The ROOM framework for preceptor participation in ambulatory resident-patient encounters

What was the educational challenge? Ambulatory clinical preceptors routinely enter encounters that residents have already established with patients. Their participation creates opportunities for direct observation, teaching, and support, but can also unintentionally shift authority away from the resident. While existing ambulatory teaching frameworks guide case presentation, clinical reasoning, and feedback, there is less guidance for how preceptors should participate in the patient encounter itself.What was the solution and how was it implemented? We developed ROOM, a framework for approaching preceptor participation in ambulatory patient encounters as an intentional educational process. ROOM focuses on four moments: the purpose for entering, how roles are established, how the preceptor contributes to patient care and learning, and how ownership is reinforced with the resident.ROOM requires no additional resources and can be adapted to different models of ambulatory supervision. It provides a structure for navigating the competing priorities of supervision, learning, patient care, and resident autonomy.What lessons were learned and what are the next steps? ROOM requires evaluation across clinical and cultural contexts, including resident, preceptor, and patient perspectives.