The One Minute Learner An Innovative Tool to Promote Student-Faculty Discussion of Goals and Expectations Miriam Hoffman-Kleiner, MD Molly Cohen-Osher, MD Joanne Wilkinson, MD, MSc Medical Student Education Division Department of Family Medicine Boston University School of Medicine

Think back to when you were a third-year student… What did you want to know when you started a new rotation? How did you feel when you started? How empowered did you feel? What was hard about it? What was helpful to you?

Why is setting expectations and discussing goals important? For the learner and the teacher!

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 Improves efficiency Puts educator and learner on “the same page” Brainstorm/scratch pad

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 Brainstorm/scratch pad

ONE MINUTE LEARNER Hand out card  One Minute Learner Huddle 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? Hand out card Talk about have 2 ways of presenting it – to faculty and to students Dual presentation – faculty version and student version

One Minute Learner Overview OML Huddle - Prepare beforehand Goals Getting Going How Much and How Long Presenting Charting Questions Ok- now let’s dive in to what the tool is….

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 the rotation and/or Before any clinical session throughout the rotation If you are the primary preceptor You are any preceptor! The OML can be used: In any clinical teaching setting In any discipline With any level of learner

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 Preview the day’s schedule; identify appropriate patients Have the faculty: Preview patients for the clinical session with the student’s learning needs/goals in mind. Think about areas the student needs to work on; focus your goals there All BUSM FM clerkship students have: Completed a self-assessment Developed 3 personal learning goals

1. Goals 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?”  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. 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.” Dual presentation –student version then faculty version Miriam present how we talk about it to faculty Molly present how we talk to students Have the student think about their goals What are their goals for the entire rotation, and where they are in that trajectory? What are their goals for this particular sessions? Ask the student to think about HOW they will achieve these goals.

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? Thumbs!

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 should the student present to you? What presentation format should be used? How detailed a presentation do you want?

5. Charting 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?

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 Dual presentation – faculty version and student version Give background/hx of how/why we came up with this Hand out one-pager at end of slide

Outcomes Student feedback Mid-clerkship meeting

Outcomes Question Rated 4-5 2011-2012 2012-2013 (5 blocks) p value (5 point Likert scale) 2011-2012 2012-2013 (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% <.0001 Our faculty also noted a large decrease in student complaints about their goals and expectations being misaligned with their preceptors’.

*Remember: You can use some or all of the components of the OML! One Minute Learner OML Huddle - Prepare beforehand Goals Getting Going How Much and How Long Presenting Charting Questions *Remember: You can use some or all of the components of the OML!

Case Debrief What went well? What could have been better? What parts of the OML were used? What other parts could have been used? How? What did you get out of this conversation that you wouldn’t have if you had not used the OML? What effect would that have on the clinical session? Imagine you used the OML having already worked with the student for 5 sessions – how would the conversation be different?