Summary: Five Microskills/One Minute Preceptor
1. Learner sees patient
2. Learner presents patient to you
3. Get a commitment: Early on, get the learner to commit to a diagnosis, work up, or therapeutic plan. This allows the learner to disclose the beginning of his or her problem solving process, so you can begin to assess his or her needs as a learner. What is going on with this patient? What else might it be? What do you want to do next should do next? How shall we treat this patient? What lab tests do you think are indicated? What would you like to accomplish in this visit? Why do you think this patient has been noncompliant? Pointers: Resist temptation to ask a series of data gathering questions, because this leads the learner through your problem solving approach, rather than allowing you to assess his or hers.
4. Probe for supporting evidence: This allows the learner to think out-loud, thus providing you with valuable insight into his or her thought process. Why do you think so? What parts of the history or physical support your diagnosis? Why would you select this medication over other available medications? What factors did you take into account when you decided on that course of action?
5. Teach a general principle: When gaps or mistakes in knowledge, data, or missed connections become apparent, you have an opportunity to provide targeted teaching. If you can offer the teaching as a general principle, it is more likely the learner will remember it in other situations. If a question arises that neither the learner nor the preceptor knows how to answer, this teaching might be focused on what resources could be used to address the question.
6. Reinforce what was done well: If the learner’s presentation was done well, describe how it was done well (i.e. your presentation was logical and well organized. You provided the subjective, objective, assessment and plan as I expected to hear them, which helps ensure that we don’t miss any steps.) If the learner’s working diagnosis is appropriate, describe why you think so.
7. Correct errors and omissions: Take the opportunity to provide correction. As with reinforcement, be as specific as possible: While it’s possible this patient has that diagnosis, it’s also important to consider (x potentially fatal condition).