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Assessment of clinical teachers is a requirement by family medicine residency programs in Canada. This facilitates feedback to teachers and ensures the curriculum is delivered in an efficient and safe way. To protect resident confidentiality, preceptors often receive their teaching evaluations months to years later. Teachers have requested shorter feedback loops, greater numbers, and more frequent assessments to improve their skills. The preceptor field note (PFN) is a tool that allows learners to evaluate teachers during a single encounter providing more frequent and immediate feedback. This study documents teachers' and residents' initial impressions of the first iteration of the PFN., Competing Interests: None, (© 2024 Markovski, Jeyabalan, Stephens, Kiehn, Lockwood, Saeed, Bordman; licensee Synergies Partners.)

Background and Purpose: Colleges and schools of pharmacy and residency programs must be engaged in the purposeful development of their preceptors. Preceptor development needs vary widely from a new preceptor needing foundational preceptor skills to a more experienced preceptor who may wish to incorporate more sophisticated precepting methods such as layered learning or interprofessional precepting. It can be challenging to create preceptor development activities that meet these varied needs and keep preceptors of all levels engaged., Educational Activity and Setting: The Preceptor's Game of Life was developed to incorporate serious gaming into preceptor development to increase engagement and promote learning across all precepting levels. This game was designed to review precepting fundamentals and focused heavily on the application of these principles to authentic precepting scenarios. An element of friendly competition, collaboration, and storytelling created a safe and fun environment where participants could discuss solutions to scenario-based problems., Findings: The Preceptor's Game of Life has been well received by state and national audiences. Audience members were engaged and invested as they discussed the scenarios presented. Individual, informal feedback following the session and formal session evaluations were positive., Summary: Though the Preceptor's Game of Life required careful logistical planning, the outcome was positive. High levels of engagement amongst the participants were noted in the form of note taking and audience participation. Audience members appreciated activating their prior knowledge and experiences and applying that to future scenarios. This manuscript serves as a tool for others interested in novel preceptor development methods., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Most of all congenital cardiac surgical programs participate in public outcomes reporting. The primary end point is transparency. In this era, academic programs with surgical residents face the challenge of producing outstanding results while allowing residents to learn by doing. We sought to understand the effect of education on our surgical outcomes., Methods: We collected data for all American Board of Thoracic Surgery index cases done at our institution over a 10-year period. We identified 3406 cases and categorized them into 2 groups according to primary surgeon: attending (2269) versus resident (1137). In a multivariable logistic regression model we examined the effect of operating surgeon on in-hospital mortality, major morbidity, and length of stay. We used propensity score matching subsequently to balance differences between cohorts, and multivariable logistic regression was repeated., Results: Using the entire cohort, multivariable logistic regression model adjusted for age, sex, weight, lack of preoperative comorbidity, presence of preoperative respiratory failure, The Society of Thoracic Surgeons--European Association for Cardio-Thoracic Surgery category, and need for deep hypothermic circulatory arrest, showed a higher odds of survival in the resident cohort (odds ratio, 1.484; 95% confidence interval, 0.998-2.206; P = .05). Propensity score matching identified 1137 pairs of attending and resident cases with well-balanced preoperative variables. Logistic regression modeling using the matched cohort showed equivalent 30-day mortality, 30-day major morbidity, and length of stay., Conclusions: There was no difference in mortality, major morbidity, or length of stay when similar cases were compared that were operated on by attendings versus those by a resident. Effectively educating congenital heart surgeons without compromising an operation's quality requires thoughtful approach, including case selection and graded responsibility., (Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Today, student midwives in Sweden spend half of their midwifery education at various internships. Practice reality demonstrates that there is an insufficient number of preceptors for the students, and the workload is demanding. Therefore, the present study aimed to explore the experiences of final term Swedish students during their midwifery internship and whether other paedagogical learning experiences beyond the apprenticeship model were included. A cross-sectional survey was distributed to 288 final year midwifery students at all universities offering the midwifery programme in Sweden. This paper focuses on open-ended questions, which were answered by 108 students, and analysed inductively via thematic analysis. Students described an intensive period with pressure during their internship. They expressed a desire for fewer parallel tasks and a better-structured internship. Students revealed that it was both a challenge and stressful to be under constant high performance while practising clinically. Furthermore, students described feelings of competition towards fellow peers in regard to attaining the final number of 50 assisted births. As to the paedagogical methods, the classical preceptorship model with a one-to-one student-preceptor relationship was predominately used. Preceptors were perceived as crucial role models. However, this learning experience was considered suboptimal for learning in the event where preceptors were not engaged or felt insecure regarding their knowledge, or if the preceptor was changed. For the students, the most optimal setting would be if preceptors were selected, trained, and supported in their role to supervise students, instead of being assigned any available preceptor, who was, at times, not a midwife., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: to understand how the pedagogical knowledge that integrates the basic knowledge of teaching is perceived by preceptors in residents' teaching-learning process., Methods: a qualitative research conducted by semi-structured interview from December 2013 to July 2014, with 31 preceptors of residency programs of three university hospitals in northeastern Brazil. For analysis, the Grounded Theory's proposal was used and supported by Atlas ti(r) 7.0 software., Results: preceptors integrate preceptorship with basic teaching knowledge proposed by Lee Shulman, with emphasis on General Pedagogical Knowledge when seeking strategies to better work on specific and disciplinary content, and Pedagogical Content Knowledge when adapting content to make it comprehensible to residents., Final Considerations: the study allowed us to understand how Shulman's basic knowledge of teaching is perceived by preceptors. It is recognized that they integrate knowledge into the preceptorship, highlighting the General and Pedagogical Content Knowledge.

