What do medicine clerkship preceptors do best?

PURPOSE: Students' ratings of preceptors are widely used in medical education for feedback and evaluation purposes. The present study investigated students' ratings of the clinical teaching skills of inpatient attending physicians, inpatient residents, and outpatient attending physicians to assess differences among types of preceptors and relative strengths and weaknesses. METHOD: A total of 268 students from three academic years (1997-2000) at one medical school rated preceptors on an end-of-clerkship evaluation, for a total of 1,680 ratings. When the ratings were aggregated by preceptors' names and types, there were 691 mean ratings of preceptors. Relative strengths and weaknesses were identified. Differences in mean ratings by preceptor type (inpatient attending physician, inpatient resident, and outpatient attending physician) were evaluated, and strengths and weaknesses were identified by rank ordering the items' means. RESULTS: Students tended to rate outpatient attending physicians higher than inpatient attending physicians or residents. Areas where ratings suggested relative strengths included showing an interest in teaching, respecting students' opinions, and being available to students. Areas of relative weakness included increasing physical examination and interviewing skills. CONCLUSIONS: Students' ratings are useful for identifying strengths and weakness for groups of preceptors and, as such, are important sources of information for setting priorities for faculty development efforts.     

Third-year medical students' perceptions of effective teaching behaviors in a multidisciplinary ambulatory clerkship.

PURPOSE: The authors sought third-year medical students' perceptions of ambulatory preceptors' teaching effectiveness across primary care disciplines. METHODS: Third-year students at the University of Pittsburgh School of Medicine spent three-week rotations each in ambulatory internal medicine, pediatrics, family medicine, and an elective. After the 12-week clerkship, students anonymously evaluated the full-time and volunteer preceptors using a five-point Likert-type evaluation (1 = hardly at all; 5 = to a great degree) that had eight items addressing preceptor teaching behaviors, six items on attaining clerkship goals and an assessment of overall teaching effectiveness, the outcome variable of interest. RESULTS: The authors analyzed 276 evaluation forms (58% response rate) collected from July 2001 to June 2002. They found a mean effectiveness rating of 4.4 (SD.9) and no differences between genders, specialties, and faculty appointment types (p >.2 for each). The 14 items were associated with teaching effectiveness in univariate analysis (p <.01 for each). In multivariate analyses, effectiveness was associated with four preceptor behaviors: inspired confidence in medical skills, explained decisions, treated students with respect, and provided a role model (R(2) =.33). Effectiveness was associated with three items about attaining clerkship goals: allowed opportunity for improving clinical skills, practiced ethical medicine, and encouraged evidence-based medicine (R(2) =.20). CONCLUSIONS: Several teaching behaviors and measures of attaining clerkship goals influenced students' perceptions of teaching effectiveness. Involving students in a humanistic but rigorous approach to medicine and being a physician students wanted to emulate seem particularly important. These aspects appear potentially amenable to faculty development efforts.     

What students value: learning outcomes in a required third-year ambulatory primary care clerkship.

PURPOSE: To determine learning outcomes from the students' perspective on the clinical portion of a third-year primary care ambulatory clerkship. METHOD: Over 18 months (December 1994 to June 1996), students at the Medical College of Wisconsin identified what they had learned during the clerkship in each of seven learning settings. Responses were transcribed and a coding dictionary developed. Response frequencies were compared by logistic regression analysis over time and between rural and urban sites. Course goals set by faculty were compared to learning outcomes reported by students. RESULTS: The authors coded 3,030 student outcomes into 48 categories. The top ten learning outcomes by frequency are reported. Logistic regression analysis revealed no significant difference by time of year or by rural versus urban clerkship experiences. Twenty-six of 29 original course goals were congruent with the student-generated outcomes. CONCLUSION: Basic professional knowledge, skills, and attitudes were the learning outcomes most valued throughout the year. Being alone with patients and working with their preceptors were the students' most valued learning settings.     

Applying practical preventive skills in a preclinical preceptorship.

