PRECEPTORS STRATEGIES FOR CORRECTING RESIDENTS IN AN AMBULATORY CARE MEDICINE SETTING - A QUALITATIVE-ANALYSIS

Purpose. To understand the interactional strategies preceptors use as they relate to and occasionally correct interns in a general internal medicine teaching clinic. Method. An observational, cohort study was c arried out from May 1990 through May 1993 of the precepting conversati ons between 11 pairs of interns and faculty preceptors in the general internal medicine ambulatory care clinic of the Hospital of the Univer sity of Pennsylvania. All interactions were videotaped and transcribed . The interactions provided numerous examples of preceptors' correctin g of interns. These were analyzed qualitatively by ethnographic and co nversation-analytic methods. Results. The strategies the preceptors us ed to correct the interns were complicated and quite indirect, and ten ded to minimize exposing the interns' errors. These strategies reveale d the dilemmas inherent in being a preceptor and also the beliefs the preceptors brought to their task. The preceptors' strategies demonstra ted their high regard for maintaining the interns' self-esteem and sen se of responsibility, as well as the preceptors' willingness to forego , at least for the moment, correctional strategies that might have bee n more explicit and direct. Conclusion. The preceptors' general approa ch to correcting interns was consistent with pedagogic norms favoring discovery learning and with societal norms favoring egalitarianism and respect for individuals. This approach, however, may not be free of p roblems, and raises questions regarding the effects such strategies ha ve upon the interns' capacity for accurate self-assessment, including the assessment of their own knowledge bases.