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Module 3

Module 3 — Sharpening Your Precepting Skills

Overview and Objectives

Effective precepting, like effective teaching, is all about facilitating learning — challenging students to think and reason critically. Teaching skills, like all skills, are learned. You have already gained valuable teaching experience in providing care to patients. And, if you’ve served as a preceptor, you’ve learned a lot about how to interact with students. In order to make the best, most effective use of your time, we suggest you explore some of the precepting models found in the literature.

When you’ve finished this module, you will be able to:

  1. Compare the One-Minute Preceptor Model to the SNAPPS Model (PDF)
  2. Evaluate where your student is in the learning process and apply the appropriate strategies to fit the student’s progression in the program
  3. Use effective communication skills in guiding your student during the clinical experience

Module 3 Learning Activities

  1. Read Introduction to Preceptor Models section below and read the article “Positive Precepting: Identifying NP Student Learning Levels and Needs” (PDF)
  2. Read the One-Minute Preceptor Model, including the One-Minute Preceptor Microskills, and watch video: The One-Minute Preceptor: Primary Care Setting.
  3. Read the SNAPPS Model (PDF) and watch its video
  4. Read Using Effective Questioning Strategies
  5. Read Putting It All Together and watch Novice to Expert (video)
  6. Assignment: Module 3 Case Study Reflection
  7. Review additional preceptor resources: Optional reading

Introduction to Preceptor Models:
Why Are They Important and How Can They Be Helpful?

Research has shown an improvement in clinical reasoning when systematic and structured preceptor methods are used by preceptors in their clinical practice. It also suggests that resources such as evidence-based tools may help enhance preceptor teaching skills without impacting the busy lives and schedules of practitioners (Bazzell & Dains, 2017).

There are several models, or guides to follow, that have been used in clinical education. For the purposes of this course, we want to focus on two that preceptors and students have rated to be useful and preferred: The One Minute Preceptor (OMP) Model and the SNAPPS Model (PDF). These models, based on the case presentation approach, were developed in medical education, but have great application to NP education as well. They are particularly adaptable to primary care settings because they:

  • Capitalize on the variety of rich experiences encountered
  • Consider time constraints in a busy clinic
  • Encourage learner initiation
  • Facilitate preceptor interaction
  • Promote critical thinking in an active conversation (Neher et al., 1992; Wolpaw et al., 2003).

Read the article, “Positive Precepting: Identifying NP Student Learning Levels and Needs” (PDF)

The One-Minute Preceptor Model

The One-Minute Preceptor model was developed by family practice physicians in 1992 as a way to adapt clinical education of medical residents to a clinic setting.  According to the literature, it is considered to be an effective method of guiding NP students through their clinical experiences (put several references that confirm this here). It provides a succinct and efficient way for students to organize their thoughts about a case, and to gain confidence in discussing it. Most importantly for the preceptor, it encourages effective use of your time in guiding the student. The OMP utilizes five simple teaching behaviors, or microskills to guide students in thinking through a patient encounter.

The SNAPPS Model

The SNAPPS model was also developed to address issues arising from the unique character of medical education in the outpatient setting that could not be solved with traditional inpatient approaches (Wolpaw et al., 2003). It has been applied successfully in NP education, and engages the student directly to identify learning needs in the context of the patient being seen, and to take an active role in the learning process. Students use a process that follows six steps to guide the student in presenting a patient case to the preceptor, In the video attached to this module, below, the SNAPPS model is described. The model’s steps are summarized in the attached PDF document, and brief examples of each are provided.

Please take a few minutes to view the video and to learn more about the SNAPPS model.

Video: The SNAPPS Model – A Framework for Preceptors

Read the SNAPPS Model (PDF) to learn more about its steps. It provides an overview of the model as well as descriptions and examples of each step.

Using Effective Questioning Strategies

I cannot teach anyone anything; I can only make them think.

Socrates

One of the most valuable strategies when facilitating the development of clinical reasoning is effective use of well-thought out questions. According to the Cornell University Center for Teaching Excellence, effective questions are meaningful and understandable to students. In the clinical setting, preceptors can stimulate creative and critical thinking through effective questions, and the result can be a more disciplined pattern of thinking. Following are some suggested question formats to use with students when you perceive the need to challenge a student to go a bit deeper in thinking through a clinical situation or problem.

