Community-Based Training The Impact of Preclinical Preceptorships on Learning the Fundamentals of Clinical Medicine and Physical Diagnosis Skills Linda Z. Nieman, PhD, Lee Cheng, MD, MSc, Mark Hormann, MD, Mark A. Farnie, MD, Donald A. Molony, MD, and Patricia Butler, MD Abstract Purpose To learn whether preclinical primary care preceptorships resulted in demonstrable clinical performance benefits to medical students. Method This was a retrospective cohort study of 267 medical students who elected and 310 students who did not elect to take a four-week primary care preceptorship following the first year of training at the University of Texas Medical School at Houston in 2001–2003. Outcome variables were the students’ performances on a written examination testing their integration of basic science and fundamentals of clinical medicine and performances on a comprehensive objective structured clinical examination (OSCE). After adjusting for factors that might have explained differences in the students’ performances, logistic regression models were used to assess the association of the outcome variables with participation in a preceptorship. Results Students who participated in any one of the preceptorships performed better on the OSCE and on the fundamentals of clinical medicine examination than students who did not participate (p  .01). Students who participated in the family medicine or pediatric preceptorship scored higher on an OSCE (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.01–2.78 and OR, 2.26; 95% CI, 1.18 – 4.36, respectively) than those students who did not participate in a preceptorship. Students who participated in the internal medicine preceptorship scored higher on the fundamentals of clinical medicine examination (OR, 3.18; 95% CI, 1.92– 5.23). Conclusions Preliminary evidence indicates that a short preclinical primary care preceptorship can help medical students to consolidate and integrate the fundamental cognitive and clinical skills they will apply during the clinical years of medical training. Acad Med. 2006; 81:342–346. For the past two decades, medical school curricula throughout the United States have included an increasing amount of curriculum time and resources devoted to teaching medical students in ambulatory settings where they are supervised by physician preceptors. 1–4 Assessment of ambulatory medical education experiences proliferated, especially in the 1990s, when programs sought to graduate more primary care physicians to become generalist ambulatory medical practitioners. 5–9 Systematic reviews of teaching in ambulatory settings revealed that ambulatory clinics provided more active learning than did inpatient settings and that students were more satisfied with rural as compared to nonrural curricular experiences. 10 Recent curriculum changes have promoted learning clinical skills early in medical school. 11,12 Preceptorships in ambulatory settings were part of the recognition by medical educators that students needed to practice skills and to correlate what they learned in didactic basic science sessions with early patient care experiences. 13 Since 1970, the Texas Statewide Family Practice Preceptorship Program (TSFMPP) has matched students from an increasing number of Texas medical schools with volunteer preceptors from communities around the state. 14 The General Internal Medicine and General Pediatrics Preceptorship Programs started in 1995. 15,16 All three preceptorships now include students from Texas’s eight medical schools and receive grant funds from the Texas Higher Education Coordinating Board with formal establishment by state legislation. An eight-year study of Texas’s graduates of the TSFMPP indicated that participating in a preclinical preceptorship offered by a primary care specialty was associated with the later choice of that specialty or another primary care specialty. 5 Reviews of graduation data gathered by the Texas Higher Coordinating Board also have confirmed this finding for general internal medicine and pediatrics. 15,16 Preclinical preceptorships may offer participating students more immediate benefits than influencing later specialty choices. We could locate only two studies that used actual academic performance data and rigorous research methods to investigate the relationship between participating in a preclinical preceptorship and the subsequent clinical performance of medical students. 17,18 In one study, Elnicki and colleagues 17 found that a two-month preclinical preceptorship in internal medicine appeared to benefit students academically as well as to be related to career choices. Rodgers et al. 18 found that placing a decision-making course within a preceptorship was not academically beneficial. Specifically, over a five-year period, students who participated in the course did not receive higher ratings on their problem-solving skills than did a comparison group. In addition, Nieman Please see the end of the report for information about the authors. Correspondence should be addressed to Dr. Nieman, The University of Texas Medical School at Houston, 6431 Fannin Street, Suite JJL324, Houston, TX 77030; telephone: (713) 500-7609; fax: (713) 500- 7606; e-mail: Linda.Z.Nieman@uth.tmc.edu. Academic Medicine, Vol. 81, No. 4 / April 2006 342