The ONE-MINUTE PRECEPTOR

2. Know
Do
Learning Objectives
 Know the 5 steps of the One Minute
Preceptor (OMP) Teaching Model.
 Appreciate how OMP allows you to
identify knowledge gaps for any level
of learner.
 Based on identified gaps, learn to
select one microskill for each
learner each day.
 Facilitate self-directed learning
using the OMP.
Feel

3. MicroskillsTeaching Model
 A 5-step approach to structure
effective precepting encounters
that last 5- minutes or less OR
address problems that arise
during teaching sessions.
 Validated in teaching medical
students and residents.

4. 5 Microskills
① Get a commitment
② Probe for supporting evidence
③ Teach general rules
④ Reinforce what was done right
⑤ Correct mistakes
At first, focus on one microskill at a time.
The order can be modified to fit the need.
Neher, J. O., Gordon, K. C., Meyer, B., & Stevens, N. (1992). A five‐step “Microskills" model of clinical teaching. Journal
of the American Board of Family Practice, 5, 419‐424.

5. The OMP …
 Used when learners are presenting a patient
case.
 Fosters learner ownership of the clinical
problem.
 Allows preceptor to identify gaps in learner’s
knowledge base and focus teaching on
learner needs.
Neher, J.O., et al (1992). A Five-Step “Microskills” Model of Clinical Teaching,
Journal of the American Board of Family Practice, 5(4):419-423.

6. Get a Commitment
Examples:
“What do YOU think is going on with this client/patient?”
“What would YOU like to accomplish?”
“Why do YOU think the client/patient has been non-
compliant?”
“Can YOU tell me more?”
Non-example:
“This is obviously a case of pneumonia.”
MICROSKILL
1
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the
Teaching Conversation. Family Medicine 35(6):391-3.

7. Get a Commitment
Difficulty or unwillingness … could be due to:
 Incomplete or contradictory data
 Knowledge gaps or errors obscuring clinical
picture
 Passive, immature learning style
 Fear of making mistakes or exposing
weakness
 Fear of you!!
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the
Teaching Conversation. Family Medicine 35(6):391-3.
MICROSKILL
1

8. Probe for Supporting Evidence
You can do this by asking …
 WHAT factors make this diagnosis likely?
 WHY do you suggest getting this test first?
 WHICH medications are available for this
condition?
 HOW did this prognosis emerge as the most
probable?
MICROSKILL
2
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the
Teaching Conversation. Family Medicine 35(6):391-3.

9. Probe for Evidence
Non-examples:
 “What are the possible causes of congestive
heart failure?”
 “I don’t think this is gout. Do you have any
other ideas?”
 “This seems like a classic case of ….”
Remember:
This is not a grilling session!
MICROSKILL
2
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor:
Shaping the Teaching Conversation. Family Medicine 35(6):391-3.

10. Teach General Rules
Examples:
 “Patients with plantar fasciitis usually experience pain when
first getting out of bed in the morning and after rest.”
 “In older patients with headache, it is important to consider
glaucoma and temporal arteritis as well as the primary
headaches.”
 “This rash is not typical of any common conditions. The
best reference is … if we don’t solve the problem by
looking at that, we need to call …”
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the Teaching
Conversation. Family Medicine 35(6):391-3.
MICROSKILL
3

11. Teach General Rules
Non-example:
It is not an unsupported, idiosyncratic approach.
“I’m convinced the best treatment for diarrhea with salmonella
enteritis is still a liquid or soft diet.”
Remember:
 It is not imperative that the teacher “teach something” every
time.
 Keep it brief and focused on identified issues.
 Avoid anecdotes and idiosyncratic preferences.
 Keep it to 1-3 general rules at most.
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the
Teaching Conversation. Family Medicine 35(6):391-3.
MICROSKILL
3

12. Tell Them What They Did Right
Example:
 “You didn’t jump into solving her presenting
problem but kept open until the patient
revealed her real agenda for coming in today.”
 Make your comments to the student specific
and focused.
MICROSKILL
4
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the
Teaching Conversation. Family Medicine 35(6):391-3.

