“One Minute Preceptor” Model (OMP) Dr. Jatin G. Bhatt Professor & head Dept. of surgery Pdumc, rajkot Preceptor= Teaching at College/University “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

“Education’s purpose is to replace an empty mind with an open …….” Good Afternoon “Education’s purpose is to replace an empty mind with an open …….” -Malcolm Forbes “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Short Role Play Current Scenario in OPD, Office, Wards, Labs, etc……. Surgical Resident informs consultant regarding pt seen in OPD “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Challenges and problems in clinical teaching? Student Teacher Patient Infrastructure/Management “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Challenges and problems in clinical teaching? Time pressures  Competing demands  Clinical Patient Care Vs Teaching  Administrative  Research  Often opportunistic makes planning more difficult  Increasing numbers of students “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Challenges and problems in clinical teaching? Fewer patients shorter hospital stays patients too ill or frail more patients refusing consent Often under resourced Clinical environment not “teaching friendly” Rewards and recognition for teachers poor “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Challenges and problems in clinical teaching? Lack of clear objectives and expectations Focus on recall not problem solving skills, attitudes Passive observation, no active participation Teaching pitched at wrong level “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Challenges and problems in clinical teaching? Inadequate supervision and provision of feedback Little opportunity for reflection and discussion Teaching by humiliation (embarrassment) Informed consent not sought from patients Lack of respect for privacy and dignity of patients Lack of congruence/continuity with rest of ?????????? “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Student@ books and pt “To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all” Sir William Osler 1849-1919, Prof. of Medicine, Oxford, England. “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

OMP Model Neher and colleagues (1992) Five Step Micro skills Get a commitment Probe Supporting evidence Teach General Rules Reinforce what was done right Correct mistakes Ambulatory teaching encounters Any Setting: Office, OPD, A&E, Wards, Indoor, Rounds, OT, Laboratory “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

OMP: Five Micro skills 1. Get a commitment 2. Probe for supporting evidence 3. Teach general rules 4. Reinforce what was done right 5. Correct errors With time constraint Feedback Encouragement “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Role Play A resident in Surgery presents a case to consultant while he is consulting in outpatient clinic OMP: Ambulatory Teaching Encounters “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

1. Get a commitment “What do you think is going on?” Diagnosis "What other information do you feel is needed?“ Investigations "What would you like to accomplish in this visit?“ Fu "Why do you think this patient has been noncompliant?“ ???? Open ended questions “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

2. Probe for supporting evidence "Why do you think this?“ Prove Diagnosis…. "What were the major findings that led to your conclusion?" "What else did you consider? What kept you from that choice?“ D/D "What questions are arising in your mind?“ How will you Mx? Any Doubts!!!!!!!! Direct Questions: Knowledge & Clinical Reasoning “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

3. Teach general rules Investigations for 20 D/D: Antibioma, Traumatic fat Necrosis H/o Rapid increase in Size in short time Example: "If the patient only has cellulitis, incision and drainage is not possible. You have to wait until the area becomes fluctuant to drain it." “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

4. Reinforce what was done right Correct Diagnosis, FNAC, Surgery Example: “Obviously you considered the patient’s finances in your selection of a drug. Your sensitivity to this will certainly contribute to improving his compliance. Well done.“ Encourage “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

5. Correct errors Feedback Stage: IIIA & IIIB Explain: Prognosis and Surgery Example: "You may be right that this child’s symptoms are probably due to a viral upper respiratory infection. But you can’t be sure it isn’t otitis media unless you’ve properly examined the ears.“ Feedback “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Summary First two micro-skills diagnose learner knowledge and reasoning Get a commitment Probe Supporting evidence Last three micro-skills offer tailored instruction Teach General Rules Reinforce what was done right Correct mistakes Let Learner Speak For Teacher be specific “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

OMP: Reference First three Micro skills: 40-60% encounters 4th (Reinforce done right) & 5th (Correct mistakes) in 12.8% and 18.6% encounters William Huang, Dept. of Family and Comm. Medicine, March, 2006. “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

OMP: References Neher JO, Gordon KA, Meyer B, Stevens N. A five step “microskills” model of clinical teaching. JABFP, 5:41924, 1992. Aagaard and colleagues (2004) show in a study that five-step micro-skills encounters more effective than the traditional precepting encounters. “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Limitations If OMP used as a only teaching technique because of its simplicity may reduce richness of clinical teaching. Learners psychological reaction to encounter Poor data “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Conclusion Simple & Practical Easy to use: OPD, A & E, Indoor, Rounds Well accepted Efficient & effective Dose not prolong teaching process Preceptor feel more confident in pt diagnosis & learners evaluation Feedback more specific Motivate learner Learning Outside reading “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Summary Distinguished clinical teachers listen to case presentations during teaching rounds, they first diagnose patient’s problem, then assess learner’s needs, and finally provide targeted instruction to learner’s point of need “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Life Vs Education “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017

Thanks “One Minute Preceptor” Model Dr. Jatin Bhatt 28-04-2017