SITE ACCOMMODATIONS AND PRECEPTOR BEHAVIORS VALUED BY 3RD-YEAR STUDENTS IN AMBULATORY INTERNAL-MEDICINE CLERKSHIPS

Background: Successful ambulatory education requires teaching skills a dapted to the dynamic, fast-paced setting. Purpose: In this study, we used student evaluations to identify site accommodations and preceptor behaviors that facilitate learning. Methods: From 1993 to 1995, 189 o f 207 (91%) 3rd-year students in a 1-month ambulatory medicine clerksh ip completed evaluations. A content analysis was performed to identify valued features of clinical sites and valued preceptor behaviors. Fin dings were validated during 1995 and 1996 when 83 of 92 (90%) students ranked previously derived items and graded each as essential or nones sential. Results: The 6 most frequently cited features of clinical sit es were the opportunity to evaluate patients, effective teachers, a la rge number of variety of patients, a small number of preceptors (fewer than 4), and an orientation. The 6 most frequently cited preceptor be haviors were delegation of responsibility for patients, timely feedbac k, approachability, enthusiasm for teaching, instruction in physical e xamination, and asking for the student's ideas on diagnosis and manage ment. Correlation coefficients for ranks in the derivation and validat ion studies were .56 for site characteristics and .42 for preceptor be haviors. Conclusions: An analysis of evaluations identified site accom modations and preceptor behaviors that students value. A validation ef fort clarified the relative value students to assign to these items.