Determinants of Student Preferences for Teaching Behaviors in the Ambulatory Setting

by Yablon, Brian Richard

The purpose of this research was to examine the influence of demographic and cultural factors on learner preferences for teaching behaviors in the ambulatory internal medicine clerkship. To that end, 50 medical students at each of four US institutions (BU, Tufts, UMass, and Yale) and 50 British medical students at the University of Cambridge were invited to complete a survey on teaching behaviors in the ambulatory setting, evaluating items on two scales: one rating the behavior¡¯s importance, and one rating how highly the student recommended the behavior. Behaviors rated highly on both scales were considered ¡°valued¡± by the student. Students¡¯ values of the teaching behaviors were compared by gender, race/ethnicity, age, institution, and country, with 15% maximum difference among groups and p-value <0.05 conferring significant value difference, 10-15% maximum difference with p-value <0.05 ¡°near-significant,¡± and 15% maximum difference with p ¡Ý0.05 deemed ¡°notable.¡±

The aggregate US response rate to the survey was 82%, while the British response rate was 46%. Among four US schools, response rates varied from 64% to 98%. Significant differences were seen among groups of medical students in their values of ambulatory teaching behaviors, and distinct patterns emerged for gender, race, age, school, and country. Female students valued patient communication behaviors more than male students. Under-represented minority students valued orientation to the practice, patient care responsibility, and comfortable learning environment more than did white and Asian students. Older students valued give-and-take discussion with preceptors more than did younger students. Among the 4 medical schools, Yale students most valued a preceptor who delegated responsibility for patient care and responded to student needs, and least valued a preceptor who asked the student¡¯s probing questions. UMass students most valued patient autonomy. British medical students were less interested in functioning independently and more interested in being observed than the American students, and also placed less value on patient privacy.

Differences among student groups raise important questions about causes and consequences of these discordant values in the ambulatory setting. The variability among medical schools and between countries provides novel evidence for limits in the applicability of single-institution studies, thus suggesting a new methodological standard for the community of medical education researchers.