Date of Report: 04/2004
Source: Pacific AETC
Author: Cynthia Carmichael, MD
Description: From The 4th Level, the Pacific AETC newsletter for clinical consultants.
Introduced in 1992, the clinical teaching model known as the "One-minute Preceptor" has relevance for Level 4 training. The five tasks (or microskills) have been shown to improve key teaching behaviors. The tasks are: 1) Get a commitment 2) Probe for supporting evidence 3) Teach general rules 4) Reinforce what was done right 5) Correct mistakes. Getting a commitment involves helping the learner process the information s/he has learned about the patient. You want to find out how the learner is thinking about the patient so you can be a better teacher. Asking, in a non-threatening way, "what do you think is going on?" or "how do you plan to work-up or diagnose the patient?" may be appropriate questions. Probing for supporting evidence means finding out what clinical reasoning the learner has used so far in thinking about the patient. Asking questions like "what factors did you consider in making that decision?" or "were there other options you considered?" may make clear some knowledge deficits. Teach General rules. Once you understand what the learner knows, you can pick one or two general rules to get across. Every presented case has teaching value but learners cannot integrate more than one or two general rules per case. Rather than, "the patient needs Efavirenz and Combivir'point out that "treatment of HIV requires using meds from 2 or more antiretroviral classes because..." In putting forth 'general rules', keep the patient's concerns and the learner's needs in mind. Try to be brief. Avoid the temptation to cover too much material or to focus primarily on what you know best. Reinforce what was done right by verbally acknowledging effective behaviors. Correct mistakes by using descriptive rather than evaluative language. Comments should be well timed, case-specific and behavior focused. Sometimes asking the learner what they feel they did right and what they would like to do better is helpful since we often learn most from the mistakes we identify ourselves. Keeping these skills in mind as a "framework on which good teaching conversations can be built" can be useful in Level 4 training. "The model is most helpful when it is not viewed as static and rigid but as a pliable set of guidelines that can be shuffled and altered as the ever-changing teaching situation warrants." Neher J, Stevens N. The One-minute Preceptor: Shaping the Teaching Conversation. Fam Med 2003;35(6):391-3. Grover M. Teaching General Rules During Ambulatory Education. Fam Med 2003;35(3):160-2. | 
