MODULE ONE: A Coaching Tool

OVERVIEW: Preceptor Education >> Module One >> A Coaching Tool

Most clinical teaching takes place in the context of a busy clinical activity where time is at a premium (and it doesn’t get any busier than a plaster room clinic during Winterlude!).

There is a coaching tool that was designed for this environment and it is called “The One Minute Preceptor”. The structure of this tool encourages students to think critically about the case and gives insight into clinical reasoning skills (rationales). It enables healthcare members to assess, instruct, and give effective feedback efficiently to the clinical student and is ideal when educators/preceptors know something about a case that the learner needs and wants to know.

The One Minute Preceptor is considered a hybrid case-based teaching model that incorporates and enables the preceptor to ask questions, provide expert consultation and instruction after the student completes the task.

The One Minute Preceptor

It is comprised of 5 microskills (steps):

  1. Get Commitment
  2. Probe for Supporting Evidence
  3. Reinforce What Was Done Right.
  4. Teach General Principles.
  5. Correct Mistakes (errors and omissions)

Get Commitment

The easiest way to get commitment from the student is ask him/her; “How will you manage this patient/case?”

This action enables:

  • Learner involvement and fosters responsibility.
  • The preceptor the opportunity for insight into learner’s knowledge and reasoning.
  • Support and identification of individual learning needs.
  • Collaboration amongst preceptor and student.
  • Student to share in the care of the patient.

Preceptor must resist the urge to give the answer!

Helpful phrases:

  • “How would you like to accomplish with this case?”
  • “What do you think is going on with this patient?”
  • “What other information do you feel is needed?”

Probe for Supporting Evidence

This step explores the student’s thought processes, separated whether it was a lucky guess or a well thought out examination and promotes clinical reasoning.

This action enables the preceptor to:

  • Pursue and establish adequate knowledge from the learner.
  • Verify reasoning (rationale) and eliminate guessing.
  • Investigate evidence that supports the learner’s decision and ask if there were alternative choices.

Stay neutral – don’t agree or disagree.

Helpful phrases:

Generally, “why” type questions are probing type questions.

  • “Why did you select that method?”
  • “Why did you do it in that order?”
  • “What else did you consider? What kept you from that choice?”
  • “What are the key features of this case?”
  • “What questions are arising in your mind?”

Reinforce What Was Done Well

Positive feedback is fundamental to the learner’s progression and will encourage desirable behaviour.

  • Describe specific behaviours, skills, and/or characteristics.

  • Use procedure guidelines for giving feedback.

An example of positive feedback:

  • “When you explained the procedure to the patient you spoke slowly, repeated the information and summarized what you had said. You handled the patient with respect and did not rush.”

Teach General Rules

This step gives the preceptor a moment to correlate a teaching point that can be applied to other situations, making the encounter both memorable and transferable.

  • Identify time limitations
  • Respect learner’s capabilities and target information to the leaner’s level of understanding.
  • Be concise and not about all you know.
  • Focus on a key feature/process/management.

Example phrasing:

  • “When positioning an elderly patient…

Correct Mistakes – Errors and Omissions

Correcting mistakes first will leave the student focussed on the negative and he/she may not listen to all the positives, thereby depleting their confidence. It is best to create a positive moment and strengthen the learner’s capability to receive the correction as constructive feedback. It is important to review the mistake soon after the mistake was made, find an appropriate time and place to discuss the mistake and how to avoid the error in the future. Even an unintentional error has the potential to reoccur.

Methods to best introduce error or omissions to the learner:

  • Be specific, behaviour focused, and positive.
  • State your purpose.
  • Invite the learner to critique his/her performance.
  • Provide/ask for alternatives to correct or avoid for the future.

It is important to implement “I” statements when phrasing your suggested corrective measures. This contributes to effective communication and effective conflict resolution. Utilizing I-statements allow acceptance/ownership of the experience and acknowledgement that your statement may not be shared by others. I-statements also allow the possibility for exploration, creativity and can change the response of the situation. These statements do not alienate others, nor introduce an interpersonal conflict to, perhaps, a difficult situation.

Phrases to use:

  • “In this situation I think it would be better to…”
  • “I agree with your explanation on the importance of collimation but your patient was moving…”
  • “I am finding an inconsistency with your lead protection practices…

Phrases to avoid:

  • “worst”, “bad”
  • “You always (do this)…”
  • “You never (do this)…”

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