Community-based curricular experiences are important vehicles for introducing medical students to ambulatory care and to the effects of the community and family on health and disease.1,2 2–5 2–5
Medical school program directors must balance the need to maintain the enthusiasm of the volunteer faculty with ensuring instructional quality and consistency across multiple sites. Typically, course directors solicit evaluations from students of preceptors’ teaching effectiveness that can be used to improve teaching and learning. Medical schools have implemented various methods to evaluate preceptors’ performance, document preceptors’ involvement in the teaching process, and provide feedback to community-based preceptors.6–8 9 7,9–13 1
A few authors have reported anecdotal evidence that preceptors value feedback and evaluation.1,8,9 9 8 1
To our knowledge, however, no study has evaluated whether preceptors value feedback from students. Therefore, the purpose of our study was to determine the extent to which preceptors valued evaluation and feedback from students.
Method
Sample
In Fall 1999, we sent the survey questionnaire to all 236 volunteer physician preceptors who supervised students in the required longitudinal community-based experiences for the Department of Community Medicine at Mercer University School of Medicine (MUSM). These preceptors included family physicians, internists, pediatricians, general surgeons, and obstetrician–gynecologists who participated in either or both of two MUSM programs: the Community Science Program or the Community Office Practice Program (COPP). In the Community Science Program, students are assigned to preceptors throughout Georgia for ten weeks: two during the first year of medical school, four at the end of the second year, and four during the fourth year. Students work with preceptors to achieve defined curricular goals in population-based health, family systems, and ambulatory care. Students return to the same site for all three visits. In COPP, students spend 16 four-hour clinical sessions with physicians within 30 miles of the medical school: nine sessions during the first year of medical school and seven sessions during the second. Although preceptors are not compensated financially, they do receive benefits including academic appointments, electronic library network services, faculty discounts at the university bookstore, access to the medical school through an 800 telephone number, clinical support through the library databases, and credit for department-sponsored CME.
Instrument
We developed the questionnaire from a literature review,2,3,5,14,15 16
Data Analysis
We used statistical programs available in SPSS 10.0 for Windows (SPSS Inc., Chicago, Illinois) for all data analyses. Mean values of responses were compared using t -tests. We set statistical significance at p < .05.
The Mercer University Institutional Review Board granted approval of the study (H9910033).
Results
One hundred twenty-two preceptors responded to the first mailing, and an additional 54 preceptors responded to the second mailing. Eight of the returned questionnaires were not completed, yielding a response rate of 71% (168/236). Table 1 shows the demographic characteristics of the 168 respondents. The respondents ranged in age from 30 to 83 years with a mean age of 47.6 years, and averaged 16 years in practice with a range of one to 52 years.
Table 1: Demographic Characteristics of Preceptors Who Responded to a Questionnaire on the Resources and Rewards of Precepting, Mercer University School of Medicine, Macon, Georgia, 1999
We compared the responses of the 27 respondents who did not complete all questions to those respondents who completed all questions. We also compared the responses of the preceptors who had not supervised students during the prior academic year with those who had precepted students. We found no statistically significant differences between the groups with respect to observed mean values. Because no differences existed in the significance levels of the variables, responses from all participants were included in the overall analysis.
Table 2 shows all respondents’ mean ratings, the standard deviations, and rankings of the responses based on the Likert scores. Of the 20 items related to resources and rewards, preceptors rated evaluation and feedback from students the highest (mean = 4.02, standard deviation [SD] = .87). Preceptors placed a significantly higher value (p < .001) on evaluation and feedback from the students than on CME credit for teaching (mean = 3.67, SD = 1.14). CME credit for teaching was itself valued significantly more highly than the volunteer faculty appointment (mean = 3.37, SD = 1.21). Financial compensation was noted as the least valued factor by the preceptors (mean = 2.01, SD = 1.19).
Table 2: Preceptors’ Mean Ratings (SD) and Rankings of Types of Resources and Recognition from a Questionnaire on the Resources and Rewards of Precepting, Mercer University School of Medicine, Macon, Georgia, 1999
Due to the significance of the item “evaluation and feedback from the students,” we further examined this variable to determine if any differences existed among the respondents. The top ranking persisted across gender, specialty, length of time as a preceptor, practice location, and years of medical practice.
Discussion
To our knowledge, ours is the first study to report that community-based preceptors value evaluation and feedback from students. The importance that the preceptors placed on an assessment of learning experiences by students should stimulate medical educators to ensure that preceptors receive the information that will enable them to achieve the curricular goals of the institution, to meet the needs and expectations of students, and to improve teaching in ambulatory care sites. The contributions of community-based teachers to medical education, increased use of ambulatory care sites in medical education, and institutional concerns regarding the quality and consistency of diverse sites provide additional motivation for institutions to address preceptors’ desire for feedback and evaluation from students.
The results of our investigation confirm those of previous studies that preceptors value intrinsic and extrinsic rewards, particularly personal satisfaction, CME for teaching, volunteer faculty appointments, and teaching aids.1–3,5,14,17 1–3,5,14 6–8,18,19
The literature supports involving students in assessing the learning environment and process. Investigators have found that students can make sophisticated judgments during evaluation of their clinical teachers, that they reliably and consistently evaluate preceptor teaching, and that they provide feedback that can produce a positive change in clinical teaching.12,20–22 23
Our study had some limitations. MUSM focuses on rural primary care. Therefore, the preceptors in this study may be different as a group compared to preceptors at more traditional medical schools. Some of our preceptors also supervise medical students, nurse practitioners, and physician assistants from other institutions. Because these physicians precept multiple student types from various institutions with different curricular objectives, they may have been more likely to desire feedback than preceptors working with one program. In addition, our preceptors encounter students during the first, second, and fourth years of medical school. It is conceivable that community-based preceptors who primarily supervise third-year clerks might have responded differently to this survey. At the time of this survey, our institution provided feedback to preceptors in an aggregate format and intermittently. The lack of consistent, individualized feedback to preceptors may also have influenced the responses.
Our study has a number of implications for community-based medical education. The knowledge that community-based preceptors value feedback and evaluation provides motivation for improving the feedback obtained from students to enhance educational outcomes for both teachers and learners. This study also suggests that preceptorship programs should incorporate an ongoing system of evaluation and feedback to preceptors that will facilitate achievement of the curricular goals of both the student and the institution. Additionally, because preceptors have specified that they value feedback and evaluation, programs should make efforts to accommodate these desires of volunteer faculty.
Our results raise additional questions for exploration. What are the most appropriate methods, frequencies, and types of feedback and evaluation for meeting preceptors’ needs? Are preceptors who value students’ feedback and evaluation more likely to change their instruction than are those who value it less?
As medical education places greater value on community-based experiences, meeting the needs of physician preceptors will be increasingly more essential for medical educators who direct community-based experiences. Our study underscores the importance of providing feedback and evaluation to volunteer preceptors and suggests that periodic feedback and evaluation from students should be an integral part of preceptorship experiences.
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