Table 6

Studies reporting the impact of FM clerkships on teaching FPs and their patients

Authors (year)CountryClerkship featuresStudy methodsKey findingsStrength grade
Grant and Robling (2006)84UKY final; ? setting and duration; OAction research; participation and interviews with all staff of a FP practice preparing to have final year students for FP clerkship (3 FPs); 5 months before and 1 year after having a studentAll members of team enjoyed having students and experienced enhanced sense of professional identity and strengthened team ethics4
Heath and Beatty (1998)79USAY 3; 4 weeks; OCoding and billing forms of 4 teaching FPs at 2 sites; 10 half day sessions during April and July (varied experience of student) (438 patients) matched with 10 half days same months (431 patients) without studentNo significant differences in entering billing codes, performing office procedures or ordering diagnostic tests; mean nr patients 12.0 with/12.3 without student3
Kearl and Mainous (1993)80USAY 3; ? weeks; O; urban4264 patient encounter forms (43% with a student) at clinic of FM department; 9 FPs and 3 FM residents (over 4 months: days with/without students); paired-sample designNo significant differences in mean number of patients/half day (productivity: 6.3 with and 6.1 without, p=0.7) and average billed charges (p=0.62) between days with/without student4
Kollisch et al (1997)81USAY 3; 4 weeks; O; mixed settingPhone interviews with preceptors from 42 teaching practices (RR 35/38)55% commented on the time issue when student present (slowed down practice/had to stay longer); benefits and concerns reported4
Levy et al (1997)82USAY 3; 2–3 weeks; O; urbanPostal questionnaire to all preceptors (RR 130/139)Mean of 51±30 min/day increase in working time when student present; overall positive comments about teaching students; 87% had to stay longer; 31% saw less patients; 25% lost income; list of benefits and challenges provided; 58% complain of more time; positives: 40% positive interaction with student4
Ricer et al (1997)83USAY 3; 4 weeks; O; mixed settingObservations of 26 preceptor-student pairs; one research assistant timing teaching activities during visit and nr of patients of preceptor with (316)/without (131) student and comparing to non-teaching partner at same days; 19 full days and 7 half days July-August (first months of clerkship; little previous exposure of students so ‘max’ teaching time needed)Estimate of 1.23 h in addition to usual day without students (teaching cost calculated at US$60); for 10 preceptors with partners no significant difference in number of patients (171 preceptor vs 164 non-preceptor partner)2
Sturman et al (2011)85AustraliaY 3; 8 weeks; O; urbanFace-face interviews; quota sampling to represent diversity of teaching clinics/FPs (RR 28/29 teaching clinics; 60/61 FPs)83% comment on time issue (longer working day 30–60 min or >60 min); 52% quote ‘intellectual stimulation’ as benefit; rewards and challenges reported4
Vinson and Paden (1994)46USAY 3/4; 3 weeks; O; mixed settingPostal questionnaires to private preceptors who had taught during previous academic year (RR 46/56)40/46 reported increase of working time when with student (mean 46±32 min/day; median 45; range 30–120 min); 1% reported decrease in billing charges; 25/46 report ‘learning from students’ as a benefit; 17/46 report ‘time’ issue as a problem3
Vinson et al (1996)62USAY 3; 4 weeks; O; urban10 328 observations: 55% from (RR 22/29) private teaching FPs; researcher directly observed 1 day with and without student; recording start and end of work and nr patient encounters; 12 academic FPs for two half-days with/without student; time and motion study; researcher observed and recorded activity (list of 35) in random selected times during the day/half-day; inter-rater reliability between observers >0.70Private FPs: mean increase of time when student present 52 min (95% CI 16 to 88) p.0.007; no significant change in nr patients/day, but significant change in productivity (nr patients/h): decrease of 0.6/h (95% CI −1.1 to −0.1) p=0.03; academic FPs spent 6 min less/day when student present (95% CI −67 to 55 min), but not stat significant; no change in nr pts/day and productivity; analysis of pt, admin or teaching activities: no major differences except academic FPs allow students to be semi-independent, while private FPs more passive/observing role4
Sprenger et al (2010)30AustriaY 6; 5 weeks; OSelf-administered questionnaires immediately after clerkship (RR 114/146); Likert scale to assess satisfaction with clerkship100% agreed teaching students was positive; 91% reported there was not enough time for tutorials4
