Canadian Association of Pathologists / Association canadienne des pathologistes

Original Article

The One-Minute Preceptor Model: Can It Be Applied to Pathology?

Jaime F. Snowdon, MSc, MD

Jaime F. Snowdon, MSc, MD, is a PGY3 resident in the Department of Pathology and Laboratory Medicine, Kingston General Hospital, in Kingston, Ontario. Jaime Snowdon can be contacted at jclaude@dal.ca.

This article was peer reviewed.

ABSTRACT

This article describes the one-minute preceptor model of teaching and suggests how it may be adapted for teaching pathology residents at the microscope.

RÉSUMÉ

Cet article décrit le modèle d’enseignement fondé sur des cas « one-minute preceptor », et propose une façon de l’adapter à l’enseignement donné aux résidents en pathologie en matière d’interprétation au microscope.

The five-step microskills model of clinical teaching, also known as the one-minute preceptor (OMP) model, was first described in the family medicine literature by Neher and colleagues in 1992.1 It was originally designed for use by faculty to enhance the teacher-student interaction in busy ambulatory teaching encounters. Over the past 17 years, it has become a popular method for improving teaching skills in both faculty and residents of clinically based programs such as family medicine and internal medicine. In this brief article, the application of the OMP model to nonclinical programs such as pathology is explored.

The Model

The five microskills are as follows:

1.         Get a commitment – the preceptor asks the learner for a diagnosis

2.         Probe for evidence – the preceptor uses more direct questioning to evaluate the learner’s knowledge base or reasoning skills

3.         Teach general rules – the preceptor teaches the learner “take-home points” resulting from the case, preferably based on an area of weakness identified in the learner

4.         Reinforce what was done well – the preceptor provides positive feedback

5.         Correct mistakes – the preceptor provides constructive feedback

The Evidence

Aagaard et al.2 compared the OMP model with the traditional model of preceptorship (Table 1) and found that clinical teachers using the OMP model were equally or better able to diagnose correctly patients’ medical problems and felt more confident in rating their students’ abilities. They also rated the OMP encounter as more effective and efficient than the traditional model.

Table 1. Traditional (Patient-Centred) Model

Source: Adapted from Irby et al.3

Irby et al.3 found that preceptors using the OMP model were more likely to teach about the disease and disease processes, whereas those using the traditional model focused on generic skills such as history taking and presentation. The authors suggest that the OMP model reveals more of the thinking of the learner and thus shifts teaching toward higher-order, disease-specific points rather than general processes.

Salerno et al.4 demonstrated that preceptors using the OMP model provided more feedback and feedback that was more likely to be specific. Preceptors using the OMP model reported that teaching encounters were more successful and they were better able to evaluate learners and create plans for self-directed learning.

Furney et al.5 found that the OMP model was effective for providing improvements in residents’ teaching skills. Residents employing the OMP model reported significant improvements in giving feedback, which is one of the most challenging problems in clinical education. On the measure of resident satisfaction of the model, 87% rated the model as “useful or very useful.” A similar study6 found that the OMP model improved both residents’ teaching skills and attitudes toward teaching.

In summary, the available evidence suggests that the OMP model is easy to use, efficient, and effective. It enhances the ability of preceptors to evaluate learners and improves self-directed learning. When employing this model, preceptor feedback improves in both quality and quantity.

The Pathology Setting

Teaching is a fundamental part of a pathologist’s clinical practice. In the academic setting, pathologists are responsible for educating medical students, residents from both pathology and other clinical disciplines, and other physicians. For most academic pathologists, the majority of their teaching time is spent at the microscope with pathology residents. A recent report outlined innovative teaching methods in pathology,7 but to my knowledge there have not been any published reports detailing the challenges that pathologists face when they are teaching their craft to junior learners.

A review of teaching and learning in ambulatory care found inadequacies of teaching in these settings that can be at least partly attributed to unpredictability, variability, and lack of time.8 Teaching in the pathology setting appears to face the same challenges, although there is no objective evidence to support this claim. It could be argued that a lack of time for teaching and balancing service with educational responsibilities are significant barriers to effective teacher-learner interactions in pathology. The OMP model, which has been shown to be as time efficient as the traditional model,2 should offer the same improvements to teaching in the pathology setting and is worth further exploration. Table 2 outlines a case scenario that illustrates how the OMP model can be used to enhance a teaching encounter at the microscope.

Table 2. Case Scenario of Teaching Encounter at the Microscope

Conclusions

The OMP model is a practical teaching tool that has gained acceptance in clinical medicine. It has been shown to improve the teaching process without prolonging it. Teaching in pathology faces similar challenges to teaching in the ambulatory setting, with time constraints being the most apparent. Because pathologists spend a great deal of their time teaching, it follows that the introduction of more effective teaching strategies would be welcome. The OMP model may prove to be an easy-to-use teaching tool that can be used in the pathology setting and should be explored. In addition, further studies into the challenges of teaching in pathology are required as this seems to be an area that has been neglected in both medical education and pathology literature.

Acknowledgements

I thank Dr. Ken Newell for his assistance with the preparation of this manuscript.

References

1.         Neher JO, Gordon KC, Meyer B, et al. A five-step “microskills” model of clinical teaching. J Am Board Fam Pract 1992;5:419–24.

2.         Aagaard E, Teherani A, Irby DM. Effectiveness of the one-minute preceptor model for diagnosing the patient and the learner: proof of concept. Acad Med 2004;79:42–9.

3.         Irby DM, Aagaard E, Teherani A. Teaching points identified by preceptors observing one-minute preceptor and traditional preceptor encounters. Acad Med 2004;79:50–5.

4.         Salerno SM, O’Malley PG, Pangaro LN, et al. Faculty development seminars based on the one-minute preceptor improve feedback in the ambulatory setting. J Gen Intern Med 2002;17:779–87.

5.         Furney SL, Orsini AN, Orsetti KE, et al. Teaching the one-minute preceptor. A randomized controlled trial. J Gen Intern Med 2001;16:620–4.

6.         Spickard A, Corbett EC Jr, Schorling JB. Improving residents’ teaching skills and attitudes toward teaching. J Gen Intern Med 1996;11:475–80.

7.         Rinder HM, Smith BR. Innovative methods in laboratory medicine resident teaching. Clin Lab Med 2007;27:255–67.

8.         Irby DM. Teaching and learning in ambulatory care settings: a thematic review of the literature. Acad Med 1995;70:898–931

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