Observed versus reported precepting skills: teaching behaviours in a community ambulatory clerkship

Community-based doctors are increasingly utilised for the clinical education of medical students. Faculty development programmes are frequently provided. However, data about the community faculty-student teaching interaction and the longterm impact of such programmes are limited. This study observes community faculty-student teaching interactions and assesses the use of clinical teaching methods taught during faculty development workshops.

Between March and August 2002, 13 rural, urban and suburban community-based faculty who completed at least 1 faculty development workshop were observed during faculty-student-patient encounters and interviewed. Observer-interviewers utilised a checklist to record teaching styles, methods and skills, and administered a questionnaire to obtain community faculty's self-perceptions.

On observation, the assertive precepting style and didactic teaching predominated in 90% and 86% of teaching encounters, respectively. Interactive discussion and direct observation occurred less often, in 71% and 18% of encounters, respectively. Feedback was provided in 25% of encounters. On interview, community faculty reported that faculty development workshops resulted in improved precepting effectiveness and professional satisfaction with moderate to considerable improvement in feedback, interactive teaching and use of multiple precepting styles for 100%, 77% and 77% of community faculty, respectively. Community faculty reported that their skills in addressing problem students, direct observation and didactic teaching improved moderately. There was little statistical correlation between self-assessed and observed skills.

Community-based faculty rate their teaching skills as improved following faculty development. Observation reveals that interactive discussion, direct observation, feedback and problem management skills are still lacking.