7. Teacher Skills for the Preceptor—Learner-Centered Model

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affective preceptor series teaching
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skills for the preceptor a
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learner-centered model what is learner
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centered teaching
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learner-centered teaching is a model
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that centers around the student and a
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student-driven in contrast traditional
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faculty center teaching is
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instructionally driven with the
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instructor delivering the educational
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materials
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the traditional approach the instructor
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conveys and transmits the material and
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information the student is expected to
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learn in the inpatient environment this
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can be done during hospital rounds
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in learner-centered teaching the
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instructor is the facilitator and still
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controlled the content but the student
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is directly involved in the discovery of
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knowledge and uses inquiry based methods
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to understand the material this model
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places more responsibility in the hands
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of the students in the outpatient
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setting the preceptor is often immersed
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in his or her own clinical practice and
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learning moments tend to be few and
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squeezed in between patient encounters
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it is thus more effective for the
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student to take essential and active
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role in learning to optimize the
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educational encounter
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what are the responsibilities of the
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preceptor and learner the preceptor
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should actively guide the learner and
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promote thinking and reasoning
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traditionally students shadow faculty
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and this approach tends to be more
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passive
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the learner-centered model encourages
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students to be more proactive they
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should be a part of the discussion and
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not be afraid to verbalize their thought
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processes or ask questions the student
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needs to compliment the encounter with
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follow-up learning after leaving the
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office
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snaps is a teaching model that can be
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used in the ambulatory setting to help
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guide students through case
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presentations it consists of six steps
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one summarized briefly the history and
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findings to narrow the differential to
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two or three relevant possibilities
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three analyzed the differential by
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comparing and contrasting the
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possibilities for probe the preceptor by
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asking questions about uncertainties
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difficulties or alternative approaches
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five plan management for the patient’s
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medical issues
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and six select a case related issue for
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self-directed learning
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let’s go through these individually now
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summarize briefly the history and
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findings the student sees the patient
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obtains a history and performs a
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physical examination as appropriate the
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student then presents the case to the
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preceptor in a concise summary usually
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three minutes is sufficient
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the summary should be condensed to
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relevant information
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however the preceptor should guide or
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redirect the learner to ensure
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appropriate case related issues are
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selected the patient had onset of acute
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right lower quadrant pain which
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subsequently became more intermittent in
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nature
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narrow the differential to two or three
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relevant possibilities the student
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discusses what he or she thinks is going
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on by narrowing down the differential
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this step requires a commitment from the
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learner
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similar to the micro scale model of
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clinical teaching
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as the students problem solving skills
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advanced he or she will be able to make
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a better list of possible diagnoses most
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importantly the student should present
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the initial list to the preceptor before
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the preceptor engages in revising or
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expanding the list
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a reproductive age woman with right
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lower quadrant pain the differential
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diagnosis includes ectopic pregnancy
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ovarian torsion and appendicitis
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analyze the differential by comparing
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and contrasting the possibilities the
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student initiates a discussion about the
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possibilities and analyzes why the
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patient presentation supports or does
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not support a certain diagnosis
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I think ectopic pregnancy is a concern
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because of the right lower quadrant pain
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and the history of prior ectopic however
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it’s more likely to be an ovarian
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torsion because of the nature and onset
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of the pain as well as the timing during
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the menstrual cycle this discussion
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encourages the student to think aloud in
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front of the preceptor and outline the
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students thinking process
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probe the preceptor by asking questions
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about uncertainties difficulties or
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alternative approaches
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during this step the learner discusses
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areas of confusion and questions the
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preceptor rather than waiting for the
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preceptor to initiate the probing the
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learner should utilize the preceptors
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knowledge base to better understand the
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problem and refine his or her own
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knowledge this step exposes the learner
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and the preceptor can learn a great deal
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about the student from the asked
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questions this also provides the
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preceptor with ideas for future
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self-directed learning what else should
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I include in my differential diagnosis
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is it possible to have an ectopic
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pregnancy in a patient who reports a
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last menstrual period two weeks prior to
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presentation
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the preceptor might discuss the
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importance of ruling out pregnancy in
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all reproductive age patients and the
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potential inaccuracies and menstrual
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period reporting
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plan management for the patient’s
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medical issues the learner initiates a
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discussion of patient management with
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the preceptor and must outline a brief
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management plan the learner has to
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commit but this step encourages the
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learner to immediately use the preceptor
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as a source of knowledge and expertise I
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would like to first rule out pregnancy
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with a urine pregnancy test and if
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positive I would order a quantitative
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HCG followed by imaging
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select a case related issue for
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self-directed learning
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the learner is encouraged to identify a
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learning issue as a result of the
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discussion of the patient encounter the
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learner should devote time to explore
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this issue further on the same day as
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the encounter the preceptor should guide
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or redirect the learner to ensure an
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appropriate case related issue is
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selected
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after this encounter the learner decides
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he or she wants to learn more about
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ectopic pregnancies at the next office
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encounter or meeting the learner should
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discuss any remaining questions or areas
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of confusion with the preceptor we
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encourage you to use snaps to do the
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following actively engage and motivate
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your student help students gain
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knowledge and communication skills teach
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students to develop a habit of
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self-directed lifelong learning health
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preceptors interact more closely with
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students equip preceptors to gaining
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perspective of a student’s knowledge
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base and critical thinking skills and
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lastly to better inform preceptor
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feedback evaluations