Flinders University Rural Clinical School, Faculty of Health Sciences, Flinders University, South Australia, Australia.
Med Educ. 2011 May;45(5):455-63. doi: 10.1111/j.1365-2923.2010.03901.x.
This paper aims to consider why general practitioners (GPs) teach, in particular by defining the longitudinal supervisory relationships between rural clinician-preceptors and students.
A total of 41 individual semi-structured interviews were conducted with GPs, practice managers and students. All interviews were audiotaped, transcribed and analysed for emergent themes.
In this study preceptors identified many ways in which precepting added value to their roles. However, themes relating to the doctor-student relationship were central to GP preceptors' experiences. These developed in chronological order and resulted in changes in the triangular relationship between doctor, patient and student in the consultation.
Interpretive findings identify that the motivators for precepting represent a group of constantly changing interconnected factors that contribute to the defining of preceptors as central members of their professional community of practice. This critical finding challenges the simplistic organisational concept that universities can recruit and retain GPs by offering increased rewards. This paper introduces four clinical preceptor models, which involve the roles of, respectively: the student-observer; the teacher-healer; the doctor-orchestrator, and the doctor-advisor. Symbiosis between student learning and patient care was found to occur in the doctor-orchestrator model.
The evolution of doctor-student relationships in long-term student placements explains how students become more useful over the academic year and sheds light on how GPs are changed through precepting as part of the complex process by which they come to recognise themselves as central members of the rural generalist community.
本文旨在探讨全科医生（GP）教学的原因，特别是通过定义农村临床指导医生和学生之间的纵向监督关系来定义这一原因。
对全科医生、管理人员和学生进行了总共 41 次单独的半结构化访谈。所有访谈均进行了录音、转录和分析，以确定主题。
在这项研究中，指导医生确定了指导在其角色中增加价值的许多方式。然而，与医生-学生关系相关的主题是指导医生经验的核心。这些主题按时间顺序发展，并导致咨询中医生、患者和学生之间的三角关系发生变化。
解释性研究结果表明，指导的动机代表了一组不断变化的相互关联的因素，这些因素有助于将指导医生定义为他们专业实践社区的核心成员。这一关键发现挑战了大学通过提供更多奖励来招募和留住全科医生的简单组织概念。本文介绍了四种临床指导医生模式，分别涉及：学生观察者；教师治疗师；医生协调者和医生顾问。在医生协调者模式中，发现了学生学习和患者护理之间的共生关系。
长期学生实习中医生-学生关系的演变解释了学生如何在整个学年变得更有用，并阐明了全科医生如何通过指导发生变化，作为他们认识到自己是农村全科医生社区核心成员的复杂过程的一部分。
