Clinical Teaching & Precepting of Students and Staff

Joseph G. Sorbello, MSEd, RT, RRT

Associate Professor and Chair

Department of Respiratory Therapy Education

College of Health Professions

SUNY Upstate Medical University

Syracuse, N.Y.

Focus on Education WorkshopBecause We’re ALL Educators!

Wednesday May 6, 2015

Learning Goals

List the steps of the One-Minute Preceptor Model of clinical teaching

Explain how each step fosters effective & efficient teaching

Demonstrate understanding of the model on a sample scenario

Integrate the One-Minute Preceptor Model into your clinical teaching

Making the Most of Teaching Time

3"

1"

6"

How Time is Spent in the Teaching Encounter

Chart Review / Assessment: 6 Minutes

Questioning & Clarifying: 3 Minutes

Discussion & Actual Teaching: 1 Minute

The “One-Minute Preceptor”:Step Microskills

Get a Commitment Probe for Supporting Evidence Reinforce What Was Done Right Correct Mistakes Teach a General Principle

Step 1: Get a Commitment

Push the learner to move beyond their level of comfort and makes the teaching encounter more active and more personal.

What do you think is going on with this patient? (top 2 diagnoses)

What laboratory tests do you think we should get? How do you think we should treat this patient? What other diagnoses would you consider in this

setting?

For Review The purpose of getting a commitment is to:

A. Gain insight into the learners reasoning. B. Prove the learner wrong. C. See how the learner reacts under pressure.

Step 2: Probe for Supporting Evidence

Hear their thinking. Learn where the gaps are and what might have been missed.

What factors in the history and physical support your diagnosis?

Why would you choose that particular medication? Why do you feel this patient should be intubated? What else did you consider?

For Review It is important to ask for supporting

evidence at this stage because:

A. You can determine if the learner had adequate evidence for the

commitment. B. You need to fish out the lucky guesses. C. You can correct any faulty inferences. D. All of the Above.

Step 3: Reinforce What Was Done Right

Include specific behaviors that demonstrated knowledge, skills, or attitudes valued by the preceptor.

Your diagnosis of ‘probable pneumonia’ was well supported by your assessment.

Your assessment was well organized. You included appropriate additional medical history

and medications, as well as response to therapy.

For Review

Your positive reinforcement need not refer to specifics as the learner should know what was well done.

A. True B. False

Step 4: Guide Errors / Omissions Tell them what areas need improvement,

correct errors & omissions or misperceptions.

In your shift report you mentioned an ABG but did not report vent settings. Following standard patterns in your report will help avoid omissions and improve your communication.

I agree that, at some point, complete PFTs may be helpful, but right now the patient is acutely ill and results may not reflect her baseline. We could glean important info with just a peak flow and a pulse oximeter.

Step 5: Teach a General Principle

Brief teaching specifically focused to the encounter can be very effective.

The key features of this illness are….. The natural progression of this disease is…. Deciding how someone needs to be ventilated for

ARDS can be challenging. Fortunately there are some criteria that have been tested which help….

The “One-Minute Preceptor”:5 + 1 (6) Step Microskills

Get a Commitment Probe for Supporting Evidence Reinforce What Was Done Right Correct Mistakes Teach a General Principle Conclusion

Step 6: Conclusion

Time management Definition of roles of the learner and the

preceptor after the teaching encounter Explain what the next steps will be and what

their role is to facilitate the care of the patient

Roles and expectations for each person are made clear in a way that facilitates further learning & optimal patient care.

Give Learners a Chance! Practice Makes Perfect

-Proverb

Practice is the best of all Teachers -Maxim 469 of Publilius Syrus

Practice does not make perfect. Only perfect practice makes perfect.

-Vince Lombardi

Students need to now if, and when they are getting it right! They need feedback!

Planning Your Own Teaching Strategy

What makes sense in your practice?

The First Meeting

Elicits student’s expectation for the rotation. Describes expectations of student and format for

supervision. Ensures mutual understanding and acceptance of

expectations. Is positive and enthusiastic about the rotation.

References Irby, D., *1997, February). The One-Minute Preceptor.

Presented at the annual Society of Teachers of Family Medicine Predoctoral Meeting, Orlando, FL.

Irby, D. (1997, June). The One-Minute Preceptor: Microskills for Clinical Teaching. Present at a teleconference from East Carolina Univ. School of Medicine, Greenville, NC.

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

What types of questions do you have?

sorbellj@upstate.edu