13. Tell Them What They Did Right
Non-examples:
It is not general praise!
“You are absolutely right. That was a wise
decision.”
“Great job!” Remember:
 Competencies must be repeatedly rewarded and reinforced.
 Build upon the learner’s professional self-esteem.
 Focus on specific behaviors.
MICROSKILL
4
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the Teaching
Conversation. Family Medicine 35(6):391-3.

14. Correct Mistakes (gently)
As soon after a student mistake as possible find an
appropriate time to discuss what was wrong
and how to correct the error in the future.
Example:
“You may be right that the child’s symptoms are
due to a viral upper respiratory infection, but you
can’t be sure it isn’t otitis media until you’ve
examined the ears.”
MICROSKILL
5
Ask learner to self-assess first.
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the
Teaching Conversation. Family Medicine 35(6):391-3.

15. Correct Mistakes (gently)
Non-example:
Avoid vague, judgmental statements.
“You did what?!”
Remember to:
 Find an appropriate time and place—best done in private.
 Ask learners to critique their own performance first.
 Focus on how to correct the problem or avoid it in the future.
 Offer specific resources.
 Agree upon an action plan.
MICROSKILL
5
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the
Teaching Conversation. Family Medicine 35(6):391-3.

16. Using Microskills Strategies
in DifficultTeaching Situations
In the three clinical scenarios that follow:
① Identify possible reasons for the learners’
behavior.
② Identify the ONE microskill that would be
most appropriate for the situation.

17. Harold Hasty
Harold:
I have a patient that is coming in today with a
headache. I have not seen the patient yet but it is
probably a migraine. I plan to use Imitrex. Is that
O.K. with you?
How would you handle this?
http://wichita.kumc.edu/preceptor/difficult.html

18. Abby Absolutist
 Preceptor: So you think the patient has poison ivy? How
do you plan to treat her?
 Abby: I plan to give her a Medrol dose pack.
 Preceptor: The way you describe this area it sounded
small and was not weeping. Have you considered using
something topical?
 Abby: When I did my dermatology rotation with Dr.
DeMarco, he always used oral steroids so that is what I
plan.
How would you handle this?
http://wichita.kumc.edu/preceptor/difficult.html

19. Al Arrogant
Al Arrogant: I want to check out this patient. He is coming in with
an upper respiratory infection. Same old, same old. Is that O.K.?
Preceptor: I noticed on the chart, he is a smoker.
Al: Yeah, all of the patients in our clinic smoke.
Preceptor: I don't know about that, but have you talked with this
patient about quitting smoking?
Al: It won't do any good.
Preceptor: It especially won't do any good if you don't try it. What
do you know about smoking cessation?
Al: I know about the nicotine patches.
Preceptor: Maybe there are some things that you need to learn
about smoking cessation.
Al: (Laughing) I doubt Cecil's has anything to say about that.
How would you handle this?
http://wichita.kumc.edu/preceptor/difficult.html

20. Tips on Using the Microskills
 Clarify expectations – yours and the learners.
 Don’t interrupt the student during his/her patient
presentation.
 Make learner commit to a diagnosis or plan and give
the rationale for these decisions before critiquing the
presentation.
 Teaching includes indicating resources as well as
telling the answers.
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the Teaching
Conversation. Family Medicine 35(6):391-3.

21. Tips on Using the Microskills, cont.
 It’s okay for either preceptor or learner to say
“I don’t know”, as long as the next step is to actively
address the problem (e.g., by seeking the missing
knowledge, re-analyzing the situation) and actively
learning from the situation.
 Reinforce positive actions and provide constructive
correction of mistakes or misconceptions.
Neher, J.O., & Stevens, N.G. (2003). The One-minute Preceptor: Shaping the Teaching
Conversation. Family Medicine 35(6):391-3.

22. 2-MinuteVideo of the One Minute Preceptor In Action
One Minute Preceptor In Action
Diane Mar, MSIV Dr. Ivan Lopez
University of Nevada
School of Medicine

23. Summary
Spencer, J. (2003). Learning and teaching in the clinical environment. BMJ, 326, 591-4.

24. What will you keep the same?
What will you do more of?
What will you do less of?
What will you stop doing?
What will you do differently & how will you do it?
What will you add?
LEARN – REFLECT -
TEACH