Learning primary care medicine includes learning to apply practical, preventive medicine skills during everyday encounters with patients. The authors relate their experiences with implementing a voluntary, preventive diabetic foot-care program within the Texas Statewide Family Practice Preceptorship Program (TSFPPP). They explain the background of the TSFPPP and their rationale for introducing prevention and selecting diabetic foot care as a first preventive training module. The program's structure, educational materials, and evaluations are described. Of the 158 students and 88 preceptors who were exposed to the program, the authors received evaluations from 86 preceptors and 110 students. Students documented that they had screened and provided foot-care education to 321 diabetic patients. On average, students saved their preceptors 5-10 minutes each time they examined a diabetic patient's feet or provided foot-care education. The students said that the wide variety of preceptors' practices, the time constraints placed upon the preceptors, and the preceptors' own guidelines for the voluntary preceptorship all posed challenges to completing the preventive activities. The preceptors reported that preclinical students could play an important preventive role in their practices; however, to get optimum results from a preventive module, it may be important for students and preceptors to determine which topics are introduced. Using the preceptor's suggestions, the authors are developing a smoking-cessation module.     

From the "what" to the "how": Teaching integrative medicine-related skills to medical students during COVID-19

ObjectiveTo examine the impact of an integrative medicine (IM) course on self-perceived IM-related communication and research skills.MethodsA 3-day mandatory "hybrid" (online and in-person) IM course was held within COVID-19 restrictions for 161 pre-clerkship medical students, with workshops facilitated by mentor healthcare professionals (IM and non-IM) and student-directed tasks. Self-perceived levels of 6 IM-related skills were scored (from 1 to 5) for history-taking; communicating with patients with "alternative" health-beliefs; referral to IM consultations; assessing risks/benefits; and working with non-medical IM practitioners.Results137 students (85.1%) completed pre-/post-course questionnaires, with overall scores improving from pre-course (1.98 ± 0.92) to post-course (3.31 ± 0.63; p < 0.0001), for the entire group and student subgroups (with vs. without prior IM experience). Multivariate analysis found no association between age, gender, primary language or prior experience with IM and improvement in skill scores.ConclusionsThe IM course increased self-perceived skill levels, reflecting the course curriculum and workshops. Further research needs to explore the application of these skills during clinical training.Practice implicationsTeaching medical students about IM in a course comprising communication and research skills was shown to be feasible and effective. The application of IM-related skills needs to be evaluated during the clinical clerkship.     

A primary care preceptorship for first-year medical students coordinated by an Area Health Education Center program: a six-year review.

In 1991, the University of Florida College of Medicine established a required primary care preceptorship coordinated by the Area Health Education Center (AHEC) Program for all students in the first semester of medical school. Six years' experience with this course, which is entirely community-based and taught by community physicians, provides evidence of the success of the preceptorship. Over the first six years, 97% of students and 92% of preceptors felt strongly that this was an appropriate and valuable experience for students in the first semester of medical school. All believed that the students were capable of interacting with patients in a meaningful fashion and that the course allowed students to gain confidence as health care providers. The course also reinforced the importance of the basic science curriculum and initiated the process of professional development by affirming students' decisions to pursue a career in medicine. The use of content analysis to further evaluate attitudes and behaviors indicated that the students were highly satisfied with their experience and were active participants in the preceptors' practices. Students' approach to patients as people, rather than cases, was positive, and increased from the first to the last day of the preceptorship. After six years, this preceptorship has been demonstrated to have a positive and meaningful impact on medical student education and development.     

Perceptions of classroom goal structures, personal achievement goal orientations, and learning strategies

We examined the relations among students' perceptions of classroom goal structures (mastery and performance goal structures), students' achievement goal orientations (mastery, performance, and work-avoidance goals), and learning strategies (deep processing, surface processing and self-handicapping strategies). Participants were 323 5th and 6th grade students in elementary schools. The results from structural equation modeling indicated that perceptions of classroom mastery goal structures were associated with students' mastery goal orientations, which were in turn related positively to the deep processing strategies and academic achievement. Perceptions of classroom performance goal stractures proved associated with work avoidance-goal orientations, which were positively related to the surface processing and self-handicapping strategies. Two types of goal structures had a positive relation with students' performance goal orientations, which had significant positive effects on academic achievement. The results of this study suggest that elementary school students' perceptions of mastery goal structures are related to adaptive patterns of learning more than perceptions of performance goal structures are. The role of perceptions of classroom goal structure in promoting students' goal orientations and learning strategies is discussed.     

