Stage 1: Assessment of the educational needs of preceptors
Quantitative phase
Of the 146 preceptors from both CPH and CHS, 91 responded to the survey yielding a response rate of 62.3%. Similarly, 118 preceptors from the CMED responded with a response rate of 65.9%. The majority of respondents from CPH and CHS were female (79.3%) and from countries other than Qatar (72.73%; n=91). In contrast, the majority of respondents from CMED were male (78.6%) and with non-Qatar backgrounds (49.5%; n=118). Out of 91 respondents from CPH and CHS, 16.4% were board certificated by an Arab country, 14.3% certified by a non-Arab country, and 5.5% from other agencies or mixed countries. On the other hand, out of 118 respondents from CMED, 44.9% were board certified by an Arab country, 43.2% certified by a non-Arab country, and 11.8% from other agencies or mixed countries. The majority (24.2%) of respondents at the CPH and CHS reported having 5-9 years of teaching experience with health professional students, while the majority at CMED (30.5%) reported 1 – 4 years. Furthermore, most of the respondents at the CPH and CHS (11%) and the CMED (20.3%) reported having 1-4 years of teaching experience with residents. The majority of respondents from the CPH and CHS indicated that they have been involved or currently involved in student assessment (74.39%), whereas CMED preceptors reported a high percentage of clinical bedside teaching (79.6%). Table 2 illustrates the demographic and professional characteristics of preceptors who participated in the survey (n=209).
Table 2. Demographics and professional characteristics of preceptors
Preceptors’ educational needs in frequency and percentages are summarized in Table 3. The identified needs include: adult learning principles, curriculum and course design, writing educational objectives, lecturing and large group teaching, tutorial and small group teaching, facilitating problem-based learning, teaching and learning in clinical settings, providing feedback, assessment in clinical settings, clinical simulation, curriculum and course evaluation, mentoring skills, and educational research skills. Most of these needs were deemed to be a high priority among all respondents.
Table 3. Preceptors’ educational needs (n= 209)
Preceptors’ needs
|
Not a priority
|
Low priority
|
Medium priority
|
High priority
|
Adult learning principles*
|
6 (2.9%)
|
19 (9.22%)
|
58 (28.1%)
|
123 (59.7%)
|
Curriculum & course design*
|
3 (1.4%)
|
15 (7.25%)
|
52 (25.1%)
|
137 (66.2%)
|
Writing educational objectives*
|
2 (0.9%)
|
19 (9.27%)
|
59 (28.8%)
|
125 (61%)
|
Lecturing and large group teaching*
|
2 (0.9%)
|
31 (15.0%)
|
59 (28.6%)
|
114 (55.3%)
|
Tutorial and small group teaching*
|
1 (0.4%)
|
23 (11.1%)
|
63 (30.4%)
|
120 (58%)
|
Facilitating problem-based learning*
|
0 (0.0%)
|
16 (7.77%)
|
52 (25.2%)
|
138 (67%)
|
Teaching and learning in clinical settings*
|
4 (1.9%)
|
11 (5.3%)
|
41 (19.7%)
|
152 (73.1%)
|
Providing feedback*
|
0 (0.0%)
|
20 (9.71%)
|
51 (24.8%)
|
135 (65.5%)
|
Assessment in clinical settings*
|
6 (2.9%)
|
14 (6.7%)
|
45 (22.1%)
|
139 (68.1%)
|
Clinical simulation*
|
6 (3%)
|
13 (6.4%)
|
50 (24.8%)
|
133 (65.8%)
|
Curriculum and course evaluation*
|
0 (0.0%)
|
16 (7.9%)
|
56 (27.6%)
|
131 (64.5%)
|
Mentoring skills*
|
0 (0.0%)
|
15 (7.3%)
|
42 (20.4%)
|
149 (72.3%)
|
Educational research skills
|
0 (0.0%)
|
15 (7.2%)
|
50 (24%)
|
144 (69%)
|
* Indicates missing data
Preceptors’ preference and motivators for attending professional development programs were also identified. The face-to-face delivery method was the most preferred approach by the respondents of the CPH and CHS (55.6%); however, the blended method (i.e., both face-to-face and online) was ranked the highest by the CMED respondents. Among the weekdays, Thursday and Saturday were the most convenient days to attend such programs for the majority of respondents from the CPH and CHS (46.59%) and the CMED (45.7%). Moreover, registering for professional development programs by preceptors was highly influenced by the announced learning objectives of proposed programs. This motivational factor (i.e., learning objectives of training programs) was the most opted by the majority of the CPH and CHS (86.81%) and the CMED (81.3%) participants. Participants were asked to provide suggestions that help them develop their knowledge and skills to educate the health professional students. Table 4 presents the reported suggestions from the participants.
Table 4. Preceptors’ suggestions on how their knowledge and skills to educate health professions students can be developed
Qualitative phase
Five major themes were determined from exploring participants’ perceptions about the preceptors’ educational skills and needs: planning, instruction and delivery, assessment, feedback, and communication skills.
