The One-Minute Learner: An Tool to Promote Student-Faculty Discussion of Goals and Expectations Molly Cohen-Osher, MD; Miriam Hoffman-Kleiner, MD BUSM CCS April 2015

Think back …

Third Year Orientation

Why is Setting Expectations Important? For the learner Clarifies role Gives a sense of structure Decreases anxiety Sets groundwork for feedback and assessment For the educator Helps student to “ hit the ground running” Student is more effective in the office Sets groundwork for feedback and assessment Improves efficiency Puts educator and learner on “the same page”

Why is Setting Learning Goals Important? For the learner Facilitates self-directed learning behavior Improves learner-educator relationship Increased motivation to learn and deeper learning Learner’s needs/goals are valued For the educator Gives a framework for clinical teaching Identifies student’s level and needs Facilitates a learning experience that is “learner-directed” Puts educator and learner on “the same page” Bullock et al., 2007, Chien et al., 2002, Challis, 2000, Jones-Boggs Rye, 2008, Knowles, 1986

We don’t want students or teachers who look like this!

The One Minute Learner Promotes and structures: Proactive discussion of goals and expectations Benefits: Quick and easy! Puts everyone “on the same page” Makes the clinical session more effective and efficient Clarifies roles Gives the student structure and decreases anxiety Facilitates self-directed learning Sets groundwork for feedback and assessment

One Minute Learner Overview OML Huddle - Prepare beforehand 1.Goals 2.Getting Going 3.How Much and How Long 4.Presenting 5.Charting 6.Questions

The One Minute Learner Huddle Have this brief discussion with your student before the session starts Preparation for the huddle: Have the student think about their goals What are their goals for the rotation; where they are in that trajectory? What are their goals for this session? Ask the student to think about HOW they will achieve these goals. Have the student preview the day’s schedule, and identify appropriate patients. Preview your patients for the clinical session with the student’s learning needs/goals in mind. Think about areas that you think the student needs to work on and focus your goals there. Did the learner complete a self-assessment or develop personal learning goals? 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

1. Goals 1.Elicit the student’s current level of training “What year of training are you in?” “What rotations have you completed?” “How long have you been at this practice site?” “Do you have other prior clinical experience?” 2.Ask the student about his/her specific learning goals for the day. Encourage the student to use his/her own self-assessment of clinical skills. 3.Discuss any specific goals you have for the student Think about the student’s learning goals, self assessment, and/or your prior observations. “Today I really want you to focus on developing your assessments and plans and discussing them in your patient presentations.” “I have several well child checks on my schedule this morning, and I know you haven’t had pediatrics yet, so this would be a great opportunity for you to practice your skills in well child care.” 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

2. Getting Going When and how should the student start seeing patients? Should the student see any patient that is available? See (or not see) specific patients? Should the student room patients themselves? Talk with your MA or nurse? 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

3. How Much and How Long How much of the visit should the student do on his/her own? How long should the student spend with each patient? 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

4. Presenting Where should the student present to you? What presentation format should be used? How detailed a presentation do you want? 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

5. Charting What format should the student use for notes? When should the student write notes? 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

6. Questions When is a good time to discuss questions the student has? What is a good resource to use to look up information? 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

The One Minute Learner You can use all or parts of the OML during any given discussion Use the One Minute Learner: At any point in the rotation By any preceptor/supervisor The OML can be used: In any clinical teaching setting In any discipline With any level of learner 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

ONE MINUTE LEARNER Preceptor – Student Card One Minute Learner: For the Preceptor Have this brief discussion with your student before the session starts Have the student prepare for this conversation You and the student can preview the schedule and charts 1. GOALS: Remember to be specific! (1) Student’s current level of training/experience (2) Student’s specific goals Encourage student’s self assessment (3) Your goals for the student Use your observation of their performance 2. GETTING GOING: When, how and who should the student see? Should the student see any patient that is available? See (or not see) specific patients? Should the student room patients themselves? Talk with your MA or nurse? 3. HOW MUCH and HOW LONG How much of the visit should the student do on his/her own? How long should the student spend with each patient? 4. PRESENTING: Where and how? Where should the student present to you? What presentation format should be used? How detailed a presentation do you want? 5. CHARTING: When and how? What format should the student use for notes? When should the student write notes? 6. QUESTIONS: When is a good time to discuss questions the student has? One Minute Learner: For the Student Have this brief discussion with your preceptor before the session starts Prepare by thinking about your learning goals before your huddle with your preceptor Preview the schedule and chart “Can I touch base with you quickly about the plan for this clinical session?” 1. GOALS: Remember to be specific! (1) Preceptor’s and (2) Learner’s (3) Think about your current level/stage “Are there specific patients/diagnoses/skills I should focus on?” “I have been in clinic for 3 weeks, so I am very comfortable with the patient population. I need to work on giving the full plan and patient education directly to the patient.” 2. GETTING GOING: When, how and who should I see? “Should I room patients myself?” “Should I see any patient that is available?” “Should I see (or not see) specific patients?” 3. HOW MUCH and HOW LONG “How much of the visit should I do on my own?” “How long should I spend with the patient?” 4. PRESENTING: Where and how? “Where should I present to you?” “What presentation format should I use?” “How detailed a presentation do you want?” 5. CHARTING: When and how? “What format should I use for my notes?” “When should I write them?”

