An Encounter-Based Analysis of the Nature of Teaching and Learning in a 3rd-Year Medical School Clerkship

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Abstract
Background: Much of medical education has shifted from the hospital to ambulatory settings where each student works with a preceptor. Purpose: Our objectives were to describe the nature of community-based learning and to explore how learning experiences vary by type of health care visit. Methods: This prospective study used both paper- and computer-based documentation systems to collect information on student-patient-preceptor encounters. A consecutive sample of 3rd-year medical students contributed data on 1 full clinical day each week as they rotated through a required 8-week family medicine clerkship. The main measures of interest included patient age, gender, health care visit type (acute, acute exacerbation of chronic, chronic, and health maintenance), method of learning in history taking and physical examinations (observing preceptor, being observed by preceptor, performing unobserved, or working jointly with preceptor), content of physical examinations, amount of preceptor feedback, and preceptor t...