Extent to which guided-discovery teaching strategies were used by 20 preceptors in family medicine

Learners learn more and are able to categorize problems at higher levels when their teachers use guided-discovery strategies (e.g., questions and advice to investigate relationships between concepts), as opposed to directly telling learners the answers. This study examines the extent to which clinician preceptors of residents use guided-discovery strategies when faced with a diagnostic problem-solving situation.

Twenty family medicine preceptors from four residencies volunteered in 1991-92 to role-play with a simulated first-year resident on a single standardized case. Judges coded the preceptors' verbal behaviors by type (question, statement, or advice) and by category. The categories were teacher, i.e., behaviors relating to more than the present case (hence exemplifying guided-discovery strategies), and consultant, i.e., behaviors relating to the successful disposition of the case (without overt concern for the education of the resident).

Of the preceptors' 846 verbal behaviors, 602 (71%) were coded as teacher behaviors, but only 329 (39%) were teacher behaviors that were of the specific types (high-level advice or questions promoting reflectivity, i.e., mindfulness) described in the literature as being most likely to promote learners' reflectivity and transfer of knowledge and skills from a lower level of abstraction to a higher level.

The results suggest that the 20 perceptors were aware of the importance of "getting residents to think" and did use teaching strategies known to promote transfer. However, their repertoire of strategies was limited.