Precepting: Tip (printable sheet)
Definition: Teaching learners medical facts and clinical reasoning skills through individual patient care encounters.
- Case- based experiential learning provides a memorable context to acquire & reinforce concepts.
- One on one encounter allows the teacher to identify the individual learning needs of the student
- Each case provides a wide array of potential learning points
- Teaching may easily be tailored to individual levels
- Individual cases may not generalize well for other patients with similar symptoms.
- Because the learning objectives are not defined it is easy for teachers to cover too much material, diluting the potency of teaching points.
- Probing the learner for their level of understanding may lead to excessive focus on facts over concepts. It may also develop into a pattern of “pimping” which learners may find a negative reinforcement of the experience.
- Teachers must carefully balance the needs of patient care with teaching, allowing sufficient time and attention for teaching while expediting care.
5 Step Microskills Model or “One Minute Preceptor”
This teaching model is designed to efficiently use the patient care encounter to identify learning needs, teach a few salient points in a positive manner and analyzes clinical reasoning skills. This exercise emphasizes active learning by requiring the learner to interpret the data rather than simply communicate information and wait for the teacher’s instruction. The model is initiated after a case presentation by the learner.
- Step 1: Get a Commitment
- √ Insist that the learner propose a differential diagnosis including both most likely diagnoses as well as most serious diagnoses.
- Step 2: Probe for Supporting Evidence
- √ Challenge the learner to provide an explanation for their diagnosis and plan.
- Step 3: Teach General Rules
- √ Simple & focused teaching points.
- √ Avoid the urge to provide a lecture on the subject
- Step 4: Reinforce what was done right
- √ Specific examples of what the learner did correctly
- Step 5: Correct Mistakes
- √ Performed in the appropriate setting to avoid embarrassment.
- √ Ideally the learner can indentify the mistakes first.
- √ Specific examples with explanations rather than generalizations.
Similar to the One Minute Preceptor but more learner-directed. The focus is place more on clinical reasoning skills than medical facts. The teacher coaches the learner through the model until they are familiar with how to do this on their own.
Summarize: Summarize briefly the history and findings
Narrow Down: Narrow down the differential to 2 or 3 relevant possibilities
Analyze: Analzye the differential by comparing and contrasting the possibilities
Probe: Probe the preceptor for better understanding by asking questions about uncertainties, difficulties or alternative approaches
Plan: Plan management for the patient’s medical problems
Select: Select a case related problem for self-directed learning
Aunt Minnie Model
This model is best suited to more experienced learners. It is designed to promote rapid pattern recognition . The name comes from the adage that if the woman across the street walks and dresses like your Aunt Minnie then she probably is your Aunt Minnie, even if you can’t see her face. The model begins after the learner has performed a history and physical examination of the patient.
Step 1: Learner presents only the main complaint & their presumptive diagnosis to the teacher.
Step 2: While the learner begins documentation the teacher evaluates the patient.
Step 3: The teacher discusses the case comparing the learner’s impression with the teacher’s.
This model is ideal for less experienced learners who may find performing and interpreting a particular history and physical examination too complicated or beyond their knowledge base. While this approach emphasizes learner observation it is important to include some specific objectives or tasks for the learner. For example, taking a learner to see a trauma patient in the emergency department. The teacher tells the learner “Watch how I quickly assess the patient using a Primary Survey.” After the demonstration, the teacher needs to “activate” the learner by asking him or her to describe what was observed. A brief discussion typically ensues in which the rationale for the actions is examined and independent study is assigned.
This approach requires that the patient is evaluated by the learner prior to the teaching encounter and that both learner and patient are comfortable with this format. Learners present the history, physical examination and the differential diagnosis in front of the patient. The educational benefit of this approach is that it allows the patient to correct information in front of both learner and teacher. This can help the learner understand how the teacher explores the history to get pertinent information. It also allows the learner to observe physical examination techniques performed by the teacher.