A Model for Every Occasion

Michael Greenwald, MD  FACEP

Associate Professor of Pediatrics and Emergency Medicine

Emory University/Children’s Healthcare of Atlanta

A new academic year is upon us and that means brand new students and interns who rotate through the emergency department with a variety of backgrounds, skills, comfort and interests.  To some this may cause a flare-up of acid reflux; but I love this time of year.  The new learners are eager and optimistic and each new face represents a puzzle.  What kind of learner do I have? Moreover – what approach should I take when trying to make the most out of each patient encounter.

Multiple models in precepting are well described in the literature.  Most of you have heard of the “One Minute Preceptor” and perhaps you have also heard of SNAPPS, Activated Demonstration and the Aunt Minnie Model.  Like most paradigms each has strengths and indications and each is a little challenging to remember until they are practiced regularly.  Most of us intuitively use at least elements of these different approaches without even thinking about it.

I’d like to suggest not a new paradigm, but a few guiding principles that reflect the strengths of these different approaches:

  • Diagnose your learner. That means try to assess not only where their understanding ends (the “Zone of Proximal learning”) but also what motivates their learning (i.e. interests, ways of learning)
  • Separate the precepting interaction from patient care. Assume that the information you receive from the learner has errors – you need to verify the facts personally.  You can teach something based on any clinical story, whether it is true or not.
  • Focus on the Assessment and its rationale. Any recording device can regurgitate a history.  Creating a reasonable differential is where being a doctor starts.
  • Take on the role of consultant. Taking ownership of the patient is a big hurdle.  Make the learner identify their learning needs by asking YOU a specific question to help care for the patient.
  • Teaching them something, but don’t try to teach everything. Some of us can go on for hours on a topic.  More is not better.  If each patient encounter provides 1 new useful and memorable learning experience you will be Teacher of the Year.
  • Build on lessons learned. Retention is based on repetition.  Look for opportunities to reinforce concepts with future patients or independent research.

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