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Special Theme: Complementary, Alternative, and Integrative Medicine: RESEARCH REPORTS

Primary Care Education

Measuring Instruction to Improve Quality

James, Paul A., MD; Shipengrover, Judith A., PhD; Crosson, Jesse, PhD; Young, B. Lauren, MA; Kernan, Joan B., MA; Heaton, Caryl J., DO; Holmes, David, MD

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Developing standards for instructional quality in ambulatory training sites is complicated.1 A 33-item student questionnaire, the MedEd IQ©, measures four constructs of clinical instruction: (1) preceptor activities that facilitate learning, (2) role of the site as an effective learning environment, (3) availability of learning opportunities, and (4) learner involvement in clinically relevant experiences.2 The instrument has also shown good generalizability across multiple training sites.3 We used the MedEd IQ to monitor instructional quality at ambulatory-based sites.


During 1997–99 at two northeastern medical schools the MedEd IQ was administered at course end to first- and third-year medical students in introductory clinical medicine experiences and family medicine clerkships. The study received IRB approval and students provided written informed consent. The mean of responses across items within the four (MedEd IQ) subscales was computed, as were means of item and subscale scores across clinical instructors (site scores). Preceptor and site data were summarized.


Of the 1,871 students administered the MedEd IQ, 1,440 (76.9%) returned valid questionnaires for 244 sites. MedEd IQ subscale scores were internally consistent and were similar for the two medical schools. The preceptor activities subscale demonstrated the highest reliability coefficient (α = .90–.91), while the learning environment (α = .78–.80), learning opportunities (α = .73–.78), and learner involvement (α = .88) subscales also had acceptable reliability. Ratings of the learning environment, learning opportunities, and learner involvement were in general lower and more varied than preceptor ratings (contact authors for data). Learner involvement had the lowest rated subscale, especially with first-year students in the clinical environment, possibly reflecting the presence of novice learners. First-year students rated instructional quality lower than did third-year students with the greatest difference found in the learner involvement subscale.


The MedEd IQ measures processes that contribute to learning in the ambulatory setting. Responses were consistent between schools and courses and showed greater variability for the first-year students. When comparing data using this instrument, the level of the learner is one important contributor to scoring. Preliminary findings suggest opportunities for instructional quality improvement based on increased variability for the learning environment, learner involvement, and learning opportunities subscales. Faculty development and educational resources should focus on these areas in addition to traditional preceptor activities.


1. Shipengrover JA, James PA. Measuring instructional quality in community-orientated medical education: looking into the black box. Med Educ. 1999;33:846–53.
2. James P, Osborne J. A measure of medical instructional quality in ambulatory settings: the MedIQ. Fam Med. 1999;31:263–9.
3. James PA, Kreiter CD, Shipengrover J, Crosson J, Kernan J, Heaton C. A generalizability study of a standardized rating form used to evaluate instructional quality in clinical ambulatory sites. Acad Med. 2001;76(10 suppl):S33–S35.
© 2002 Association of American Medical Colleges