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Student perspectives on primary care preceptorships: enhancing the medical student preceptorship learning environment.

BACKGROUND: Medical students participate in a longitudinal (3-year) primary care preceptorship to assist them in developing skills in interviewing and examining patients in an ambulatory care setting. PURPOSE: To identify from a student's perspective important context and process issues in a longitudinal preceptorship. METHODS: The investigators used an "editing" style of analysis to identify significant themes across 24 medical student focus groups held between October 1995 and December 1997. RESULTS: Significant themes emerged from the data analysis that describe important features of what makes the preceptorship work for students. The main themes are active teaching, active learning, a trusting relationship, sufficient time, and a shared understanding of preceptorship objectives. The potential benefits to students in an enhanced learning environment are comfort, confidence, responsibility, skills, knowledge, reinforcement, learning opportunities, teaching opportunities, and models for practice. CONCLUSIONS: We offer recommendations for enhancing longitudinal preceptorships for preceptors, students, and leaders in medical education.

Attitude of Health Personnel↗

What do newly-qualified nurses expect from preceptorship? Exploring the perspective of the preceptee.

Preceptorship plays an important role in ensuring the smooth transition from student to registered nurse (UKCC 1993). To date, there has been little evidence to demonstrate the extent to which preceptorship has been introduced, and scant research into newly-qualified nurses' expectations and experiences of preceptorship. A longitudinal, questionnaire survey is exploring the expectations of preceptorship, from the perspective of newly qualified nurses, as part of a Department of Health funded study into the careers of people qualifying from nursing diploma courses. The paper demonstrates how pilot work with a cohort of newly qualified nurses, combined with literature on preceptorship, enabled the identification of key aspects of preceptorship. Findings are presented on the expectations of adult branch nurses at the point of qualification. There was an overwhelming demand for preceptorship, and the majority of respondents anticipated that all identified aspects of preceptorship would be important in their first job. Aspects identified as particularly important were 'constructive feedback on my clinical skills' and 'teaching new clinical skills'. Future questionnaires will reveal the extent to which these expectations are met.

Adult↗

The impact of preclinical preceptorships on learning the fundamentals of clinical medicine and physical diagnosis skills.

PURPOSE: To learn whether preclinical primary care preceptorships resulted in demonstrable clinical performance benefits to medical students. METHOD: This was a retrospective cohort study of 267 medical students who elected and 310 students who did not elect to take a four-week primary care preceptorship following the first year of training at the University of Texas Medical School at Houston in 2001-2003. Outcome variables were the students' performances on a written examination testing their integration of basic science and fundamentals of clinical medicine and performances on a comprehensive objective structured clinical examination (OSCE). After adjusting for factors that might have explained differences in the students' performances, logistic regression models were used to assess the association of the outcome variables with participation in a preceptorship. RESULTS: Students who participated in any one of the preceptorships performed better on the OSCE and on the fundamentals of clinical medicine examination than students who did not participate (p < .01). Students who participated in the family medicine or pediatric preceptorship scored higher on an OSCE (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.01-2.78 and OR, 2.26; 95% CI, 1.18-4.36, respectively) than those students who did not participate in a preceptorship. Students who participated in the internal medicine preceptorship scored higher on the fundamentals of clinical medicine examination (OR, 3.18; 95% CI, 1.92-5.23). CONCLUSIONS: Preliminary evidence indicates that a short preclinical primary care preceptorship can help medical students to consolidate and integrate the fundamental cognitive and clinical skills they will apply during the clinical years of medical training.

Adult↗

Relationship of a preceptorship experience to the views about nursing as a profession of baccalaureate nursing students.

