Simon Steven R, Davis Darlene, Peters Antoinette S, Skeff Kelley M, Fletcher Robert H
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA.
J Gen Intern Med. 2003 Sep;18(9):730-5. doi: 10.1046/j.1525-1497.2003.20838.x.
To study how clinical preceptors select patients for medical student teaching in ambulatory care and to explore key factors they consider in the selection process.
Qualitative analysis of transcribed interviews.
Harvard Medical School, Boston, Mass.
Nineteen physicians (14 general internists and 5 general pediatricians) who serve as clinical preceptors.
Responses to in-depth open-ended interview regarding selection of patients for participation in medical student teaching.
Preceptors consider the competing needs of the patient, the student, and the practice the most important factors in selecting patients for medical student teaching. Three dominant themes emerged: time and efficiency, educational value, and the influence of teaching on the doctor-patient relationship. These physicians consciously attempt to select patients whose participation in medical student teaching maximizes the efficiency of the clinical practice and optimizes the students' educational experiences, while minimizing any potential for harming the relationship between preceptor and patient.
These findings may help validate the frustration preceptors frequently feel in their efforts to teach in the outpatient setting. Becoming more cognizant of the competing interests-the needs of the patient, the student, and the practice-may help physicians to select patients to enhance the educational experience without compromising efficiency or the doctor-patient relationship. For educators, this study suggests an opportunity for faculty development programs to assist the clinical preceptor both in selecting patients for medical student teaching and in finding ways to maximize the efficiency and educational quality of the outpatient teaching environment.
研究临床带教老师如何为医学生门诊教学选择患者，并探讨他们在选择过程中考虑的关键因素。
对访谈录音进行定性分析。
马萨诸塞州波士顿市哈佛医学院。
19名担任临床带教老师的医生（14名普通内科医生和5名普通儿科医生）。
对关于选择参与医学生教学患者的深入开放式访谈的回答。
带教老师认为患者、学生和医疗机构的相互竞争需求是为医学生教学选择患者时最重要的因素。出现了三个主要主题：时间与效率、教育价值以及教学对医患关系的影响。这些医生有意识地尝试选择那些参与医学生教学能使临床实践效率最大化、优化学生教育体验，同时将对带教老师与患者关系造成伤害的可能性降至最低的患者。
这些发现可能有助于证实带教老师在门诊教学中经常感到的挫败感。更加意识到相互竞争的利益——患者、学生和医疗机构的需求——可能有助于医生选择患者，以在不影响效率或医患关系的情况下提升教育体验。对于教育工作者而言，本研究表明师资发展项目有机会协助临床带教老师为医学生教学选择患者，并找到提高门诊教学环境效率和教育质量的方法。
