2007; 29: 323–327

Student perceptions of the one minutepreceptor and traditional preceptor models

ARIANNE TEHERANI1, PATRICIA O’SULLIVAN1, EVA M. AAGAARD2, ELIZABETH H. MORRISON3

& DAVID M. IRBY1

1Department of Medicine and Office of Medical Education, University of California, San Francisco (UCSF), 2Department ofMedicine, Denver Health Sciences Center, University of Colorado, 3Department of Family Medicine, University of California,Irvine, School of Medicine, USA

Abstract

Background: The one-minute preceptor (OMP) model was developed to effectively and efficiently teach learners while

simultaneously addressing patient needs. This study was conducted to determine if third- and fourth-year medical students prefer

the OMP model over the traditional precepting model and what teaching points they needed from the clinical encounters.

Methods: Third- and fourth-year students (N¼ 164) at two medical schools completed a questionnaire and prompts on teaching

points in response to viewing two videotaped precepting encounters. Differences between OMP and traditional precepting scores

were computed using a factorial repeated measures analysis of co-variance (ANCOVA). Teaching points were coded and counted.

Results: Students preferred the OMP precepting model to the traditional teaching model (p¼ 0.001). While the desired teaching

points changed as the case presentation/discussion progressed, students were most interested in learning about the clinical

presentation or natural progression of the disease regardless of teaching model used.

Conclusions: Students rate the OMP as a more effective model of teaching than the traditional model. The teaching points desired

by students change as the case presentation/discussion unfolds.

Work carried out at: University of California, San Francisco, Office of Medical Education and University of California, Irvine,

Department of Family Medicine

Introduction

Teachers in the ambulatory care setting are pressed for time,

living with the tension between efficiently caring for patients

and making time for teaching in the context of a busy clinical

practice. Learners, on the other hand, must receive enough

guidance, instruction and feedback to learn from this

apprenticeship. Consequently, the case presentation and

discussion with the faculty member play a vital role in patient

care and instruction, not only as a means of critical information

transfer between learner and teacher, but also as a way for

learners to demonstrate their clinical knowledge and skills

(Kim et al. 2005).

Traditionally, case presentations and discussions are used

by the preceptor to verify findings and ensure appropriate

patient care; preceptors acting primarily as expert consultants

to learners and providing relatively little instruction. The one-

minute preceptor (OMP) model was developed to simulta-

neously diagnose the patient and the learner’s thinking process

in a time efficient manner to target teaching without

compromising patient needs (Neher et al. 1992; O’Malley

et al. 1999). The OMP model proposes five micro-skills:

(1) get a commitment from the learner about what (s)he

thinks is going on with the case;

(2) probe for underlying reasoning to explore the learner’s

understanding;

Practice points

. Students and preceptors prefer the OMP to the

traditional model of precepting for learning.

. Teaching points preceptors make should be determined

in the context of a case and what students feel they

would like to know.

. Students desire the same teaching points that preceptors

would normally share, focusing initially on diagnostic

reasoning and subsequently on evaluation and treatment.

Correspondence: Arianne Teherani, PhD, University of California San Francisco School of Medicine, Office of Medical Education, 521 Parnassus

Ave. Room C-254, San Francisco, CA 94143-0410. Tel: 415-514-2280; fax: 415-514-0468; email: arianne.teherani@ucsf.edu

ISSN 0142–159X print/ISSN 1466–187X online/07/040323–5 � 2007 Informa UK Ltd. 323DOI: 10.1080/01421590701287988

(3) teach general rules pertaining to the case;

(4) provide positive feedback for what the learner

did correctly;

(5) correct learner’s errors and make recommendations for

improvement.

Studies of the OMP have focused primarily on preceptor

perceptions and behaviors. Preceptors perceive the utility of

the OMP model and report being better able to rate learner’s

abilities and more confident in their ratings of videotaped OMP

interactions compared to traditional interactions (Aagaard

et al. 2004). Preceptors’ feedback behaviors improved after

participating in an OMP faculty development program (Salerno

et al. 2002). Residents and students rated residents trained

in the OMP higher than control residents on getting a

commitment, providing feedback and motivating learners to

do outside reading, but no different in overall teaching

effectiveness (Furney et al. 2001). Since student satisfaction

is associated with greater motivation to learn (Forrest 2004),

we wondered if students would find the OMP model more

satisfying than the traditional precepting model; a finding that

might encourage preceptors to use the model.