In nursing education, preceptorship experiences have gained much popularity as a teaching/socializing strategy. This strategy is assumed to assist students in bridging the practice-theory gap and in becoming socialized to the professional role of the nurse but there has been minimal research on the effectiveness of the strategy in the professional socialisation of nursing students. This study examined the effects of a preceptorship experience on baccalaureate nursing students' perceptions about professional nursing before and after 4-week and 7-week preceptorship experiences. Variables such as the length of the experience and the educational preparation of preceptors were included to determine their influence on students' perceptions of the professional role. A pre-test/post-test design was used. Senior baccalaureate nursing students with a preceptorship component in their program formed the non-randomised convenience sample (n = 103). Data collection was through the administration of the Valiga Concept of Nursing Scale (1982). Results showed that, while there were no significant differences in students' perceptions after a 4-week preceptorship experience, a significant difference was found after the 7-week preceptorship experience. Interestingly, no significant differences were discerned when the two groups were compared post preceptorship. The students paired with baccalaureate prepared nurses had a significantly greater increase in score than the students paired with diploma prepared nurses.

Adult↗

Contributing to the theory development of preceptorship.

The purpose of the study was to clarify and analyze the concept of preceptorship as experienced by the preceptor. Preceptorship is a teaching method commonly used in many professions. The current study assists in the clarification and analysis of the concept of preceptorship as experienced by the preceptor. Regarding methodology, the literature was reviewed to compare the experience of clinical teaching with preceptorship. Literature was reviewed from the following fields/domains: nursing, medicine, education, social work, rehabilitation, dentistry, law, and pharmacy. Through application of the framework outlined by Walker, L.O., Avant, K.C., 1995. Strategies for Theory Construction in Nursing, third ed. Appleton & Lange, Norwalk, attributes, antecedents, consequences, and empirical referents were identified that help define preceptorship. There were three main findings: The nature of the relationship between the preceptor and preceptee is pivotal, evaluation is a challenge, and preceptorship is distinct from mentorship. The consequences of a preceptorship experience are better prepared and more confident preceptors, evolution into a mentorship relationship, and professional development of both the preceptor and the preceptee. This article concludes with numerous topics that could be addressed in future research: (a) screening tools for the preceptor; (b) evaluation of the preceptee; (c) the relationship between preceptee, preceptor, and faculty; (d) preparation of the preceptor, and (e) rewarding the preceptor.

Attitude of Health Personnel↗

Effect of a second-year primary care preceptorship on medical students' career plans.

BACKGROUND: Preceptorships with community physicians have been incorporated into medical curricula to foster interest in generalist careers. An evaluation of our preceptorship program was undertaken to determine this influence. METHODS: Students were asked about career interests before and after a second-year community preceptorship. When graduating, those students entering primary-care residencies were surveyed to validate whether they planned to become generalist or specialist. Associations between career choice at graduation and career interest before and after the preceptorship were examined. RESULTS: Of 73 students who maintained a generalist career plan after the community preceptorship, 57 (78%) continued with the same at graduation. After the preceptorship, 70 students reported a change in career interest toward generalism, compared with 9 who reported an interest in specialism. A significant relationship was found between career interest change and career choice at graduation. CONCLUSION: Our community preceptorship had a modest impact in stimulating students to consider generalist careers.

Career Choice↗

Unique learning contributions of a family medicine preceptorship.

BACKGROUND: There is a belief among family medicine educators that a third-year family medicine rotation provides unique clinical learning experiences, but there is limited research to support this belief. This study identified clinical skills performed by third-year medical students only during a community-based family medicine preceptorship, even when the family medicine rotation occurs after all other required clerkships. METHODS: During 6 academic years (1990-1996), 87 third-year students completed the family medicine preceptorship as their final rotation and rated their experience with 80 clinical activities (preventive health care, clinical problem management, and procedures) after completing all required clerkships other than family medicine and again after the family medicine preceptorship. Ratings measured whether the activities occurred on the family medicine rotation, only on other rotations, or combinations of both. RESULTS: More than 50% of students who performed five preventive skills (health maintenance for adolescents, young adults, middle-aged adults, or senior citizens and weight control counseling) gained that experience only during the family medicine preceptorship. The majority of students actively managed six clinical problems (acute strains and sprains, low back pain, sinusitis, strep throat, acute bronchitis, and osteoarthritis) uniquely during the family medicine preceptorship. The preceptorship offered few unique opportunities to perform procedures. CONCLUSIONS: This family medicine educational experience was not merely a repeat of what is experienced on the traditional major rotations. The family medicine preceptorship provided a setting where students were able to perform several important ambulatory, primary care skills they had not performed during their core curriculum of traditional third-year rotations.

