title: Exploring instructional quality indicators in ambulatory medical settings: an ethnographic approach.
abstract: OBJECTIVE
  As medical education moves to community settings, the quality of learning is influenced by differences in the practice environment, organization, resources, patient case mix, and demographics. This ethnographic study identified experiences and processes that influence student learning in community-based practice settings.
  
  
  METHODS
  Trained field researchers conducted participant observation in eight community teaching sites. Data were analyzed using a qualitative, grounded theory approach.
  
  
  RESULTS
  Three dominant themes emerged: 1) the preceptor's role in situating learning opportunities, 2) the learner's role in transforming experience into learning, and 3) the practice organization as a classroom setting. The findings highlight the importance of exploiting learning opportunities and the contributions of other medical staff and patients in facilitating unique learning experiences.
  
  
  CONCLUSIONS
  This research suggests the need to move beyond the typical student ratings of teacher effectiveness to consider and assess additional important factors and processes that affect instructional quality.
authors.affiliation: Department of Family Medicine, State University of New York at Buffalo, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Zayas
authors.forename: P A
authors.initials: PA
authors.lastname: James
authors.forename: J A
authors.initials: JA
authors.lastname: Shipengrover
authors.forename: D G
authors.initials: DG
authors.lastname: Schwartz
authors.forename: J W
authors.initials: JW
authors.lastname: Osborne
authors.forename: R P
authors.initials: RP
authors.lastname: Graham
mesh_terms: D000884:Anthropology, Cultural; D003154:Community Medicine; D005194:Family Practice / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D011231:Preceptorship