|Year : 2018 | Volume
| Issue : 4 | Page : 297-301
Impact of a one-minute preceptor on learning of pulmonary medicine postgraduates: Perceptions and review of literature
Deepak Aggarwal, Varinder Saini, Manisha Bhardwaj
Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India
|Date of Web Publication||14-Nov-2018|
Department of Pulmonary Medicine, Block-D, Level-5, Government Medical College and Hospital, Sector-32, Chandigarh - 160 030
Source of Support: None, Conflict of Interest: None
Context: Clinical reasoning and patient management skills are integral part of postgraduate (PG) medical education. Often, traditional teaching practices and paucity of time hinder this aspect of a resident's development. One-minute preceptor (OMP) is a learner-centered model that might improve PG learning. Aims: The study was conducted to introduce OMP as an educational tool for pulmonary medicine PG students and to evaluate the perceptions of residents and faculty on its utility. Subjects and Methods: Thirteen pulmonary medicine PG residents and six faculty members participated in this study. After initial sensitization about the teaching tool, thirty OMP sessions were conducted in the outpatient department with each resident undergoing a minimum of two sessions. Resident and faculty perceptions on this process were evaluated through validated questionnaires that were graded on a Likert scale. Results: All 13 residents perceived that OMP can improve their clinical reasoning skills as well as increase their motivation for further study (average Likert score for both: 4.69 + 0.48). However, 53.8% (n = 7) of residents perceived that the time devoted to OMP session was inadequate. Faculty also perceived that OMP was an effective teaching method and advocated its routine use in PG teaching. Conclusion: Both residents and faculty perceived OMP as an effective teaching tool in outpatient teaching of PG residents.
Keywords: One minute preceptor, clinical reasoning, postgraduate
|How to cite this article:|
Aggarwal D, Saini V, Bhardwaj M. Impact of a one-minute preceptor on learning of pulmonary medicine postgraduates: Perceptions and review of literature. CHRISMED J Health Res 2018;5:297-301
|How to cite this URL:|
Aggarwal D, Saini V, Bhardwaj M. Impact of a one-minute preceptor on learning of pulmonary medicine postgraduates: Perceptions and review of literature. CHRISMED J Health Res [serial online] 2018 [cited 2019 Dec 7];5:297-301. Available from: http://www.cjhr.org/text.asp?2018/5/4/297/245456
| Introduction|| |
Time constraints and other competing priorities in the ambulatory care setting prevent medical teachers from delivering optimal and high-quality educational experience to postgraduate (PG) students. Traditional teaching during postgraduation is usually limited to seminars, lectures, and journal clubs that usually do not emphasize acquisition of clinical skills and competencies. In the outpatient teacher–student interactions, the focus is on planning patient management with minimal and often unstructured learning inputs. The same encounters can be converted into an organized teaching model to improve PG students' learning.
One-minute preceptor (OMP), a five-step “microskill” model of clinical teaching, is one such teaching–learning method which provides a framework around which teacher–student conversations during daily clinical work can be built and ordered into short but practically useful teaching sessions. It consists of five serial steps: (1) getting a commitment, (2) probing for underlying reasoning, (3) teaching a general rule, (4) providing positive feedback, and (5) correcting mistakes.
In contrast to traditional teaching, OMP is a learner centered and easy to administer model that promotes meaningful student–teacher interaction in an ambulatory care setting with minimal disruption to patient care., This model has been well studied and proposed in different outpatient and inpatient settings as well as in basic sciences with mixed perceptions from the learners and preceptors.,,,,, Most of the data on OMP have been generated in the Western world with an unproven relevance in Indian scenario. Moreover, there is a scarcity of evidence of its use in PG teaching., Hence, we sought to conduct this study to introduce OMP in our discipline and to generate some data on its perception and acceptance among the pulmonary medicine residents and the faculty.
| Subjects and Methods|| |
The study was conducted in Government Medical College and Hospital, Chandigarh, over a period of 3 months (December 2017–February 2018). A total of 13 pulmonary medicine PG residents with no previous OMP experience were enrolled in the study. Six faculty members from the clinical disciplines including three from pulmonary medicine consented to participate in the study. Explained written consent was taken from all participants. The study was approved by the Institutional Research and Ethics Committee.
