Tuesday, February 22, 2011

The Microskills

It's a typical Saturday night in the department.  You're busy.  I mean really busy; the "too busy to make a run to the bathroom and empty your overly distended bladder" busy.  Your resident comes up to you with their next patient.  At first, you think of just hearing out the chief complaint, telling them what to order, and moving on to the next patient.  Fortunately, a voice in your head reminds you that there is a better way, a way to promote a morsel of learning despite the challenges stacked before you.  Enter the microskills.

The microskills model of teaching, also referred to as the "One Minute Preceptor," is a series of easily performed steps that allow you to maximize a teaching encounter when time is precious.  The steps are:

1. Get a commitment: I love using this step to shorten the presentations from my learners.  Too often, they get lost in the forest when presenting a case.  Simply stepping back and asking, "What do you think is causing their symptoms?" allows me to hone in on the important parts of their presentation.  I can then focus my questions to help me understand why they are concerned about possible conditions on the differential that they have created.  "I don't know" is not an acceptable answer.

2. Probe for supporting evidence: The follow up.  Once they take a stand, you're able to ask the why and what if questions.  The more direct questioning focuses them on the task at hand and allows you to understand the history a little better as well as determining the learners decision-making process.

3. Teach general rules: The time to teach a mini-lecture is not when time is limited.  Instead, focus on a key point of the case, whether a historical factor, workup issue, or interpersonal problem and teach short and succinct pearls.

4. Reinforce what was done right: Reward the learner for their efforts.  Point out the good catches on the history or exam, congratulate them on making the correct diagnosis or picking the most effective workup.

5. Correct mistakes: Feedback is always critical.  Point out errors in their decision-making and explain methods to correct them in the future.  Point them toward resources for future learning.

The microskills have been employed in clinical teaching for over 20 years now.  While effective use of the skills takes more than the allotted "one-minute" advertised by the other name, the skills are quite helpful at keeping the teaching encounter short and focused.  When it gets too busy to teach, reach into your armamentarium for this quick and easy teaching tool. You'll be glad that you did.


Parrot SDobbie AChumley HTysinger JW. Evidence-based office teaching-the five-step microskills model of clinical teaching. Fam Med. 2006 Mar; 38(3): 164-7. PMID: 16518731 

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  1. Agree. I find the first 2 steps immesenly helpful, even though it is empting sometimes just to hurry and steam roll over their plan. It ends up saving teaching time since you will then teach about their learning gap.

  2. I totally steam rolled yesterday. Will need to do better. Thanks, Rob!

  3. How do you get them to buy in? as a resident in a surgical specialty, I'd love the EM residents to give better referrals, but often they want nothing more than to sell the patient and move the meat.

  4. This was very informative and helpful. Thanks so much for posting. You are a darling. Love your blog !