Further, we wondered if there was congruity between what

and how preceptors taught in particular cases and what

students wanted to learn. In a prior study, we obtained faculty

teaching scripts for these two cases and sought to compare

student learning needs to the teaching scripts used in

precepting these cases (Irby et al. 2004). Teaching scripts

consist of three to five teaching points which guide the

interaction between the preceptor and learner (Irby et al.

2004). In the OMP model, the preceptor addresses the

teaching points starting at Step 3 (teach general rules) building

upon the exchange between preceptor and learner during Step

1 (get a commitment) and 2 (probe for underlying reasoning).

The purpose of this study was to examine, from the medical

student point of view, (1) if the OMP model of precepting is

preferred over the traditional precepting model, and (2) what

teaching points students would want to receive during and

after the OMP and traditional teaching encounters.

Methods

Sample and Design: This study was conducted in the spring of

2004 on a sample of 164 third- and fourth- year medical

students at the University of California, San Francisco (UCSF)

and the University of California, Irvine (UCI). Both groups

were sufficiently experienced with clinical settings to judge

their own learning needs, preceptors’ teaching abilities, and

the quality of precepting encounters. We recruited the third-

year students at UCSF and all fourth-year students during

sessions in which the entire class was present. The third-year

students at UCI were recruited during the orientation for the

last clerkship of their third year. Human subjects committees

at both universities approved this study. Students viewed a

videotape of one preceptor in two equally long precepting

encounters involving two different third-year medical students

and two different clinical scenarios. Students recorded desired

teaching points and rated the precepting viewed in the model.

Intervention: The first video clip that students watched

portrayed the traditional precepting model and showed a

student presenting a case of a 40-year old man with a chief

complaint of acute chest pain that emerged the evening prior

to his visit, with a final diagnosis of hiatal hernia and

gastroesophageal reflux (GERD). The second video clip

portrayed the OMP model and the student presented a

34-year old woman with a subacute onset of shortness of

breath the morning of her visit with a final diagnosis of a small

spontaneous pneumothorax. Both cases had a ‘serious’

medical condition in their primary differential diagnosis,

acute myocardial infarction in the first case, and pulmonary

embolism and pneumothorax in the second case.

We created the scripts for both cases based on real student-

preceptor interactions that have been used in standardized

patient encounters at UCSF. In the traditional precepting

encounter, after the case presentation by the student, the

preceptor inquired about the patient data and then discussed

the case and plan for patient care. That is, the preceptor asked

a series of questions that focused on understanding what was

going on with the patient (e.g. Does the patient have pain? Did

you ask if the patient was a smoker?). In the OMP video, after

the case presentation by the student, the preceptor followed

the five OMP micro-skills asking the student first, what she

thought was going on with the patient (e.g. What do you think

is going on? What lead you to that conclusion?). In the

traditional model, the preceptor asked questions to make her

own diagnosis of the patient problem. In the OMP, the

preceptor asked questions to reveal the students’ thinking and

then followed up with questions to clarify patient care issues.

The cases were selected based on their minimal complexity

and their association with a fairly narrow differential diagnosis.

Both encounters were 3–4 minutes in duration, which is typical

of most case presentation/discussions (Irby 1992). Upon

request from the first author, the scripts and recorded

encounters are available for use.

In two earlier studies we used these same two cases

(Aagaard et al. 2004; Irby et al. 2004). In our prior research, the

order of cases and models were alternated and no order or

interaction effects were found. Therefore a single order was

used for administration of the tapes in this study and a single

case for each type of precepting. Thus, the students would not

be influenced by repeated observation of the same clinical

case with a different teaching model.

Measures (Perception of Precepting Model): We con-

structed 10 five-point Likert items to determine: (1) the

preceptor’s ability to rate the knowledge and clinical reasoning

of the student in the video, (2) the preceptor’s ability to teach

key points, involve the student in the decision making process,

and provide (positive and corrective) feedback to the student

in the video, and (3) the effectiveness, efficiency of, and

satisfaction with the teaching encounter. We developed items

based on prior OMP studies (Aagaard, et al. 2004; Furney

et al. 2001; Neher et al. 1992).

