Effectiveness of the One-Minute Preceptor Model for Diagnosing the Patient and the Learner: Proof of Concept, Eva Aagaard, MD, Arianne Teherani, PhD and David M. Irby, PhD Academic Medicine (2004) 79: 42-49.Reviewed by Barry Evans, MD
Effectiveness of the One-Minute Preceptor Model for Diagnosing the Patient and the Learner: Proof of Concept, Eva Aagaard, MD, Arianne Teherani, PhD and David M. Irby, PhD
Academic Medicine (2004) 79: 42-49.Reviewed by Barry Evans, MD
Aagaard et al from the San Francisco Medical School provide some needed insight into two of the more common teaching methods used for students in their ambulatory rotations - the "traditional" and the "One Minute Preceptor Model (OMP)". The major hypothesis being that the OMP model, a model more in line with modern day adult teaching principals would prove to be the better modality.
The two models were used in two tightly scripted cases to create four videotapes wherein the same preceptor, student, and standardized patient performed the encounters. 116 faculty members from multiple faculty development programs were asked to rate the student's skills in history taking/physical examination, presentation, clinical reasoning, and fund of knowledge; to rate their own confidence in rating these items; and to finally rate the quality of the interaction. The participants were also asked to identify the two most likely diagnoses and two teaching points the student might have benefited from.
The faculty performed better on all measured tasks and rated the overall performance of the patient encounter much higher when the OMP model was used. The time to use either method of teaching was exactly the same.
In contrast to the traditional method whereby a case is presented by the student, questions from the preceptor follow about patient related data, and finally the interaction is completed by a discussion on patient management; the OMP model requires a commitment from the learner about what he/she thinks is going on, thus focusing the experience. The learner is then asked to support their conclusion and to consider other options. Using this information the faculty than can assess what the learner actually understands, what they need to add to the student's learning experience, and then provide the most needed feedback.
The authors feel the rigorousness of their experimental design support their conclusions despite the lack of direct observations of student/patient interaction and randomization. An unwarranted conclusion, though, of the study was that the OMP model may be an effective method of managing patient care. There is no support or focus of this anywhere in the study.
(Comment: The results of this nicely-done study are compelling: in the same amount of time, preceptors can diagnose patients as well or better and more effectively assess student abilities, particularly students' clinical reasoning skills. The study itself is a very good model for educational studies. To me, the key feature in the OMP model is to actually stop, take a breath and ask the learner: "What do you think is going on? Why?" Jon Fliegel)
(This study actually takes on the issue of how teaching style could impact on patient outcomes. The diagnostic accuracy was similar, if not better, for the faculty who used the one-minute preceptor model. They assert that more open-ended questions of the learner might support better diagnostic accuracy.
A) Do you use the one-minute preceptor model?
B) Do you believe that the style of teaching you use could impact patient care outcomes?
C) Do you believe that the traditional model of precepting (case presented, case discussed all outside the room) is best for patient care?
D) Do you use bedside presentations when precepting students?