1. The One-Minute Preceptor & The One-Minute Observation
Effective & Efficient
Outpatient Clinical Teaching
Presented to the
JHUSOM Department of Neurology
December 21, 2006

2. This workshop is based on “Teaching in the Ambulatory Setting”
Produced by the Office of Medical Education Research and Development, College of Human Medicine, Michigan State University, 1999

3. Objectives By end of this session, participants should be able to:
State the components of the “one-minute preceptor” model
Recognize effective modeling
State the components of the “one-minute observation”

4. Settings & Challenges

5. Teaching in the Clinic In-depth Lectures Seminars
Formal Educational Sessions
Extensive Discussion
1-8

6. 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.
1-9

7. Trigger Tapes What is going well? What is not going well?
Vignette 5 (2:19)
Vignette 6 (0:58)
Vignette 7 (0:20)

8. 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

9. Trigger Tape (1:23)
What effective teaching behaviors do you see?

10. The One-Minute Preceptor The 5 Microskills of Clinical Teaching
Get a commitment
Probe for supporting evidence
Teach general rules
Take each encounter to a learning point
Feedback: Reinforce what was right
Feedback: Correct mistakes

11. The One-Minute Preceptor The 5 Microskills of Clinical Teaching
Get a commitment
What do you think is going on?
Probe for supporting evidence
What led you to that conclusion?
Teach general rules
When this happens, do this…
Reinforce what was right
I really liked that you did….
Correct mistakes
Next time this happens, try this…

12. Case Presentation Presenting in Front of the Patient
PROs
CONs

13. 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

14. 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%)
*Lehman L, N Eng J Med 1997:336:1150

15. 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
The physicians should respect the patients privacy more
Physicians should ask permission to present at the bedside
Physicians should be seated during the presentation
*Lehman L, N Eng J Med 1997:336:1150

16. Modeling
Trigger Tape (1:35)
What is being done well?

17. Modeling Determine the learner’s relevant knowledge
Identify what the learner should learn
Provide guidelines of what the learner should do during the observation
Include learner in discussion and examination of patient
Provide for brief discussion of learning points after observation

18. The One-Minute Observation
Trigger Tape (1:44)

19. The One-Minute Observation
Explain the purpose of the observation
Explain how the observation will occur
Inform patient of what will take place
Observe without interrupting
Leave room without disrupting the student or patient
Provide feedback
Agenda for future learning

20. “Trainees do not perform required skills incorrectly on purpose…errors in performance are typically the result of insufficient feedback. They are seldom the result of insufficient interest or caring.”
-Westberg and Jason, 1991
4-3

21. FEEDBACK IS:
Information you provide to learners about their clinical performance that is intended to guide their future clinical performance
-Adapted from K. Skeff
4-5

22. Teaching Strategies 5 Microskills: the one minute preceptor Modeling
The one minute observation

23. Bibliography
Ende J. Feedback in clinical medical education. JAMA 1983;250:777
Hewson MG. Clinical teaching in the ambulatory setting. JGIM 1992;7:76.
Irby DM, et. al. Characteristics of effective clinical teachers of clinical ambulatory care medicine. Acad Med 1991;66:54.
Lehman LS,et.al. The effect of bedside case presentations on patients’ perception of their medical care. NEJM 1997;336:1150.
Neher JO, et. al. A five-step “microskills” model of clinical teaching. J Am Board Fam Pract 1992;5:419.
Wright SM, et. al. Attributes of excellent attending-physician role models. NEJM 1998;339:1986.