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One Minute Preceptor

Five microskills that facilitate teaching when time is tight

You’ve probably heard of (and maybe forgotten) the One Minute Preceptor tool, but have you actually taken the time to try it out?  

The One Minute Preceptor is a structured teaching conversation that utilizes five microskills, each of which can also be used individually to create super-efficient teaching moments.

 


STEP ONE: Eliciting a commitment is most naturally done during decision making processes like diagnosis and plan development. Consider asking an open-ended question. We like, "What do you think is going on?" and, "What's your plan?" Possible answers include:

  • Correct/reasonable diagnosis or plan (go to STEP 2)

  • Multiple differential diagnoses/waffling (push the learner to take a stand, then go to STEP 2)

  • "I have no idea." (often denotes lack of confidence and not usually true. Push for a differential or get a commitment about other aspects of the case, then go to STEP 2) Start more open ended and narrow as needed:

    • did you rule any diagnoses out?

    • what is your plan?

    • could this be ____________?

    • is this an emergency? 

    • what's the likely disposition? 

STEP 2: Probe for supporting evidence to evaluate thought process and identify knowledge gaps. These should be open-ended questions and the learners' responses are the key their thought processes. 

  • How did you come to that conclusion? 

  • What else did you consider? How did you rule that out? 

  • Why is not ___________? 

  • How will you use the results of the workup? 

You should, at this point, have gathered some useful intel to help you take advantage of some teaching moments. 

 

 

STEP 3: Teach general rules that you want the learner to take away from the encounter. Think outside the box to provide tips that are helpful. Consider:

  • common comorbid diseases or injuries

  • physical signs or historical features that point toward or are pathognomonic for pathology

  • communication strategies for difficult patients, families, or consultants

  • sharing your experiences and tips

   (General rules don't necessarily have to be used in the context of the One Minute            Preceptor. Try using this micro-skill when walking with the resident between rooms or      when debriefing a case or procedure.)
 


STEP 4: Reinforcing what the learner did well and STEP 5: correcting mistakes, when used together, are really just an open-faced feedback sandwich. Ideally, the two ideas should be connected in some way ("You were right to think of X, but you might also have included Y in your differential"). 
 


It's perfectly reasonable and effective to separate the components into different teaching moments. You can and should reinforce good decisions, management, technique, and communication, for example, without identifying behaviors that are in need of correction. Similarly, you can make gentle corrections without priming the learner with positive feedback first. Just make sure the context of your corrective feedback is established before you provide it. 


PINNACLE TIP: Ideally, asking open-ended questions will get your learners talking and allow you to spend some time listening. If you're finding that you have to ask a lot of questions, reassure the learner that your questions are meant to be supportive and collaborative. Uncertain learners may perceive a barrage of questions, even well intentioned ones, as an interrogation.  

Additional resource:

Farrell SE. et al. What's the Evidence: A Review of the One-minute Preceptor Model of Clinical Teaching and Implications for Teaching in the Emergency Department. Journal of Emergency Medicine 2016;51(3):278–83.

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