Purpose: To determine the potential value of an adapted questionnaire to discover the predictors of preceptors' higher interest in precepting pharmacy interns and to evaluate preceptors' motivational factors and incentives for teaching as well as their professional satisfaction., Method: A link to the survey study of adapted questionnaire (JSAMPPP) was e-mailed to all pharmacists registered with the Pharmaceutical Chamber of the Republic of Srpska. Pharmacists' demographic and work experience characteristics, their attitudes related to motivation for precepting, value of incentives for precepting, job satisfaction, and influence of interns on pharmacists' professional practice were obtained., Results: Half of the preceptors who reported feeling satisfied with their professional life also showed interest in teaching. In addition, teaching pharmacy students positively contributed to the overall job satisfaction of the preceptors. Pharmacy preceptors were found to be most motivated by intrinsic factors. The most valued incentives reported were those related to continuing education., Conclusions: The adapted questionnaire has potential value and it revealed the following predictors of preceptors' higher interest in precepting: enjoyment of teaching, satisfaction with professional life, satisfaction as a pharmacy preceptor, and interns' influence on preceptors. These identified predictors can be emphasized to improve pharmacy students' internship experiences, thereby reinforcing the pharmacy profession.

Objective: To reflect on the contributions of the clinical supervision and preceptorship/tutorship as means to approach and engage nurses of healthcare services in activities related to the Supervised Curricular Internship, discussing conceptual, theoretical, and practical approaches for higher education in nursing., Method: This is a reflection based on the discursive formulation concerning clinical supervision and preceptorship/tutorship., Results: Clinical supervision has been widely used by international healthcare institutions to qualify the work processes of nurses, supporting their self-development. Currently, is has been supporting the work of nurses who are preceptors/tutors and monitors students on clinical internships., Final Considerations: The clinical supervision of nursing students features a robust and effective strategy for the development of interns and for the completion of the teaching-service integration.

Introduction: Educators have theorized that interventions grounded in dual process theory (DPT) and script theory (ST) may improve the diagnostic reasoning process of physicians but little empirical evidence exists. Methods: In this quasi-experimental study, we assessed the impact of a clinical reasoning (CR) curriculum grounded in DPT and ST on medicine residents participating in one of three groups during a 6-month period: no, partial, or full intervention. Residents completed the diagnostic thinking inventory (DTI) at baseline and 6 months. At 6 months, participants also completed a post-survey assessing application of concepts to cases. Results: There was a significant difference between groups in application of concepts (no intervention 1.6 (0.65) compared to partial 2.3 (0.81) and full 2.2 (0.91), p  = 0.05), as well as describing cases in problem representation format (no intervention 1.2 (0.38) and partial 1.5 (0.55) compared to full 2.1 (0.93), p  = 0.004). There was no significant difference in change in DTI scores (no intervention 7.0 (16.3), partial 8.8 (9.8), full 7.8 (12.0)). Conclusions: Residents who participated in a CR curriculum grounded in DPT and ST were effective in applying principles of CR in cases from their practice. To our knowledge, this is the first workplace-based CR educational intervention study showing differences in the reasoning process residents apply to patients.

