by Ahmed Eid, Pharm.D., PGY1 Pharmacy Practice Resident, Frederick Memorial Hospital
As residents muddle their way through postgraduate training, they have countless learning opportunities and witness different approaches to precepting. Residents typically spend far more time grappling with the new information to be learned rather than analyzing the strategy used to teach it. This creates a challenge for them when they transition from learners to preceptors. Evidence shows that untrained medical educators often utilize inefficient and unimaginative ways of teaching.1
Participating in a teaching certificate program can help residents develop their precepting skills including the examination of effective techniques to maximize learning. One of the most commonly used teaching strategies in the experiential learning environment is the five-step microskills model of clinical teaching - also known as the one-minute preceptor (OMP) technique. This teaching method focuses not on teaching learners new information, but provoking critical thinking. The method is intended to promote efficient preceptor-learner interactions. The teaching model consists of five steps: 1) get a commitment, 2) probe for supporting evidence, 3) teach general rules, 4) reinforce what was done right, and 5) correct mistakes.2
The initial step is making a commitment. This step often takes place before the preceptor-learner interaction happens. Through this step the learner assumes the responsibility for making decisions. By forcing a commitment, this helps the learner learn to gather and process information in order to develop a tentative therapeutic plan. It is crucial to create a safe environment where learners can present their thoughts without judgment and to encourage them to keep the commitment. During this step the preceptor begins to identify areas of weakness and potential teaching opportunities. A common mistake preceptors make during this step is to provide answers to questions learners pose. Instead, the preceptor should ask questions such as “why do you think this is happening?”, “what additional information do you need to make a decision?”, or “how do you prioritize the patient’s problems?” Such questions will not provide answers to learners, but will help them develop their problem-solving skills and keeps the learners engaged.3
Probing for supportive evidence follows. During the second step the preceptor helps the learner reflect on their decisions and their prior knowledge. This yields an easy transition into the third step — teaching general rules. This is the first time the preceptor starts “teaching” by pointing out knowledge gaps and connections the learner may have missed during the first two steps. The brevity of this model dictates teaching general and succinct information focused on specific facts rather than abstract concepts.
The final two steps of this learning model focus on providing feedback to learners to reinforce appropriate practices and correct mistakes. Positive feedback is not only important for rewarding competency, but also for encouraging the learner to maintain and grow best practices. Furthermore, reinforcing well-reasoned decisions helps learners develop their self-esteem. It is also appropriate to provide feedback by asking learners to reflect on their performance rather than directly giving feedback, which creates an opportunity to identify areas of improvement in a fashion that is easier for learners to accept and allow the learners to develop their self-evaluation skills.
The model places "correcting mistakes" as the final step because there is a natural tendency for preceptors to point out errors first. If done excessively, criticisms, even when they are constructive and delivered skillfully, can deter learners from making decisions in the future. Thus learners begin to avoid making a commitment to a decision in order to evade criticism. To circumvent this negative outcome, some suggest a “sandwich” technique where positive feedback is offered about what was done correctly followed by exploring areas for improvement then closing with a recap of the overall performance with an emphasis on the positive aspects of the performance.
The interaction need not be limited to one minute. The duration of the encounter should vary based on the needs of the learner and the complexity of the case. In nursing, a five-minute preceptor technique is often used. The two techniques share similar steps but the five-minute technique fits the needs to students in a nursing environment.4 The preceptor should be flexible – a dogmatic adherence to “one” minute isn’t the intent.
The one-minute precepting (OMP) technique was first described in the 1990’s and multiple studies have evaluated its effectiveness in improving teaching behaviors. A randomized controlled trial enrolled 57 second and third-year medical residents. The study compared the teaching behaviors of residents who received OMP training to those who did not. The study showed statistically significant improvements in almost all teaching skills except “teaching general rules.”5 A survey of faculty preceptors found that, after OMP training, they believed learning encounters were more successful and they were better about letting learners reach their own conclusions.6 Similarly, a study conducted with nurse preceptors found significant improvements in self-perceived clinical teaching skills.7 Finally, after one-minute preceptor training, preceptors performed better in four out of the five microskills compared to preceptors who did not receive the training.8 While the evidence supports improvements in teaching behaviors, there is no proof (yet) that learning is improved. In other words, studies are needed that document improvements in learners’ clinical decision-making skills.
The one-minute preceptor technique is a widely accepted strategy. It is quick, easy to learn, and engages learners in the critical thinking processes they need to develop in order to be successful in practice.
- Bazuin CH, Yonke AM. Improvement of teaching skills in a critical setting. J Med Educ. 1978; 53:377-82.
- Neher JO, Gordon KC, Meyer B, et al. A five-step “microskills” model of clinical teaching. J Am Board Fam Pract. 1992; 5: 419-24.
- The University of Colorado, School of Medicine. Clinical teaching tips- the one-minute preceptor. (Accessed 2016 Apr 9)
- Bott G, Mohide EA, Lawlor Y, et al. A clinical teaching technique for nurse preceptors: the five minute preceptor. J Prof Nurs. 2011; 27: 35-42.
- Furney SL, Orsini AN, Orsetti KE, et al. Teaching the one-minute preceptor. A randomized controlled trial. J Gen Intern Med. 2001; 16: 620-4.
- Salerno SM, O’Malley PG, Pangaro LN, et al. Faculty development seminars based on the one-minute preceptor improve feedback in the ambulatory setting. 2002; 17: 779-87.
- Kertis, M. The one-minute preceptor: a five-step tool to improve clinical teaching skills. J Nurses Staff Dev. 2007; 23: 238-42.
- Eckstrom, E, Homen L, Bowen JL, et al. Measuring outcomes of a one-minute preceptor faculty development workshop. J Gen Intern Med. 2006; 21: 410-4.