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The One Minute Preceptor:

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The One Minute Preceptor:. The University of British Columbia Faculty of Medicine Department of Family Practice Post Graduate Program. 5 Microskills for One-On-One Teaching written by Dr. Garry Knoll - PowerPoint PPT Presentation
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1 The One Minute The One Minute Preceptor: Preceptor: The University of British Columbia The University of British Columbia Faculty of Medicine Faculty of Medicine Department of Family Practice Department of Family Practice Post Graduate Program Post Graduate Program
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Page 1: The One Minute Preceptor:

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The One The One Minute Minute

Preceptor:Preceptor:The University of British ColumbiaThe University of British ColumbiaFaculty of MedicineFaculty of MedicineDepartment of Family PracticeDepartment of Family PracticePost Graduate ProgramPost Graduate Program

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5 Microskills for 5 Microskills for One-On-One One-On-One TeachingTeaching written by Dr. Garry Knollwritten by Dr. Garry Knoll Based on:Based on:Neher, J. O., Gordon, K. C., Neher, J. O., Gordon, K. C., Meyer, B., & Stevens, N. (1992). A Meyer, B., & Stevens, N. (1992). A five-step "microskills" model of five-step "microskills" model of clinical teaching. Journal of the clinical teaching. Journal of the American Board of Family American Board of Family Practice, 5, 419-424 Practice, 5, 419-424

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What teaching techniques What teaching techniques do you currently use?do you currently use?

Take 2 minutes to write down Take 2 minutes to write down the “techniques” you are the “techniques” you are consciously using to teach consciously using to teach now.now.

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One Minute Preceptor One Minute Preceptor Objectives:Objectives:

List the Steps of the One-Minute Preceptor List the Steps of the One-Minute Preceptor model of clinical teaching. model of clinical teaching.

Explain how each step fosters effective Explain how each step fosters effective and efficient teaching. and efficient teaching.

Demonstrate understanding of the One-Demonstrate understanding of the One-Minute Preceptor on a sample student Minute Preceptor on a sample student presentation. presentation.

Integrate the One-Minute Preceptor model Integrate the One-Minute Preceptor model into your clinical teaching. into your clinical teaching.

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Typical Teaching Typical Teaching EncounterEncounter

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One Minute Preceptor One Minute Preceptor The Five StepsThe Five Steps

1/Get a Commitment 1/Get a Commitment 2/Probe for Supporting Evidence2/Probe for Supporting Evidence 3/Reinforce What Was Done Well 3/Reinforce What Was Done Well 4/Give Guidance About Errors 4/Give Guidance About Errors

and Omissions and Omissions 5/Teach a General Principle5/Teach a General Principle

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One Minute PreceptorOne Minute Preceptor

An ExampleAn Example

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One Minute PreceptorOne Minute PreceptorWhat do you say next What do you say next after being presented after being presented with this history?with this history?

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One Minute PreceptorOne Minute PreceptorFirst StepFirst Step

Get a CommitmentGet a Commitment

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First step: First step: Getting a Getting a CommitmentCommitment

Suggested QuestionsSuggested Questions::What do you thing is going on What do you thing is going on

with this patient?with this patient?What other diagnosis would you What other diagnosis would you

consider in this situation?consider in this situation?What laboratory tests do you What laboratory tests do you

think we should get?think we should get?How do you think we should treat How do you think we should treat

this patient?this patient?

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First stepFirst step Getting a Getting a CommitmentCommitment

Notice that questions used Notice that questions used in getting a commitment in getting a commitment do not simply gather do not simply gather further data about the further data about the case. The goal is to gain case. The goal is to gain insight into the learner's insight into the learner's reasoningreasoning..

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One Minute PreceptorOne Minute PreceptorSecond StepSecond Step

Probe for Supporting Probe for Supporting EvidenceEvidence Give some examples of questions Give some examples of questions

which probe for the rationale for an which probe for the rationale for an answer. What is the learner thinking?answer. What is the learner thinking?

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Second Step:Second Step: Probe for Probe for Supporting EvidenceSupporting Evidence

Suggested Questions:Suggested Questions:What factors in the history and physical support your diagnosis? What do not?Why would you choose that particular medication?Why do you feel this patient should be hospitalized?Why do you feel it is important to do that part of the physical in this situation?

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Second StepSecond Step: Probe for : Probe for Supporting EvidenceSupporting Evidence

This step allows the preceptor This step allows the preceptor to closely observe the vital to closely observe the vital skill of clinical reasoning and skill of clinical reasoning and to assist the learner in to assist the learner in improving and perfecting improving and perfecting that skill.that skill.

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One Minute PreceptorOne Minute PreceptorThird Step Third Step

Reinforce What Was Reinforce What Was Done WellDone WellGive some examples of Give some examples of

statements you might use to statements you might use to reinforce what was well donereinforce what was well done

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Third StepThird Step: Reinforce what : Reinforce what was done wellwas done well

Possible reinforcement:Possible reinforcement:““Your diagnosis of `probable pneumonia' was Your diagnosis of `probable pneumonia' was

well supported by your history and physical. well supported by your history and physical. You clearly integrated the patient's history You clearly integrated the patient's history and your physical findings in making that and your physical findings in making that assessment.”assessment.”