Background: Despite focus on increasing the quality of ambulatory education training, few studies have examined residents' perceptions of learning during case discussions with their preceptors (i.e., "check-out"). The objective of this study was to assess the difference between residents' and preceptors' perceptions of behaviors that should occur during check-out discussions., Methods: We conducted a cross-sectional survey of categorical internal medicine and family medicine residents and preceptors. The survey was distributed electronically and assessed 20 components of the check-out discussion., Results: Of 38 preceptors, 22 (61%) completed the survey. Of 172 residents, 82 (48%) completed the survey. For residents, we identified discrepancies in desired and perceived check-out behaviors. Specifically, utilizing a dependent sample t-test, residents felt that all 20 areas needed additional teaching during check-out (P < 0.05). Preceptors believed that demonstrating physical examination skills in the patient room during check-out was significantly more important than did residents (P = 0.01). Increasing years of preceptor experience did not statistically relate to their valuation of components important to residents., Discussion: Our research highlighted a major deficiency in training in the check-out process, with residents desiring more patient management education in all components. Moreover, faculty and residents do not necessarily agree with what is an important focus in the "teachable moment." Our results serve as a training needs assessment for future faculty development seminars and highlight the need to consider resident learning needs in general., Competing Interests: None

This article describes best practice recommendations in program development for a nurse residency program. This registered nurse residency program is the first in New England to acquire the American Nurses Credentialing Center's Practice Transition Accreditation. Best practices identified in this effort include (a) use of a quality improvement analyst for data trending, (b) inclusion of an off-shift nurse educator, (c) use of evidence-based practice, (d) a standardized preceptor program, and (e) appropriate evaluation instruments. New graduate nurse satisfaction increased and turnover decreased after program implementation.

Introduction: Experiential pharmacy preceptors should provide formative and summative feedback during a learning experience. Preceptors are required to provide colleges and schools of pharmacy with assessments or evaluations of students' performance. Students and experiential programs value on-time completion of midpoint evaluations by preceptors. The objective of this study was to determine the number of on-time electronically documented formative midpoint evaluations completed by preceptors during advanced pharmacy practice experiences (APPEs)., Methods: Compliance rates of on-time electronically documented formative midpoint evaluations were reviewed by the Office of Experiential Education of a five-member consortium during the two-year study period prior to the adoption of Standards 2016. Pearson chi-square test and generalized linear models were used to determine if statistically significant differences were present., Results: Average midpoint compliance rates for the two-year research period were 40.7% and 41% respectively. No statistical significance was noted comparing compliance rates for year one versus year two. However, statistical significance was present when comparing compliance rates between schools during year two. Feedback from students and preceptors pointed to the need for brief formal midpoint evaluations that require minimal time to complete, user friendly experiential management software, and methods for documenting verbal feedback through student self-reflection., Conclusions: Additional education and training to both affiliate and faculty preceptors on the importance of written formative feedback at midpoint is critical to remaining in compliance with Standards 2016., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Accumulating data suggest that team-based learning (TBL) is more effective than lecture-based teaching strategies. Educational sessions at national meetings, however, tend to be lecture-based, and unlike most examples of TBL, involve participants who do not know each other or the instructor., Objective: We evaluated a 1-day TBL genomic pathology workshop for residents held at 3 national meetings., Methods: A committee of experts developed the workshop. Prior to attending, participants were provided access to readings and asked to answer preparation questions. Each of the 4 modules within the workshop consisted of a 60-minute TBL activity flanked by 15- to 30-minute preactivity and postactivity lectures. We used surveys to acquire participant evaluation of the workshop., Results: From 2013-2014, 86 pathology residents from 61 programs participated in 3 workshops at national meetings. All workshops were well received, with over 90% of attendees indicating that they would recommend them to other residents and that the material would help them as practicing pathologists. An incremental approach facilitated decreasing faculty presence at the workshops: the first 2 workshops had 7 faculty each (1 facilitator for each team and 1 circulating faculty member), while the final workshop involved only 2 faculty for 6 teams. For this final session, participants agreed that circulating faculty provided adequate support. Participant "buy-in" (requiring completion of a preworkshop survey) was critical in enabling a TBL approach., Conclusions: These results demonstrate that TBL is a feasible and effective strategy for teaching genomic medicine that is acceptable to pathology residents at national meetings.

