Senior Residents' Perspectives and Intentions to Teach in Outpatient Primary Care Settings.

Abstract

Primary care is pivotal to delivering effective healthcare. However, interest in primary care continues to decline; this is compounded by difficulties recruiting and retaining community-based preceptors to train and inspire trainees to enter primary care. Prior research explored the perspectives of community preceptors, but more concerted efforts across primary care specialties need to be directed upstream to understanding residents' perceptions on becoming future preceptors. We aimed to understand the experiences and factors that shape graduating residents' attitudes about and desire to serve as outpatient preceptors. This was a qualitative study, using a narrative inquiry approach, based on semi-structured interviews. Graduating Internal Medicine, Pediatric, and Internal Medicine-Pediatric residents at a single institution were interviewed. We developed an interview guide based on researchers' own experiences as medical educators and a pilot interview. Applying inductive analysis, we identified common themes that influenced participants' perspectives on outpatient precepting. With the derived themes, we identified an existing theory that best explained the results. After interviewing 13 residents, four themes were constructed that influence participants' perspectives on becoming outpatient preceptors. The Theory of Planned Behavior, where one's intention is informed by one's behavioral beliefs, normative beliefs, and control beliefs, conceptualized the themes. Witnessed advantages and disadvantages of precepting informed participants' behavioral beliefs, preparedness to practice medicine and teach informed their control beliefs, physicians' responsibility to teach contributed to their normative beliefs, and clinical demands were a secondary determinant that influenced all three beliefs. Using identified themes and the Theory of Planned Behavior, we propose the following recommendations to improve resident outpatient training with the goal of improving long-term community preceptor recruitment: (1) enrich the outpatient learning experience, (2) reinforce the teacher identity, (3) advocate for structural and cultural changes to address current clinical barriers to teaching.