Welcome to Welcome to “One Minute Preceptor”“One Minute Preceptor”

Presented by Tatum KorinPresented by Tatum KorinThe presentation will begin shortlyThe presentation will begin shortly..

This webinar will be recorded and used for future presentations.

Funds for this webinar were provided by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) with the American Recovery and Reinvestment

Act (ARRA) funding for the Retention and Evaluation Activities (REA) Initiative.

This webinar is being offered by the Community Clinic Association of Los Angeles County and the California Statewide AHEC program in partnership with the Office of Statewide Health Planning and

Development (OSHPD), designated as the California Primary Care Office (PCO).

Disclosure of Financial Relationships

Tatum Korin, Ed.D.

April 2013

Disclosure:I have no relationships with entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Tatum Korin, EdDAssistant Dean

Graduate Medical Education, LAC+USC County and Keck HospitalAssociate Professor

Department of Medical Education, Keck School of Medicine

April 3, 2013

HOW MANY OF YOU SUPERVISE MEDICAL STUDENTS AND/OR

TRAINEES?

HOW MANY OF YOU HAVE FORMAL TRAINING IN TEACHING?

WHAT IS THE BIGGEST CHALLENGE YOU FACE

PRECEPTING LEARNERS?

Which of the following is most strongly associated with improved learning?1.Supervision2.Number of patients seen3.Board scores4.Medical School

Supervision & Feedback: A Winning Combo

• Quality and frequency of supervision has a stronger correlation to improved performance than does number of patients seen.

• Conversely, studies have shown that lack of supervision was most strongly correlated adversely affecting student learning.

Supervision & Feedback: A Winning Combo

• Quality and frequency of supervision has a stronger correlation to improved performance than does number of patients seen.

• Conversely, studies have shown that lack of supervision was most strongly correlated adversely affecting student learning.

ObjectiveAt the completion of this presentation, as busy preceptors, you will be better prepared to:•Implement several quick and easy teaching strategies, including The One-Minute Preceptor and giving effective feedback, into your daily teaching

Characteristics of Excellent Clinical Teachers

Literature review of “Good Clinical Teachers in Medicine” Sutkin, et al (2008)

• 68 articles or essays (1909-2006)• Teacher and human characteristics

identified

State of Clinical Skills Teaching(Howley and Wilson, Academic Medicine, 2004 )

• In a survey of 345 medical students completing their clinical clerkship at a large US medical school (averaged across clerkships): by either faculty or residents:

• 49% never observed taking a history • 46% never observed doing focused PE • 20% never observed doing a complete PE

• Maintains positive relationships with students and a supportive learning environment (27)• Demonstrates enthusiasm for teaching (18)• Is accessible/available to students (16)• Provides effective explanations, answers to questions, and demonstrations (16)• Provides feedback and formative assessments (15)• Is organized and communicates objectives (14)• Demonstrates knowledge of teaching skills, methods, principles, and their application (12)• Stimulates students’ interest in learning and/or subject (12)• Stimulates of inspires trainees’ thinking (11)• Encourages trainees’ active involvement in clinical work (11)• Provides individual attention to students (10)• Demonstrates commitment to improvement of teaching (10)• Actively involves students (10)• Demonstrates learner assessment/evaluation skills (7)• Uses questioning skills (4)• Stimulates trainees’ reflective practice and assessment (4)• Teaches professionalism (4)• Is dynamic, enthusiastic and engaging (3)• Emphasizes observation (2)• Other (5) Teacher

characteristics

Top 5 Teacher Characteristics

1. Maintains positive relationships with students and a supportive learning environment (27)

2. Demonstrates enthusiasm for teaching (18)3. Is accessible/available to students (16)4. Provides effective explanations, answers to

questions, and demonstrations (16)5. Provides feedback and formative assessments

(15)

