The One-Minute Preceptor Technique

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.

References:

1. Bazuin CH, Yonke AM. Improvement of teaching skills in a critical setting. J Med Educ. 1978; 53:377-82.
2. 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.
3. The University of Colorado, School of Medicine. Clinical teaching tips- the one-minute preceptor. (Accessed 2016 Apr 9)
4. 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.
5. 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.
6. 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.
7. Kertis, M. The one-minute preceptor: a five-step tool to improve clinical teaching skills. J Nurses Staff Dev. 2007; 23: 238-42.
8. 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.

The Impact of Culture on Student-Teacher Relationships

by Maureen Muthoni, PharmD, PGY1, Sibley Memorial Hospital-Johns Hopkins Medicine

I remember my first day of school in the United States — January 7^th 2002. As I walked to the front of the class, I immediately noticed that I was one of only four students in the entire class wearing what the school’s dress code policy stated should be worn. Mrs. Walker greeted me and then introduced me to the class. I took my seat. I found it odd that students were talking to each other while the teacher was speaking. Moreover, the teacher was very welcoming during class and she even encouraged discussion and participation. I did not voluntarily participate that day, or week, or month.  But I was not the only one who did not feel comfortable engaging in conversations with the teacher.

Students spend many hours in school and most of that time with a teacher present. The relationships between students and teachers are crucial to the learning and development processes.¹ Positive student-teacher relationships improve academic performance, enhance self-esteem, inspire success, promote self-awareness, and create warm classroom environments.^1,2,3 But it is important to recognize that student-teacher relationships vary based on culture.  What might be considered a “good” student-teacher relationship is different.

Until the 6^th grade, I went to school in Kenya. My relationships with my teachers could be best characterized as me listening and them doing the talking. I only spoke after raising my hand in class and never really spoke to my teachers outside classroom times. If a teacher wanted to meet with a student after class, it was nearly always for disciplinary reasons.

In the Japanese culture, most teachers direct what students should do without student input. Classes tend to be very quiet and students address the teachers in a very formal way.⁴  Traditionally, in China, student teacher relationships are viewed as being similar to a parent and child. The teacher teaches the student about important virtues and morals, and bestows his/her wisdom.⁵ Students are expected to be very obedient and respectful to the teacher. And to value the teacher’s knowledge and principles.⁵ Although the formality of the relationship between teacher and student has decreased a little in recent years, Chinese students still hold full obedience towards their teachers and are very disciplined.⁵

A study done comparing student teacher relationships between Turkey and the United States showed that Turkish teachers reported more closeness with their students. In Turkey, students keep the same teachers throughout preschool and primary school, allowing for a close bond to form.² All over the world, one might find that student-teacher relationships are different.  But there are some similarities.

Many people refer to the United States as a melting pot. It is a place where many cultures mix.² It is important for students and educators to be aware that different cultures have different understandings of what appropriate student-teacher relationships are and different expectations may exist in one classroom.¹ For example, some students might feel very comfortable with speaking up in class and asking the teacher questions. Other students prefer to do their own research and will only ask a question as a last resort. Some students might make eye contact with the teacher while others will avoid eye contact at all times.³ Some students might eat and drink in class while others do not. In high school or college, it is common for teachers to give their telephone numbers to students and encourage them to contact when not in school. While some students might appreciate this, other students might perceive this as overstepping boundaries. When a teacher gave her mobile phone number to the class, I thought it was odd. So did my friends.

The great thing about this country is how rich it is in diversity. While this may be challenging for teachers and students coming from different cultures for the first time to get accustomed to, it is a great opportunity to learn from and teach others about your culture.^1,3  A great way for teachers, professors, and preceptors to help overcome difficulties faced due to cultural boundaries might include activities where students share information about their cultural backgrounds. This might help the students see different perspectives, create a friendlier classroom environment, help the teacher recognize ways he/she can connect with the students, and help the students realize they are not alone when it comes to cultural differences. In my sixth grade class, we had a class project where we presented on where we thought the Olympics should be held next and why that country/state was a great choice. Students could showcase their country of origin if they wanted or choose to speak about another country. This activity taught my classmates and teacher many wonderful things about different cultures all over the world.

As I look back now to my first day of school, I am grateful. Although it felt odd at first to be so close to a teacher, it is the relationship that I built with her that truly helped me through middle school. She helped me through a lot and made me feel truly welcomed. I cannot say that there is a culture that has the best student-teacher relationship, but I do believe that a healthy student-teacher relationship positively impacts learning outcomes.

A student summarizes the importance of a great student-teacher relationship this way:

“The key to being a good teacher is to know the kids. You have to know every single one and have a relationship with every single one. I think that one thing that really allows me to work hard is knowing that my teacher knows where I am in life at that moment. If they don’t know me, I will tend not to work as hard for them.”³

References

1. Rimm-Kaufman S, Sandilos L. Improving students' relationships with teachers to provide essential supports for learning [Internet]. American Psychological Association. 2011 [cited 2016 Mar 30]
2. Beyazkurk D, Kesner J. Teacher-child relationships in Turkish and United States schools: A cross-cultural study. International Education Journal 2005;6(5):547-554.
3. Knoell C. The role of the student-teacher relationship in the lives of fifth graders: A mixed methods analysis. Doctoral thesis, University of Nebraska, 2012. [cited 2016 Mar 30]
4. Takeya K. Culture Shock: Schools in the U.S. and Japan. KALEIDOSCOPE [Internet] 2000 [cited 2016 Mar 30]
5. Zhang X. Parent-Child and Teacher-Child Relationships in Chinese Preschoolers: The Moderating Role of Preschool Experiences and the Mediating Role of Social Competence. Early Childhood Research Quarterly 2011; 26(2):192-204.

