The impact of preclinical preceptorships on learning the fundamentals of clinical medicine and physical diagnosis skills.

Purpose To learn whether preclinical primary care preceptorships resulted in demonstrable clinical performance benefits to medical students. Method This was a retrospective cohort study of 267 medical students who elected and 310 students who did not elect to take a four-week primary care preceptorship following the first year of training at the University of Texas Medical School at Houston in 2001–2003. Outcome variables were the students’ performances on a written examination testing their integration of basic science and fundamentals of clinical medicine and performances on a comprehensive objective structured clinical examination (OSCE). After adjusting for factors that might have explained differences in the students’ performances, logistic regression models were used to assess the association of the outcome variables with participation in a preceptorship. Results Students who participated in any one of the preceptorships performed better on the OSCE and on the fundamentals of clinical medicine examination than students who did not participate (p .01). Students who participated in the family medicine or pediatric preceptorship scored higher on an OSCE (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.01–2.78 and OR, 2.26; 95% CI, 1.18–4.36, respectively) than those students who did not participate in a preceptorship. Students who participated in the internal medicine preceptorship scored higher on the fundamentals of clinical medicine examination (OR, 3.18; 95% CI, 1.92– 5.23). Conclusions Preliminary evidence indicates that a short preclinical primary care preceptorship can help medical students to consolidate and integrate the fundamental cognitive and clinical skills they will apply during the clinical years of medical training.