Todd Zakrajsek Family Medicine - University of North Carolina at Chapel Hill

One thing I have noticed in working in medical education over the past three years is that the teaching and learning material, techniques, and tips do not typically “cross over” across areas of the academy as much as they should. Ok, there is nothing new about “silos” of information, but when moving from the main to campus to health professions the lack of information exchange seems even more pronounced. Just a few months ago I was explaining the “think-pair-share” to a group of clinician educators and it became apparent that most of the teaching physicians had never heard of the technique. Some, of course, knew of the technique but most had not. The same is true of material developed in clinical education. Many faculty members outside of clinical education have never heard of many valuable teaching strategies used by physicians, nurses, pharmacists, and a host of others in the health professions. One such approach is the “One Minute Preceptor.”

The One Minute Preceptor is built on what are commonly referred to in clinical settings as the five-step microskills model of teaching. Although this approach was first published over 25 years ago (Neher, 2001), it is a model I had not heard of until I began working with preceptors and in clinical settings.

The One Minute Preceptor model is designed so direct feedback can be given in a very short period of time. This is extremely valuable in clinic settings, where everything is done at a harried pace. That said, this technique strikes me as also being extremely important in any situation in which quick feedback needs to be given on a task or process requiring critical thinking. And it certainly isn’t only the clinic that is fast paced. We all face the time crunch.

Teaching and giving feedback in very short blocks of time can be both time efficient and an effective method to facilitate learning. The One Minute Preceptor (OMP) model recognizes that teaching can take place when a larger block of teaching time simply isn’t possible. The model has also been the focus of research in clinical settings. One such example is a randomized controlled trial conducted by Furney, et al. (2001) to measure the effectiveness of the OMP. A sample of 57 second and third year internal medicine students who were given feedback using the OMP model showed statistically significant changes in a number of behaviors, including student responses to “motivated me to do outside reading,” “getting a commitment,” and “feedback.” In addition, 87% of the participants in the experimental group rated the intervention (learning the OMP) as “useful” or “very useful.”

The OMP has 5 quick steps designed to get the learner directly engaged in the learning process. As you read through the steps, think of a situation in your own teaching where a student or small group of students may have studied a block of material or a case and is now ready to report out on what they have learned.

The first step is to “Get a Commitment.” After the learner has provided a summary of the situation, she is asked what she thinks is the most important aspect of the material, what course of action she recommends, or to identify the next action to be taken. For this step to be effective it is important for the student to take a stance and make a commitment.

Once a commitment has been stated it is important to determine the rationale for that decision. Sometimes the stance taken is simply a guess or quick statement based on the response noted in a similar case. Step two of the OMP involves asking for supporting evidence. Here the learner must provide “back up” information or evidence, which also gives you the opportunity to see the thinking behind for the commitment stated. Once a commitment has been made and you have probed for supporting evidence, the following two steps are to reinforce correct thinking and correct errors for incorrect thinking. The extent to which these two steps come into play are based heavily both on the learner and the information provided. It is important to establish and maintain a culture that correcting errors is not synonymous with “bad” thinking. The concept is to teach the student to take risks, make commitments and then learn from incorrect information when it occurs.

The final step is for you to “Teach a General Rule.” Taking into account the specific facts of the given case and your expertise in the area, this is the opportunity to explain to a learner what should be watched for overall and general tendencies pertaining to that which has been proposed. Mostly, this last step is a great time for you as a “teacher” to model good thinking for learners. The difficult, but important, concept for the final step is to teach the rule quickly. Do not go into depth and strive to finish the concept you are stating in 30 seconds or less.

In summary, the steps of the OMP are to (1) Get a Commitment, (2) Probe for Supporting Evidence, (3) Reinforce What Was Done Well, (4) Correct Errors and Give Guidance about Mistakes, and (5) Teach a General Principle. There are many ways the OMP may be adopted and adapted to your teaching style and the circumstances in which you teach. If you have not tried this method before, give it a go and then talk to your students about ways to adapt. I have been involved in many conversations about the OMP and there are a many opinions and data about variations. One certainty is that any conversation I have been in about the OMP has provided interesting new considerations for engaging learners in the learning process…particularly when time is of the essence.

References

Furney, S.L., Orsini, A.N, Orsetti, K.E., Stern, D.T., Gruppen, L.D., & Irby, D.M.. (2001). Teaching the one-minute preceptor: A randomized controlled trial. Journal of General Internal Medicine, 16 (9), 620-624.

Neher J.O.,Gordon K.C.,Meyer B, Slevens, N., (1992). A five step “Microskills” model of clinical teaching. Journal of the American Board of Family Practice, 5,419-424.