Assessing the teaching behaviors of ambulatory care preceptors

Medical educators are increasingly concerned about the quality of skills instruction at medical schools in the United States, yet few data exist to support quality assessment and faculty development. The purpose of this research was to (1) develop an instrument for measuring teaching behavior of ambulatory care preceptors (the Teaching Encounter Card), and (2) assess current teaching practices at one institution.

Based on published guidelines for teaching in the ambulatory setting, the authors identified nine teaching behaviors for inclusion on a Teaching Encounter Card. Students completed the card immediately after a supervised patient (teaching) encounter, indicating (yes/no) if they observed each behavior. Validation of the card was assessed using standardized patients and scripted teaching encounters. A field application of the card assessed behaviors for 17 preceptors and 270 teaching encounters in one ambulatory care clerkship.

Validation testing revealed the card was highly accurate. Specificity exceeded 75% for all behaviors and sensitivity exceeded 75% for eight. During the field application, preceptors used each of the behaviors except three in over 70% of encounters. The three exceptions were observing the student interviewing or counseling (68% of encounters), providing feedback (52% of encounters), and observing the student perform any part of the physical examination (24% of encounters). Interpreceptor variability was substantial for several behaviors.

The Teaching Encounter Card is valid and represents a new tool for quality assessment and faculty development. Preceptors and course directors will need guidelines or educational standards to help them interpret individual results.