A study of primary care teaching comparing academic and community-based settings

To compare teaching activity and content between academic and community-based practices used in third year medical student primary care training.

Academic and community-based primary care practices participating in third-year internal medicine, family medicine, and primary care core clerkships.

Five-hundred thirteen preceptor-student encounters involving 32 preceptors and 26 third-year medical students were evaluated.

Student-preceptor pairs collected a convenience sample of data from shared patient encounters. Preceptors recorded the content of teaching interventions, and students independently documented learning points received for each clinical encounter.

Comparison of problem exposure, frequency and content of teaching interventions, and the effect of patient complexity and patient care workload on teaching frequency was made between the academic and community-based practices. Several small differences were found in the frequency of clinical problem exposure between the 2 settings. The frequency and focus of teaching interventions did not differ by practice type. Teaching by community-based preceptors tended to decrease with increased patient care workload, but increased in academically based practices.

Although several differences exist between educational experiences in community- and academically based primary care practices, they appear to be minor and of minimal educational significance.