Clinical Competence↗

An evaluative study of clinical preceptorship.

Clinical preceptorships, in collaboration between clinical agencies and educational institutions have been documented as an effective and innovative means of facilitating student learning, providing advantages for both the clinical and educational settings. A preceptorship programme of 100 hours duration was developed and delivered by the nurse education institute, in consultation with a health care organization. The objectives of the preceptorship programme were to help registered nurses, in partnership with clinical nurse educators, to effectively integrate, support and assist the development of clinical competence in the undergraduate nursing student. Following the implementation of the preceptorship programme a research study was conducted to evaluate programme effectiveness. The purpose of the study was to examine preceptors, preceptees, and nurse managers' preceptions of the preceptor role and factors which influenced the performance of preceptors. The methods used in this study included those commonly found in evaluation research. That is, participants were drawn from those who were involved, either directly or indirectly, in the preceptorship programme, namely preceptors, preceptees and nurse managers. Using focus groups, they were each asked to identify the outcomes of the programme in practice. Study findings highlighted the importance of formal preceptor preparation, which was shown to enhance teaching and learning opportunities for student preceptees, personal and professional development of the preceptors, and the promotion of positive partnerships between nurse educators and nurse practitioners. The need for formal recognition of the preceptor role in practice, particularly in relation to the provision of adequate time and resources, emerged from the study. The research findings enabled the development of an evaluative model of preceptorship, which highlights the intrinsic and extrinsic factors impacting on the preceptor role.

Education, Nursing, Baccalaureate↗

The impact of a required preceptorship on senior medical students.

The impact of a required preceptorship program was measured by comparing the perceptions of senior medical students who would have elected the preceptorship rotation had it not been required (the elective group) and those who participated only to fulfill the requirement (the required group). The main difference between the two groups before the preceptorship was the elective group's career preference for family medicine and the required group's preference for an internal medicine subspecialty. The preceptorship had no impact for either group on inclinations toward other specialties, preferred practice setting, or assessment of practice location determinants. Both groups, however, perceived an increase in knowledge of primary care practice and confidence in relevant clinical skills following the preceptorship. These results are used to support the value of a required preceptorship program.

Attitude↗

The Appalachian Preceptorship: over two decades of an integrated clinical-classroom experience of rural medicine and Appalachian culture.

There is a need to encourage careers in rural medicine and to prepare potential rural physicians for life in rural communities. The authors describe a program that addresses this need, the Appalachian Preceptorship Program, and report the program's experience from 1985 to 2004. The Appalachian Preceptorship is a four-week summer elective conducted by the Department of Family Medicine of East Tennessee State University (ETSU) that offers students clinical preceptorships in rural areas of southern Appalachia. By the conclusion of the 2004 preceptorships, the program had served 225 medical students from 95 medical schools across the country and abroad. The program combines an individual community-based preceptorship with an interactive group instructional block, emphasizes rural medicine, and provides students an understanding of the interface between culture and medicine in southern Appalachia. Follow-up of Appalachian Preceptorship students during the 18-year period studied demonstrates that 82% of the 157 participants who matched before 2004 had selected residencies in primary care, with 60% entering family medicine. Those completing the program were more than three times as likely to practice in a rural community compared with the national average. Fifty-six percent of their practice settings carry multiple rural or underserved designations. The program has helped transform a legislative mandate to train doctors for rural communities into an institutional culture leading to more extensive programs and a greater recognition of ETSU's rural mission. The authors encourage other medical schools to develop combined clinical/classroom electives that reflect their institutional priorities and that can address a wide variety of clinical interests.

Appalachian Region↗

The effect of preceptorship rurality on students' self-perceived clinical competency.

