinical area to the learner. Shadowing can be a useful introduction to clinical care, but this technique alone grows old after several days of following the preceptor. Learners value appropriate increases in responsibility coupled with careful oversight and guidance. With careful ongoing analysis, the effective preceptor can balance the educational needs of the learner with the needs of the patients and the office.. The preceptor must not only have knowledge and skill but must be able to share it in a way that is useful and interesting to the learner. Learners also value an organized approach to teaching. Organization and clarity are important in the impromptu teaching in your practice as well as in a formal lecture. What should the learner focus on with this next patient? How do you want the next case presentation to be different? Actively directing the learning will create small individual goals that will build into greater accomplishments.

12. Skill in Teaching and Practice Provides effective role modeling Provides effective role modeling Demonstrates skillful interactions with patients Demonstrates skillful interactions with patients Generates interest in the subject matter Generates interest in the subject matter Presents information with organization and clarity Presents information with organization and clarity Organizes and controls the learning experience Organizes and controls the learning experience Balances clinical and teaching responsibilities Balances clinical and teaching responsibilities Give appropriate responsibility to the learner Give appropriate responsibility to the learner

13. MOTIVATING THE LEARNER This clinical experience may be the first time that a learner has been able to select some of his or her own learning goals and to help direct the methods to best achieve them. This also can be an important step to life-long self- directed learning. A recurrent theme in reviewing the qualities of the effective preceptor is the value of enthusiasm. Demonstrating enjoyment of patient care and teaching is among the most important characteristics of the effective preceptor. This clinical experience may be the first time that a learner has been able to select some of his or her own learning goals and to help direct the methods to best achieve them. This also can be an important step to life-long self- directed learning. A recurrent theme in reviewing the qualities of the effective preceptor is the value of enthusiasm. Demonstrating enjoyment of patient care and teaching is among the most important characteristics of the effective preceptor.

14. MOTIVATING THE LEARNER Learners in health care professions usually enter their training with high levels of energy and motivation. Sometimes though, the rigors and challenges of pre-clinical teaching in the classroom can take their toll, leaving the learner depleted and questioning the relevance of what they have learned. Learners in health care professions usually enter their training with high levels of energy and motivation. Sometimes though, the rigors and challenges of pre-clinical teaching in the classroom can take their toll, leaving the learner depleted and questioning the relevance of what they have learned. The application of knowledge to solving problems and the generalization of the current experience to future patients can help revive flagging energy and waning motivation in early clinical training. The application of knowledge to solving problems and the generalization of the current experience to future patients can help revive flagging energy and waning motivation in early clinical training. Adult learning involves internal motivation – learning because one wants to and not for some external reward such as a grade. Adult learning involves internal motivation – learning because one wants to and not for some external reward such as a grade. Many of the learners we encounter have not made this transition to the adult learning style. Many of the learners we encounter have not made this transition to the adult learning style. Active involvement of the learner is a characteristic of the effective preceptor; and is an important method of encouraging the adult style of learning and thereby increasing motivation Active involvement of the learner is a characteristic of the effective preceptor; and is an important method of encouraging the adult style of learning and thereby increasing motivation

15. MOTIVATING THE LEARNER Emphasizes problem solving Emphasizes problem solving Translates specific cases into general principles Translates specific cases into general principles Promotes active involvement of the learner Promotes active involvement of the learner Demonstrates enjoyment and enthusiasm for patient care and teaching Demonstrates enjoyment and enthusiasm for patient care and teaching Develops a supportive relationship with the learner Develops a supportive relationship with the learner

16. Remember Most clinical learning takes place in the context of busy clinical practice where time is at a premium. The five microskills of the One Minute Preceptor teaching model enable preceptors to effectively assess, instruct and provide feedback more efficiently. This model is used when the preceptor knows something about a case that is being presented that the learner either needs or wants to know. Most clinical learning takes place in the context of busy clinical practice where time is at a premium. The five microskills of the One Minute Preceptor teaching model enable preceptors to effectively assess, instruct and provide feedback more efficiently. This model is used when the preceptor knows something about a case that is being presented that the learner either needs or wants to know.