Office Hours: A Hidden Learning Experience

by Meryam Gharbi, Doctor of Pharmacy Candidate 2018, University of Maryland School of Pharmacy

Picture from: https://pixabay.com/

It’s 4:00pm. You had clinic for 6 hours this morning and taught a 2-hour class in the afternoon. As you relax into your office chair, you grab your second cup of coffee and take a gulp as you check your calendar for the day. You see “meeting with Jill” scheduled for 4:15pm. You take a deep breath and eye the clock. You open Jill’s email that she sent the other day:

“Hi Professor, I would like your advice about how to deal with some issues in pharmacy school. I hope we can meet soon! Thank you! Jill”

Exhausted, you close the ambiguous email and wait for your student to enter your office.

Whether it is something you enjoy or not, if you are an educator, it is inevitable that one of your students will request a one-on-one appointment with you. The truth is, students run into road blocks from time to time, and naturally, you are the one they trust to help solve problems.¹ Students initiate office hour visits for many reasons including to ask questions about course content, make up an assignment, seek advice, or simply to socialize.  Regardless of the reason, there are hidden learning opportunities in an office hour meeting – not just for the student, but also for the educator! 

Office hour visits can help enhancing problem-solving skills. Many times, students are entering your office because they need help solving a problem. Using your expertise and experience, you teach learners how to go about looking at a problem from a different perspective. The office provides a quiet and calm setting to slowly evaluate the problem and bounce ideas off of one another to solve it. Sometimes the problems students present can be quite unexpected and may challenge you as an educator to think outside of the box. Indeed, both the student and the educator learn from one another and enhance their problem-solving skills. The student can use what he/she has learned from the educator to apply to future situations, and the educator can use the experience to advise other students who may face similar issues.²

Jill frantically enters your office. “I am failing your class, Professor! I have studied for hours, I went to tutoring and I keep failing the tests.”

You think deeply. “Okay, Jill. Let’s think about why this is happening and ways to improve your performance.”

With that, you write down Jill’s troubles with learning the material and offer new ways she can study. As you consider Jill’s problem, you consider how to apply this to other students who may be struggling in your course.  You consider new strategies that might help all students.

Office hour appointments encourage metacognition. Metacognition is the process of thinking about what you are thinking. Talking over students’ problems related to academic performance or problems faced in their personal life should prompt them (and you) to think about thinking and evaluate how best to approach situations. By developing an awareness of their own thoughts, students become more successful during assessments and problem solving in real life situations. Having this conversation also encourages you as the educator to think about your own thinking. Understanding your own thoughts allows you to communicate your advice effectively and clearly to your students.³  Problem solving and metacognition go hand in hand. Without understanding how you think, it will be significantly more difficult to solve a problem.

“Have you thought about the way you study, Jill?”

Deep in thought, Jill analyzes the way she studies. “I guess I’m more of a visual learner. I understand things better when I read. However, I’ve been spending a lot of time listening to the recordings of your lectures. That’s what my classmates are doing and it seems to work for them.”

Office hours are an opportunity for students to Learn from Feedback. Office hours give you the opportunity to give personal feedback to your students that they can use to improve their performance in the future. But feedback during office hours is a two-way street. As an educator, you are learning what motivates your students, what they struggle with, and what they are confident about. It grants you the opportunity to get a glimpse of how well you are teaching your students, which will encourage you to constantly reevaluate yourself and improve.²

You smile at Jill and ask her “Please, be honest with me, is there a better way I can teach you this material?”

Jill smiles back and says, “maybe assigning more reading material could help me learn better.”

You nod, “Will do. You’re doing a great job by coming to me for help early. Come back whenever you are in trouble again, or just to say hello!”

Jill grins and thanks you profusely before stepping out of your office.

Although it can seem a nuisance, especially for a busy educator, office hours can be a rewarding experience! It not only allows you to get to know your students, but it also gives you the chance to teach them and learn from them too! Despite the potential benefits of meeting students one-on-one, a study found that only 76% of faculty actually keep their stated office hours.⁴

So next time a “Jill” visits your office, have an open mind and be ready to not only teach, but learn!

References

1. Barry, E. Using office hours effectively [Internet]. APS Observer. 2008; 21(6): 37-40.
2. Acitelli LK. Learning and teaching during office hours [Internet]. Ann Arbor, MI.: Center for Research on Learning and Teaching, University of Michigan at Ann Arbor; 2000. [cited 2016 Apr 12].
3. Tanner KD. Promoting Student Metacognition. Cell Biology Education. 2012; 11(2): 113-120.
4. Pfund R, Rogan J, Burnham B, Norcross J. Is the Professor In? Faculty Presence during Office Hours. College Student Journal. 2013; 47(3): 524-528.