ONE MINUTE LEARNER Inpatient – Outpatient Card One Minute Learner: For the Outpatient Have this brief discussion with your preceptor before the session starts Prepare by thinking about your learning goals before your huddle with your preceptor Preview the schedule and chart “Can I touch base with you quickly about the plan for this clinical session?” 1. GOALS: Remember to be specific! (1) Preceptor’s and (2) Learner’s (3) Think about your current level/stage “Are there specific patients/diagnoses/skills I should focus on?” “I have been in clinic for 3 weeks, so I am very comfortable with the patient population. I need to work on giving the full plan and patient education directly to the patient.” 2. GETTING GOING: When, how and who should I see? “Should I room patients myself?” “Should I see any patient that is available?” “Should I see (or not see) specific patients?” 3. HOW MUCH and HOW LONG “How much of the visit should I do on my own?” “How long should I spend with the patient?” 4. PRESENTING: Where and how? “Where should I present to you?” “What presentation format should I use?” “How detailed a presentation do you want?” 5. CHARTING: When and how? “What format should I use for my notes?” “When should I write them?” One Minute Learner: Inpatient Have this brief discussion with your attending/resident at the beginning of the block/week or at the start of the day. Prepare by thinking about your learning goals before your huddle with your supervisor Preview patients on the service “Can I touch base with you quickly about the plan for today?” 1. GOALS: Remember to be specific! (1) Supervisor’s and (2) Learner’s (3) Think about your current level/stage “Are there specific patients/diagnoses/skills I should focus on?” “I have been on service for 3 weeks, so I am very comfortable with doing an H&P. I need to work on making a comprehensive A/P.” “I want to learn more about interpreting ABGs.” 2. GETTING GOING: When, how and who should I see? “Which patients should I follow?” “How do I pick up new patients to admit?” “Which resident should I follow?” “What information should I have so that I am prepared for rounds?” “Should I see patients on my own, or with the intern?” 3. HOW MUCH and HOW LONG “How much time do I have for pre-rounding?” How much time do I have with the patient when I am doing an admission?” 4. PRESENTING: Where, when, and how? “Where and when should I present to you?” “What presentation format should I use?” “How detailed a presentation do you want?” 5. CHARTING: When and how? “What format should I use for my notes?” “When should I write them?” “When do they need to be completed?” 6. QUESTIONS: When and what? “When is a good time to ask questions that come up?” “What is a good resource to use to look up information?”

The One Minute Learner: For the Trainee

Created to empower students to have these proactive conversations Give students the language to use depending on their learning environment Get the information students need quickly so students can actually start learning Different language for different settings 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

The One Minute Learner: Inpatient Prepare by thinking about your learning goals in advance Preview patients on the service Have this discussion with your attending or resident: At the beginning of the block or week or At the start of a day “Can I touch base with you quickly about the plan for today?” 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

The One Minute Learner: Outpatient Prepare by thinking about your learning goals before your huddle with your preceptor Preview the schedule and charts Have this discussion with your preceptor: At the beginning of the clerkship or At the start of a clinical session “Can I touch base with you quickly about the plan for this clinical session?” 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

1. Goals 1.Think about your current level of training Prior rotations? How long have you been on this service? Other clinical experience? 2.Think about your specific learning goals for the day Use your self-assessment and clerkship/personal learning objectives 3.Ask for your supervisor’s specific goals for you “I have been on service for 3 weeks, so I am comfortable doing H&Ps, I need to work on making a full A/P.” “I need to work on interpreting ABGs.” “Are there specific patients I should see today?” “I want to get better doing a full pelvic exam.” 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

2. Getting Going When, how, and who should you see? “Which patients should I follow?” “How do I pick up new patients to admit?” “Which resident should I follow?” “What information should I have so that I am prepared for rounds?” “Should I room patients myself?” “Should I see any patient that is available?” “Should I see (or not see) specific patients?” 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

3. How Much and How Long “How much time do I have for pre-rounding?” “How much time do I have with the patient when I am doing an admission?” “How much of the visit should I do on my own?” “How long should I spend with the patient?” 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

4. Presenting “Where and when should I present to you?” “What presentation format should I use?” “How detailed a presentation do you want?” “Will my presentation at attending rounds be different than tonight when I present to the admitting resident?” 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

5. Charting “What format should I use for my notes?” “When should I write them?” “By when do they need to be completed?” 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

6. Questions “When is a good time to ask questions that come up?” “What is a good resource to use to look up information?” 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

The One Minute Learner You can use all or parts of the OML during any given discussion Use the One Minute Learner (OML): At the beginning of a clerkship/block/week and/or Before any clinical session throughout the rotation With your: Attending Preceptor Resident Intern Any supervisor! 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

The One Minute Learner Benefits: Quick and easy! Puts everyone “on the same page” Makes the clinical teaching session more effective and efficient Clarifies roles Gives the student structure and decreases anxiety Facilitates self-directed learning Sets groundwork for feedback and assessment 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

The One Minute Learner Promotes and structures a proactive discussion of goals and expectations Can be initiated by student or teacher Empowers students; gives them actual language Is a powerful faculty development tool 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

Outcomes QuestionRated 4-5 (5 point Likert scale) Rated 4-5 (5 point Likert scale) (5 blocks) p value Expectations of my role were communicated to me clearly 66.27%89.19%.0014 I was oriented to my responsibilities and role 46.67%87.63%< GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

Now let’s practice

Role Play Which parts of the One Minute Learner were used? Goals (students’; preceptors’)yes/no:_______________ Getting goingyes/no:_______________ How much and how longyes/no: ______________ Presenting yes/no:______________ Chartingyes/no: ______________ Questionsyes/no: ______________ What did the student and preceptor get out of this conversation that they wouldn’t have if they had not used the One minute Learner? What effect would that have on the clinical session? 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

Case Debrief 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS

Implementation 1.Add OML to clerkship orientations 2.Handing out cards – during block 1 orientation (extras available) 3.Add OML to Blackboard (pocket cards, one pagers) 4.Faculty development 1.GOALS 2.GETTING GOING 3.HOW MUCH and HOW LONG 4.PRESENTING 5.CHARTING 6.QUESTIONS