17. Clinical Instruction Much of clinical teaching involves the learner interviewing and examining a patient, and then presenting the information to the preceptor. This strategy is common both in the office and hospital setting. Studies have indicated that on average, these interactions take approximately 10 minutes and the time is divided into several different activities. (See Figure) Much of the time is taken up by the presentation of the patient by the learner. Additional time is spent in questioning and clarifying the content of the presentation. As a result only about one minute of time is actually spent in discussion and teaching. Much of clinical teaching involves the learner interviewing and examining a patient, and then presenting the information to the preceptor. This strategy is common both in the office and hospital setting. Studies have indicated that on average, these interactions take approximately 10 minutes and the time is divided into several different activities. (See Figure) Much of the time is taken up by the presentation of the patient by the learner. Additional time is spent in questioning and clarifying the content of the presentation. As a result only about one minute of time is actually spent in discussion and teaching.

18. The Learning Encounter Questioning Discussion Presentation 3 Minutes 6 Minutes 1 Minute

19. The One Minute Preceptor The One-Minute Preceptor approach allows the preceptor to take full advantage of the entire encounter in order to maximize the time available for teaching. The teaching encounter will still take longer than a minute but the time spent is more efficiently used and the teaching effectiveness is optimized. This method consists of a number of skills that are employed in a stepwise fashion at the end of the learner's presentation. Each step is an individual teaching technique or tool, but when combined they form one integrated strategy for instruction in the health care setting. The One-Minute Preceptor approach allows the preceptor to take full advantage of the entire encounter in order to maximize the time available for teaching. The teaching encounter will still take longer than a minute but the time spent is more efficiently used and the teaching effectiveness is optimized. This method consists of a number of skills that are employed in a stepwise fashion at the end of the learner's presentation. Each step is an individual teaching technique or tool, but when combined they form one integrated strategy for instruction in the health care setting.

20. History "The One Minute Preceptor: Microskills of Clinical Teaching" was originally developed by Kay Gordon, M.A., and Barbara Meyer, M.D., M.P.H., Department of Family Medicine, University of Washington School of Medicine. Initially introduced as the “Five- Step `Microskills' Model of Clinical Teaching” * the One Minute Preceptor strategy has been taught and tested across the nation ** and has been welcomed by busy preceptors. The dissemination of this technique has been allowed and is encouraged. "The One Minute Preceptor: Microskills of Clinical Teaching" was originally developed by Kay Gordon, M.A., and Barbara Meyer, M.D., M.P.H., Department of Family Medicine, University of Washington School of Medicine. Initially introduced as the “Five- Step `Microskills' Model of Clinical Teaching” * the One Minute Preceptor strategy has been taught and tested across the nation ** and has been welcomed by busy preceptors. The dissemination of this technique has been allowed and is encouraged. * Neher, Gordon, Meyer, & Stevens, 1992. ** Irby 1997. ** Irby 1997.

21. A Couple of Things about Microskills Get a commitment. What do you think is going on? Get a commitment. What do you think is going on? Probe for supporting evidence. Why do you think this? Probe for supporting evidence. Why do you think this? Teach general rules. Teach general rules. Reinforce what was right. Tell them what they did right and the effect that it had. Reinforce what was right. Tell them what they did right and the effect that it had. Correct mistakes. Tell them what they did right. Tell them what they did not do right. Tell them how to improve for the next time. Correct mistakes. Tell them what they did right. Tell them what they did not do right. Tell them how to improve for the next time.

22. Commitment The One-Minute Preceptor method suggest that you get a commitment from the learner – to get them to verbally commit to an aspect of the case. The act of stating a commitment pushes the learner to move beyond their level of comfort and makes the teaching encounter more active and more personal. This can show respect for the learner and fosters an adult learning style. The One-Minute Preceptor method suggest that you get a commitment from the learner – to get them to verbally commit to an aspect of the case. The act of stating a commitment pushes the learner to move beyond their level of comfort and makes the teaching encounter more active and more personal. This can show respect for the learner and fosters an adult learning style.

