Effective and Efficient Preceptor Techniques

1. Effective and Efficient Preceptor Techniques Pediatric ExCEED Program Spring Advisory Council Meeting June 4, 2004

2. At the End of the Session: • Use patient schedules to plan patient encounters • Appreciate importance of “priming” • Develop “priming scripts” • Use efficient preceptor techniques • Identify alternative learning opportunities

3. Planning your Day • Trainee level drives encounters selected • Novice • Patient with good communication skills • Classic presentations of common diseases • Advanced • Random patient assignment • Undifferentiated and varying complexity of diseases

4. Planning your Day • Identify level of trainee • Use schedule to identify appropriate patient encounters • Exposure to pediatric diagnosis list • Patients and families tolerant of trainee

5. Planning your Day • Use schedule to identify difficult patient encounters • Alert student to these patient encounters • Alert office staff to these patient encounters • Plan alternative activities using office staff

6. Priming: • brief teacher-directed orientation of the trainee to the patient just prior to the patient encounter

7. Priming • Task: Define task and time frame of encounter • Attending role: When and how reconnect • Patient: Background information • Product: Note, presentation, problem list, etc

10. Efficient Clinical Teaching Techniques • Structured Clinical Observations • Teaching in the Patient’s Presence • One Minute preceptor • “Aunt Minnie” method

11. Structured Clinical Observations • Can be used to split patient encounters between yourself and trainee • Prior to patient encounter identify portion of history, physical or instructions trainee will assume • Explain trainee’s role with patient/parents at beginning of encounter

12. Structured Clinical Observations • During observation identify 1 to 2 major feedback points to give student • Variation of method: • Observe trainee-patient encounter • Identified 1 to 2 major feedback points • Exit exam room, give feedback to trainee during patient presentation

13. Teaching in Patient’s Presence • Trainee presents patient’s presentation in exam room • Ability to observe trainee and patient interactions • Ability to verify history and exam findings

14. Teaching in Patient’s Presence • Ability to give trainee immediate feedback • Ability to demonstrate history taking skills and physical exam maneuvers • Ability to document history simultaneously during presentation

15. Teaching in Patient’s Presence • Prime student regarding expectations for presentation in room • Prime patient/parent regarding encounter • Identify their role in process • Identify content of teaching encounter especially if challenging the learner

18. One Minute Preceptor • Quick assessment of trainee’s knowledge and clinical reasoning skills • Focused clinical instruction • Focused and immediate feedback

19. One Minute Preceptor • Get commitment regarding diagnosis, work up or therapeutic plan • Probe for supporting evidence • Teach general rules • Reinforce what did right • Correct mistakes

20. “Aunt Minnie Method” • If a lady across the street dresses and walks like your Aunt Minnie…is your Aunt Minnie • Uses rapid pattern recognition for clinical problems • Efficient in teaching common and normal

21. “Aunt Minnie Method” • Trainee gives one liner identifying age, chief compliant, and diagnosis • Preceptor sees patient while trainee writes ups encounter • Preceptor discusses case with trainee • Preceptor reviews and signs medical record

22. Aunt Minnie’s Limitations • Requires acknowledgment of uncertainty of diagnosis • Not effective for complicated unusual presentations

23. Back at your Office • Use patient schedules to plan patient encounters and alternative learning opportunities • Feel comfortable using “priming” • Use “priming scripts” • Identify one new preceptor technique to try next week