Preceptorsʼ strategies for correcting residents in an ambulatory care medicine setting

Abstract

To understand the interactional strategies preceptors use as they relate to and occasionally correct interns in a general internal medicine teaching clinic. An observational, cohort study was carried out from May 1990 through May 1993 of the precepting conversations between 11 pairs of interns and faculty preceptors in the general internal medicine ambulatory care clinic of the Hospital of the University of Pennsylvania. All interactions were videotaped and transcribed. The interactions provided numerous examples of preceptors' correcting of interns. These were analyzed qualitatively by ethnographic and conversation-analytic methods. The strategies the preceptors used to correct the interns were complicated and quite indirect, and tended to minimize exposing the interns' errors. These strategies revealed the dilemmas inherent in being a preceptor and also the beliefs the preceptors brought to their task. The preceptors' strategies demonstrated their high regard for maintaining the interns' self-esteem and sense of responsibility, as well as the preceptors' willingness to forego, at least for the moment, correctional strategies that might have been more explicit and direct. The preceptors' general approach to correcting interns was consistent with pedagogic norms favoring discovery learning and with societal norms favoring egalitarianism and respect for individuals. This approach, however, may not be free of problems, and raises questions regarding the effects such strategies have upon the interns' capacity for accurate self-assessment, including the assessment of their own knowledge bases.