A multiple-station test of the teaching skills of general practice preceptors in Flanders, Belgium.

PURPOSE: The Interuniversity Center for Education in General Practice in Flanders, Belgium, supervises its general practice (GP) preceptors so they will meet the quality criteria required for their role in training general practitioners. The author developed a teaching skills assessment test to determine the individual preceptors' competence regarding teaching. The preliminary research described in this article, carried out in 1999, aimed to verify the reliability, validity, and acceptability of that multiple-station test. METHOD: The test consists of seven stations in which simulated teaching situations are portrayed. In the present study, in each station, the GP preceptors (n = 35) had a learning conversation with a standardized GP trainee. The teaching situations were (1) drawing up a learning agenda, (2) leading an advisory conversation, (3) having an exchange of information about practice visits, (4) having a case-related discussion, (5) having a feedback conversation, (6) giving a demonstration of a particular skill or technique, and (7) having an intermediate evaluation conversation. In each station two observers independently scored the preceptors on a five-point scale. RESULTS: The preceptors' scores on the entire test ranged from 30 to 82.7 on a scale whose maximum was 100. The average score was 54.4 (SD, 11.6), and the average scores on the various stations fluctuated between 51.2 and 57.7. The interobserver reliability varied from good to very good for five of the seven stations (Pearson r = 0.77-0.92). The separate stations had a good internal consistency (Cronbach alpha = 0.85). Based on these research results only, the content validity and acceptability of the instrument are good for the GP preceptors in Flanders. CONCLUSIONS: The study findings suggest that the teaching skills assessment test is a reliable instrument, especially fit for screening GP preceptors' teaching skills. However, validation of the instrument needs further investigation.     

The satisfaction, motivation, and future of community preceptors: the North Carolina experience.

PURPOSE: To measure satisfaction and motivation of community-based preceptors, and to examine differences between degree groups of physicians, pharmacists, advanced-practice nurses (nurse practitioners and certified nurse midwives), and physician assistants. METHOD: In spring 2005, the authors mailed a four-page, 24-item survey to all 2,061 community-based primary care preceptors served by the North Carolina Area Health Education Centers system. The survey measured preceptor satisfaction, likelihood of continuing as a preceptor, influence of having students, motivation for teaching, satisfaction in professional practice, satisfaction with incentives, and value of incentives. RESULTS: Response rate was 69.3%, or 1,428 preceptors. Most preceptors (93.0%) reported high satisfaction with their precepting experience, and 90.9% indicated high likelihood of continuing to precept for the next five years. Almost all preceptors (93.7%) reported they were satisfied with their professional life. Many community preceptors (57.2%) were satisfied with incentives. They placed greater value on the intrinsic reasons for precepting (i.e., enjoyment of teaching) rather than extrinsic rewards (such as no-cost online library resources). Degree groups placed differing values on intrinsic and extrinsic rewards. Physicians reported more negativity about the influence of students and regarding aspects of their professional lives. CONCLUSIONS: Tailoring support to better meet individual degree groups' preferences can maximize resources and may encourage preceptor retention. Special attention to physicians' needs may be warranted to avoid decreased preceptor numbers in this at-risk group. Future studies are needed to determine whether these findings are unique to North Carolina, which has a strong infrastructure to support preceptors.     

Is there a relationship between attending physicians' and residents' teaching skills and students' examination scores?

PURPOSE: Faculty development programs and faculty incentive systems have heightened the need to validate a connection between the quality of teaching and students' learning. This study was designed to determine the association between attending physicians' and residents' teacher ratings and their students' examination scores. METHOD: From a database of 362 students, 138 faculty, and 107 residents in internal medicine, student-faculty (n = 476) and student-resident (n = 474) pairs were identified. All students were in their third year, rotating on inpatient general medicine and cardiology services, July 1994 through June 1996, at a single institution. The outcome measure for students' knowledge was the NBME Subject Examination in internal medicine. To control for students' baseline knowledge, the predictors were scores on the USMLE Step 1 and a sequential examination (a clinically-based pre- and post-clerkship examination). Teaching abilities of faculty and residents were rated by a global item on the post-clerkship evaluation. Faculty's ratings used only scores from prior to the study period; residents' ratings included those scores students gave during the study period. RESULTS: Multivariate analyses showed faculty's teaching ratings were a small but significant predictor of the increase in students' knowledge. Residents' teaching ratings did not predict an increase in students' knowledge. CONCLUSION: Attending faculty's clinical teaching ability has a positive and significant effect on medical students' learning.     