Effective Questions: A List

  1. What do you think is going on here?
  2. When have you seen these symptoms before?
  3. What similarities are there between this patient and ______?
  4. How is this situation like ______?
  5. What would you do to confirm that?
  6. Are there other reasons that could be happening?
  7. What are the alternatives to that plan?
  8. What are the consequences of that plan?
  9. How does ______ affect ______?
  10. What could we assume instead?
  11. What are some alternative explanations?
  12. How can you verify or disprove that assumption?
  13. What would happen if ______?
  14. Tell me what you’re thinking.
  15. What would cause that to happen?
  16. What are the consequences of doing that?
  17. What is the meaning of _______?
  18. What makes you think that?
  19. How did you arrive at that conclusion?

Putting it All Together:
Applying the Models to the Student’s Level of Experience from Novice to Expert

Pearson & Hensley (2019) explored the importance of understanding where your student is in his/her level of learning and explained that applying methods of teaching to that level, helps to facilitate experiential learning. The authors applied Benner’s Novice to Expert model to NP student learning progression, and provided recommendations on adjusting teaching style to meet those needs. According to Patricia Benner, work experience has a major impact on the development of expert thinking in nursing. The results of her work suggested a continuum of expertise based on number of years of work, and described the differences in thinking based upon number of years of work in nursing and specific experiences. According to Benner, graduate nurses (novice stage on the continuum) are not capable of thinking at the same level as nurses with more than five years of work experience and who are thus at the highest stage on the continuum — expert thinking. Advanced practice students, while having gained experience as registered nurses, are not experienced as nurse practitioners and are thus functioning in a novice role. Instructors and preceptors, as proficient or expert nurses, can assist NP students by remembering that they, too, were once novices, and their current thinking is different from novice thinking. Proficient and expert nurses should further realize that students cannot be expected to perform at the expert level.

Watch the video below to learn more about the differences between novice to expert thinking, and strategies for addressing student learning needs based on levels of experience.

Video: Benner’s Novice-to-Expert Theory

Case Study: Think About It

This case study is an opportunity for you to think about some of the things you’ve read and videos you’ve watched thus far. There are no right or wrong answers, but you are encouraged to reflect and think about how you can use some of the strategies presented.

Scenario: A patient is scheduled for a visit with her provider. You have been precepting LuAnn, a FNP student in her third clinical course, for about 8-9 weeks, and have developed a rapport with her.  You ask LuAnn to see the patient. After the encounter, LuAnn presents the following to you:

“Ms. Z is a 58-year-old female who fell on her stairs about 3 days ago. At first she only thought it was bruised but now it really hurts and she says she needs an xray. I think she hit her head, but I’m not too clear on that. She’s been taking ibuprofen, and she’s had trouble sleeping since it happened. She says she was trying to write a grocery list, but her hand “wouldn’t work” — she is left-handed, so falling on her left hand caused her a lot of distress. Physical exam shows bruising on her left shoulder, which is weak and painful — she can’t lift her arm more than a few inches. Left biceps reflex is 3+. Her vital signs are normal, except that her BP is a bit elevated.”

Please reflect on the following two questions:

  1. Reflecting on the One-Minute Preceptor model, how would you apply the 5 Clinical Microskills in responding to LuAnn’s presentation of the case?
  2. What are your main concerns, given she is at least halfway through her third clinical course?

Adapted from: Farrell, S., E., Hopson, L. R. Wolff, M, Hemphill, R. R., &Santen, S.A. (2016). What’s the evidence: A review of the one-minute preceptor model of clinical teaching and implications for teaching in the emergency department. The Journal of Emergency Medicine, 51(3), 278-283.

Additional Preceptor Resources (Optional)

As your preceptor role evolves, it is important to have sources of information that you may refer back to.  Please take a moment to follow the links provided so that you may familiarize yourself with resources that are available. We have also provided a video that contains some great information regarding precepting. This video does require a passcode, please note that it is listed by the video link.

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