Background: Various techniques have been developed to enable preceptors to teach residents effectively in outpatient settings to promote active learning, including SNAPPS and the One-Minute Preceptor (OMP). This study aimed to ascertain the differences between SNAPPS and the OMP in case presentation content and learner evaluation when used to teach residents about case presentation., Methods: From 2011 to 2013, participants were 71 junior clinical residents employed in two hospitals for clinical training. They were randomly allocated to two groups, one using SNAPPS and the other the OMP. From recorded discussions, the "differential diagnoses", "questions and uncertainties", "treatment plans", and "learning issues" were counted. Also, a self-evaluation form was distributed at the end of the study to evaluate the residents' satisfaction with the case presentation., Results: Members of the SNAPPS group used significantly more meaning units related to questions and uncertainties compared with those of the OMP group (P < 0.001). Self-evaluation sheets revealed that members of the SNAPPS group had significantly higher positive responses than those of the OMP group in terms of the following evaluations: "It was easy to bring up questions and uncertainties" (P = 0.046), "It was easy to present the case efficiently" (P = 0.002), "It was easy to present the case in the sequence given" (P = 0.029), and "I was able to give an in-depth case presentation" (P = 0.005)., Conclusions: SNAPPS may induce more meaning units related to questions and uncertainties and give more satisfaction to residents than the OMP.

Hospitalist educators face a number of challenges in teaching clinical reasoning to residents and medical students. Helping to develop trainees' clinical acumen is an essential and highly nuanced process, yet complex patients, documentation requirements, and productivity goals compete with teaching time. Workplace-based assessment is particularly important for residents with the institution of the developmental milestones for meeting Accreditation Council for Graduate Medical Education competencies. Two frameworks for facilitating the clinical reasoning discussion-the One-Minute Preceptor preceptor and SNAPPS-have been well studied in the outpatient setting with positive results. Both models show promise for use in the inpatient teaching environment with little modification. This narrative review compares and contrasts these 2 teaching frameworks and discusses their application to the inpatient teaching environment. These models can provide opportunities for hospitalist educators to better assess trainees, integrate regular feedback, and encourage self-directed learning. These teaching frameworks can also allow hospitalists to provide more focused education to trainees without taking additional valuable time., (© 2015 Society of Hospital Medicine.)

Objective: To evaluate the effectiveness of field notes in assessing teachers' confidence and perceived competence, and the effect of field notes on residents' perceptions of their development of competence., Design: A faculty and resident survey completed 5 years after field notes were introduced into the program., Setting: Five Dalhousie University family medicine sites--Fredericton, Moncton, and Saint John in New Brunswick, and Halifax and Sydney in Nova Scotia., Participants: First- and second-year family medicine residents (as of May 2009) and core family medicine faculty., Main Outcome Measures: Residents' outcome measures included beliefs about the effects of field notes on performance, learning, reflection, clinical skills development, and feedback received. Faculty outcome measures included beliefs about the effect of field notes on guiding feedback, teaching, and reflection on clinical practice., Results: Forty of 88 residents (45.5%) participated. Fifteen of 50 faculty (30.0%) participated, which only permitted a discussion of trends for faculty. Residents believed field note-directed feedback reinforced their performance (81.1%), helped them learn (67.6%), helped them reflect on practice and learning (66.7%), and focused the feedback they received, making it more useful (62.2%) (P < .001 for all); 63.3% believed field note-directed feedback helped with clinical skills development (P < .01). Faculty believed field notes helped to provide more focused (86.7%) and effective feedback (78.6%), improved teaching (75.0%), and encouraged reflection on their own clinical practice (73.3%)., Conclusion: Most surveyed residents believed field note use improved the feedback they received and helped them to develop competence through improved performance, learning, reflection, and clinical skills development. The trends from faculty information suggested faculty believed field notes were an effective teaching, feedback, and reflection tool.

