1. Medical Precepting Strategies – Lora Cotton, DO
Fast, Fun and rewarding!!!!
Medical Precepting Strategies – Lora Cotton, DO

2. Objectives List benefits of precepting medical learners
Describe commonly perceived barriers
Explore strategies to overcome barriers
Review strategies to increase efficiency
Review strategies for effective teaching
Provide contacts on how to get involved

3. Benefits of Precepting (Warm-fuzzies)
Increased enjoyment of work
Giving back to the profession
Less sense of isolation
Satisfaction of being a role model
Teaching improves your own skill

4. Benefits of Precepting (practical)
CME credit – 160 1B CME for every 4-week rotation
Potential opportunity for Medicaid Enhanced Reimbursement
Access to all OSU-COM medical library resources and services
Access to CME events

5. Perceived Barriers
Patients won’t accept learners
Lack of teaching experience
Productivity will decrease if I teach
Not enough time to teach if I maintain productivity

6. Perceived Barriers – some answers
Patients won’t accept learners
Most patients will accept a learner
Ask permission first
Define and respect stated limits of learner’s involvement
Lack of teaching experience
Experience comes from doing
Reflect on your best (and worst) teachers
Start with a clear plan and a few basic strategies

7. Perceived barriers Productivity will decrease Not enough time to teach
True with traditional precepting model
Not true with other teaching methods
More efficient
More effective
More fun for learner and preceptor

8. Strategy 1 make a plan and orient the learner
Dates, times, planned absences
Dress code
When should learner speak when both of you are in the patient’s presence?
Clear point of contact – you or specified office staff

9. Strategy 2 agree on mutual expectations
Agree that feedback will be given
Ask: How do you prefer to get feedback?
Agree to be accountable for answering learning issues
Remember to review assigned learning issues
Model life long learning – assign yourself learning issues and report back to learner

10. Strategy 3 Set Learning Goals
Ask learner to identify 3 learning goals for the rotation
Set 2-3 learning mini-goals for each learning session
Discuss and agree on mini-goals at beginning of each learning session (1-3 minutes)
You can’t teach everything, so focus
Simple, clear, identifiable:
Run and read 4 EKGs
Have 2 knee exams observed and critiqued
Interpret 4 sets of diabetes care labs

11. Strategy 4 Plan for efficiency
Limit number of patients learner sees
They shouldn’t see every patient with you
No more than 3-6 cases/half-day
Consider some double booking
You see one or two patients while learner sees one patient

12. Strategy 4 Plan for efficiency
Encourage just-in-time learning
Learner steps aside to find the answer immediately
One does, one scribes
Set time limits
Presentations minutes
“You have 10 minutes to collect the HPI and do a physical exam, then come out and tell me what you found.”

13. Strategy 4 Plan for efficiency
Pre-Identify good teaching cases
Patients with interesting medical histories often like to tell their stories to students
Debrief and plan for the next day
Provide important feedback not already given
Clarify learning issues for homework

14. Strategy 5 Vary teaching Method
Day 1 – learner observes preceptor
Day 2 – Learner does portions of visit while observed by preceptor
Day 3 and beyond……..

15. Strategy 5 Vary teaching methods
Learner does HPI independently, then reports
Learner observes HPI and exam, then steps out to develop Assessment and Plan – compare plans later
Always “Think Out Loud” and encourage learner to do so also
They can hear how you describe things and how you reason
You can hear how they describe things and how they reason

16. Strategy 5 Vary teaching Method
One Minute Preceptor
Teaching with patients
Service learning opportunities

17. One minute Preceptor Five micro-skills of clinical teaching
Get a commitment
Probe for supportive evidence
Teach general rules
Reinforce what was done right
Correct mistakes
Don’t have to apply all 5 in the same case
Learner “what do I do now?” Teacher “What do you think is going on?” “What do you think we should do next?” “What choice would you make at this point?”
Evidence – . Even if they are RIGHT. Guessing or really reasoning it out, or really based on true knowledge. Knowledge base, clinical reasoning skills. “What factors did you consider in making your decision?” “What are other options you considered but then discarded?”
Teach general rules: Teach something that applies to the case at hand but that can be carried forward to other cases more generally – “ACE-I decrease mortality and prolong life in pts with dilated cardiomyopathy” NOT “that pt needs an ACE-I” Limit teaching dose in each case – can’t assimilate all that there is every case.
If commitment was a guess and supporting evidence was weak – assign just in time learning or homework

18. One minute Preceptor Five micro-skills of clinical teaching
Get a commitment
Probe for supportive evidence
Teach general rules
Reinforce what was done right
Correct mistakes
Don’t have to apply all 5 in the same case
Ask learner to self assess – what part did you do well? What part do you think you could improve upon? Opens the conversation is a less intimidating way.
Early observations of things done well often decreases learners performance anxiety – makes them more open to correction “your interview style puts patients at ease”
Corrections – well timed (no surprises at end of rotation or on eval), expected (set pattern early), case specific, behavior focused, descriptive (not evaluative) “You palpated all 4 quadrants of the abdomen lightly and deeply, but you forgot to auscultate first. I’ll have you show me the abdominal exam again on the next patient.”

19. Teaching with patients
Identify a collection of teaching patients
Classic physical findings
Unique histories
Some can provide informal feedback
Teach in the patient’s presence
Teaching learner informs the patient
Have learner present in front of patient – when appropriate

20. Service Learning Help with lab/study call backs
Call pharmacy to clarify medication list
Assist staff in rooming, vitals, entering histories into record
Start IV’s, do EKG, place Foley’s,
Shadow a patient
Have students learn to teach patients
Inhaler use, injection use, glucometer, post- procedure care, contraception choices

21. Last words
Create a positive learning environment
Recognize things done right, coach for improvement
Case specific and skill focused, not learner focused
Small doses of teaching with time for synthesis
Model lifelong learning skills

22. Want more information on how to precept OSU-COM Medical students?
education/clinical/clerkship.php

23. Want more information on precepting OSU Residents?
Contact the Program Director for the training program of interest: nstitutions/osumc.php

24. Resources
Biagioli, F. (2008) I Don’t Have Time for Students” Showing Preceptors How to be More Efficient with Students [PowerPoint slides]. Retrieved from Bordley, D.R. Teaching Clinical Reasoning “On the Fly” Part 1 [PowerPoint slides]. Retrieved from Heaton, C.J. (2009) Patient Witnessed Precepting: Faster Precepting That is Effective and Fun. Retrieved from Dobbie, A.E., Tysinger, J.W., Freeman, J. (2005) Strategies for Efficient Office Precepting . Retrieved from Neher, J.O., Stevens, N.G. (2003) The One Minute Preceptor: Shaping the Teaching Conversation. Retrieved from