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Microskill #2 - Getting a Commitment

The most effective and enduring clinical learning occurs when the learner collaborates with an experienced clinician-teacher to benefit the patient. Collaboration requires the learner to risk articulating his/her opinions as the basis for the learning, rather than waiting to receive the conclusions of the teacher.

The learner must feel safe enough to risk a commitment – even if it is wrong.

Commitment usually needs the preceptor to ask questions beginning with "What…."

The Issue

How to Ask for a Commitment

Differential diagnosis

What....? (do you think is going on or is most likely?)

Diagnostic strategy

What....? (investigations should be ordered?)

Selection of therapy

What....? (is your first choice of medication?)

Prognosis

What....? (do you think is probably going to happen?)

Management issue

Why....? (do you think this patient is non-compliant?)
What....? (would you like to achieve this visit)

Quote

In asking these questions, the words are only part of the total communication. The preceptor’s tone and body language must convey that a reasonable professional opinion is expected from the learner.

When the learners know from the beginning that the preceptor will take this approach, they improve their data-gathering and focus early on problem identification.

Difficulty or unwillingness to make a commitment could be due to:

  • Incomplete or contradictory data
  • Knowledge gaps or errors obscuring clinical picture
  • Passive, immature learning style
  • Fear of making mistakes or exposing weakness
  • Fear of you!!

An important caution: students from some non-US cultures may need extra encouragement as the student offering an opinion first could be interpreted as disrespectful of the teacher.

Forcing the learner to make a commitment enables learning to occur.

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Community-Based Teaching Benefits - Strategies for Teaching in a Busy Practice
The Precepting Microskills - Observation and Feedback - Bedside Teaching
What is Evidence-Based Medicine? - Teaching Evidence-Based Medicine
The Ten-Minute Talk - Strategies Home Page

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