Quality of student learning and preceptor productivity in urban community health centers

Background and Objectives: Clinicians in community health centers find it difficult to balance the demands of increased productivity and effective teaching. We hypothesized that precepting thirdyear students would decrease clinical productivity and that many elements related to the quality of the learning experience (eg, amount of patient contact, student autonomy) would be adversely affected by pressure to see increasing numbers of patients. Methods: Students and preceptors in a 6-week family medicine clerkship completed daily surveys that measured the presence of quantifiable elements of the ambulatory teaching experience. They also rated the overall quality of learning during each session. Results: For 62 sessions for which both students and preceptors completed evaluations, students rated the overall quality of learning more highly than preceptors. For students, the elements most positively associated with quality of learning were total teaching time and the frequency with which family issues were raised. For preceptors, the elements that predicted quality of learning were the number of patients that students saw independently and total teaching time. The clinical productivity of preceptors did not differ for sessions with and without a student. Conclusions: Preceptors can be effective teachers who encourage student autonomy and who model behaviors central to family practice, without decreasing productivity.