23. Probe for Supporting Evidence Now that you have a commitment from the learner, it is important to explore what the basis for their opinion was. The educational setting often rewards a lucky guess to the same degree as a well-reasoned, logical answer. In the clinical setting, it is important to determine that there is an adequate basis for the answer and to encourage an appropriate reasoning process. By the same token it is important to identify the “lucky guess” and to demonstrate the use of appropriate supporting evidence. Now that you have a commitment from the learner, it is important to explore what the basis for their opinion was. The educational setting often rewards a lucky guess to the same degree as a well-reasoned, logical answer. In the clinical setting, it is important to determine that there is an adequate basis for the answer and to encourage an appropriate reasoning process. By the same token it is important to identify the “lucky guess” and to demonstrate the use of appropriate supporting evidence.

24. Positive Reinforcement In order for the learner to improve they must be made aware of what they did well. The simple statement “That was a good presentation” is not sufficient. The learner is not sure if their presentation is “good” because they included current medications or because they omitted the vital signs. Comments should include specific behaviors that demonstrated knowledge skills or attitudes valued by the preceptor. In order for the learner to improve they must be made aware of what they did well. The simple statement “That was a good presentation” is not sufficient. The learner is not sure if their presentation is “good” because they included current medications or because they omitted the vital signs. Comments should include specific behaviors that demonstrated knowledge skills or attitudes valued by the preceptor.

25. Give Guidance About Errors and Omissions Just as it is important for the learner to hear what they have done well, it is important to tell them what areas need improvement. This step also fosters continuing growth and improved performance by identifying areas of relative weakness. In framing comments it is helpful to avoid extreme terms such as `bad' or “poor”. Expression such as “not best” or “it is preferred” may carry less of a negative value judgment while getting the point across. Comments should also be as specific as possible to the situation identifying specific behaviors that could be improved upon in the future. Just as it is important for the learner to hear what they have done well, it is important to tell them what areas need improvement. This step also fosters continuing growth and improved performance by identifying areas of relative weakness. In framing comments it is helpful to avoid extreme terms such as `bad' or “poor”. Expression such as “not best” or “it is preferred” may carry less of a negative value judgment while getting the point across. Comments should also be as specific as possible to the situation identifying specific behaviors that could be improved upon in the future.

26. Teach a General Principle One of the key but challenging tasks for the learner is to take information and data gained from an individual learning situation and to accurately and correctly generalize it to other situations. There may be a tendency to over generalize – to conclude that all patients in a similar clinical situation may behave in the same way or require the exact same treatment. On the other hand, the learner may be unable to identify an important general principle that can be applied effectively in the future. Brief teaching specifically focused to the encounter can be very effective. Even if you do not have a specific medical fact to share, information on strategies for searching for additional information or facilitating admission to the hospital can be very useful to the learner. One of the key but challenging tasks for the learner is to take information and data gained from an individual learning situation and to accurately and correctly generalize it to other situations. There may be a tendency to over generalize – to conclude that all patients in a similar clinical situation may behave in the same way or require the exact same treatment. On the other hand, the learner may be unable to identify an important general principle that can be applied effectively in the future. Brief teaching specifically focused to the encounter can be very effective. Even if you do not have a specific medical fact to share, information on strategies for searching for additional information or facilitating admission to the hospital can be very useful to the learner.

