The one-minute preceptor is a quick and effective way to teach medical students and residents at the bedside. It is a structured approach to teaching that can be used to cover a wide range of topics, from physical exam findings to diagnostic reasoning to treatment plans.
Get a commitment. Ask the learner what they would like to learn from the encounter.
Probe for existing knowledge. Ask the learner what they already know about the topic.
Teach the new information. Briefly and clearly teach the learner the new information.
Get a commitment to apply what was learned. Ask the learner how they will apply what they learned to the next patient they see.
Be prepared. Think about what you want to teach the learner before the encounter begins.
Be concise. Get to the point quickly and avoid using jargon.
Be interactive. Ask the learner questions and engage them in the teaching process.
Be positive. Focus on the learner's strengths and provide constructive feedback.
Preceptor: "What would you like to learn from this encounter?"
Learner: "I'm not sure what's causing this patient's abdominal pain."
Preceptor: "What do you know about abdominal pain?"
Learner: "I know it can be caused by a variety of things, such as indigestion, constipation, or appendicitis."
Preceptor: "That's correct. Let's go through the patient's history and physical exam together to narrow down the possibilities." (The preceptor and learner review the patient's history and physical exam.)
Preceptor: "Based on the patient's presentation, what do you think is the most likely cause of their abdominal pain?"
Learner: "I think it could be appendicitis."
Preceptor: "Excellent. Let's discuss the next steps in evaluating the patient for appendicitis." (The preceptor and learner discuss the next steps in evaluating the patient for appendicitis, which may include ordering an ultrasound or a CT scan.)
Preceptor: "What will you do if the patient's imaging is positive for appendicitis?"
Learner: "I will consult with a surgeon and arrange for the patient to have an appendectomy."
Preceptor: "Great. You've done well in identifying the most likely cause of the patient's abdominal pain and outlining the next steps in their care."
In this example, the preceptor used the one-minute preceptor to teach the learner about abdominal pain and how to approach the diagnosis and management of a patient with this symptom. The preceptor began by getting a commitment from the learner about what they wanted to learn. Then, the preceptor probed for the learner's existing knowledge about abdominal pain. Next, the preceptor guided the learner through the diagnostic process, focusing on the most likely cause of the patient's symptoms. Finally, the preceptor reinforced the learner's understanding by asking them to explain how they would manage the patient if the imaging confirmed the diagnosis of appendicitis
The DEFT (Diagnosis, Evidence, Feedback, Teaching) method is a modified version of the One-Minute Preceptor approach for teaching medical students and residents at the bedside. It replaces the emphasis on time with a focus on the skillful application of teaching microskills in a flexible manner. Deft means 'skilful'.
In addition to the original microskills, DEFT encourages learners to discuss risk factors, disease mechanisms, and potential complications, demonstrating a deeper understanding of infectious disease concepts. Role-modeling by the preceptor can further reinforce skills by providing a behavioral and analytical model.
The DEFT framework is as follows:
Diagnosis:
Ask the learner to commit to a unifying or differential diagnosis.
Explain predisposing conditions, risk factors, disease mechanisms, and complications.
Address a specific discussion point if the diagnosis is self-evident.
Evidence:
Probe for supporting and opposing evidence to evaluate the learner's knowledge and clinical reasoning.
Feedback:
Ask the learner to provide self-feedback on their own performance.
Provide constructive, specific, and non-judgmental feedback about the learner's effort and ability.
Reinforce what was done well and explain how to improve performance in the future.
Use role-modeling to demonstrate how to succinctly formulate an assessment and conduct skillful clinical reasoning.
Teaching:
Teach a general principle or clinical pearl.
Guide the next steps in patient management and the learning process.
Preceptor: "What would you like to learn from this encounter?"
Learner: "I'm not sure what's causing this patient's persistent cough."
Preceptor: "Excellent. Let's go through the patient's history and physical exam together to identify possible causes."
Diagnosis:
Ask the learner to commit to a unifying or differential diagnosis.
