Differences in ambulatory teaching and learning by gender match of preceptors and students

Background and Objectives: Important differences exist in traditional medical education by gender of the teachers and learners. Much less is known about how gender influences educational experiences in community-based ambulatory settings. In this study, we explored how community-based teaching and learning varies by gender of the students and preceptors. Methods: This prospective study used both paper- and computer-based documentation systems to collect information on student-patient-preceptor encounters. A consecutive sample of third-year medical students contributed data on one full clinical day each week as they rotated through a required 8-week family medicine clerkship. The main measures of interest included patient age and gender, health care visit type (acute, acute exacerbation of chronic, chronic, and health maintenance), method of learning in history taking and physical examinations (observing preceptor, being observed by preceptor, performing unobserved, or working jointly with preceptor), content of physical examinations, amount of preceptor feedback preceptor teaching content, and gender of the students and their preceptors. Results: Ninety-three students contributed data on 5,017 patient encounters. The distribution of encounters by student-preceptor dyad included: 1,926 (38%) female students with male preceptors, 1,716 (34%) male students with male preceptors, 841 (17%) female students with female preceptors, and 534 (11%) male students with female preceptors. We found that female preceptors conduct more complete physical exams with students than do male preceptors (28% versus 23%). Female students with male preceptors devoted more encounters to observation only than any other dyad (20% versus 12%), and female preceptors are more likely than male preceptors to allow students to perform unobserved (70% versus 59%). Patient gender played little if any role in how students and their preceptors worked together. Conclusions: Differences of potential importance were found in teaching and learning by gender of the student-preceptor dyad. This factor can and should be considered when determining how students can best meet educational objectives in community-based ambulatory settings.