Planning: Preparation for experiential education is one of the most important areas that need improvement, as reported by study participants. Also, developing learning objectives, managing time, and applying effective strategies for well-organized clinical rotations were highlighted by participants as one of the weakest skills possessed by preceptors.
Instruction and delivery: Students’ involvement in the learning experience varied from being exclusively observers to fully independent practitioners under preceptors’ supervision. In addition, the FG findings showed that there is a need for a preceptor to improve their styles of teaching. Students experienced a gap between classroom learning and practice because of preceptors' inadequate clinical teaching. The findings also suggest that the level of motivation and enthusiasm displayed by the preceptor during the experiential training of students varies among preceptors. While some show willingness, interest, and passion for teaching, others demonstrate dissatisfaction and impatience.
Assessment: Despite the preceptors’ efforts to implement variable assessment approaches, assessment malpractices were reported by students. For example, students indicated incidents where assessment practices were applied inconsistently among preceptors. In addition, there was a tendency demonstrated by preceptors to express judgmental attitudes and lack of objectivity in their evaluation. The participants also illuminated some challenges encountered during this process. For example, time restrictions with long and exhausting assessment forms and disregard for the assessment criteria.
Feedback: The FG findings indicated that there was an apparent lack of comprehensive understanding among preceptors regarding the significance of feedback provision and the skills needed to deliver feedback to students effectively. Lack of professionalism, judgmentality, and harshness are all examples of immoral practices conducted by preceptors when providing feedback. Additionally, although there was satisfaction among students regarding the clinical rotations where they received an end of task or end of day feedback, yet incidences were still reported whereby students either did not receive any feedback or they received it indirectly through a third party. Furthermore, insufficient feedback on preceptors’ performance from faculty or administrators in the university was reported by preceptors, indicating their need for clear guidance and observation.
Communication skills: A cohort of participants indicated satisfaction regarding the overall level of communication demonstrated by preceptors. However, there was a claim regarding the preceptors' lack of necessary communication skills such as superiority and judgmental attitudes, use of improper language, and inappropriate ways of answering students’ questions. The finding also highlighted the preceptors’ need to learn how to deal with challenging students and cultural diversities. Table 5 provides a summary of the main themes, subthemes, and the participant quotes reflecting preceptor educational needs.
Table 5. Themes, subthemes and quotes reflecting preceptors’ educational needs
Integration between qualitative and quantitative phases
This study followed a convergent mixed-methods triangulation study design where both quantitative and qualitative data were collected at the same time, and integrated for analysis. As indicated earlier, the purpose of the quantitative phase was to identify and prioritize the educational needs of preceptors in order to improve them through the most convenient way (e.g., delivering face-to-face or online continuing education programs). Clear evidence emerged from the preceptors’ self-assessment, indicating that preceptors possess inadequate skills to almost all studied educational competencies and the real need for improvement. On the other hand, the qualitative phase was meant to capture all thoughts of preceptors, students, and faculty members about preceptors’ educational practices in experiential training. Focus group interviews shed light on the areas of proficiency or deficiency, reasons behind the suboptimal educational practices, available or needed support for preceptors, and the experienced challenges in the current system. Notably, an in-depth understanding of the educational needs prioritized in the quantitative phase was achieved by the qualitative FG discussions. For instance, the assessment of students was one of the areas that were ranked as a high priority for most preceptors to learn. Complementary, qualitative evidence points to the unrecognition of the assessment tools and/or assessment criteria among preceptors, which could lead to unfair or irrational assessment. Also, fundamental suggestions for improving preceptors’ educational competencies were explicitly captured in the survey’s qualitative data and reinforced by the participants’ narrations.
Stage 2: The design of ‘The Practice Educators’ Academy’ program
This stage involved six research team meetings to design the provisional syllabus based on the expressed preceptor educational needs while benchmarking against other preceptor educational development programs internationally. The syllabus comprised of five main modules: principles of teaching and learning, planning for the experiential learning, teaching and instructional strategies, students’ assessment, and feedback, and finally, communication skills for effective preceptorship and conflict resolution. In addition, the syllabus included the educational needs expressed by the preceptors and learning outcomes for each module that were benchmarked against other available international programs. An agreement was reached by the research team to deliver this program over 12 hours in a weekend, through face-to-face interactive workshops.
Stages 3: Validation and refinement of ‘The Practice Educators’ Academy’ program
Eighteen health professional education scholars from Monash University, University of Toronto, Western University, University of British Columbia, University of Tasmania, National Taipei University of Nursing and Health Sciences, University of Cincinnati, Howard University, Lebanese American University, College of North Atlantic-Qatar, and Qatar University were approached and asked to provide in-depth feedback regarding the designed syllabus. Feedback and general comments were received from around half of the contacted scholars. The followings are examples of the received and considered comments:
“There is lesser exposure to reflective practice in this program.”
(Scholar from the University of Toronto)
“Add a hands-on simulation to allow attendees time to practice.”
(Scholar from Lebanese American University)
Table 6 represents examples of feedback provided by the health education scholars and changes proposed by the research team, while Table 7 illustrates the refined version of the syllabus after considering health education scholars’ feedback.
Table 6. Examples of health education scholars’ feedback and action taken
Table 7. Validated syllabus