27. Goertzen, J., Stewart, M., & Weston, W. (1995). Effective teaching behaviors of rural family medicine preceptors. Canadian Medical Association Journal, 153 (2), 161-8. Goertzen, J., Stewart, M., & Weston, W. (1995). Effective teaching behaviors of rural family medicine preceptors. Canadian Medical Association Journal, 153 (2), 161-8. Irby, D. M. (1978). Clinical teacher effectiveness in medicine. Journal of Medical Education, 53, 808-815. Irby, D. M. (1978). Clinical teacher effectiveness in medicine. Journal of Medical Education, 53, 808-815. Irby, D. M. (1994). What clinical teachers in medicine need to know. Academic Medicine, 69 (5), 333-42. Irby, D. M. (1994). What clinical teachers in medicine need to know. Academic Medicine, 69 (5), 333-42. Irby, D. M. (1995). Teaching and learning in ambulatory care settings. Academic Medicine, 70 (10), 898-931. Irby, D. M. (1995). Teaching and learning in ambulatory care settings. Academic Medicine, 70 (10), 898-931. Irby, D. M., Ramsey, P. G., Gillmore, G. M., & Schaad, D. (1991). Characteristics of effective clinical teachers of ambulatory care medicine. Academic Medicine, 66 (1), 54-5. Irby, D. M., Ramsey, P. G., Gillmore, G. M., & Schaad, D. (1991). Characteristics of effective clinical teachers of ambulatory care medicine. Academic Medicine, 66 (1), 54-5. Skeff, K. M. (1988). Enhancing teaching effectiveness and vitality in the ambulatory setting. Journal of General Internal Medicine, 3 (Mar/Apr Supplement), S26-33. Skeff, K. M. (1988). Enhancing teaching effectiveness and vitality in the ambulatory setting. Journal of General Internal Medicine, 3 (Mar/Apr Supplement), S26-33. Stritter, F. T., & Baker, R. M. (1982). Resident preferences for the clinical teaching of ambulatory care. Journal of Medical Education, 57, 33-41. Stritter, F. T., & Baker, R. M. (1982). Resident preferences for the clinical teaching of ambulatory care. Journal of Medical Education, 57, 33-41. Tumulty, P. A. (1973). Effective Clinician. Philadelphia: W. B. Saunders. Tumulty, P. A. (1973). Effective Clinician. Philadelphia: W. B. Saunders. Whitman, N. (1990). Creative Medical Teaching. Salt Lake City: University of Utah School of Medicine. Whitman, N. (1990). Creative Medical Teaching. Salt Lake City: University of Utah School of Medicine. Bibliography

28. Bibliograp hy Irby, D. (1997, February). The One-Minute Preceptor. Presented at the annual Society of Teachers of Family Medicine Predoctoral meeting, Orlando, FL. Irby, D. (1997, February). The One-Minute Preceptor. Presented at the annual Society of Teachers of Family Medicine Predoctoral meeting, Orlando, FL. Irby, D. (1997, June). The One-Minute Preceptor: Microskills for Clinical Teaching. Presented at teleconference from East Carolina Univ. School of Medicine, Greenville, NC. Irby, D. (1997, June). The One-Minute Preceptor: Microskills for Clinical Teaching. Presented at teleconference from East Carolina Univ. School of Medicine, Greenville, NC. 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. 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. STFM. (1993, February). The One-Minute Preceptor. Presented at the annual Society for the Teachers of Family Medicine Predoctoral meeting, New Orleans, LA STFM. (1993, February). The One-Minute Preceptor. Presented at the annual Society for the Teachers of Family Medicine Predoctoral meeting, New Orleans, LA

29. The lines of communication begin at the level of the student and preceptor. The lines of communication begin at the level of the student and preceptor. Please view the YouTube video The One Minute Preceptor Model for a brief description of the One Minute Preceptor. This video can be viewed at: https://www.youtube.com/watch?v =rKGMkbPWekk&feature=related Please view the YouTube video The One Minute Preceptor Model for a brief description of the One Minute Preceptor. This video can be viewed at: https://www.youtube.com/watch?v =rKGMkbPWekk&feature=related https://www.youtube.com/watch?v =rKGMkbPWekk&feature=related https://www.youtube.com/watch?v =rKGMkbPWekk&feature=related If you have an issue that cannot be resolved, please contact the EMS Clinical Coordinator Linda Avery- Patz at: (715) 764-2788 If you have an issue that cannot be resolved, please contact the EMS Clinical Coordinator Linda Avery- Patz at: (715) 764-2788

30. THANK YOU! It is dedicated preceptors like you that allow us to educate and train quality prehospital medical providers. Policies and procedures for clinical education can be obtained by referring to the WITC Preceptor Handbook. It is dedicated preceptors like you that allow us to educate and train quality prehospital medical providers. Policies and procedures for clinical education can be obtained by referring to the WITC Preceptor Handbook. witc.edu