Ask her to commit
The first microskill is a commitment, and it comes before your own opinion. What do you think is going on. Then what would you do about it. A student who is never asked to commit will hedge for two minutes, list findings in the order she happened to collect them, and hand the decision back to you. A student who has to name a diagnosis exposes her reasoning, and reasoning is the only part of her you can actually teach.
Hold the silence after you ask. Four seconds feels long in a corridor, and that is where the answer comes from. If she says she is not sure, narrow the question rather than answering it: what are the two most likely, and which do you favour. Do not rescue her with the diagnosis. A commitment you supplied teaches nothing, and by week three she will stand there waiting for it every time.
Probe for the evidence
Second microskill: ask what supports the answer she just gave. What made you land there. On the sore throat, the useful probe is what she considered and set aside. If she says viral pharyngitis, ask what moved her away from a bacterial cause and what she would need to see to change her mind. You are not quizzing her on criteria she can look up. You are asking her to show the path she walked.
The probe catches two different problems, and it matters which one you have found. Sometimes the reasoning is sound and the data is thin, which means she needs to go back and ask two more questions. Sometimes the data is complete and the reasoning skipped a step, which means she needs a rule rather than more history. The teaching that follows differs in each case, so probe before you decide what to say.
Teach one rule, not five
Third microskill: give her one general rule she can carry into the next patient. One. Not a differential, not a paper, not the whole topic. Make it portable and short enough to repeat back: which cases need a score before a test, when a negative rapid test still earns a culture, how to word a return precaution so the patient actually hears it. The rule works precisely because it is small.
Preceptors overrun this step more than any other, and it is understandable. You know a great deal, and she is standing right in front of you. But a rule delivered inside a four-minute lecture arrives at the same moment as the next patient's chart and does not survive the trip. Say the rule, ask her to say it back in her own words, then open the door. She will still have it on Thursday.
Reinforce, then correct
Fourth microskill: reinforce something specific she did. Specific means the behaviour and its effect, in one sentence. You asked whether she could swallow fluids, and that answer is what told you she is not dehydrated. That sentence teaches. Good job teaches nothing, and students discount it inside a week because they can hear that it is filler rather than observation. This is the step that gets skipped when the clinic is running behind, and the ten seconds it saves cost more than they are worth, since a student who never learns which moves worked is guessing about what to repeat.
Fifth microskill: name the error and the fix in the same breath, in private. You did not ask about the rash on her trunk. On a sore throat with fever, ask about rash every time, because it changes what you are looking at. Behaviour, correction, reason. No preamble and no compliments stacked around it. Timing beats gentleness here: an error named thirty seconds after it happened is a technical note, while the same error raised at the midpoint is a verdict, because by then she has repeated it thirty times.
The exchange, start to finish
Here is the whole thing in the corridor, on the sore throat, at about ninety seconds. Read it as five moves rather than a script, because the words change with the case and the order does not. Notice that you speak four times and none of your turns runs longer than two sentences.
Two habits make it hold. Ask for the commitment before you say your own answer out loud, and keep the rule to a single sentence. Then let her write the note while it is fresh. For the other format worth learning, the one where the student runs her own presentation and you mostly listen, see SNAPPS. If you are still weighing whether teaching fits your clinic day, the rotation itself is laid out on precepting NP students.
- You: What do you think this is, and what would you do about it?
- Student: Viral pharyngitis. Supportive care, fluids, and a note for work.
- You: What moved you away from a bacterial cause?
- Student: No exudate, the nodes are soft, and she has a cough.
- You: The rule is that fever with a sore throat gets a rash question every time.
- You: Asking about swallowing fluids is what settled the dehydration question. Add the rash next time.
If ninety seconds between rooms is time you can find, <a href="/apply/">open your hours</a> and take one student this term.
Apply to preceptQuestions
What is the one-minute preceptor?
A five-step teaching method for the short exchange between patients. Get the student to commit to a diagnosis, probe for the evidence behind it, teach one general rule, reinforce something specific she did well, and correct one error. The whole sequence fits in about ninety seconds, which is why it survives in a full clinic where longer teaching does not.
Why ask a student to commit before giving your own opinion?
Because the commitment is the only clear view you get of her reasoning. A student who hears your assessment first will present the findings that support it and quietly drop the ones that do not, and you learn nothing about how she thinks. Asking for a diagnosis and a plan first shows you where the actual gap is, which decides what you teach.
What if the student says she does not know?
Narrow the question instead of answering it. Ask for the two most likely possibilities and which she favours, or ask what she would need to know in order to choose. If she still cannot commit, that itself is information: she is short of data, short of a framework, or short of nerve. Supplying the answer removes your only chance to find out which.
How is the one-minute preceptor different from SNAPPS?
The one-minute preceptor is driven by the preceptor, who asks the five questions in order. SNAPPS is driven by the learner, who summarises, narrows the differential, analyses it, asks her own questions and proposes a plan. Use the first with a new student, and move to the second once she can structure a presentation without help.
Does teaching this way slow the clinic down?
Less than you would expect once the first fortnight is over, because the exchange is bounded. Five moves and one rule take roughly ninety seconds, and a student who knows the shape of it arrives with an assessment and a plan rather than a narrative. The expensive part of precepting is the opening two weeks, not the method you choose.
Sources: AANP: Precepting With Purpose
Tamsin R., DNP, FNP-BC
Reads every application and every midpoint evaluation. Has precepted FNP students in a rural family practice since 2014 and still takes one a term. Writes the teaching-method pieces in Off the Clock.