Pichlhofer et al (2013)29AustriaY ?; ? weeks; O; urbanOnline questionnaire survey (RR 59/74)∼92% feel always/frequently positively motivated by student’s presence; 51%: student’s presence caused need for more time always/frequently; ∼90%: teaching facilitates reflecting on daily work always/frequently4
McKee et al (1998)28USAY 3; 6 weeks; O; urbanDaily activity logs and quality scores during the clerkship (RR 21/60; 105 sessions without and 98 with student)No decrease in clinical productivity (number of patients/h: 2.74 vs 2.81 p=0.58) and overt-time hours (34 vs 41 min p=0.27); clinical productivity correlated to nr of patients seen independently by the student3
Bentham et al (1999)86UKY 6; 5 weeks; O; mixed settingQuestionnaires after consultations at 6 FP teaching practices (RR 130/148 patients)62%: no negative impact on the quality of consultation when student present; 98% would not refuse a student; 35% report advantages and 2% negative effect when student present; 2%: consultation longer when student present4
Haffling and Hakansson (2008)91SwedenY final; 16 days; O; mixed settingQuestionnaires after consultation, handed out by 3 cohorts of students (RR 429 patients; 150/222 students reported)92%: no negative impact on quality of consultation when student present; 64% would not refuse a student; 1%: dissatisfied by student’s presence (longer consultation; difficult to talk about personal problems; other reasons); 22%: thought they could contribute to teaching students4
Monnickendam et al (2001)90IsraelY 6; 3 weeks; OQuestionnaire after consultation handed out by students at 46 teaching practice (RR 375/375? patients)Majority: no negative impact on quality of consultation when student present; 77% would not refuse a student; 25% report advantages and 4% did not report a positive effect of student’s presence on the physical examination and medical interview4
O’Flynn et al (1999)87UKY 4; unclear duration and settingFP posted questionnaires to 25 patients the day after consultation with student present (RR 335/480)38.8%: learned more about their problem due to FP teaching the student; 33.3%: more time to talk when student present; 8.4%: left without saying what they wanted; 32%: less space to talk about personal problems; 34% would prefer to see physician alone3
Price et al (2008)88UKY 5; 4 weeks; OQuestionnaire to consecutive patients after consultation with and without student; handed out by FP who also recorded length of consultation (RR 35/60 FPs; 1351 consultations with and 1119 without student)Patients in consultations with vs without student present: validated scores for enablement 4.3 (3.9) vs 4.6 (3.9) p=0.06 and empathy 42.7 (8.0) vs 43.7 (7.2) p<0.01 (but no practical relevance); consultation length: 10.9±6 min with and 9.4±4.8 without student (p<0.01); 21% who had consented to a student present would have preferred to see physician alone; 72% learned more about their problem due to the FP teaching the student and 59% had more time to talk about their problem4
Prislin et al (2001)31USAY 3; 1 day/week; OQuestionnaires after consultation handed out by FPs for 3 consecutive consultations with student (RR FP practices of 45/87 students; 121 patients)80%: no negative impact on the quality of consultation when student present; 76% report advantages and 6% negative effect of student’s presence; 10–12% consultation took longer when student present; 67% did not decrease time with doctor3
Salisbury et al (2004)89AustraliaY 3; 2 weeks; O; urbanQuestionnaires handed out by researcher before and after consultation with student. FP and student blinded (RR 8/30 FPs; 88/94 patients who consented/104 available)71% would not refuse a student; for any aspect (Hx taking, PE, procedure) student observing doctor: 93.2% expected, 88.6% occurring, 86.3% would accept in future; doctor observing student 77.2% expected, 69.55% occurring; 84% accepted; student alone for some part 42% expected, 20.4% occurring, 59% accepted3
Pichlhofer et al (2013)29AustriaY ?; ? weeks; O; urbanQuestionnaires either pre or post consultation with student present (RR 28/74 FPs; 508 patients before and 346 after consultation questionnaires)95% (pre)−97% (post) report presence of student did not interfere with patient-doctor relationship; 75% did not report consultation took longer when student present; 5–13% who had consented to a student present would have preferred to see physician alone4
  • ?, No data available in the paper; FM, family medicine/general practice; FP, family/general practitioner; Hx, history; nr, number; O, obligatory; Y, year.