What Do Residents Want from Preceptors? A Study of Feedback Generated by Family Medicine Residents

<h3>Context:</h3> Preceptors need authentic feedback from residents to continually improve their teaching skills. Existing evaluation tools ask residents to grade preceptors using predetermined criteria. However, these instruments do not provide guidance to preceptors about specific behaviors they should change or maintain to meet the residents’ practice and learning needs. <h3>Objective:</h3> To identify precepting best practices from residents’ perspectives by analyzing feedback they provided to preceptors. <h3>Study Design and Analysis:</h3> We performed qualitative thematic analysis on feedback collected during preceptor feedback sessions with residents. Using the “nonviolent communication” (NVC) approach, we converted unalloyed feedback from residents, some of which could be psychologically harmful, to statements ending in “requests” rather than judgments or evaluations. Each request was coded and linked to a teaching theme. Within each of the themes, individual requests were coalesced, by coders working in pairs, into statements that reflected the intent of the individual requests. These statements were reviewed and revised through discussion and then were distributed to all residents for correction and addition. <h3>Setting or Dataset:</h3> A single family medicine residency using the 188 requests generated during 32 feedback collection sessions. <h3>Population Studied:</h3> Physicians precepting family medicine residents in an outpatient setting. <h3>Intervention/Instrument:</h3> Feedback was formatted using the 4 aspects of NVC: “When you [a behavior], We feel [an honest feeling]. We need [a need not being met]. Please [request for a behavior].” All behaviors are described in positive (“Please do X”) terms. These requests for behavior served as the basis for identifying best practices. <h3>Outcome Measures:</h3> Statements of best practice based on the feedback given to preceptors by residents. Results: We developed 26 statements of best practices, organizing them to align with different parts of the precepting encounter: Setting the learning climate; Before the patient care session; During Precepting; and, the Post-session debrief. <h3>Conclusions:</h3> Precepting residents in an outpatient office requires nuanced and intentional guidance on the part of preceptors. This is the first study to evaluate what “end-users” of the precepting experience find valuable to enhance their learning by creating a psychologically safe, supportive, and nurturing learning environment.