Medical resident education. A cross-sectional study of the influence of the ambulatory preceptor as a role model.

A teaching practice of a residency program in primary care internal medicine was used for a cross-sectional study of the record-keeping habits of ambulatory preceptors and the residents they supervise. A retrospective review of 12 charts per physician over a six-month period was used to compare the charting behavior of three practice groups. Each group was comprised of an attending preceptor and a resident in each of the first, second, and third years of residency. Compared with the other two ambulatory preceptors, one ambulatory preceptor had significantly fewer charts with problem lists, medication lists, and health maintenance records as well as a lower ratio of psychosocial problems to total problems noted on his problem lists. The medical records of the residents supervised by this ambulatory preceptor were also significantly more deficient in each of these areas than the medical records of the other two resident groups. The fact that poor medical record keeping by an ambulatory preceptor was similarly deficient for the residents he supervised across each major area studied suggests that the ambulatory preceptor's actual practice behavior may exert a broad influence on the behavior of his residents. Future educational efforts in primary care internal medicine should be partially directed toward the ambulatory preceptors who serve as potent role models.