Objective: To assess residents' clinical questions, where they get their answers, the utility of those answers, and if an evidence-based medicine (EBM) workshop improves the use of evidence-based electronic resources., Design: Prospective observational cohort study., Setting: Urban family medicine teaching clinics in Edmonton, Alta, in 2007., Participants: First- and second-year family medicine residents training in the family medicine teaching units., Methods: An observer recorded clinical questions posed by residents in clinic, the resources used to answer these questions, and how residents thought the answers modified practice. Resources were categorized broadly as colleagues, electronic, or paper. Answer utility was ranked in decreasing order as large change, small change, confirmed, expanded knowledge, or no help. Use of resources was compared before and after an EBM workshop, and between residents under normal supervision and those in semi-independent clinics., Results: Thirty-eight residents from 5 sites were observed addressing 325 questions in 114 clinical half-day sessions (420 patients). Residents had 0.8 questions per patient and answered 83.4% of questions with 1 resource (range 1 to 6). Residents made 406 attempts to answer questions, using colleagues 65.5% of the time (93.6% were preceptors), electronic resources 20.7% of the time, and paper resources 13.8% of the time. Answers from colleagues were least likely to require secondary resources (F test, P < .001). The utility of answers from colleagues (F test, P = .002) was superior to that of answers from electronic resources, and this difference remained significantly higher in sensitivity analysis. The EBM workshop training did not influence electronic resource use (17.8% before and 15.1% after, Fisher-Freeman-Halton test, P = .18), but semi-independence from preceptors increased the use of electronic resources from 16.5% to 51.0% (Fisher-Freeman-Halton test, P < .001)., Conclusion: Residents have many questions during clinical practice. Preceptors were used more commonly than all other resources combined and were the most dependable resource for residents to obtain answers. Although an EBM workshop was not associated with increased use of electronic evidence-based resources, semi-independent work appeared to be.

Background: Direct observation of residents for training and assessment is a core recommendation in medical education policy initiatives. Limited research exists about the impact of direct observation on precepting, and we are unaware of any research examining the impact of interdisciplinary precepting on trainees or preceptors. Over the past 3 years we have implemented an Interdisciplinary Direct Observation Precepting Model (IDOPM). Residents are directly observed via closed-circuit television by a behavioral scientist and family physician team., Methods: Surveys and focus groups were used to examine the impact of the IDOPM. Authors analyzed survey responses and focus group transcripts using an immersion/crystallization approach to arrive at themes., Results: Between February and June 2009, 24 residents, 14 physician faculty, and eight behavioral science faculty members participated in 19 IDOPM clinics. Eighty-two percent of residents and 95% of faculty responded to surveys. Key findings were (1) Residents and faculty report addressing topics that are not usually discussed in traditional precepting, including communication skills, time management, electronic medical record use, responding to emotional complexity, and physical exam skills, (2) The model reinforced a biopsychosocial approach to care, (3) Residents report ambivalent feelings about being observed, and (4) Faculty value the team approach to strengthen training and promote faculty development., Conclusions: The IDOPM addresses many core skills that are overlooked in traditional precepting encounters. Interdisciplinary direct observation may strengthen faculty ability to provide formative competency assessment in preparing residents to work in the complex world of primary care.

Background: At times, preceptors struggle with aspects of resident education. Many are looking for more support and faculty development in this area., Aims: To address preceptors' needs for resources and provide a proactive framework for their teaching, the Academic Support Process (ASP) website was developed and evaluated. Preceptors' (N = 35) experiences using the ASP website, as well as their perceptions of its usefulness in supporting resident education, were identified., Methods: The research comprised two phases: a self-directed workshop involving the creation of a web-based learning plan for a standardised scenario of a resident in difficulty followed by 3 months use of the ASP website with residents in their practice. Information on their experiences was solicited via surveys and focus group interviews., Results: Findings revealed the ASP website enabled preceptors to find words for their concerns around resident competency, gave them a proactive teaching framework, expanded their arsenal of teaching strategies, and supported a customised approach for all learners along the performance spectrum. However, there were a number of challenges encountered by the preceptors that affected site use and buy in., Conclusions: Results are promising. Next steps involve developing a clear strategy for adoption.