OBJECTIVE: This study's objective was to determine whether students' learning experiences, as measured by the improvement in students' perceived competence in several clinical areas, varied by the preceptorship county's rurality. METHODS: Rural preceptorship experiences from 1990 to 2003 were assessed using pre- and post-preceptorship questionnaires regarding students' perceived levels of competence. Questionnaires addressed basic clinical skills, common diagnoses, and advanced clinical skills. Rurality was measured both as population density and using the Rural-Urban Continuum (RUC) codes. RESULTS: Primary analysis was completed using 1,037 sets of questionnaires; 231 questionnaires were unsuitable for analysis due to missing information. Mean perceived competency improved for all items. Students in rural locations, regardless of operationalization, had no statistically significant differences from students in urban locations in perceptions of their clinical skill or comfort with basic diagnoses. Individual item analyses revealed a gendered pattern. Women improved more than men on the technical skills; men improved more on women's health and psychosocial items. CONCLUSIONS: There were no differences in medical students' perceived competence based on the rurality of their family medicine preceptorship site. The preceptorship experience provides both women and men with a variety of experiences that lead to increased confidence in areas where they were least confident prior to the preceptorship.

Clinical Competence↗

Changes in student learning styles and adaptive learning competencies following a senior preceptorship experience.

The purpose of this pre-post comparison study was to examine the effect of the preceptorship experience on the learning styles (the manner in which individuals process information from the environment), adaptive competencies (the congruences between personal skills and task demands) and environmental press perceptions (the subjects' perceptions of the importance of each adaptive competency to effective functioning in a designated environment) of 37 fourth-year baccalaureate nursing students. Using Kolb's theory of experiential learning as the theoretical framework for the study, it was found that the students' learning styles were inconsistently categorized by two versions of Kolb's learning style inventory. The preceptorship experience was perceived by students to have significantly (P < 0.05) improved the development of their adaptive learning competencies. Students perceived the importance of divergent, accommodative and convergent learning competencies to be lower after the preceptorship experience, with the only significant difference (P < 0.05) being between pre- and post-convergent competencies. The preceptorship experience, however, was found to contribute significantly more (P < 0.001) to the students' development of most adaptive competencies than their weekly clinical experiences. The findings support the notion that a senior preceptorship programme is a valuable and worthwhile learning experience to include in baccalaureate nursing curricula.

Adult↗

Preceptorship: a review of the literature.

Preceptorship is an important part of the United Kingdom Central Council for Nursing's (UKCC) post-registration and practice recommendations. Therefore, there is a great need for educationalists and clinical practitioners to explore the issues surrounding preceptorship and come to informed decisions on how they intend to implement preceptor programmes. There is a need to identify existing knowledge and its application to practice based on the commonly occurring themes within the theoretical and empirical literature. This paper reviews the current literature addressing these themes of role definition, preceptor selection, preceptorship programmes, the preceptorship experience and the limitations of preceptorship in clinical practice.

Clinical Competence↗

The meaning of preceptorship: nurses' lived experience of being a preceptor.

AIM OF THE STUDY: This phenomenological study is aimed at illuminating nurses' lived experience of the process of preceptoring and the meaning of preceptorship in a Swedish context. METHODS: Seventeen nurses from the North of Sweden with varied previous experience of preceptorship volunteered to participate. Their narratives, describing their experience of being a personal preceptor for a student nurse during practical training on a hospital ward in the third year of a 3-year diploma programme within a university college of nursing in Sweden, were transcribed verbatim. A phenomenological-hermeneutic interpretation disclosed the themes 'sheltering the students when learning' and 'facilitating the students' learning', together with eight sub-themes, which created an understanding of the meaning of preceptorship. FINDINGS AND DISCUSSION: The meaning of preceptorship was understood as reducing the risk of the students learning helplessness and empowering the students when learning in practice. The meaning of preceptorship highlighted the need for further preceptor support and development of the role of the preceptor. On the basis of the findings, suggestions were made to increase the preceptors' awareness of values in nursing practice and use of pedagogical strategies in the process of preceptoring. Through such strategies a reciprocal development of the preceptors' and the faculty's knowledge may take place, to the best advantage of the students' learning and the development of the profession.

