To the Editor: In 1992, Neher et al. (1) introduced an instructional algorithm to enhance clinical teaching. Used and studied primarily by faculty physicians and resident physicians in family medicine and internal medicine, there are as yet no papers reporting on its use among faculty or resident physicians in psychiatry. This letter reviews the five steps of the One-Minute Preceptor model for an audience of psychiatric educators, including psychiatric residents, using a hypothetical case.
The patient is a 35-year-old elementary school teacher who presents on intake to the university’s psychiatric teaching clinic with symptoms of depressed mood, decreased energy including sexual energy, disrupted sleep, and diminished appetite with a 15-lb weight loss. Her past psychiatric history is significant for a major depressive episode when she was 25 years old. This illness responded well to sertraline, 50 mg daily, a medication she continued for 12 months. The patient has no general medical illnesses and is not currently on any medications. She is married, has two children ages 10 and 8, and has recently relocated to the area for a new employment opportunity. The patient’s mental status examination revealed an intelligent and interpersonally attuned woman who was intermittently tearful during the interview. She was predominantly depressed, although she retained some capacity for affective range appropriate to the conversational context. There were no psychotic elements in her presentation, and she was not unduly anxious. She credibly denied past suicide attempts and current suicidal thinking.
The five “microskills” of clinical teaching include getting a commitment, probing for supporting evidence, reinforcing what was done well, giving guidance about errors and omissions, and teaching a general principle (1).
Getting a verbal commitment from the medical student regarding an aspect of the case gives focus to the teaching encounter and invites more active engagement from the student. Verbal commitments can be obtained about any meaningful facet of the case. Commonly these include some part of the subjective history (e.g., “patient’s first major depressive episode followed shortly after the birth of her first child”), an objective finding (e.g., depressed affect), diagnosis (e.g., major depression, adjustment reaction with depressed mood), further diagnostics (e.g., obtaining a thyroid-stimulating hormone), setting (e.g., outpatient, partial hospitalization, inpatient), or other aspect of treatment (e.g., medications, psychotherapy, or both).
Probing for supporting evidence explores the basis for the commitment. This encourages the medical student to develop logical reasoning skills. The resident instructor may find it helpful to proceed with questions beginning with one of the five Ws (who, what, where, when, why), such as “What factors in the history and mental status examination support your diagnosis?” “Why would you be inclined to use an SSRI?”
To promote the medical student’s continued learning, the resident physician needs to reinforce what the medical student did well. Specific positive feedback is more useful than general praise. For example, “Your diagnosis of major depression, recurrent, moderate, is well supported by the history of a previous major depressive episode and the mental status finding of depressed affect.”
To encourage the medical student’s ongoing improvement, the resident physician needs to give guidance about errors and omissions. This feedback is best heard if the resident avoids words that suggest negative judgment, such as “poor,” “disorganized,” “skimpy.” Instead, a phrase such as “a more preferable approach would be” can be substituted. Again, specific feedback is more useful than general feedback. For instance, “Your suicide examination would be more informative if it includes data about recent, past, and current suicide thoughts and behaviors.”
In the final step, the resident physician highlights a general principle that can be applied to appropriate future clinical situations. For instance, “Most major depression is recurrent” or “With each additional episode, the antidepressant medication needs to be maintained longer.”
The One-Minute Preceptor model has been shown to improve the quality of faculty feedback to third-year medical students by making the feedback more specific (2). In addition, the One-Minute Preceptor model resulted in teachers shifting instruction from generic clinical skills to disease-centered instruction (3). Moreover, the model allowed teachers to correctly diagnose the patient’s medical problems and increased their confidence in rating students in their clinical performance more than traditional models of teaching (4). Finally, third- and fourth-year medical students rated the One-Minute Preceptor as a more effective model of teaching than the traditional model (5).
In addition to faculty, resident physicians are important contributors to the education of medical students, especially in the acquisition of practical clinical skills. A recent review of the literature on residents as teachers found 24 studies of varying design, including uncontrolled, nonrandomized controlled, and randomized controlled studies. Authors concluded that compact curricula, in particular the One-Minute Preceptor, significantly improve residents’ teaching skills (6).
The One-Minute Preceptor is an accessible instructional method that both psychiatry faculty and residents may wish to learn, test, and modify in their instruction of medical students.
At the time of submission, Dr. Tsao reported no competing interests.