TEAM BASED VERSUS PRECEPTOR-BASED ASSIGNMENT OF JUNIOR SURGERY STUDENTS

BACKGROUND: Clinical evaluations of junior surgery students frequently tack sufficient detail for effective formative or summative feedback. We hypothesized that this was in part due to a lack of personal accou ntability associated with large general surgery teams, and that alteri ng the format to assign students to specific surgical faculty precepto rs rather than to teams would affect the clinical evaluation products. METHODS: Over a 1-year period, 154 junior medical students grouped in to 8 successive clerkships were assigned alternately in the usual Team (3-5 junior students, with 2-4 general surgery faculty, 2-4 residents , and 0-2 senior students) or a new Preceptor format (1-2 students to each faculty preceptor). In order to keep the ratio of students to fac ulty low, approximately one-third of the Preceptor format students wer e assigned to subspecialists. RESULTS: The preceptor format resulted i n the use of more adjectives to describe students in the open-ended po rtions of the faculties' clinical evaluations (mean of 3.2 as compared with 2.5, P = 0.003), and a greater proportion of students recommende d for overall clinical Honors (47% as compared with 25%, P = 0.004). T he clerkship format had no impact on exam performance, students' perce ptions of the faculty, or the amount of students' serf-reported clinic al activity. Nevertheless, twice as many Team format students felt the y had too few patients, whereas twice as many Preceptor students felt their informal instruction had been less than ''good.'' CONCLUSIONS: P receptor assignment increased the number of students recommended for H onors, but this did not correlate with students' exam performance. Fro m the students' standpoint, each format had advantages and disadvantag es, Limiting the number of students on the general surgery teams and a dding structured formative feedback from faculty before the end of the clerkship might give students the instructional advantages of the Pre ceptor format without sacrificing those of the Team format. (C) 1997 b y Excerpta Medica, Inc.