Objectives: Being a good doctor requires competency in ethics. Accordingly, ethics education during residency training is important. We studied the everyday ethics-related issues (i.e. ordinary ethics issues commonly faced) that internal medical residents encounter in their out-patient clinic and determined whether teaching about these issues occurred during faculty preceptor-resident interactions., Methods: This study involved a multi-method qualitative research design combining observation of preceptor-resident discussions with preceptor interviews. The study was conducted in two different internal medicine training programme clinics over a 2-week period in June 2007. Fifty-three residents and 19 preceptors were observed, and 10 preceptors were interviewed. Transcripts of observer field notes and faculty interviews were carefully analysed. The analysis identified several themes of everyday ethics issues and determined whether preceptors identified and taught about these issues., Results: Everyday ethics content was considered present in 109 (81%) of the 135 observed case presentations. Three major thematic domains and associated sub-themes related to everyday ethics issues were identified, concerning: (i) the Doctor-Patient Interaction (relationships; communication; shared decision making); (ii) the Resident as Learner (developmental issues; challenges and conflicts associated with training; relationships with colleagues and mentors; interactions with the preceptor), and; (iii) the Doctor-System Interaction (financial issues; doctor-system issues; external influences; doctor frustration related to system issues). Everyday ethics issues were explicitly identified by preceptors (without teaching) in 18 of 109 cases (17%); explicit identification and teaching occurred in only 13 cases (12%)., Conclusions: In this study a variety of everyday ethics issues were frequently encountered as residents cared for patients. Yet, faculty preceptors infrequently explicitly identified or taught these issues during their interactions with residents. Ethics education is important and residents may regard teaching about the ethics-related issues they actually encounter to be highly relevant. A better understanding of the barriers to teaching is needed in order to promote education about everyday ethics in the out-patient setting., (© Blackwell Publishing Ltd 2011.)

Objectives: The objective was to describe the implementation of a program of structured direct observation of emergency medicine (EM) residents during clinical shifts in the emergency department (ED)., Methods: The authors developed a program in which an observer spent 4 to 5 hours with each resident, without intervening in the clinical encounters. A structured data form was developed to document the resident's performance in a number of defined clinical areas relevant to patient care and mastery of the core competencies. Individual strengths and weaknesses were noted, and the observer provided directed feedback at the end of the session., Results: Over an 18-month period, 32 EM residents were observed during their ED shifts. The sessions not only provided specific information on individual residents' performances, but also identified areas where the residency program curriculum could be enhanced and provided a means of assessing mastery of the core competencies. In addition, the program provided an opportunity to give detailed and timely directed feedback to residents. Both residents and attending staff found the sessions acceptable and useful., Conclusions: Implementation of a structured direct observation program was feasible and well received and provided insight into the strengths and weaknesses of residents both individually and as a group.

Background: Certain teaching style (TS) and learning style (LS) combinations may enhance learning., Purpose: The objective was to examine the effects of combinations of TS and LS in preceptor-resident (PR-RE) dyads in a long-term teaching-learning environment., Methods: Forty-four pediatric PR-RE pairs responded to Grasha's TS and LS inventories, the Clinical Teacher Characteristics Instrument (CTCI) and the Preceptor-Resident Relationship Inventory (PRPRI). Combined CTCI and PRRI means were compared using the t test., Results: The facilitator or personal model TS and collaborative LS pairs supported a healthy teaching-learning environment. Independent learners rated their preceptors' teaching characteristics positively. Competitive LS residents rated the relationship with the preceptor and preceptor teaching effectiveness less favorably. Residents overall indicated a less favorable relationship and clinical teaching characteristics than preceptors., Conclusions: Certain combinations of TS with LS are perceived by preceptors and residents as more positive than others. This suggests TS and LS should be considered when pairing residents and preceptors.

