摘要：Purpose: This study examines teaching by preceptors in a longitudinal, primary care clerkship
for third year medical students. The authors compared observations from different points in the
clerkship to determine the validity of a three-stage model (modeling, supervision, and consultation) based on their previous research.
Methodology: Seven experienced preceptors were observed three times over the course of the
year while teaching third-year medical students. A single observer recorded the teaching behaviors using an observation instrument containing 30 behaviors relevant to ambulatory teaching.
The behaviors were categorized into five groups (Modeling, Supervision, Consultation, Validation, and General Teaching) for purposes of comparing their relative contribution to the proposed
three-stage model.
Results: Frequencies of teaching behaviors within the five categories were compared over the
three observations. Modeling behaviors declined over the three time periods (p<.02), while Validation increased from the first to the second observation (p<.02). The examining room was the
predominate location for teaching. Location differences in favor of the examining room were
statistically significant for Modeling, Supervision, and Validation teaching behaviors.
Conclusions: There was a shift in teaching behavior over time in a longitudinal clerkship. The
decrease in Modeling behaviors coupled with the increase in Validation behaviors supports the
proposed model of teaching. The failure to identify change in supervision behaviors may be due
to the long time interval between observations. Additional observations at more frequent intervals are needed to clarify this part of the hypothesis.