Adult↗

Enhancing critical thinking in the preceptorship experience in nursing education.

BACKGROUND: To date no research has been conducted to examine the process used in the preceptorship experience to enhance critical thinking at the graduate level. This study provides data that could revitalize the preceptor/learner relationship and in turn influence future preceptorship programmes in graduate nursing education. AIM: The purpose of this study was to examine the preceptorship experience and its role in the enhancement of critical thinking in graduate nursing education. DESIGN: A grounded theory approach was employed, through semi-structured, tape-recorded interviews. Overall, 45 interviews were completed with graduate nursing students ranging in age from 26 to 53 years, and master's and doctorally prepared preceptors who ranged in age from 47 to 58 years. In addition, a journal of personal reflections was kept by each of the researchers. Analysis of data included the process of open coding, theoretical coding, selective coding, reduction and comparison. FINDINGS: Data revealed that a process, designated The Relational Process, occurred in the preceptorship experience to enhance the critical thinking ability of graduate nursing students. This process was found to be a complex, ongoing interpersonal dynamic between the graduate student and assigned preceptor. CONCLUSIONS: The relational process that emerged from this study indicates that specific preceptor behaviours are pivotal to the enhancement of critical thinking of graduate nursing students and ultimately impact on the success or failure of the preceptorship experience.

Adult↗

A case study of a preceptorship programme in an acute NHS Trust--using the European Foundation for Quality Management tool to support clinical practice development.

AIMS: To discuss the results of the evaluation, assessment and effectiveness of the trust-wide clinical practice development of a preceptorship programme for newly qualified nurses at Salford Royal Hospitals NHS Trust. To apply the European Foundation for Quality Management (EFQM) model as a tool for monitoring and assessing the performance of the programme. BACKGROUND: Newly qualified nurses need support and preparation for their working role in their first recruitment. A preceptorship programme, developed around a quality-monitoring framework, was introduced to address this need at Salford Royal, an acute NHS Trust. METHOD: The generic EFQM model was adapted to the specific case of the preceptorship programme. A questionnaire survey was undertaken to obtain evidence to assess how the EFQM tool was applied in the context of the preceptorship programme. Pre- and post-programme questionnaires were sent to preceptees and post-programme questionnaires to respective ward managers. FINDINGS: Following introduction of the preceptorship programme, recruitment and retention of newly qualified nurses have increased, with preceptees self-reporting increased levels of confidence. Use of the EFQM tool has provided the information that managers and departments require. Anecdotal evidence to date suggests that barriers are being broken down. Utilization of the framework has also identified areas of practice that need to change. CONCLUSIONS: This paper demonstrates how use of a generic tool such as EFQM can provide systematic and evaluative information for nursing.

Clinical Competence↗

Effective collaboration enhances rural preceptorship training.

Preceptorship is a valuable strategy largely underestimated in its ability to influence nursing students' attitudes and beliefs about mental health nursing. As a model, it has the potential to influence nursing practice, enhance clinical learning, promote recruitment and retention, and generate a more collaborative approach for nursing student supervision. The relationship is usually for a fixed and limited timeframe where the preceptor inspires and supports the growth and development of the student nurse, and encourages role socialization into the profession (Morton-Cooper & Palmer 2000). The challenge for mental health services is to achieve success in the provision of effective preceptorship, ensure positive and rewarding clinical experiences for nursing students, and improve recruitment and retention rates for the service. These aims are substantially more difficult to achieve in the absence of quality education, training and support for preceptors. This paper describes the use of preceptorship training to address recruitment issues in a rural service, particularly the need for effective preceptorship at undergraduate level, which has been shown to have an impact on the willingness of new nursing graduates to enter the mental health nursing field. The design and delivery of the training programme is outlined, including details of the program evaluation and its subsequent impact on psychiatric nurses' approach to and practice of preceptorship. Finally, the broader issue of the value of training nurses in larger groups, enlisting a critical mass of preceptors within an individual mental health service, is discussed.

Community Mental Health Services↗