Ambulatory teaching: do approaches to learning predict the site and preceptor characteristics valued by clerks and residents in the ambulatory setting?
BACKGROUND
In a study to determine the site and preceptor characteristics most valued by clerks and residents in the ambulatory setting we wished to confirm whether these would support effective learning. The deep approach to learning is thought to be more effective for learning than surface approaches. In this study we determined how the approaches to learning of clerks and residents predicted the valued site and preceptor characteristics in the ambulatory setting.


METHODS
Postal survey of all medical residents and clerks in training in Ontario determining the site and preceptor characteristics most valued in the ambulatory setting. Participants also completed the Workplace Learning questionnaire that includes 3 approaches to learning scales and 3 workplace climate scales. Multiple regression analysis was used to predict the preferred site and preceptor characteristics as the dependent variables by the average scores of the approaches to learning and perception of workplace climate scales as the independent variables.


RESULTS
There were 1642 respondents, yielding a 47.3% response rate. Factor analysis revealed 7 preceptor characteristics and 6 site characteristics valued in the ambulatory setting. The Deep approach to learning scale predicted all of the learners' preferred preceptor characteristics (beta = 0.076 to beta = 0.234, p < .001). Valuing preceptor Direction was more strongly associated with the Surface Rational approach (beta = .252, p < .001) and with the Surface Disorganized approach to learning (beta = .154, p < 001) than with the Deep approach. The Deep approach to learning scale predicted valued site characteristics of Office Management, Patient Logistics, Objectives and Preceptor Interaction (p < .001). The Surface Rational approach to learning predicted valuing Learning Resources and Clinic Set-up (beta = .09, p = .001; beta = .197, p < .001). The Surface Disorganized approach to learning weakly negatively predicted Patient Logistics (beta = -.082, p = .003) and positively the Learning Resources (beta = .088, p = .003). Climate factors were not strongly predictive for any studied characteristics. Role Modeling and Patient Logistics were predicted by Supportive Receptive climate (beta = .135, p < .001, beta = .118, p < .001).


CONCLUSIONS
Most site and preceptor characteristics valued by clerks and residents were predicted by their Deep approach to learning scores. Some characteristics reflecting the need for good organization and clear direction are predicted by learners' scores on less effective approaches to learning.
Delva
M Dianne
MD
Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. mdd2@post.queensu.ca
Schultz
Karen W
KW
Kirby
John R
JR
Godwin
Marshall
M
D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D002982:Clinical Clerkship / Q000458:organization & administration / Q000592:standards*; D003258:Consumer Behavior / Q000706:statistics & numerical data; D003657:Decision Making; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration / Q000592:standards*; D007858:Learning; D009864:Ontario; D011231:Preceptorship / Q000458:organization & administration*; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D017132:Workplace / Q000523:psychology