We conducted a principal components factor analysis to

determine the dimensionality of the scale. Factors with eigen

values greater than 1 were retained. Items with factor loadings

of 0.5 were considered significant for this sample size (Stevens

1996). Factor analysis indicated two factors accounting for 51%

A. Teherani et al.

324

of the variance. The individual questionnaire items, means and

standard deviations, and their factor loadings are displayed in

Table 1. The factors related to (1) the traditional/GERD

teaching scenario (31% of variance explained, �¼ 0.93) and

(2) the OMP/PNX teaching scenario (20% of variance

explained, �¼ 0.82). This confirmed that the questionnaire

was unidimensional.

We also reviewed the factor loadings to determine

if students saw the same type of precepting within each

case. The factor loading varied between the two sets of ratings.

When reviewing the mean ratings (see Table 1), we noted that

within the traditional precepting case the highest rating was

given to efficiency of the teaching encounter and for the OMP

the highest rating was given to the overall effectiveness of the

teaching encounter. Taken together, these data suggest that

the learners in their responses to the items distinguished

between precepting models rather than cases. Therefore, we

calculated two student perception scores, one for each model.

Teaching points: We asked the learners to write down at

two points in each precepting session what they thought the

student would have wanted to learn at that point. These

statements were coded and counted as teaching points.

Procedures: The videotapes were stopped at the end of the

students’ patient presentation (stop 1) to ask what students

thought were the two most likely diagnoses for the patient and

what teaching points they would have wanted to learn had

they been the student in the encounter. After the tape was

resumed the preceptor asked questions and instructed using

OMP or traditional precepting techniques. Once the instruction

was complete, the students again identified what teaching

points they wanted to learn and completed the perceptions of

teaching model scale for the model they had just observed

(stop 2).

Analysis: We calculated descriptive statistics to provide

percents, means and standard deviations. We used chi-square

and one-way analysis of variance (ANOVA) to compare

participants between the two schools. Differences between

OMP and traditional precepting scores were computed using

a factorial repeated measures analysis of co-variance

(ANCOVA). The between subjects factors was year in school

and the within subjects factor was precepting model. The

perception score was the dependent variable. To account for

institutional differences, institution was included as a covariate

in the repeated measures ANCOVA. Twenty fourth-year

Table 1. Questionnaire items and their respective factor loadings comparing medical student perceptions (n¼ 164) of the one minutepreceptor vs. traditional precepting.

Items* Loading

Traditional Precepting (Gastroesopheageal reflux disease clinical scenario) Mean (SD) Factor 1 Factor 2

Traditional: Ascertain the student’s diagnosis 2.61 (1.44) 0.758 �0.155

Traditional: Assess student’s underlying clinical reasoning 2.44 (1.18) 0.867 �0.159

Traditional: Assess student’s fund of knowledge 2.41 (1.11) 0.835 �0.078

Traditional: Teach the student a few key points for use in future patient care 3.76 (1.04) 0.590 0.184

Traditional: Provide positive feedback to reinforce what was done well 2.19 (1.17) 0.841 �0.041

Traditional: Provide constructive feedback with recommendations for improvement 2.06 (1.15) 0.831 �0.057

Traditional: Involve student in the decision-making process 1.89 (1.15) 0.856 �0.025

Traditional: The efficiency of this teaching encounter 3.45 (1.04) 0.565 0.244

Traditional: The overall effectiveness of this teaching encounter 2.87 (0.96) 0.832 0.088

Traditional: Overall satisfaction with the teaching encounter 2.93 (0.98) 0.848 0.116

One Minute Preceptor Precepting (Pneumothorax clinical scenario)

OMP: Ascertain the student’s diagnosis 4.58 (0.74) �0.125 0.606

OMP: Assess student’s underlying clinical reasoning 4.46 (0.74) �0.037 0.658

OMP: Assess student’s fund of knowledge 4.24 (0.82) 0.096 0.606

OMP: Teach the student a few key points for use in future patient care 4.64 (0.58) �0.025 0.623

OMP: Provide positive feedback to reinforce what was done well 4.62 (0.65) �0.072 0.554

OMP: Provide constructive feedback with recommendations for improvement 4.38 (0.82) 0.081 0.547

OMP: Involve student in the decision-making process 4.24 (0.81) �0.026 0.526

OMP: The Efficiency of this teaching encounter 4.57 (0.65) 0.119 0.510

OMP: The overall effectiveness of this teaching encounter 4.70 (0.51) �0.006 0.719

OMP: Overall satisfaction with the teaching encounter 4.61 (0.52) 0.023 0.706

*The first 7 items for each video clip were rated on a 5-point Likert-type scale as follows: 1¼ poor, 3¼good; 5¼ excellent. The Effectiveness, efficiency and

satisfaction items were rated on a 5-point scale as follows: 1¼ not very efficient/effective/satisfied; 3¼ somewhat efficient/effective/satisfied; 5¼ very efficient/

effective/satisfied.