Initially, a teaching session consisting of didactic lecture (Power-Point presentation) and interactive discussion was conducted to sensitize all residents and faculty about the OMP framework. At the end of the session, all participants were able to recall the five microskills of OMP. Out of six faculty members sensitized, two teachers from pulmonary medicine department consented to conduct OMP sessions as preceptors and the rest accepted to observe the OMP sessions (at least two sessions for each faculty). Each resident underwent at least two sessions (within a period of 4 days) of structured clinical case discussion using five microskills of OMP. The sessions were conducted on common diagnoses such as chronic obstructive pulmonary disease, tuberculosis, asthma, lung cancer, and interstitial lung disease. Each OMP session was approximately of 7–10 min in duration (that included case presentation, questioning and teaching general rules, and feedback) in which one resident presented the case and other residents and faculty observed the session.
After two clinical sessions, the residents were asked to fill a 9-item questionnaire consisting of questions about their perception on different aspects of OMP. Six of the nine items were derived from previously validated questionnaires with some modifications.,, The questionnaire was validated from PG students, faculty members, and members of medical education unit. The question format included both open-ended and close-ended questions. Rating was done on a five-point Likert scale of 1 = “strongly disagree” to 5 = “strongly agree.” Faculty perception about usefulness and implementation of OMP as a regular teaching tool was also evaluated through a separate, validated structured questionnaire.
The statistical analysis was done using SPSS (IBM SPSS Statistics 21.0; Armonk, NY, USA). The categorical variables were summarized using percentages and frequencies, and continuous data were analyzed using mean and standard deviation wherever applicable.
| Results|| |
A total of 30 OMP sessions were conducted during the study period in which each resident underwent at least two sessions. Apart from the resident presenting the case, the session was also observed by other residents and faculty, whenever available, for better learning and acclimatization about OMP.
Feedback of postgraduate residents about one-minute preceptor
[Table 1] shows the distribution of scores in each of the questionnaire items. After the OMP sessions, all 13 residents (100%) perceived that OMP improved their clinical reasoning skills (average Likert score: 4.69 ± 0.48) and proposed that it should be routinely used for teaching PG residents (average Likert score: 4.61 ± 0.50). However, 53.8% (n = 7) of residents felt that the time devoted to OMP session was inadequate. Out of these seven residents, five were in their 1st year of postgraduation. Furthermore, 69% (n = 9) of students felt that only limited knowledge is delivered during the sessions. All nine students belonged to the 1st (n = 5) and 2nd year (n = 4) of residency. There was no significant difference in the perception scores among the 1st, 2nd, and 3rd-year residents for the remaining seven items.
|Table 1: Likert scale scores for the one-minute preceptor perception questionnaire items|
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Feedback from faculty about one-minute preceptor
Faculty also gave a positive feedback about OMP. Feedback was given by all the six faculties who conducted/observed the OMP sessions. All of them perceived that OMP improved confidence in assessing clinical knowledge of residents as well as helped them to focus on students' weak areas. They advocated that OMP should be incorporated as a routing teaching method for PG students. In contrast to PG residents, only one faculty member (16.6%) felt that the time devoted to OMP was inadequate and two faculties (33.3%) believed that only limited knowledge is delivered during OMP session [Figure 1].
|Figure 1: Bar chart showing feedback of faculty about one-minute preceptor|
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| Discussion|| |
The present study was conducted to evaluate the perception of PG residents and the faculty about OMP teaching model in an ambulatory setting. The results showed that the residents perceived OMP as an effective teaching tool in improving their clinical reasoning skills and enhancing their confidence and motivation for further study. However, in contrast to the faculty, students felt that the time devoted to teaching and the content of knowledge delivered during OMP session was inadequate.
A median number of 12 residents agreed or strongly agreed to 7 out of 9 items in the study questionnaire. All of them advocated routing use of OMP in PG teaching. Similar results on student perception have been seen in previous studies from India,, and abroad,, [Table 2]. In a comparative study using videotaped teaching encounters, 164 medical students preferred OMP model to the traditional teaching. A significantly high rating was given to all the items, especially students' clinical reasoning, fund of knowledge, feedback, student involvement in decision-making process, and overall effectiveness. Similar learning experience, though not significant, was perceived by anatomy students after the OMP-based teaching [Table 2]. The lack of significant difference was possibly due to the students' (new entrants) behavior who were more comfortable with didactic teaching and hence could not properly interpret learner-centered processes such as OMP.
