4 EXEMPLARY PRECEPTORS STRATEGIES FOR EFFICIENT TEACHING IN MANAGED CARE SETTINGS

To identify time-efficient and educationally effective methods for tea ching in ambulatory care and managed care settings, the authors studie d four exemplary preceptors who taught family medicine clerks in manag ed care clinics. They interviewed all four preceptors and observed thr ee of them. All of these preceptors claimed re, practice more efficien tly with students than without them. Analysis of 33 patient encounters involving students revealed that each of the five students observed s pent an average of 12.0 minutes conducting a history and physical exam ination, 2.2 minutes presenting the case to the preceptor, 7.9 minutes observing the preceptor reviewing and/or repeating the examination wi th the patient, and 1.8 minutes receiving direct instruction and feedb ack from the preceptor. The total time er patient encounter was 23.7 m inutes, 11.7 minutes of which directly involved the preceptor. The aut hors then compared these 33 encounters with encounters involving the p receptors alone; these encounters took an average of 10.6 minutes of t he preceptors' time. The 1.1-minute difference between the amount of t ime preceptors spent in encounters involving students and the amount o f time they spent in encounters on their own was not statistically sig nificant as measured by t-test (p < .05). However, in calculating this time difference, possible time saved by students' assistance with cha rting was not accounted for. In interviews the preceptors identified t hree major instructional strategies for time-efficient teaching: plann ing and preparing; teaching with patients; and charting, giving feedba ck, and reflecting. Students described these preceptors as enthusiasti c teachers and good role models; however, they also felt that their fi rst two years of education had not prepared thorn for seeing patients in fast-paced ambulatory care settings. The challenge for medical scho ols is to better prepare both students and preceptors for learning and teaching in productivity-driven ambulatory care and managed care envi ronments.