Student perceptions of the OMP

325

students at UCI had participated in an elective on teaching in

the clinical setting. To control for possible differences, elective

participation was included as the second covariate in the

analysis.

Teaching points were coded by one investigator (AT) using

codes developed in an earlier study (Irby et al. 2004). Another

investigator (EA) selectively checked the coded teaching

points to ensure accuracy and consistency of coding. The

concordance between the two raters for the selectively coded

teaching points was 90%. Differences were reconciled through

discussion. We reported percents and order of teaching points.

Results

One-hundred sixty four medical students participated in the

study, 55% from UCI and 45% from UCSF. A typical participant

was female (53%), fourth-year (66%), and 28 years old. The

students who participated in this study were older than most

graduating medical students.

Chi-square analyses indicated that student age and

gender did not differ by institution or by year in medical

school. One-way ANOVAs indicated no differences by age or

gender on students’ ratings of the traditional vs. OMP

case which differs from the results of others (Distlehorst

et al. 2005; Joyce et al. 2006). Therefore, we did not include

age or gender as covariates in the repeated measures

ANCOVA.

Repeated measures ANCOVA results indicated a significant

effect of precepting model (F¼ 20.77, df¼ 153, p¼ 0.001,

eta¼ 0.89). There were no differences between 3rd and 4th

year students in their preference for precepting model and no

interaction effects between year and model. Students preferred

the OMP precepting model (M¼ 4.52, SD¼ 0.40) to the

traditional teaching model (M¼ 2.64, SD¼ 0.85). A review of

Table 1 indicated higher mean ratings for all items for OMP

compared to the traditional model.

Students listed 325 diagnoses for the traditional model

(GERD/hiatal hernia) and most (93%) identified the correct

diagnosis. For the OMP model (pneumothorax), 320 diagnoses

were generated and 57% of the students listed the correct

diagnosis.

The teaching points requested by students were similar

across cases. The top three teaching points at each stop

accounted for 55–63% of the total teaching points cited and

were the focus of the analysis. At the end of the student

presentation (stop 1) in the traditional model, students listed

303 teaching points and the top three of all teaching points

listed were: the presentation of the disease (22%), creating

a differential diagnosis (20%) and history taking skills (18%).

For the OMP model (stop 1), students listed 291 teaching

points and the top three were: creating a differential diagnosis

(26%), history taking skills (16%) and the presentation of the

disease (13%).

At the end of the case discussion for the Traditional model

(stop 2), the top three desired teaching points (276 teaching

points total) were: diagnostic tests (28%), therapy (23%) and

the presentation of the disease (12%). For the OMP model

(stop 2), the top three teaching points (222 teaching points

total) were: the presentation of disease (21%), diagnostic tests

(20%) and therapy (15%).

Discussion

This study explored medical students’ perceptions of two

different precepting models and we found that students clearly

preferred the OMP model, but desired essentially the same

teaching points regardless of model. Students in this study and

preceptors in our prior study valued complementary features

of the OMP model (Aagaard et al. 2004). Preceptors felt more

confident in their ability to rate students’ knowledge and

clinical reasoning skills when using the OMP model. Students

appreciated the OMP for the quality of feedback it provided

and that it involved students in the decision making process.

This study is in line with findings from earlier studies that the

OMP model is effective in enhancing feedback (Furney et al.

2001; Salerno et al. 2002). Moreover, OMP model instructional

strategies support recommendations for improving clinical

judgment by actively involving students in the patient care

decision-making process. (Marckmann 2001).

During two teaching encounters, third and fourth year

medical students were concerned most about learning the

natural progression of the disease. The teaching points most

desired by students changed during the course of the teaching

encounters from history taking and creating a differential

diagnosis early on to diagnostic tests and therapy at the end.

This follows the natural flow of the presentation and

discussion process from diagnostic reasoning to selecting

tests and treatment options. The top three teaching points

desired by students did not differ by teaching model or case

even though the relative order shifted.

