Graduation Year

2013

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Adult, Career and Higher Education

Major Professor

James Eison

Keywords

grounded theory, instruction, medical education, qualitative, thematic analysis, undergraduate

Abstract

The changing dynamics in patient care, along with the increasing role of early clinical experiences and community-based teaching models, can be a catalyst in furthering important research and training for clinical teaching excellence. Curricular challenges as well as limited scholarly work generate educational possibilities for study. Embracing a strong educational doctrine of teaching excellence in undergraduate medical education will help shape the future of health care and ultimately enhance patient care.

This grounded theory study (a) described and explained descriptions of teaching excellence among first and second year academic and community-based preceptors in the Longitudinal Clinical Experience (LCE) program at the University of South Florida (USF), Morsani College of Medicine and (b) generated theory related to the explanation of the phenomenon of clinical teaching excellence. The single site study drew upon preceptors in the Longitudinal Clinical Experience (LCE) course who were nominated for a teaching excellence award by second, third, and fourth year medical students through a voluntary, online survey. Based on these surveys, 17 academic and 17 community-based preceptors who represented someone who had gone above the student's expectations in providing an exceptional learning experience were nominated. From the list of 34, 13 eligible preceptors were invited to participate in the study and a sample of eight (four academic and four community-based preceptors) were interviewed.

The semi-structured, one-hour face-to-face interviews were conducted between April and December 2012 using an interview process. All interviews were located in the preceptor's academic, hospital, or practice setting except one, which took place in the preceptor's private residence. Interview questions were distributed to participants in preparation of the meeting. After obtaining written informed consent by the participants, interviews were tape recorded and lasted an average of 60 minutes.

Data analysis was completed using a complimentary, manual and electronic coding method to categorize and develop initial concepts and themes. Data were continuously tested with field notes, observations of the interviews and settings, and thoughts from the researcher's journal, supporting the fluid and constant comparative analysis of grounded theory. The following four thematic categories, supported by preceptors' reflective and reframing practices, emerged from the presentation of data for theory development: (a) preceptors have an awareness of, and adapt to, each student's readiness to learn; (b) preceptors demonstrate an intrinsic commitment to teaching; (c) preceptors create supportive learning environments; and (d) preceptors utilize sound pedagogical practices. As a result of an in-depth, reciprocal analysis from the selected categories and descriptions of clinical teaching excellence, a higher-order construct (theory) was generated, and suggested transforming and implementing adult learning principles and strategies into early clinical education experiences can have a positive influence on medical education and strengthen student learning.

Recommendations for practice and future research include (a) utilizing findings in curriculum planning, (b) expanding the study to increase awareness of the value of reflection and reframing in clinical teaching, (c) investigating the impact of clinical teaching excellence on patient care practices, and (d) expanding the study to compare primary care and specialty disciplines. Professional development programs should include designing activities based on preceptors' instructional needs, sound pedagogical practices, and in compliance with continuing medical education requirements.

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