Disagreement between students and preceptors regarding the value of teaching behaviors for ambulatory care settings

Background: Medical students and preceptors; commonly disagree on methods of clinical instruction in ambulatory care, although the extent of the problem is not documented. Purpose: The purpose is to identify disagreement and concordance between students and preceptors for teaching behaviors in ambulatory care. Methods: We surveyed students and preceptors at 4 U.S. schools. Respondents rated 58 behaviors on two scales. Disagreement was recognized when the percentage of students and preceptors who recommended a behavior and rated it important differed by over 15% (p < .01). Results: Disagreement was identified for 8 behaviors (14%). Six were valued less by students, including "watch the student perform critical tasks in history taking and other communication" (59% compared with 82%). Two behaviors were valued more by students, including "delegate responsibility to the student for the wrap up discussion with the patient" (82% compared with 61%). Conclusions: Students and preceptors; disagree regarding the value of a minority of teaching behaviors. Because some are potentially important, however, early negotiation regarding their use may enhance teaching effectiveness and mutual satisfaction with learning.