Objective: This article evaluates the impact of establishing extensive continuity clinics on a psychiatry residency training program., Method: The PGY-2 , -3, and -4 residents completed a 15-item attitude survey, and patients were surveyed for their satisfaction., Results: The residency survey revealed increasing satisfaction with the continuity clinics as residents advance in their training. They reported improved learning about the course of mental illness, improvement in the therapeutic alliance with their patients, and only minimal interference with other training experiences., Conclusions: The resident survey revealed increasing satisfaction with the clinics. Residents reported improved learning about the course of mental illness over time and only minimal interference with other training experiences. Continuity clinics are an alternative to the traditional outpatient block assignment.

Objective: The Future of Pediatric Education II Report affirmed the importance of providing resident education in community settings. Yet we know little about related experiences of trainees and whether experiences and perspectives regarding community involvement vary by gender. We assessed gender differences in pediatric residents' involvement in and perspectives regarding community activities., Methods: A national survey of US pediatric residents assessed residents' involvement in 14 activities before medical school and the intensity and perceived importance of involvement in 17 activities during medical school and residency. Expected future involvement 10 years hence was assessed for 11 community settings. chi2 and analysis of variance were used to examine bivariate relations by gender. Multivariate linear regression was used to model the relationship between gender and expected future involvement., Results: Of the 700 respondents, 68% were women. Relative to men, more women reported exposure to child health advocacy and other community activities before and during medical school. Women and men reported similar involvement in residency, although women placed greater importance on inclusion of 16 of 17 community activities in their training. Female residents were more likely to report that current training in the community would influence their future career activities. Women anticipated greater future involvement in 6 of 11 settings. In adjusted analyses, gender remained associated with future involvement in 5 settings., Conclusions: As women come to comprise an increasing proportion of the pediatric workforce, further efforts are needed to understand the impact of gender on future involvement in community child health activities.

Objective: This study's objective was to develop and implement a model of "active precepting" as a teaching and patient care quality improvement project at a community-based family medicine residency program., Methods: The Prepare, Orchestrate, Educate, Review (POwER) model was developed with input from faculty, students, residents, and staff. Five measures of conformance to the model were monitored with daily feedback cards from November 2001 to February 2002. Faculty, residents, and clinic staff were surveyed and interviewed after the intervention for perceptions about active precepting. Two follow-up patient flow studies were completed for concomitant quality improvement efforts, and those findings were reviewed along with intervention findings., Results: Preceptors reported reviewing resident schedules prior to clinic sessions more often after the model was put in place, and clinic staff reported that residents and faculty were more willing to help solve problems. Concurrent flow studies showed that patient time in clinic decreased from 110 minutes before the intervention to < 70 minutes after, while resident time with patients, including precepting time, decreased from 44 minutes to < 30 minutes., Conclusions: Our results point to the potential of the POwER model of active precepting to contribute to improved patient care, teaching, stakeholder satisfaction, and better flow in the family medicine teaching clinic.

Background: Telephone precepting is a major tool in residency training that has not been evaluated or specifically taught., Description: Residents and attendings of 2 family practice residency programs were surveyed for their experiences and needs with telephone precepting., Evaluation: Residents and attendings each felt that the other could improve their role in a phone precepting encounter. After considering various options, a workshop was developed that involves residents and attendings learning together. The workshop was tested at residency sites and national meetings. It involves playing taped simulated phone encounters followed by group discussion of the replayed tapes. The tapes recount tested examples of various phone preceptor encounters., Conclusion: Participants agreed that telephone precepting is an area of residency training that has not been explored and that discussing the tapes was helpful.

Introduction: The purpose of this study was to analyse the learning environment of medical students in a medical ward and on the basis of this study to make specific suggestions as to how the students' clinical stay in a ward can be optimized. These suggestions were implemented and the effect evaluated., Material and Methods: This is a qualitative study. Through observations and interviews with students and staff in the ward the learning environment was analysed. After that an evaluation of the implemented project was carried out in a questionnaire to the ward and in interviews with the persons involved in the project., Results: The result of the study concerning analysis and improvement of the students' stay can briefly be summarized as follows: The students' position in the unit can be characterized as that of an observer rather than as an active working participant in the ward. With this there is a risk that the medical student's trainee stay in a ward will turn into a "work-experience placement", the primary purpose of which will be for the medical student just to dip into the profession. This has consequences for the students' learning process in securing that the students acquire the necessary practical qualifications and acquire essential personal qualifications, such as self-dependence and abilities in decision-making and working under pressure., Discussion: The study shows that doctors and students agree on the aim of the students' trainee stay: To involve the students in a working partnership in order to obtain the best learning experience. The study concludes that it is difficult to change well-established routines despite good intentions of all parties involved. Therefore, the study rises the question on how new routines are established in the educational culture of medicine.

