Team-based versus preceptor-based assignment of junior surgery students

Background Clinical evaluations of junior surgery students frequently lack sufficient detail for effective formative or summative feedback. We hypothesized that this was in part due to a lack of personal accountability associated with large general surgery teams, and that altering the format to assign students to specific surgical faculty preceptors rather than to teams would affect the clinical evaluation products. Methods Over a 1-year period, 154 junior medical students grouped into 8 successive clerkships were assigned alternately in the usual Team (3–5 junior students, with 2–4 general surgery faculty, 2–4 residents, and 0–2 senior students) or a new Preceptor format (1–2 students to each faculty preceptor). In order to keep the ratio of students to faculty low, approximately one-third of the Preceptor format students were assigned to subspecialists. Results The preceptor format resulted in the use of more adjectives to describe students in the open-ended portions of the facultiesʹ clinical evaluations (mean of 3.2 as compared with 2.5, P = 0.003), and a greater proportion of students recommended for overall clinical Honors (47% as compared with 25%, P = 0.004). The clerkship format had no impact on exam performance, studentsʹ perceptions of the faculty, or the amount of studentsʹ self-reported clinical activity. Nevertheless, twice as many Team format students felt they had too few patients, whereas twice as many Preceptor students felt their informal instruction had been less than “good.” Conclusions Preceptor assignment increased the number of students recommended for Honors, but this did not correlate with studentsʹ exam performance. From the studentsʹ standpoint, each format had advantages and disadvantages. Limiting the number of students on the general surgery teams and adding structured formative feedback from faculty before the end of the clerkship might give students the instructional advantages of the Preceptor format without sacrificing those of the Team format.