How do precepting physicians select patients for teaching medical students in the ambulatory primary care setting?

Objective: To study how clinical preceptors select patients for medical student teaching in ambulatory care and to explore key factors they consider in the selection process.

Design: Qualitative analysis of transcribed interviews.

Setting: Harvard Medical School, Boston, Mass.

Participants: Nineteen physicians (14 general internists and 5 general pediatricians) who serve as clinical preceptors.

Measurements: Responses to in-depth open-ended interview regarding selection of patients for participation in medical student teaching.

Main Results: Preceptors consider the competing needs of the patient, the student, and the practice the most important factors in selecting patients for medical student teaching. Three dominant themes emerged: time and efficiency, educational value, and the influence of teaching on the doctor-patient relationship. These physicians consciously attempt to select patients whose participation in medical student teaching maximizes the efficiency of the clinical practice and optimizes the students' educational experiences, while minimizing any potential for harming the relationship between preceptor and patient.

Conclusions: These findings may help validate the frustration preceptors frequently feel in their efforts to teach in the outpatient setting. Becoming more cognizant of the competing interests-the needs of the patient, the student, and the practice-may help physicians to select patients to enhance the educational experience without compromising efficiency or the doctor-patient relationship. For educators, this study suggests an opportunity for faculty development programs to assist the clinical preceptor both in selecting patients for medical student teaching and in finding ways to maximize the efficiency and educational quality of the outpatient teaching environment.