Transcript The-Paramedic-Precep..

Wisconsin Indianhead Technical College
The Paramedic Preceptor
Thank you for agreeing to serve as a preceptor for the WITC
Paramedic Program. You will play a key role in the lives of our
paramedic students, as they acquire the knowledge and skills
to perform the job of a paramedic in our community. We value
your dedication to the medical field and your contribution to
the success of our paramedic students.
The purpose of this orientation is to familiarize you with:
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The Preceptor
Clinical Training
How to provide feedback
How to evaluate students
You were once but a learner; now you
are the master. The Effective Preceptor
What are the characteristics of the effective
preceptor? As a health care professional you
strive to maintain and improve your knowledge
and skills in order to provide the highest quality
of care possible. For many of you, this passion
for excellence spills into other areas of your
lives and professional work, and the evidence is
seen in the high quality of teaching you provide
as a preceptor.
The Effective Preceptor
The effective preceptor communicates their clinical
knowledge clearly to the learner while remaining
open and respectful. Specific concepts are expanded
to general principles. Careful listening indicates
respect for the learner. Goals and expectations are
defined and clearly communicated, and a pleasant
and stimulating learning environment is fostered
using humor and enthusiasm.
The Effective Preceptor
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Possesses and demonstrates broad knowledge
Explains the basis for actions and decisions
Answers learner questions clearly and precisely
Open to conflicting ideas and opinions
Connects information to broader concepts
Communicates clear goals and expectation
Captures learners attention
Makes learning fun
Communication and the Effective Preceptor
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Possesses and demonstrates broad knowledge
Explains the basis for actions and decisions
Answers learner questions clearly and precisely
Open to conflicting ideas and opinions
Connects information to broader concepts
Communicates clear goals and expectation
Captures learners attention
Makes learning fun
Communication and the Effective Preceptor
Clear communication of goals is vital to effective precepting . Too
often teachers do not define the specific observable behaviors that are
desired. When clear expectations are set and communicated the
learner is better able to focus his or her energies and efforts.
Developing goals for what you wish learners to achieve while working
with you can assist you in measuring your own effectiveness. The
environment in which teaching takes place has a major effect on the
transfer of information. For example, the preceptor’s body language
and tone of voice has a significant effect on communication with the
patient. Likewise, learners remember more when a preceptor who can
capture their attention and make learning fun. This can be
accomplished by using humor, dramatic case examples, suspense and
enthusiasm.
ANALYSIS OF THE LEARNER
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The most skillful clinical interview and physical examination is useless if the clinician
is not able to analyze the information and use it to assist the patient in his or her
problem. The effective preceptor analyzes the data obtained from his or her
interaction with the learner and uses this information to benefit the learner through
assessment, feedback and evaluation.
In order to accurately assess the learner's performance the effective preceptor
observes that performance directly as often as is possible. Often a preceptor's
observations tend to be second hand – based on presentations or write-ups. It is
important to directly observe those vital history-taking and physical exam skills in
order to give the necessary guidance to the learner.
Feedback is highly valued by learners; It is the mechanism by which the effective
preceptor promotes the positive behavior and skills and works to modify those areas
where improvement is needed.
Evaluation is a key function of the effective preceptor. Through clear goals and
expectations, ongoing assessment of the learner, and continuing feedback to guide
progress, the preceptor has integrated the evaluation process into the entire
rotation. The final evaluation is the culmination of an ongoing process and is more
relevant and valuable as a result.
ANALYSIS OF THE LEARNER
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Accurate assessment of
learner's knowledge attitudes
and skills
Uses direct observation of the
learner
Provides effective feedback
Performs fair and thoughtful
evaluations
Skill in Teaching and Practice
The demonstration of skill is important in clinical
practice and in clinical teaching. Students value the
demonstration of skillful clinical practice and
effective role modeling. Clinical teaching is more
than telling someone what to do and how to do it –
the effective preceptor not only “talks the talk” but
also “walks the walk.” In the close quarters of the
teaching relationship, true role modeling involves
being consistent in what you say and do in your
relations with patients, staff and learners.
Skill in Teaching and Practice
The effective preceptor recognizes that, when appropriate, he or she
must relinquish some of the control in the clinical area to the learner.
Shadowing can be a useful introduction to clinical care, but this
technique alone grows old after several days of following the preceptor.
