Medical College of Wisconsin, Milwaukee, Wisconsin.
WMJ. 2021 Apr;120(1):23-28.
Clinical education often relies on a one-to-one student-preceptor model. Recruiting and retaining quality preceptors to sustain this model has become increasingly difficult at academic institutions across the nation. While ample literature describes preceptor barriers and incentives as viewed by physician educators, few studies explore the issue from institutional leadership perspectives.
This study aimed to describe leadership perceptions across an academic institution to better understand knowledge gaps, system barriers, and proposed solutions to help institutions take action and address preceptor shortages.
Between February and July 2019, the researchers conducted one-on-one semi-structured interviews with sampled representation of Medical College of Wisconsin leadership. The researchers reviewed transcriptions of each interview verbatim and used a qualitative grounded theory approach to generate content codes and themes. Researchers iteratively refined codes using the constant comparison method until all interviews were analyzed and final themes and subthemes were defined.
Twelve institutional leaders participated, of whom 5 were clinical executives, 1 was an academic executive, 4 were academic deans, and 2 were educational directors. Analysis yielded 4 major themes: student impact, recognition, physician well-being, and leadership.
Each content theme highlighted areas to consider when addressing preceptor issues within an institution: (1) leadership knowledge gaps regarding the scope of preceptor challenges, particularly time commitments and the number of preceptors required; (2) improving career advancement or promotion criteria to recognize teaching efforts; (3) enhanced physician well-being from teaching, while important, may no longer be sufficient for participation, especially without financial compensation; (4) distributed leadership may be needed to address issues at the course, clinic, and system levels.
临床教育通常依赖于学生与导师一对一的模式。在全国范围内，各学术机构越来越难以招募和留住高质量的导师来维持这种模式。虽然有大量文献描述了医师教育者眼中的导师障碍和激励因素，但很少有研究从机构领导层的角度探讨这个问题。
本研究旨在描述学术机构的领导层观点，以更好地了解知识差距、系统障碍和提出的解决方案，帮助机构采取行动解决导师短缺问题。
在 2019 年 2 月至 7 月期间，研究人员对威斯康星医学院领导层进行了抽样代表性的一对一半结构化访谈。研究人员逐字逐句地审查了每次访谈的记录，并使用定性扎根理论方法生成内容代码和主题。研究人员使用不断比较的方法迭代地精炼代码，直到分析完所有访谈并确定了最终主题和子主题。
12 位机构领导参与了研究，其中 5 位是临床执行官，1 位是学术执行官，4 位是学术院长，2 位是教育主任。分析产生了 4 个主要主题：学生影响、认可、医生福祉和领导力。
每个内容主题都强调了在机构内部解决导师问题时需要考虑的领域：（1）领导层对导师挑战范围的知识差距，特别是时间承诺和所需导师数量；（2）改进职业发展或晋升标准以认可教学努力；（3）教学带来的医生福祉固然重要，但可能不再足以促使他们参与，尤其是没有经济补偿的情况下；（4）可能需要分布式领导力来解决课程、诊所和系统层面的问题。