In this article, central theories of learning in practice are discussed in relation to medical education, especially the first clinical stay. In the light of a project in the ward, the article attempts to demonstrate the importance of this stay, which is vital to students' development of a professional identity. In the theories of learning in practice, it is stressed that learning and development of a professional identity are inextricably linked. The article discusses what impact clinical stays have on students. It is stressed that it is necessary to create a structure for ward-based learning that will incorporate students into the daily working routine.

The success of community-based resident education depends on a partnership between a residency program and a variety of individuals, physician and nonphysician, in the community. The process of recruiting community faculty in the education of pediatric residents begins with selection of learning objectives. Next, characteristics of effective teachers and teaching sites should be listed so that appropriate faculty may be identified and recruited. A residency program's existing physician network of both referring physicians and graduates of the residency is a good beginning point for making contacts. Selection of specific educational goals, objectives, and activities will lead to identification of potential nonphysician participants. Understanding why community colleagues might want to become part of the training program leads to techniques for contacting and recruiting them.

Two elements are essential for implementing community-based educational programs: a vision of how community experiences fit into the training of the health professionals of the future and a local environment that will support innovation, change, and growth. Change cannot occur unless very basic assumptions regarding medical education are challenged. What is "quality education"? Can programs oriented toward tertiary and specialty care adequately provide the training that should be the core of a 3-year general training program? Do schools and programs select and train physicians to function within the microcosm of the academic center, or do they prepare physicians to manage the country's health care needs? National consensus has had little influence over local environments. Each medical school, training program, and teaching facility must reexamine its values and its culture. Each must have a vision of the physicians of the future and a commitment to train them appropriately. The role of vision and culture in creating successful programs has been clearly described. Several key elements have been found to be consistent with success, the first being vision. Four basic principles will bring the vision to fruition: (1) preserving core values while still stimulating progress; (2) emphasizing the process by which programs are created, implemented, and changed rather than the product; (3) avoiding the "tyranny of the or," learning to be inclusive with a broad vision rather than limited to an "either-or" approach; and (4) aligning the process, management, and values in working toward envisioned progress for the future. Effective leadership is essential for a group or organization to accomplish its mission, as is an organizational structure that aligns responsibility, authority, resources, and accountability.

Background and Objectives: Highly specific accreditation requirements have led to a uniform approach in US family practice continuity training. In this paper, we describe an experiment in practice-based preceptoral continuity training., Methods: We assessed the impact of assigning a resident to a private faculty practice for the second- and third-year levels of family practice continuity training. Data analysis included comparisons of practice demographics, clinical content, training costs, and resident assessment of training quality., Results: The preceptoral resident practice better approximated community demographic patterns than did the established residency practice. However, the preceptoral resident practice had relatively fewer visits for hypertension and diabetes mellitus than did the established residency, preceptoral site faculty, and National Ambulatory Medical Care Survey practices. Resident training at the preceptoral site resulted in a positive training expense differential of $69,300 calculated on an annual per third-year resident basis. The preceptoral resident expressed high levels of satisfaction with the quality of family practice center training., Conclusions: Practice-based preceptoral continuity training in family practice appears feasible in terms of clinical content exposure and may offer substantial financial advantages. Important questions remain, particularly about the quality of teaching and supervision in a preceptoral training model.

Although certified nurse-midwives collaborate with ob/gyn residents in teaching settings, they are rarely given the opportunity to have input into how residents learn to deliver ambulatory care. This study is a preliminary evaluation of a program in which one nurse-midwife was assigned responsibility for the orientation and preceptorship of all post-graduate year 1 residents to the ambulatory care setting in an inner-city women's health center. At the end of the academic year, all of the post-graduate year 1s completed an evaluation of their orientation. Findings included positive responses to the preceptorship orientation and agreement that the residents were comfortable with the competence and educational background of the CNM preceptor. The recurring theme was that orientation by a CNM was an appropriate learning experience. Suggestions for improvement of the program are included.