Mozella Williams, MD, Department of Family and Community Medicine, University of Maryland
This year the "5 Microskills Model of Clinical Teaching" method refined by Neher et al,1 now more commonly dubbed "The One Minute Preceptor" turns 20 years old. Maturing over the past 2 decades, most would agree this method has come through adolescence in good stead and has left in its legacy the aiding of numerous preceptors as they've instructed, refined, and molded several generations of learners—month after month, rotation after rotation, year after year.
In family medicine teaching, as in practice, we pause to acknowledge milestones, to take note of those fundamental practices that make our craft meaningful. So, allow a few minutes to review a method that has likely impacted your training, if not your day-to-day teaching, and will likely continue to do so in the future.
Clinical precepting must be among one of the most nebulous skills to master as a physician. With ever-changing learner turnover, additional multi-tasking during clinical sessions, not to mention the enormous volume of clinical knowledge to impart, the holy grail of clinical teaching must be a method that maintains a balance between patient, preceptor, and learner needs, desires, and expectations. The One Minute Preceptor method, tweaked appropriately case by case, affords us an opportunity to actualize this goal.
As described by Neher, the five microskills are as follows:
- Get a commitment (about one aspect of the case)
- Probe for supporting evidence (by asking the learner to explain his/her reasoning)
- Reinforce what was done well (by specifically indicated areas of competence)
- Give guidance about errors and omissions (again, using specifics)
- Teach a general principle (for which the learner could apply to another case)
Perhaps the most helpful thing about this method is that it keeps the learner's attention focused upon one area (ie, find the teaching pearl), helps the preceptor not delve too deeply into what could be dozens of clinical teaching points (ie, teach the teaching pearl), and provides reinforcement of past and future learning (ie, remember the teaching pearl).
While every case presentation could use different aspects of the method, and every learner benefiting from different aspects therein, preceptors who are able to incorporate this practice into their teaching may well be rewarded with more satisfied learners and increased enjoyment in teaching skills, abetting the next generation of family physicians to more effectively and efficiently teach.
1. Neher JO, Gordon KC, Meyer B, Stevens N. A five step microskills model of clinical teaching. J Am Board Fam Pract 1992;5:419-24.