Physician Preceptor Satisfaction and Productivity Across Curricula: A Comparison Between Longitudinal Integrated Clerkships And Traditional Block Rotations

Abstract

Phenomenon: Physicians are under intense pressure to improve clinical productivity. High clinical load, limited availability, and decreased clinical efficiency are well-documented barriers to precepting medical students and threaten clinical productivity. In an era of increasing medical student enrollment, these barriers have already led to a decreased availability of clinical teachers and training sites across the United States. Improved preceptor satisfaction could have a great impact on recruitment and retention of medical student preceptors and is likely linked to changes in productivity. Curriculum structure could impact both preceptor productivity and satisfaction. Comparing productivity and satisfaction of physician preceptors teaching in longitudinal integrated clerkships (LICs) to those teaching in traditional block rotations (TBRs), or in both settings (LIC-TBR), could lead to a better understanding of the impact of curriculum structure on preceptor productivity and satisfaction. Approach: Data were collected through a quantitative cross-sectional survey of outpatient physician preceptors in North Carolina in 2017. Preceptor satisfaction and student influence on productivity-related aspects of practice were analyzed with bivariate chi-square statistics and multivariate logistic regression. Findings: Analyses included 338 physician preceptors: 79 LIC (23%), 50 LIC-TBR (15%), and 209 TBR preceptors (62%). LIC preceptors were more likely to indicate being “very satisfied” with precepting than either their LIC-TBR or TBR counterparts. There were no differences in perceived productivity-related aspects of practice across the different curricula, such as patient flow, income, or physician working hours. Logistic regressions controlling for potential confounding variables suggested that those teaching in LICs were almost 3 times more likely to be “very satisfied” relative to those teaching in LIC-TBR and TBR settings and that the negative influence of students on patient flow and physician working hours had an adverse effect on preceptor satisfaction. Insights: Preceptor satisfaction was high overall, though satisfaction was significantly higher among preceptors who teach in LICs. The perceived impact of students on clinical productivity was stable across the different curricula. In an era of increasing need for physician preceptors, the higher satisfaction of those who teach in LICs should be considered in curricular design and for preceptor recruitment and retention.

Keywords:

• longitudinal integrated clerkships
• LIC
• traditional block rotations
• preceptor satisfaction
• preceptor productivity

Acknowledgments

We thank the North Carolina AHEC Program Office for facilitating financial support and preceptor data and the North Carolina AHEC Program’s nine Offices of Regional Primary Care Education for support with data collection. We thank Dr. Beat Steiner for his support of the project.

Other disclosures

None

Date availability

Data from this study can be made available by reasonable request.

Ethical approval

This study received ethical approval from the institutional review board of Mission Hospital in December 2016, IRB 16-11-1643, NF.

Disclaimers

None

Previous presentations

Preliminary data presented on May 9, 2018, at Mountain Area Health Education Center Research Day in Asheville, North Carolina, and on October 16, 2018, at the Muster Conference in Mt. Gambier, Australia.

Additional information

Funding

This study was supported in part by funds from the North Carolina AHEC Program Office.