The effect of candidates' perceptions of the evaluation method on reliability of checklist and global rating scores in an objective structured clinical examination.

PURPOSE: Process-oriented global ratings, which assess "overall performance" on one or a number of domains, have been purported to capture nuances of expert performance better than checklists. Pilot data indicate that students change behaviors depending on their perceptions of how they are being scored, while experts do not. This study examines the impact of the students' orientation to the rating system on OSCE scores and the interstation reliability of the checklist and global scores. METHOD: A total of 57 third- and fourth-year medical students at one school were randomly assigned to two groups and performed a ten-station OSCE. Group 1 was told that scores were based on checklists. Group 2 was informed that performance would be rated using global ratings geared toward assessing overall competence. All candidates were scored by physician-examiners who were unaware of the students' orientations to the rating system and who used both checklists and global rating forms. RESULTS: A mixed two-factor ANOVA identified a significant interaction of rating form by group (F(1,55) = 5.5, p <.05), with Group 1 (checklist-oriented) having higher checklist scores but lower global scores than did Group 2 (oriented to global ratings). In addition, Group 1 had higher interstation alpha coefficients than did Group 2 for both global scores (0.74 versus 0.63) and checklist scores (0.63 versus 0.40). CONCLUSIONS: The interaction effect on total exam scores suggests that students adapt their behaviors to the system of evaluation. However, the lower reliability coefficients for both forms found in the process-oriented global-rating group suggest that an individual's capacity to adapt to the system of global rating forms is relatively station-specific, possibly depending on his or her expertise in the domain represented in each station.     

职高生自我概念、成就目标与心理健康的关系

目的:探察职高生自我概念、成就目标及与心理健康之间的相互关系。方法:采用自我概念问卷、成就目标问卷和SCL-90对450名职高生进行问卷调查。结果:人口学变量中除年级因素外(P<0.05),是否独生子女、性别和年龄等因素对心理健康的预测作用不显著(P>0.05);越倾向成绩目标者,心理问题越多(P<0.05);越倾向于学习目标者,心理问题越少(P<0.001),但此作用受到自我概念的中介,拥有更高自我概念者,心理问题越少(P<0.001)。结论:在关注职高生的心理健康状况时,可以从自我概念和成就目标两个方面入手进行干预。     

Using early clinical experiences to integrate quality-improvement learning into medical education.

Health care providers are delivering care in an increasingly complex environment; this requires that providers develop new competencies to better understand their work and to design changes that can help them succeed. Recognizing these new educational requirements, Dartmouth Medical School created a model two-pronged program for teaching quality improvement to its medical students. The goal of the program is to provide students with an active learning experience as well as an education in the theory and application of continuous quality improvement. The program includes two educational experiences: one curriculum is for all medical students and the other is for selected, highly motivated students. The first curriculum is incorporated in Dartmouth's required "On Doctoring" course, in which students spend time with community-based physician preceptors. The quality-improvement curriculum is designed around an improvement project developed at the students' preceptor sites. The second curriculum for students with a special interest in quality improvement is offered as an elective summer program between the first and second years of medical school. Working in groups of two, students identify an area for improvement within a preceptor's practice, assist the practice in articulating an improvement plan, help implement that plan, and write up their experiences. The authors describe the two curricula, factors associated with their successful implementation, and lessons learned.     

