Bedside teaching: It only takes a minute

Last week was my annual opportunity to work with our 4th year medical students on the concept of the “One-minute Preceptor” in order to prepare them for their required Students as Teachers activity.  Although the One-minute Preceptor came from the family medicine literature, it is equally valuable in other specialties (including surgery!).  As initially described, the One-minute Preceptor method of teaching is executed using the following five “microskills” of teaching:

  1. Get a commitment– Ask your learner what they think or what they want to do (open-ended questions please!).  A way to raise the bar here is to ask them how confident they are  in their response as a percentage, then ask how they could be 100% confident.  Thanks to Deb DaRosa for this great tip!  (Example:  “Bob, what do you think is the cause of Mrs. Brown’s abdominal pain?”
  2. Probe for supporting evidence– Ask your learner why they responded as they did.  This is especially important for evaluating their clinical reasoning and critical thinking skills. (Example:  “Michele, why do you suspect that Mrs. Brown has pancreatitis?”)
  3. Teach general rules-  If you’re really trying to do a One-minute Preceptor intervention,  you probably don’t have time to delve into all of the literature on a topic. This is something quick, something that is relevant to the case that the learner can latch on to as a take-home message.  (Example:  “The two most common causes of pancreatitis are gallstones and alcohol.  Mrs. Brown’s description of recent biliary colic that has not been managed formally evaluated would make me suspect that she has gallstone pancreatitis.”)  The use of a general rule for teaching a broader principle provides a great jumping-off point for the learner to do some guided reading that can be discussed at a later time.  (Example: “Ed, please read up on Ranson’s criteria for tomorrow and we’ll have you lead a discussion on rounds.”)
  4. Reinforce what was done well, and
  5. Correct mistakes-  4 and 5 can travel together, providing an opportunity for feedback.  Remember that these two items need to be very specific (I beg you, do not just say, “Good job, buddy!”) and should be given on a short time frame from the discussion.  It can also be helpful to ask the learner what they felt went well and what they would do differently; remember that as they progress through their medical career that they will ultimately have to become self-directed learners who identify their own learning gaps.  (Example: “Helen, your description of the patient’s abdominal pain was included most key points with your discussion of provocative and palliative factors, the quality of the pain, the severity and timing of the pain.  For this patient with your concern about pancreatitis, it would be helpful to know if there were any radiation of the pain, particularly if she describes a boring pain between her shoulder blades.  That will be an important question to include when we go see her together.”)

If want an alternative approach to using the five teaching microskills, there are also five terrific open-ended questions that you can ask as a teacher:

  1. What do you think?
  2. Why do you think that?
  3. How do you know this?
  4. Can you tell me more?
  5. What questions do you still have?

Clearly these questions can tie back into many of the ideas behind the One-minute Preceptor so they provide a nice alternative approach.  However, one VERY important general principle for you as a clinical teacher, regardless of the approach you choose?

Give your learners enough time to formulate an answer.  Particularly if you are a surgeon, wait about twice as long as you are inclined to wait- we tend to expect answers very quickly, which is appropriate in an urgent situation but doesn’t serve us well when we’re trying to foster clinically thoughtful learners and assess their reasoning skills.  Learn to lob the question out there…then wait.