Factors associated with higher clinical skills experience of medical students on a family medicine preceptorship.

BACKGROUND AND OBJECTIVES Educators should document students' clinical skills experience and whether curriculum and other course changes impact this experience. We wanted to determine the factors associated with students' clinical skills experience during their third-year family medicine preceptorship. METHODS We conducted an observational study of 1,419 third-year students at the University of Iowa taking a required family medicine preceptorship during 9 academic years: 1994-1995 to 2002-2003. Students rated their level of experience with 57 clinical skills on a 5-point scale. Student ratings were summed to obtain scores for total clinical skills (n=57), procedural skills (n=22), and female-specific skills (n=9). RESULTS Students who completed their preceptorship in rural areas (as opposed to urban areas or in a residency), prior to the implementation of Centers for Medicare and Medicaid Services regulations, prior to integration with ambulatory internal medicine and community-based primary care, or who rotated during the second half of the academic year reported a higher mean level of experience with clinical skills in univariate and multivariate analyses. Both years of experience as a preceptor and total number of previous students taught were positively associated with students' total clinical skills scores. In addition, several preceptor teaching qualities were significantly and positively associated with overall skills experience: opportunity for clinical procedures, delegation of appropriate responsibility, and preceptor conveyed expectations clearly. CONCLUSIONS Use of a consistent clinical skills checklist allowed us to document important effects of curriculum, legislation, and preceptor teaching qualities on the students' clinical skills experience.