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Strategy for efficiently structuring an interaction with a learner

1. Get a learner commitment 

• So, what do you think is going on with this patient? How would you like to treat this patient? 

• Why do you think the patient came today? 

• What would you like to accomplish on this visit? 

2. Probe for supportive findings and evaluate the thinking leading to that commitment 

• How did you reach that conclusion? What makes you... ? 

• What findings support your diagnosis? What else did you consider? 

3. Reinforce what was correct and give positive feedback 

• I agree with your interpretation. 

• I am pleased that you included... that aspect of the physical exam. 

• I appreciate your consideration of the patient's financial situation in prescribing... 

4. Constructive guidance about errors or omissions/give negative feedback 

• I disagree with...the scope of your differential diagnosis. 

• What else do you think you might have included?

• Including the abdominal exam would have been important… 

• A more efficient way to... 

5. Teach a general principle and clarify "the take home" lesson 

• So, in general, it's important to remember... 

• It is always important to think about... 

• In general taking a little extra time... 

• Why don't you read up on this tonight and report back tomorrow. 

Adapted by the Physician Assistant Program, Oregon Health Sciences University, Ponland. with credit to the Department of Family Medicine, University of Washington, Seattle. 

Reference: Neher JO, Gordon KC, Meyer B, Stevens N. A Five-Step "Microskills" Model of Clinical Teaching. JAm Brd of Fam Pract July-Aug, 1992; Vol. 5 No.4, 419-424.