Effective Precepting: Nurturing Clinical Skills and Resilience
Precepting Essentials
•
You have a lot to share
•
You are assisting intelligent people who have
good learning ability
•
Nobody knows everything.
•
It’s OK to express what you don’t know
•
This may give the resident an opportunity for self
education
•
It’s also an opportunity for you to do some
reading to strengthen and expand your own
clinical abilities
•
Be open to taking the larger role of a mentor for
a resident
•
but individual personality and needs will determine to
whom a resident turns outside of the session
•
Recognize when the right time to teach
presents itself
•
vs. when you need to help the resident focus on moving
forward in the session
•
It’s OK to give the answers sometimes but remember: the
resident will learn more by discovering or reasoning the
solution
–
“
The difficult patient
”
–
An overwhelming clinical situation
•
Too sick
•
Too many chronic and acute problems
•
Patient not responding to treatment
–
Personal issues affecting the resident
–
Learning how to handle one’s own behavior and recognize
one’s own reactions is an essential part of becoming an
effective clinician
•
setting up a sustainable mindset for one’s career
•
it takes time and the learning may be painful
Vulnerable Situations
–
Finding one’s own way of responding to these cases is where
the art of medicine lies
–
Be careful not to be too directive when there may be different
solutions
•
It’s OK to say “I often handle these things this way, but
it’s important to find your own approach”
–
Help the resident chunk the issues into more manageable
challenges
–
When the “case” feels overwhelming, that’s often because the
patient is overwhelmed.
•
Help the resident recognize how her own feelings and
responses may be the key to figuring out the dilemma at
hand
Vulnerable Situations
–
Rarely, you may choose to rescue a resident from such a
situation
•
Engage the difficult patient yourself
•
See one of the other patients to give the resident more
time
•
Give her a way to temporize and then debrief later when
not under such time pressure
•
Give the resident one thing
not
to worry about
–
“unfreeze”
–
“just forget about the CBC results for now; then you’ll
be able to move forward with your thought process”
Vulnerable Situations
Attribution: Kay Gordon, MA; Barbara Meyer MD, MPH; and David Irby PhD
developed this teaching tool at the University of Washington, Seattle
The One Minute Preceptor:
5 Microskills for Clinical Teaching
•
Cue
: After presenting the facts of a case, the resident
then waits for a response or asks what to do
•
“What do you think about this case?”
•
The preceptor assesses the learner’s level of
understanding this way and can tailor the teaching
Microskill 1: Get a Commitment
•
Cue
: The resident then looks to you to confirm the
opinion or suggest alternative
•
Ask the resident for evidence for his opinion and
against other possibilities
•
You will again be encouraging the resident to think
things through while assessing learning level.
Microskill 2: Probe for supporting evidence
•
Cue:
You have ascertained (during 1 and 2) that you
know something about the case which the resident
needs or wants to know
•
Provide general rules, concepts, or considerations, and
target them to the learner’s level of understanding.
Microskill 3: Teach general rules
•
Cue
: The resident has handled a situation (or a part of
one) in an effective manner
•
Take the first chance you find to comment on the
specific good work and the effect it had
•
This will reinforce skills that may not be well
established.
•
This will also make microskill # 5 gentler
Microskill 4: Teach them what they did right
•
Cue
: You notice omissions, distortions, or
misunderstandings
•
As soon as it is appropriate, but in the appropriate
place.
–
Take care not to embarrass the resident
–
such as in front of the patient
•
First, allow the resident to critique his performance
•
Correct the error
•
Teach general rules
Microskill 5: Correct Mistakes
Helping residents navigate vulnerable clinical situations, emphasizing self-education, mentorship, and building resilience. Encouraging individual problem-solving approaches while managing overwhelming cases with empathy and skill.
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Presentation Transcript
You have a lot to share You are assisting intelligent people who have good learning ability Nobody knows everything. It s OK to express what you don t know This may give the resident an opportunity for self education It s also an opportunity for you to do some reading to strengthen and expand your own clinical abilities
Be open to taking the larger role of a mentor for a resident but individual personality and needs will determine to whom a resident turns outside of the session Recognize when the right time to teach presents itself vs. when you need to help the resident focus on moving forward in the session It s OK to give the answers sometimes but remember: the resident will learn more by discovering or reasoning the solution
Vulnerable Situations The difficult patient An overwhelming clinical situation Too sick Too many chronic and acute problems Patient not responding to treatment Personal issues affecting the resident Learning how to handle one s own behavior and recognize one s own reactions is an essential part of becoming an effective clinician setting up a sustainable mindset for one s career it takes time and the learning may be painful
Vulnerable Situations Finding one s own way of responding to these cases is where the art of medicine lies Be careful not to be too directive when there may be different solutions It s OK to say I often handle these things this way, but it s important to find your own approach Help the resident chunk the issues into more manageable challenges When the case feels overwhelming, that s often because the patient is overwhelmed. Help the resident recognize how her own feelings and responses may be the key to figuring out the dilemma at hand
Vulnerable Situations Rarely, you may choose to rescue a resident from such a situation Engage the difficult patient yourself See one of the other patients to give the resident more time Give her a way to temporize and then debrief later when not under such time pressure Give the resident one thing not to worry about unfreeze just forget about the CBC results for now; then you ll be able to move forward with your thought process
The One Minute Preceptor: 5 Microskills for Clinical Teaching Attribution: Kay Gordon, MA; Barbara Meyer MD, MPH; and David Irby PhD developed this teaching tool at the University of Washington, Seattle
Microskill 1: Get a Commitment Cue: After presenting the facts of a case, the resident then waits for a response or asks what to do What do you think about this case? The preceptor assesses the learner s level of understanding this way and can tailor the teaching
Microskill 2: Probe for supporting evidence Cue: The resident then looks to you to confirm the opinion or suggest alternative Ask the resident for evidence for his opinion and against other possibilities You will again be encouraging the resident to think things through while assessing learning level.
Microskill 3: Teach general rules Cue: You have ascertained (during 1 and 2) that you know something about the case which the resident needs or wants to know Provide general rules, concepts, or considerations, and target them to the learner s level of understanding.
Microskill 4: Teach them what they did right Cue: The resident has handled a situation (or a part of one) in an effective manner Take the first chance you find to comment on the specific good work and the effect it had This will reinforce skills that may not be well established. This will also make microskill # 5 gentler
Microskill 5: Correct Mistakes Cue: You notice omissions, distortions, or misunderstandings As soon as it is appropriate, but in the appropriate place. Take care not to embarrass the resident such as in front of the patient First, allow the resident to critique his performance Correct the error Teach general rules
