One Minute Preceptor
Effective 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.
2.
3.
4.
5.
Ask for a Commitment
Probe for Underlying Reasoning
Teach General Rules
Provide Positive Feedback
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 Standards
The 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