OMP model may be useful in the promotion of self-directed learning among residents. The fact can be inferred from the finding that all 13 residents in the present study perceived an increased motivation for further study after the OMP sessions. The perception is similar to that perceived by 120 students/interns who, in a previous randomized control trial, felt more motivated to do additional reading after OMP-based sessions as compared to the control group. However, the overall teaching effectiveness did not show a significant difference between the two groups [Table 2]. Reiterating the role of OMP in PG teaching, a recent Indian study also showed improvement in learning and level of confidence in 12 radiology residents after the OMP-based session.
Apart from learners, faculty (preceptor) acceptance of OMP was also been found to be high in the present study. All of them agreed that OMP increased their confidence in rating the students' knowledge as well as helped in assessing their learning needs. The results are in concordance with a previous multicentric study in which 116 preceptors after viewing videotaped encounters of both OMP and traditional model felt more confident in rating students' presentation skills, clinical reasoning, and fund of knowledge [Table 2]. They rated OMP as more effective and efficient than the traditional model of teaching. In coherence with results, positive perceptions about OMP were also given by the faculty after undergoing faculty development programs in previous research, [Table 2]. The preceptors acknowledged that OMP helped them to acquire OMP microskills such as quality of feedback, getting the commitment, and probing for evidence. Interestingly, these faculty perceptions often did not correlate with similar faculty rating by students, as well as with student satisfaction. Of the remaining microskills, “teaching general rules,” which require thorough subject understanding, were found to be the most difficult skill to acquire for teaching.,,
In the present study, 9 residents (69.2%) felt that only limited knowledge is delivered in OMP session and 7 (53.8%) perceived that the time devoted to each session was inadequate. However, majority of the faculties disagreed with this perception. This student perception was largely skewed due to the responses of five 1st-year residents that might be due to the inadequate sensitization and/or lack of experience. OMP is aimed to deliver need-based crisp clinical pearls to the learners so as to enhance their clinical reasoning skills rather than the fund of knowledge. This fact will likely be clarified once OMP is routinely practiced in the ambulatory PG teaching.
Another useful feature of OMP is that it can be easily taught in a single 1–2-h sensitization session, as was also seen in the present study. Despite its obvious advantages, it has yielded mixed perceptions both among learners and preceptors in previous studies. Plausible factors include differences in study design, hierarchy of students and the preceptors enrolled, level of their knowledge and previous experience, and time devoted to OMP training and its application.
The present study successfully introduced OMP in a clinical discipline and examined PG residents and faculty perspective on it in a real-life Indian setting. With a paucity of published literature from India, the results consolidate the evidence for its use in PG medical education. However, the study had few limitations. First, a small sample size of 13 residents might have affected the results. However, organizing multiple OMP sessions on the residents before taking their perceptions might have ensured the authenticity of results. Second, being a single-center study on PG residents, the results may not be generalizable, especially to undergraduate teaching. Third, the study did not measure long-term durability of the intervention's effects as well as its impact on actual (disease specific) learning. The study was a pilot project that was aimed to introduce OMP for PG medical teaching. Favorable results in it will pave the way for bigger studies evaluating its long-term feasibility, applicability, and educational impact. Even though multiple OMP sessions were conducted by two independent preceptors, underrating or over-rating of the OMP model due to lack of experience or inherent bias due to participant self-assessment cannot be ruled out.
| Conclusion|| |
With the level of favorable evidence generated for OMP over the last decade, there is virtually no ambiguity on its use in ambulatory PG teaching. With a heavy patient burden seen in teaching hospitals across India, this mode of teaching seems to be the need of the hour. It can supplement traditional teaching to improve analytical skills of the residents. However, more robust data from multicentric and longitudinal studies with multiple preceptors are needed to consolidate the findings and to evaluate its long-term impact on medical teaching.
We are highly thankful and indebted to Prof. Tejinder Singh, Vice Principal, Christian Medical College, Ludhiana, and Convener, Advanced Course in Medical Education (ACME), and Prof. Dinesh Badyal, Prof. and Head, Department of Pharmacology, Christian Medical College, Ludhiana, and Co-Convener, ACME, for mentoring and guiding us throughout the course of this study on medical education.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]