Preceptor: "Based on the patient's presentation, what do you think are the most likely causes of their persistent cough?"
Learner: "I think it could be asthma, chronic obstructive pulmonary disease (COPD), or post-nasal drip."
Preceptor: "Those are all reasonable possibilities. Let's explore each of them further."
Explain predisposing conditions, risk factors, disease mechanisms, and complications.
Preceptor: "Asthma is a chronic inflammatory condition of the airways that causes recurrent episodes of wheezing, coughing, and breathlessness. It is often triggered by allergens, exercise, or respiratory infections."
Preceptor: "COPD is a chronic obstructive lung disease that causes airflow obstruction, making it difficult to breathe. It is most commonly caused by smoking, but can also be caused by exposure to air pollution or occupational dusts."
Preceptor: "Post-nasal drip is a condition in which mucus drips from the back of the nose into the throat, causing a cough. It is often caused by allergies, sinus infections, or a deviated septum."
Address a specific discussion point if the diagnosis is self-evident.
Preceptor: "If the patient has a history of asthma, what are some key features you would expect to find on their physical exam?"
Learner: "I would expect to hear wheezing on auscultation, especially with expiration."
Preceptor: "Correct. And if the patient has COPD, what other signs or symptoms might you expect to find?"
Learner: "I would expect to find shortness of breath, especially with exertion, and a prolonged expiratory phase on lung sounds."
Evidence:
Probe for supporting and opposing evidence to evaluate the learner's knowledge and clinical reasoning.
Preceptor: "The patient has a history of smoking and recurrent episodes of wheezing. What are some additional questions you would ask to gather more evidence for or against a diagnosis of asthma?"
Learner: "I would ask about the duration of their cough, any triggers they have noticed, and their family history of allergies or asthma."
Preceptor: "Those are all important questions to ask. And if the patient's cough is primarily productive with yellow or green sputum, what would that suggest about the likelihood of asthma?"
Learner: "That would suggest that the cough is more likely due to a respiratory infection or COPD."
Feedback:
Ask the learner to provide self-feedback on their own performance.
Preceptor: "How do you think you did in identifying the possible causes of the patient's cough?"
Learner: "I think I did a good job of identifying the most likely causes and asking relevant questions to gather more information."
Preceptor: "Yes, you did a good job of taking a systematic approach to the patient's history and physical exam. You also asked some thoughtful questions to narrow down the possible diagnoses."
Provide constructive, specific, and non-judgmental feedback about the learner's effort and ability.
Preceptor: "One area where you could improve is in your discussion of risk factors. While you mentioned smoking as a risk factor for COPD, you could also discuss other factors such as exposure to occupational dusts or fumes."
Preceptor: "Additionally, you could provide more specific examples of how the patient's symptoms might manifest differently in each of the potential diagnoses. For instance, you could explain how the timing and quality of the cough might differ between asthma and COPD."
Reinforce what was done well and explain how to improve performance in the future.
Preceptor: "Overall, you did a great job of applying the DEFT approach to this patient encounter. You showed a strong understanding of the principles of clinical reasoning, and you were able to effectively communicate your thought process to me."
Preceptor: "Remember, the goal of the DEFT approach is to help learners develop their clinical skills and become more confident in their ability to diagnose and manage patients. By providing constructive feedback and fostering a supportive learning environment, we can help our learners reach their full potential."
Teaching:
Teach a general principle or clinical pearl.
Preceptor: "One important teaching point from this case is the value of considering multiple potential diagnoses, even when a single diagnosis seems likely. By keeping an open mind and considering all of the available evidence, we can avoid making premature assumptions and ensure that
Savaria, M.C., Min, S., Ghazal Aghagoli, Tunkel, A.R., Hirsh, D. and Michelow, I.C. (2022). Enhancing the one-minute preceptor method for clinical teaching with a DEFT approach. International Journal of Infectious Diseases, [online] 115, pp.149–153. doi:https://doi.org/10.1016/j.ijid.2021.12.314.