PRECEPTOR
PEARLS II
Sonoma State University
Family Nurse Practitioner Program
Dr. Wendy Smith and Dr. Mary Ellen Wilkosz
Part II Tools and Practice
Objectives- A Reminder of EB Learning
Theory and Tools for Precepting
• 1. Develop knowledge and understanding of the history
and current status of the preceptor role.
• 2. Develop an understanding of three learning
theories/models that support the preceptor role and
learning styles. Knowles ALT, Kolb’s Experiential Learning
Theory, Benner’s Novice to Expert
• 3. Have a clearer understanding of the:
• Student and Program responsibilities
• Preceptor and Clinical Faculty responsibilities
• 4. Become familiar with Practice teaching and tools to
augment clinical learning
Tools to Facilitate
FOCUS on Tools in Precepting
• To Provide Quality Care
• To Maintain Efficiency
• To Provide Quality Education
Group Activity #2
• Think of a preceptor you had, what are
four attributes/qualities you can recall
that made them an effective preceptor,
or not so effective preceptor. Then lets
share!
Tools
• Four (4) Specific clinical
teaching strategies.
1. One Minute Precepting (5 micro skills)
2. SNAPPS- Learner Led Education
3. “Aunt Minnie”
4. Activated Demonstration
Tool 1.
“One minute preceptor” (OMP)
• 5 key steps or “micro skills”
• Getting a commitment (from student re situation – What does
student want to do here? If I weren’t here what would you do?)
• Probe for supporting evidence – What factors did you consider in
making that decision? Where there other options you R/I, R/O
• Teach general rules – the case at hand this is what the standard of
care is, these are the principles – mini lecture, with advice for
suggested reading.
• Reinforce what was done right – provide case descriptive and
behavior focused feedback. Focus first on what was done right
• Correct mistakes – in reviewing case correct NOW. Focus on
behaviors and decision making.
Tool 2. SNAPPS- Learner
led experience – Ask student!
(Based on Cognitive learning and reflective Practice)
• To Summarize, in 3 min or less -Relevant hx and physical
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•
•
•
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findings.
Narrow the Diff Dx. or poss. interventions to 2 -3 most relevant
and likely possibilities – PRIOR TO Preceptor Input.
Analyze the Diff Dx by comparing and contrasting poss.
explanations. Allows learner to verbalize thought process.
Probe the Preceptor – learner asks about uncertainties,
difficulties, or other approaches – Preceptor as Knowledge
resource.
Plan of Care - Attempts brief management plan or suggests
specific interventions further refines with input
Select a case-related issue for self-directed learning
Tool 3. “Aunt Minnie”
Value of Pattern Recognition
“If the lady across street walks, talks, dresses like your
Aunt Minnie she probably is your Aunt Minnie”
• Technique employed by most clinicians for approach to
common ambulatory problems.
• 1. student evaluates patient then presents the CC and Dx
• 2. student begins write-up and preceptor evaluates pt.
• 3. the preceptor discusses case with student,
• 4. the preceptor reviews and signs the medical record.
Researchers found that instruction to students using familiarity driven
pattern recognition combined with careful consideration of the
presenting features led to improved dx accuracy.
Tool 3. Activated Demos Teaching a skill
A way to maximize the educational Value of a
demonstration and provide learner with more than just a
passive experience.
1. Preceptor selects pt to see, CC known. Preceptor
assess Student’s relevant knowledge of case/condition.
2. Est. objs for exp and visit. What should student learn?
3. Preceptor provides clear guidance during skill demo,
includes Preceptor/student discussion pre/during/post.
4. Student demonstrates skill, preceptor may interrupt and
re-demo if not an evaluation/grading situation.
5. Discuss learning points and details of observation with
student.
6. Set agenda for future learning opportunities.
In Closing
OMP has been evaluated the most extensively, and has
been shown to improve diagnostic skills and disease
specific teaching. Improvement in all areas of diagnostic
process.
SNAPPS less extensive eval, show promise for improving
student case presentations, clinical reasoning and
independ learning.
“Aunt Minnie” – AKA Pattern Recognition - Studies show
pattern recog can play a role in teaching and testing
clinical reasoning so far (as of 2011) no formal eval of this
teaching model pub.
Activated Demo – Shows promise for preceptors to select
learner focused teaching strategies but needs further
evaluation and study.
Other Tools/techniques
• What have you used?
• Any good Mnemonics?
• OLDCARTS
• PQRST
• YOUR OWN AOLRAPPE
• Toileted, DIAPPERS
Where the Rubber Meets the Road!
• Get to know your preceptee
• Identify learning needs early on
• Assess biases or values
• Ask about other commitments
• Be clear about expectations
• Try some of these tools