Learners value appropriate increases in responsibility coupled with
careful oversight and guidance . With careful ongoing analysis, the
effective preceptor can balance the educational needs of the learner with
the needs of the patients and the office. . The preceptor must not only
have knowledge and skill but must be able to share it in a way that is
useful and interesting to the learner. Learners also value an organized
approach to teaching. Organization and clarity are important in the
impromptu teaching in your practice as well as in a formal lecture . What
should the learner focus on with this next patient? How do you want the
next case presentation to be different? Actively directing the learning will
create small individual goals that will build into greater accomplishments.
Skill in Teaching and Practice
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Provides effective role modeling
Demonstrates skillful interactions with
patients
Generates interest in the subject matter
Presents information with organization and
clarity
Organizes and controls the learning
experience
Balances clinical and teaching responsibilities
Give appropriate responsibility to the learner
MOTIVATING THE LEARNER
This clinical experience may be the first time that a learner has
been able to select some of his or her own learning goals and to
help direct the methods to best achieve them. This also can be an
important step to life-long self-directed learning. A recurrent
theme in reviewing the qualities of the effective preceptor is the
value of enthusiasm. Demonstrating enjoyment of patient care and
teaching is among the most important characteristics of the
effective preceptor.
MOTIVATING THE LEARNER
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Learners in health care professions usually enter their training with high
levels of energy and motivation. Sometimes though, the rigors and challenges
of pre-clinical teaching in the classroom can take their toll, leaving the learner
depleted and questioning the relevance of what they have learned.
The application of knowledge to solving problems and the generalization of
the current experience to future patients can help revive flagging energy and
waning motivation in early clinical training.
Adult learning involves internal motivation – learning because one wants to
and not for some external reward such as a grade.
Many of the learners we encounter have not made this transition to the adult
learning style.
Active involvement of the learner is a characteristic of the effective preceptor;
and is an important method of encouraging the adult style of learning and
thereby increasing motivation
MOTIVATING THE LEARNER
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Emphasizes problem solving
Translates specific cases into general
principles
Promotes active involvement of the
learner
Demonstrates enjoyment and enthusiasm
for patient care and teaching
Develops a supportive relationship with
the learner
Remember
Most clinical learning takes place in the context of
busy clinical practice where time is at a premium. The
five microskills of the One Minute Preceptor teaching
model enable preceptors to effectively assess, instruct
and provide feedback more efficiently. This model is
used when the preceptor knows something about a
case that is being presented that the learner either
needs or wants to know.
Clinical
Instruction
Much of clinical teaching involves the learner interviewing and
examining a patient, and then presenting the information to the
preceptor. This strategy is common both in the office and hospital
setting. Studies have indicated that on average, these interactions take
approximately 10 minutes and the time is divided into several different
activities. (See Figure) Much of the time is taken up by the
presentation of the patient by the learner. Additional time is spent in
questioning and clarifying the content of the presentation. As a result
only about one minute of time is actually spent in discussion and
teaching.
The Learning Encounter
Questioning
3 Minutes
Discussion
1 Minute
Presentation
6 Minutes
The One Minute Preceptor
The One-Minute Preceptor approach allows the preceptor to
take full advantage of the entire encounter in order to
maximize the time available for teaching. The teaching
encounter will still take longer than a minute but the time
spent is more efficiently used and the teaching effectiveness
is optimized. This method consists of a number of skills that
are employed in a stepwise fashion at the end of the learner's
presentation. Each step is an individual teaching technique
or tool, but when combined they form one integrated strategy
for instruction in the health care setting.
History
"The One Minute Preceptor: Microskills of Clinical Teaching"
was originally developed by Kay Gordon, M.A., and Barbara
Meyer, M.D., M.P.H., Department of Family Medicine,
University of Washington School of Medicine. Initially
introduced as the “Five-Step `Microskills' Model of Clinical
Teaching” * the One Minute Preceptor strategy has been
taught and tested across the nation ** and has been welcomed
by busy preceptors. The dissemination of this technique has
been allowed and is encouraged.
* Neher, Gordon, Meyer, & Stevens, 1992.
** Irby 1997.
A Couple of Things about Microskills
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Get a commitment.
What do you think is going on?
Probe for supporting evidence.
Why do you think this?
Teach general rules.
Reinforce what was right.
Tell them what they did right and the effect that it had.
Correct mistakes.
Tell them what they did right.
Tell them what they did not do right.
Tell them how to improve for the next time.
Commitment
The One-Minute Preceptor method suggest that you
get a commitment from the learner – to get them to
verbally commit to an aspect of the case. The act of
stating a commitment pushes the learner to move
beyond their level of comfort and makes the teaching
encounter more active and more personal. This can
show respect for the learner and fosters an adult
learning style.
