Finding time to teach can be challenging in the clinical environment and it is easy to miss valuable teaching opportunities. The Five Step micro skills tool (also known as the one-minute preceptor) is a tool originally developed for teaching in outpatient clinics that can easily be applied to any clinical environment with minimal added time or effort.

1. Get a commitment

Early in the discussion with the learner encourage a commitment to a diagnosis or plan. Example: “What laboratory test do you think we should order to confirm or refute that diagnosis?”

2. Probe for supporting evidence

Explore the learner’s reasoning that led them to their diagnosis or plan. Example: “What elements of the history led you to your diagnosis?”

3. Teach general rules

From the learner’s reasoning, a teaching point will be apparent from gaps in knowledge or integration. Note: In some cases, both the learner and the teacher do not have all the information or the learner has done well and the teacher has nothing to add. In the former, the teacher may explain their method of obtaining the information; in the latter, this step may be skipped. Example: “An ECG should be performed on all patients complaining of dull substernal chest pain.” Example: “I am not sure how to interpret that test either. The best resource in this office would be ______.”

4. Reinforce what was done right

To assist the learner in recognizing skills or techniques employed correctly, comments should be directed specifically at those skills or techniques. Example: “Your complete social history, including his occupation, helped you correctly identify a connection between his symptoms and his workplace.”

5. Correct mistakes

Mistakes made by the learner should be suitably and expeditiously addressed with thought given to the appropriateness of the environment. Example: “I agree the absence of ST-Segment changes on the ECG is reassuring; however, it is early to rule out a cardiac event. In some cases, myocardial infarction and ischemia is not reflected with ST segment changes and we should obtain serial cardiac enzymes and admit this patient for observation to be sure.”

Reference: Neher JO, Gordon KC, Meyer B, Stevens N. A five-step “micro-skills” model of clinical teaching. J Am Board Fam Pract. 1992;5(4):419–424.

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