Preclinical preceptorships in medical school: Can curricular objectives be met in diverse teaching settings?

Background: Although preclinical preceptorships for medical students during the first 2 years are now common, little is known about how well the curricular objectives can be met in clinical training sites. Purpose: To evaluate whether a clinical encounter system can help align preclinical preceptorship experiences with the core curriculum. Methods: Using a PDA documentation system, 27 students collected student-preceptor-patient encounter information on all patients (N = 2,953) during a 2-year clinical training course. We compared Years 1 and 2 teaching and learning processes, common symptoms seen, and counseling skills performed and examined how well these clinical experiences aligned with the curricular goals. Results: The majority of encounters in Year 1 involved the student observing the preceptor perform a history (47%) or physical exam (40%). In Year 2, there was a shift to student and preceptor both participating in the history (Year 1, 12%; Year 2, 24%; p = .004) and physical exam (Year 1, 34%; Year 2, 47%; p = .002). Cardiovascular; pulmonary; and head, eyes, ears, nose, and throat examinations were most common in Year 1 and increased in Year 2. Genitourinary, gynecologic, and neurological examinations occurred least often, and only the neurological examinations increased significantly in Year 2. Overall, at least 75% of students could find opportunities in Years 1 and 2 to achieve the majority of curricular goals. Conclusions: Knowing what students experience at their preceptor sites is vital for clinical skills course evaluation. Student-preceptor-patient encounter data should be used to complement other course evaluations to aid curriculum planning and decrease variability in student experiences.