ABSTRACT
BACKGROUND AND OBJECTIVES: Variability exists in the instructional experiences of medical students in clinical settings. As relationships between community-based physicians and medical students expand, it is important to promote instructional styles that enhance teaching and learning. This study identified attitudes and approaches toward teaching that distinguish preceptors with high student ratings from those with lower ratings. METHODS: Interviews were conducted with a purposive sample of 14 preceptors who had received either high or low scores from first-year students on the MedEd IQ, a standardized tool for assessing ambulatory clinical training experiences. Transcripts were analyzed using a qualitative approach. RESULTS: High-scoring preceptors were distinguished by six attributes: welcoming novice clinicians as legitimate participants in a community of practice, creating a central role for students in patient care and teaching, regularly engaging students in self-reflection to monitor their progress, helping students discover learning opportunities in routine patient encounters, using feedback to shape rather than evaluate student performance, and creating an environment where novices felt comfortable practicing new skills with patients. CONCLUSIONS: The results suggest that high-scoring preceptors provide a decidedly different experience through their approach to the challenge of training inexperienced students. These findings have implications for preceptor selection criteria and faculty development curricula.
Subject(s)
Clinical Clerkship/methods , Family Practice/education , Preceptorship/methods , Teaching/methods , Educational Measurement , Humans , Interviews as Topic , New York , Students, MedicalABSTRACT
The authors describe a validated instrument to measure instructional quality, using responses from first- and third-year medical students to assess ambulatory training sites.
Subject(s)
Education, Medical, Undergraduate/standards , Primary Health Care/standards , Quality of Health Care/standards , Teaching/standards , Ambulatory Care/standards , Humans , Reproducibility of Results , Students, MedicalABSTRACT
BACKGROUND: Instructional quality in ambulatory settings may vary. The MedEd IQ is an instrument that measures unique aspects of the clinical instructional process. This study assesses the construct and factorial validity of the MedEd IQ. METHODS: First-year students (n = 764) in Introduction to Clinical Medicine courses and third-year students (n = 711) in family medicine clerkships evaluated 249 clinical teaching sites affiliated with two medical schools, using MedEd IQ questionnaires at the conclusion of clinical training (1996-2000). Factor structures were identified and relationally defined through exploratory and confirmatory factor analytic techniques, and a measurement model for assessing instructional quality was refined. RESULTS: Four unique factors were identified that contribute to instructional quality: preceptor activities, learning environment, learner involvement, and learning opportunities. Of 33 items within the instrument, 22 were retained in the final structural model. Two indices of fit, a comparativefit index of .935, and a root mean square error of approximation of .063 indicated close agreement between the defined model and the observed relationships between items. CONCLUSIONS: The MedEd IQ measures four factors important to ambulatory medical education and provides a basis for a new measurement approach to assessing instructional quality.
