Defining differences in the instructional styles of community preceptors

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.