Site accommodations and preceptor behaviors valued by 3rd-year students in ambulatory internal medicine clerkships

Background: Successful ambulatory education requires teaching skills adapted to the dynamic, fast-paced setting. Purpose: In this study, we used student evaluations to identify site accommodations and preceptor behaviors that facilitate learning. Methods: From 1993 to 1995, 189 of 207 (91%) 3rd-year students in a 1-month ambulatory medicine clerkship completed evaluations. A content analysis was performed to identify valued features of clinical sites and valued preceptor behaviors. Findings were validated during 1995 and 1996 when 83 of 92 (90%) students ranked previously derived items and graded each as essential or nonessential. Results: The 6 most frequently cited features of clinical sites were the opportunity to evaluate patients, effective teachers, a large number of variety of patients, a small number of preceptors (fewer than 4), and an orientation. The 6 most frequently cited preceptor behaviors were delegation of responsibility for patients, timely feedback, approachability, enthusiasm for teaching, instruction in physical examination, and asking for the student's ideas on diagnosis and management. Correlation coefficients for ranks in the derivation and validation studies were .56 for site characteristics and .42 for preceptor behaviors. Conclusions: An analysis of evaluations identified site accommodations and preceptor behaviors that students value. A validation effort clarified the relative value students to assign to these items.