• Communication skills (21)• Act as a role-model (15)• Is an enthusiastic person in general (14)• Is personable (12)• Is compassionate/empathetic (11)• Respects others (11)• Displays honesty/integrity (10)• Has wisdom, intelligence, common sense and good judgment (7)• Appreciates cultural and different cultural backgrounds (6)• Considers others’ perspectives (6)• Is patient (4)• Balances professional and personal life (4)• Is perceived as a virtuous person and a globally good person (4)• Maintains health, appearance and hygiene (3)• Is modest and humble (3)• Has a good sense of humor (3)• Is responsible and conscientious (3)• Is imaginative (3)• Has self-insight, self-knowledge, and is reflective (2)• Is altruistic (2)• Other (12)

Human Characteristics

Top 5 Human Characteristics

1. Communication skills (21)2. Act as a role-model (15)3. Is an enthusiastic person in general (14)4. Is personable (12)5. Is compassionate/empathetic (11)

Learners Want More…

Medical students and residents report (locally & nationally)•They do not receive adequate and appropriate supervision•They do not receive (enough) timely and useful feedback

What accounts for the “Feedback Gap”?

• Learners say the don’t receive enough feedback• Faculty say they give feedback all the time

Strategy #1: Start any discussion where you plan to give feedback with “The feedback I have for you is…”

Strategy #2Priming the Learner

• Orient the learner to the patient prior to the encounter• One-minute patient orientation with a contextual

framework• Preceptors should:

– Review the patient medical background– Tell the learner what complaint to focus on– Set guidelines for the Px– Set time limit for the initial encounter

• Communicate your priorities for learners before each patient interaction

Rapid Teaching Techniques

• Maximum teaching in limited time– Strategy #3: The One-minute Preceptor– The Aunt Minnie Model– SNAPPS– “Activated Demonstrations”– Case presentations at the bedside

The “One-Minute Preceptor”

• The most widely known and researched teaching method is the “one-minute preceptor” model.

• Research on the one-minute preceptor model has found – strong “happiness data” or satisfaction with the

model by learners and teachers– improved faculty and resident teaching ratings after

students were observed and provided feedback on the basis of the model

“The One-Minute Preceptor”Involves identifying the needs of each individual learner, teaching, and providing feedback by using a four step approach:

•Get a commitment about what the learner thinks is going on with the patient; •Probe for underlying reasoning or alternative explanations; •Teach a general principle; •Provide positive feedback about what was done well; Correct errors and make suggestions for improvement

Beware of preceptor teaching pitfalls

• “Taking over” • Inappropriate lectures• Insufficient “wait-time”

– 3-5 second wait• Pre-programmed answers

– Could it be an ulcer? Do you think it’s cancer?• Rapid reward

– Ends the learners thinking process and is insincere• Pushing past ability

– Pushing the learner beyond their understanding

Role Play

Get a commitment about what the learner thinks is going on with the patient;

Probe for underlying reasoning or alternative explanations;

Teach a general principle;

Provide positive feedback about what done right; Correct any errors and/or make suggestions for improvement

Last words on the Importance of Giving Feedback

• One of the most underused yet powerful instructional strategies available

• Takes less than a minute, and several of the above models build feedback into the sequence.

• Provides the learner with a description of their strengths and recommendations for improvement.

• Go beyond praise to specific descriptive comments about a learners performance.

• Serves as an opportunity to promote self reflection and independent study

4-25

The The ““Feedback SandwichFeedback Sandwich””

What was done rightWhat needs improvement

What to do next time

What’s wrong with the…

Feedback & Self-Reflection

• Giving feedback and encouraging students to reflect [on their own performance], supervisors can have a positive affect on learning (Irby & Bowen, 2004).

• Feedback and reflection are basic teaching methods of the clinical setting; unfortunately, they are generally underused (Branch & Paranjape, 2002)

• Ask learners to rate, discuss, express how they feel/think an experience went.

• Ask learners to explain what they did well• Ask learners to explain what they need help

with, have trouble with, would like to learn more about, etc.

Strategy #4: Feedback & Self-Reflection

Summary

• Strategy #1: “The feedback I have for you is…”• Strategy #2: Priming the student• Strategy #3: The One-minute Preceptor• Strategy #4: Self-assessment/feedback

Questions?Comments?

Thank you

Tatum Korin, EdD.LAC+USC/Keck Hospital

korin@usc.edu