Students were more likely to identify the correct diagnosis

for the GERD case and were most interested in the steps

following diagnosis (i.e. diagnostic tests and therapy). Whereas

at the end of the teaching encounter in the more difficult

pneumothorax case, students were interested in diagnostic

tests but were still concerned about understanding the

presentation of the disease. Thus, the more complex the

case, the more that the diagnostic issues predominate and

serve as the focus for instruction.

The OMP model is a student-oriented, patient-centered

method that helps make the student’s learning needs visible

for teaching purposes. This is made possible by the first two

steps in the OMP model: to find out how the student thinks

about the case and to delve into the learner’s underlying

reasoning and knowledge base, in order to target teaching to

the learner’s gaps in knowledge or errors in reasoning. An

alternative learner-centered strategy would be to encourage

students themselves to raise uncertainties, difficulties, and/or

alternative approaches as focal points for instruction (Wolpaw

et al. 2003).

In this study, we asked students to report teaching points

that they desired to learn, which made the teaching points

visible and comparable with what the preceptors in our prior

study reported they would teach around these same cases

(Irby et al. 2004). We found congruence between what

students want to learn and what preceptors typically teach

regarding history taking skills, differential diagnosis, natural

A. Teherani et al.

326

presentation of disease, diagnostic tests and therapeutic

options. These teaching points provide students with a solid

foundation of understanding about the case and are essential

for the development of their clinical reasoning abilities.

However, preceptors also typically teach about case presenta-

tion skills and physical examination skills that are needed to

effectively function in the clinical environment. Thus, pre-

ceptors should address student’s needs to understand the case

and provide a rationale for the importance of broader skill

development.

There are some limitations to this study. It did not address

actual learning or impact on patient care. While we did not

have actual measures of previous precepting experience for

these students, we used level of education as a proxy and

found that preference for precepting model was not affected

by level of education (3rd vs. 4th year). Another limitation was

that the clinical case associated with the OMP model was more

difficult to diagnose than the traditional case; however, the

ratings and factor analysis appear to support the argument that

students were rating the precepting model rather than the case.

Also, in the original preceptor studies, multiple variations of

the clinical scenarios and teaching encounters did not affect

outcomes (Aagaard et al. 2004; Irby et al. 2004).

The strength of this study is that it examined thoroughly the

medical student perspective on the OMP. Moreover, the study

portrayed the OMP model in a pure form using a controlled,

standardized videotaped encounter. Future research on the

OMP should compare how well the first two steps of the OMP

model diagnose learning deficiencies to students’ own reports

of what they want to learn. This will ascertain the circum-

stances under which the OMP produces optimal learner

outcomes. Learning outcomes of the two models and the

extent to which the OMP model is time efficient when put into

practice in the clinical setting also require more investigation.

Conclusion

Students, like preceptors, prefer the OMP model to the

traditional precepting model. Teaching points preceptors

make should be determined by the nature of the case and

the identified student learning needs. Preceptors can be

reassured that students desire similar teaching points to what

they would normally share, focusing initially on diagnostic

reasoning and subsequently on evaluation and treatment.

Notes on contributors

ARIANNE TEHERANI, Ph.D. is Assistant Professor in the Office of Medical

Education and Department of Medicine at the University of California,

San Francisco. Her research has focused on learning in the clinical setting

and professionalism.

PATRICIA O’SULLIVAN, Ed.D. is Associate Director for Educational

Research and Professor of Medicine at the University of California.

Her research focuses on clinical assessment and faculty development.

EVA M. AAGAARD, M.D. is the Associate Vice Chair for Education is at the

University of Colorado Denver Health Science Center. Her research

interests include teaching and mentoring in the outpatient setting,

curriculum development, and patient education.

ELIZABETH H. MORRISON, M.D. serves on the family medicine faculty at

the University of California, Irvine. Her research to date has focused on

clinical teaching. As a Robert Wood Johnson Foundation Generalist

Physician Faculty Scholar from 2000–2004, she completed a randomized,

controlled trial of an interdisciplinary residents-as-teachers curriculum.

DAVID M. IRBY, Ph.D. is Vice Dean for Education and Professor of

Medicine at the University of California, San Francisco. As a Senior Scholar

at the Carnegie Foundation for the Advancement of Teaching, he co-directs

a national study on the professional preparation of physicians.

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