““Your presentation was well organized. You had Your presentation was well organized. You had the chief complaint followed by a detailed the chief complaint followed by a detailed history of present illness. You included history of present illness. You included appropriate additional medical history and appropriate additional medical history and medications and finished with a focused medications and finished with a focused physical exam.”physical exam.”

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Third StepThird Step:: Reinforce what Reinforce what was done wellwas done well

With a few sentences you have With a few sentences you have reinforced positive behaviors reinforced positive behaviors and skills and increased the and skills and increased the likelihood that they will be likelihood that they will be incorporated into further incorporated into further clinical encounters.clinical encounters.

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One Minute PreceptorOne Minute PreceptorFourth StepFourth Step

Give Guidance About Errors Give Guidance About Errors and Omissionsand Omissions Can you give some examples Can you give some examples ??

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Fourth stepFourth step: Give Guidance : Give Guidance about errors and omissionsabout errors and omissions

Examples:Examples:““In your presentation you mentioned a temperature In your presentation you mentioned a temperature

in your history but did not tell me the vitals signs in your history but did not tell me the vitals signs when you began your physical exam. Following when you began your physical exam. Following standard patterns in your presentations and note standard patterns in your presentations and note will help avoid omissions and will improve your will help avoid omissions and will improve your communication of medical information.”communication of medical information.”

““I agree that, at some point, complete pulmonary I agree that, at some point, complete pulmonary function testing may be helpful, but right now function testing may be helpful, but right now the patient is acutely ill and the results may not the patient is acutely ill and the results may not reflect her baseline and may be very difficult for reflect her baseline and may be very difficult for her. We could glean some important information her. We could glean some important information with just a peak flow and a pulse oximeter.”with just a peak flow and a pulse oximeter.”

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Fourth stepFourth step: Give Guidance : Give Guidance about errors and omissionsabout errors and omissions

In a few sentences an In a few sentences an opportunity for behavior opportunity for behavior change has been identified change has been identified and an alternative strategy and an alternative strategy given.given.

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One Minute PreceptorOne Minute PreceptorFifth StepFifth Step

Teach a General Teach a General PrinciplePrincipleSuggest a general principle Suggest a general principle that could be taught in this that could be taught in this scenario.scenario.

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Fifth step:Fifth step: Teach a general Teach a general principleprinciple

Examples:Examples:““Smokers are more likely than non-smokers to be Smokers are more likely than non-smokers to be

infected with gram-negative organisms. This is one infected with gram-negative organisms. This is one situation where you may need to broaden your situation where you may need to broaden your antibiotic coverage to be sure to cover these more antibiotic coverage to be sure to cover these more resistant organisms.”resistant organisms.”

““Deciding whether someone needs to be treated in the Deciding whether someone needs to be treated in the hospital for pneumonia is challenging. Fortunately hospital for pneumonia is challenging. Fortunately there are some criteria that have been tested which there are some criteria that have been tested which help...”help...”

““In looking for information on what antibiotics to choose In looking for information on what antibiotics to choose for a disease I have found it more useful to use an up-for a disease I have found it more useful to use an up-to-date hand book than a textbook which may be to-date hand book than a textbook which may be several years out of date.”several years out of date.”

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Fifth step:Fifth step: Teach a general Teach a general principleprinciple

A statement or two outlining a A statement or two outlining a relevant and practical relevant and practical teaching point can have a teaching point can have a significant impact on the significant impact on the learner.learner.

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One Minute PreceptorOne Minute Preceptor

ConclusionConclusion

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ConclusionConclusionExample:Example:““OK, now we'll go back in the room and OK, now we'll go back in the room and

I'll repeat the lung exam and talk to the I'll repeat the lung exam and talk to the patient. After, I'd like you to help the patient. After, I'd like you to help the nurse get a peak flow, a pulse ox, and a nurse get a peak flow, a pulse ox, and a CBC. When we have all those results, let CBC. When we have all those results, let me know and we can make a final me know and we can make a final decision about the need for decision about the need for hospitalization and our treatment plan.”hospitalization and our treatment plan.”

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ConclusionConclusion

The teaching encounter is The teaching encounter is smoothly concluded and the smoothly concluded and the roles and expectations for roles and expectations for each person are made clear each person are made clear in a way that will facilitate in a way that will facilitate further learning and optimize further learning and optimize patient care.patient care.

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SummarySummary

The more the student processes and the less you say ….the more successful the encounter is likely to be.

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Thank YouThank You This module was written as an aid to This module was written as an aid to

the Preceptors in the Postgraduate the Preceptors in the Postgraduate Family Practice Program at the Family Practice Program at the University of BC.University of BC. Study credit is available to groups of Study credit is available to groups of

preceptors who complete the modulepreceptors who complete the module Please give us your feedback on the module Please give us your feedback on the module

so that we may improve it for others.so that we may improve it for others. Email your comments to Dr. Fraser Norrie, Email your comments to Dr. Fraser Norrie,

Faculty Development, UBC Family PracticeFaculty Development, UBC Family Practice [email protected]@vch.ca


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