Comparison of computer-based and paper-based imagery strategies in learning anatomy

This study evaluated the use of computer-based interactive imagery on students' achievement scores when compared with paper-based static imagery. It also assessed students' perceptions about the two imagery strategies and their different components. Sixty-four freshmen veterinary students (50 females, 14 males), enrolled in a comparative anatomy course, volunteered to participate in the study. This study used a pretest/posttest comparison group design and data was examined by analysis of covariance (ANCOVA). A close-ended questionnaire was administered to collect students' perceptions about the two imagery strategies. The mean difference in students' perceptions between the two strategies was analyzed using a two-tailed paired t-test. No significant differences were observed between computer-based interactive imagery and paper-based static imagery in the immediate recall of anatomical information. There was a significant difference in students' opinions toward the two strategies: students perceived computer-based interactive imagery as a better strategy in the assimilation of anatomical information than paper-based static imagery.     

A workshop program to train volunteer community preceptors

This paper describes a program initiated in 1984 by the University of Minnesota Department of Family Practice and Community Health to train volunteer community preceptors for their instructional role in the Ambulatory Care Rotation (ACR), a six-week outpatient medicine offering for third- and fourth-year medical students. The preceptor training program consists of a full-day faculty development workshop for prospective community preceptors and periodic follow-up activities designed to reinforce workshop goals. Five workshops have been held from 1984 to 1987 and have provided a group of trained faculty preceptors for the ACR. The authors reviewed the methods and results of the workshops; self-ratings by participants demonstrated a significant gain in teaching skills and knowledge. Students' ratings of both the ACR course and the teaching by preceptors have been high and compare favorably with ratings of other preceptors and clinical rotations. There has been a 97% retention rate of the workshop-trained preceptors as active teachers in the ACR course, which suggests that the preceptors are satisfied with their role.     

Development of a handheld computer documentation system to enhance an integrated primary care clerkship.

Documentation systems are used by medical schools and residency programs to record the clinical experiences of their learners. The authors developed a system for their school's (Dartmouth's) multidisciplinary primary care clerkship (family medicine, internal medicine, pediatrics) that documents students' clinical and educational experiences and provides feedback designed to enhance clinical training utilizing a timely data-reporting system. The five critical components of the system are (1) a valid, reliable and feasible data-collection instrument; (2) orientation of and ongoing support for student and faculty users; (3) generation and distribution of timely feedback reports to students, preceptors, and clerkship directors; (4) adequate financial and technical support; and (5) a database design that allows for overall evaluation of educational outcomes. The system, whose development began in 1997, generated and distributed approximately 150 peer-comparison reports of clinical teaching experiences to students, preceptors, and course directors during 2001, in formats that are easy to interpret and use to individualize learning. The authors present report formats and annual cost estimate comparisons of paper- and computer-based system development and maintenance, which range from $35,935 to $53,780 for the paper-based system and from $46,820 to $109,308 for the computer-based system. They mention ongoing challenges in components of the system. They conclude that a comprehensive documentation and feedback system provides an essential infrastructure for the evaluation and enhancement of community-based teaching and learning in primary care ambulatory clerkships, whether separate or integrated.     

Do volunteer community-based preceptors value students' feedback?

PURPOSE: A key component of educational practice is to provide feedback and evaluation to teachers and learners to improve the teaching and learning process. The purpose of this study was to determine whether volunteer community preceptors value evaluation and feedback by students as much as they value other resources or rewards. METHOD: In Fall 1999, a questionnaire concerning the resources and rewards of preceptorship was mailed to 236 community preceptors affiliated with the Mercer University School of Medicine, Macon, Georgia. Preceptors were asked to rate 20 factors on a five-point Likert scale (5 = very important to 1 = not very important). The mean values were compared using t-tests. RESULTS: One hundred sixty-eight preceptors (71%) completed questionnaires. Preceptors rated evaluation and feedback from students significantly higher (p < .001) than all other factors (mean = 4.02, standard deviation [SD] = .87). Continuing medical education for teaching was the next most highly valued factor (mean = 3.67, SD = 1.14). Preceptors rated financial compensation the lowest (mean = 2.01, SD = 1.19) of all factors. The high rank of feedback and evaluation from students persisted across gender, specialty, length of time as a preceptor, practice location, and years practicing medicine. CONCLUSION: This study demonstrates that feedback and evaluation from students is highly valued. The knowledge that community-based preceptors highly value feedback and evaluation from students should stimulate medical school programs to provide feedback and evaluation to preceptors that will enhance the educational outcomes for both faculty and learners.