Probe for Supporting Evidence
Now that you have a commitment from the learner, it is
important to explore what the basis for their opinion was.
The educational setting often rewards a lucky guess to the
same degree as a well-reasoned, logical answer. In the
clinical setting, it is important to determine that there is an
adequate basis for the answer and to encourage an
appropriate reasoning process. By the same token it is
important to identify the “lucky guess” and to demonstrate
the use of appropriate supporting evidence.
Positive Reinforcement
In order for the learner to improve they must be
made aware of what they did well. The simple
statement “That was a good presentation” is not
sufficient. The learner is not sure if their
presentation is “good” because they included
current medications or because they omitted the vital
signs. Comments should include specific behaviors
that demonstrated knowledge skills or attitudes
valued by the preceptor.
Give Guidance About Errors and Omissions
Just as it is important for the learner to hear what they have
done well, it is important to tell them what areas need
improvement. This step also fosters continuing growth and
improved performance by identifying areas of relative
weakness. In framing comments it is helpful to avoid extreme
terms such as `bad' or “poor”. Expression such as “not
best” or “it is preferred” may carry less of a negative value
judgment while getting the point across. Comments should
also be as specific as possible to the situation identifying
specific behaviors that could be improved upon in the future.
Teach a General Principle
One of the key but challenging tasks for the learner is to take information
and data gained from an individual learning situation and to accurately and
correctly generalize it to other situations. There may be a tendency to over
generalize – to conclude that all patients in a similar clinical situation may
behave in the same way or require the exact same treatment. On the other
hand, the learner may be unable to identify an important general principle
that can be applied effectively in the future. Brief teaching specifically
focused to the encounter can be very effective. Even if you do not have a
specific medical fact to share, information on strategies for searching for
additional information or facilitating admission to the hospital can be very
useful to the learner.
Bibliography
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Goertzen, J., Stewart, M., & Weston, W. (1995). Effective teaching behaviors of rural family medicine
preceptors. Canadian Medical Association Journal, 153 (2), 161-8.
Irby, D. M. (1978). Clinical teacher effectiveness in medicine. Journal of Medical Education, 53, 808815.
Irby, D. M. (1994). What clinical teachers in medicine need to know. Academic Medicine, 69 (5), 333-42.
Irby, D. M. (1995). Teaching and learning in ambulatory care settings. Academic Medicine, 70 (10), 898931.
Irby, D. M., Ramsey, P. G., Gillmore, G. M., & Schaad, D. (1991). Characteristics of effective clinical
teachers of ambulatory care medicine. Academic Medicine, 66 (1), 54-5.
Skeff, K. M. (1988). Enhancing teaching effectiveness and vitality in the ambulatory setting. Journal of
General Internal Medicine, 3 (Mar/Apr Supplement), S26-33.
Stritter, F. T., & Baker, R. M. (1982). Resident preferences for the clinical teaching of ambulatory care.
Journal of Medical Education, 57, 33-41.
Tumulty, P. A. (1973). Effective Clinician. Philadelphia: W. B. Saunders.
Whitman, N. (1990). Creative Medical Teaching. Salt Lake City: University of Utah School of Medicine.
Bibliography
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Irby, D. (1997, February). The One-Minute Preceptor. Presented at
the annual Society of Teachers of Family Medicine Predoctoral
meeting, Orlando, FL.
Irby, D. (1997, June). The One-Minute Preceptor: Microskills for
Clinical Teaching. Presented at teleconference from East Carolina
Univ. School of Medicine, Greenville, NC.
Neher, J. O., Gordon, K. C., Meyer, B., & Stevens, N. (1992). A fivestep "microskills" model of clinical teaching. Journal of the American
Board of Family Practice, 5, 419-424.
STFM. (1993, February). The One-Minute Preceptor. Presented at the
annual Society for the Teachers of Family Medicine Predoctoral
meeting, New Orleans, LA
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The lines of communication begin
at the level of the student and
preceptor.
Please view the YouTube video The
One Minute Preceptor Model for a
brief description of the One Minute
Preceptor. This video can be viewed
at:
https://www.youtube.com/watch?v
=rKGMkbPWekk&feature=related
If you have an issue that cannot be
resolved, please contact the EMS
Clinical Coordinator Linda AveryPatz at: (715) 764-2788
witc.edu
THANK YOU!
It is dedicated preceptors like you
that allow us to educate and train
quality prehospital medical
providers. Policies and procedures
for clinical education can be
obtained by referring to the
WITC Preceptor Handbook.