one minute preceptor hdr
clinician educators
One-Minute Preceptor
Finding the time to teach in busy clinical environments can be challenging. Clinician educators Kathleen Timme and Pete Hannon outline a process for precepting in five minutes or less.

Case Study

It is a busy day in clinic and endocrinologist Neelu Vedantham is precepting an enthusiastic resident. She has assigned the resident to examine each patient and obtain a history. After the resident presents the information to Neelu, they plan to see each patient together. The resident emerges from the first patient’s room, ready to give the presentation. Neelu looks at her watch and realizes she only has 10 minutes to listen to the presentation and see the patient with the resident. She enjoys teaching, but struggles to find time to teach while clinic is so busy. The resident begins to describe a 60-year-old woman presenting with cough. What can Neelu do to improve clinical teaching when time is limited?

What is the One-Minute Preceptor?

F

inding the time to teach in busy clinical environments can be challenging. Physicians are tasked with providing excellent patient care, documenting visits in a timely fashion, communicating complicated plans with patients, and also, training the next generation of physicians. Unfortunately, when time is limited educating can fall by the wayside. 

One-Minute Preceptor is a teaching method first described in 1992 by a group of family physicians at the University of Washington. The goal of this approach is to provide clinical preceptors with the tools necessary to teach a general principle in five minutes or less. The method features five “microskills” that allow preceptors to assess a learner’s knowledge base and thought process, teach a specific principle, and provide timely feedback.

Why do I need One-Minute precepting skills?

Quick clinical teaching is important because medical students, residents, and fellows rely on interactions with clinical preceptors to learn how to practice both the art and science of medicine. Clinical experience under the supervision of an attending physicians helps reinforce classroom learning and gives trainees the opportunity to practice medical decision-making in a safe and supportive environment.

Effective and rapid clinical teaching also optimizes patient care. When clinical preceptors are able to teach general principles in a just few minutes during a clinical encounter, they can spend more time with patients and keep work flow on time. Furthermore, enhancing education of the next generation of physicians will ensure that patients continue to receive quality medical care for years to come.

How to precept in one minute

The One-Minute Preceptor teaching method features five “microskills.” The method works well in the context of a learner presenting their patient or explaining their thought process on any topic.

Follow these steps in order:

1. Get a Committment

The first microskill involves asking the learner to commit to a decision.  For example, this could be regarding a diagnosis, evaluation, or treatment option. The goal is for the learner to offer a specific point for you to later explore how they arrived at that conclusion.

From the case, the preceptor may ask the learner one of the following questions:

  • What do you think is causing the patient’s symptoms?
  • Which laboratory test would you like to order?
  • Which medication do you think would be best to treat their symptoms?

2. Probe for Supporting Evidence

The second microskill involves asking the learner how they arrived at the conclusion they made in the first step. Here you will assess the learner’s knowledge base and rationale behind various aspects of medical decision making.

From the case, the preceptor may ask the learner one of the following questions:

  • What led you to pneumonia as the most likely cause of the patient’s symptoms?
  • What aspects of the patient’s history and physical did you consider in suggesting allergy testing for this patient?
  • Why do you think antibiotics are the right choice for treatment?

3. Teach a General Principle

The third microskill involves teaching a general principle or rule. This is the place where you provide a clinical pearl or convey a specific piece of information pertinent to what was discussed in the first steps.

From the case, the preceptor may teach or explain a principle in the following way:

  • Patients with bacterial pneumonia often have asymmetric findings on their lung exam as this patient did, with diminished breath sounds on one side.
  • Allergy testing can be useful in patients that have symptoms only in the setting of certain environmental triggers, just as our patient only has coughing and difficulty breathing when around cats.
  • Antibiotics are not helpful in the treatment of viral upper respiratory infections.  Instead, supportive care is the better choice.

4. Reinforce What Was Done Well

The fourth microskill involves reinforcement of what was done right, or positive feedback.

From the case, the preceptor may say:

  • Your consideration of her vital signs in determining the cause of respiratory distress was helpful, in particular noting that her low oxygen saturation and fever may be signs of pneumonia.
  • I am impressed by how thorough your social history taking was with this patient.  You were able to find out that her symptoms were triggered by exposure to cats while at her neighbor’s home, where she spends much of her time.
  • Great job describing the most common antibiotics used for treating bacterial pneumonia and what specific bacteria they each cover.

5. Correct Mistakes

The fifth microskill involves correcting mistakes, or providing constructive feedback.

From the case, the preceptor may say:

  • Make sure to listen to the lower lung fields on both sides when examining a patient with cough. This would allow you to evaluate for the asymmetry that can be found in patients with pneumonia.
  • Don’t forget to ask about smoking history in patients that present with cough.
  • It is not necessary to prescribe antibiotics for this patient since she likely has viral pneumonia.  Overuse of antibiotics can lead to antibiotic resistance.

How it sounds in practice

Let’s return to our case study of Neelu and her interaction with Andrew.

Step 1: After listening to the resident’s presentation, Neelu pauses to identify a commitment.  She asks the resident what he thinks is causing the patient’s cough today. 

Step 2: He states that he thinks her cough is due to pneumonia. Neelu then asks the resident how he arrived at that conclusion.

Step 3: He states that he recently read an article on causes of cough in the outpatient setting and recalls a section on how fever with cough may be a sign of pneumonia. Neelu now understands the resident’s knowledge base and takes a couple minutes to teach on a general principle. She reviews how to use the physical exam to identify the most likely cause of her cough, including careful auscultation of the lung fields. 

Step 4: Neelu finishes up by providing feedback to the resident on his presentation. She praises his consideration of vital signs in narrowing the differential.

Step 5:  Neelu suggests that he listen closer for wheezing in future encounters, since this patient may actually be experiencing an asthma exacerbation rather than pneumonia. 

In just a few minutes, Neelu assessed the resident’s level of understanding, taught a general principle, and provided timely feedback.

References and Resources

  1. A five-step “microskills” model of clinical teaching (J Am Board of Fam Pract 1992 | 10 minutes) Neher, Gordon and Meyer present the five-step model in the family practice setting.
  2. One-minute preceptor 1-pager (PAEA Committee on Clinical Education | 2 minutes) A quick 1-page overview of when and when not to use this method.

Cite this content: Kathleen Timme and Pete Hannon, “One-Minute Preceptor”, Accelerate University of Utah Health curriculum, . Available at: http://accelerate.uofuhealth.utah.edu/explore/kathleen-timme-and-pete-hannon-one-minute-preceptor

Contributors

Kathleen Timme

Pediatric endocrinologist, Assistant Professor of Pediatrics (clinical), University of Utah Health

Pete Hannon

Neurologist, Division of Vascular Neurology, Assistant Professor, University of Utah Health