Study selection
The literature search retrieved a total of 1,642 citations after removing duplicates. Screening for eligibility based on titles excluded 1,463 papers, leaving 179 papers for review of abstracts. A further 69 papers were excluded after reviewing abstracts, with 110 papers carried forward for full text review. Careful screening provided 36 papers fitting the selection criteria. Hand searching found an additional 5 references, resulting in a total of 41(5-8, 21-57) articles to be included for review (Figure 1).
Study characteristics
Of the 41 included articles, 26 were conducted in the United States(6, 7, 22, 23, 25-28, 30-33, 35-37, 41-45, 47-49, 53, 56), three in Canada(5, 8, 51), two in Taiwan(39, 40), two in Iran(24), and one each in Thailand(54), Ethiopia(50),Saudi(21), Brazil(34), Australia(46), Sweden(55), Belgium(52) and the United Kingdom(29). Seventeen were based on preceptorship/education in medicine (7, 28, 29, 32, 41, 43, 47-49, 51-53, 55-57), twelve in pharmacy(6, 8, 21-23, 27, 30, 31, 33, 35, 50, 54), and eleven in nursing(5, 24, 25, 34, 37-40, 44-46) and one in dentistry(42). There were twelve quantitative studies(22, 23, 27, 30, 32, 36, 43, 44, 46, 50, 54), ten qualitative studies(26, 31, 34, 38, 39, 41, 42, 45, 55, 56), three mixed methods(40, 47, 48), four descriptive papers that did not report results(33, 35, 37, 53), five papers concerned with validity testing(25, 28, 49, 51, 52) and seven papers describing consensus building, three with Delphi approaches(7, 26, 29) and four with expert opinion based on literature review and qualitative synthesis(5, 6, 8, 57). Data were extracted and are presented in Additional file 2.
Competencies and methods of assessment of preceptors
Seventeen competencies with associated methods of assessment were identified, as outlined in Table 2. The methods used to identify competencies of preceptors included expert opinion based on literature reviews and qualitative synthesis(5, 6, 8, 57, 58), Delphi approaches(7, 26, 29), and qualitative studies examining the qualities of preceptors that preceptees value most (24, 34, 39, 41, 42, 48). Fifteen studies identified competencies, but assessment had not been implemented or reported(5-8, 24, 26, 29, 34, 35, 38, 42, 45, 53, 55, 57), with only four studies detailing performance indicators for the competencies described (5-8).
The competency of preceptors was measured in four ways. Most commonly, and with moderate to high confidence as per CERQual, preceptees used a survey instrument to assess the competency of their preceptor(23, 27, 43, 50, 54). Preceptee assessment was also combined with a preceptor self-assessment instrument which allowed for comparison between preceptors’ and preceptees’ perceptions of their experience working together(33, 50, 54). Preceptors were shown to overestimate their abilities when self-evaluating, compared to preceptee evaluations (CERQual assessment: low confidence). Another method used was an assessment of preceptors by peers or faculty using a survey instrument(27) or by direct observation of interactions with preceptees(28, 30, 56). While this approach provided greater specificity and detail(47), it was reported as more difficult to implement on a large scale, due to time and cost constraints, as well as lower preceptor acceptance(27). The fourth approach was associating preceptees’ examination performance with the ‘quality’ of teaching as rated by preceptees via subjective measurement(36).While the strongest evidence exists for preceptee evaluation of preceptors; there is moderate confidence in evidence for self-assessment and peer evaluation, the confidence is lowered by the limited amount of evidence. Although there was good correlation between preceptee evaluations of preceptors and preceptors’ self-assessment; preceptors overestimated their effectiveness as communicators(50) and their ability to provide feedback(50, 54). Measurement of preceptee outcomes had good but limited evidence (low confidence)(36). Only one study linked the quality of the preceptor with a preceptee outcome; preceptees with a perceived higher preceptor quality performed better in their exams(36). Table 2 describes the methods of assessment, and confidence in evidence. The full CERQual evaluation is presented in Additional file 3.
Table 2: Preceptor competency and assessment in health professions
Competency with identified measures of performance
|
GRADE CERQual Confidence in evidence
|
Assessment measure
|
Setting
|
-Effective communication skills
6-9,26,27,31-35,44,47,49-51,55,59,61,62
|
Moderate to high
|
Peer observed practice32,35,44,61
Peer observed simulation33
|
Medicine33,61Nursing44
Pharmacy32,35
|
Preceptor self-evaluation survey28,45,55,59
|
Nursing45
Pharmacy28,55,59
|
Preceptee survey6,28,35,55,59
|
Nursing6
Pharmacy28,35,55,59
|
-Role model practitioner6-8,26,27,31,32,34,35,43-46,48,50,51,61
|
Moderate to high
|
Peer observed practice32,35,38,44,61
|
Medicine61
Nursing44
Pharmacy32,35,38
|
Preceptor self-evaluation survey28,38,45
|
Nursing45
Pharmacy28,38
|
Preceptee survey6,28,38,48
|
Medicine48
Nursing6
Pharmacy28,38
|
-Adapts to the learning needs of students 8,9,32,39,46,49,61
|
Moderate to high
|
Peer observed practice32,33,44,61
Peer observed simulation57
|
Medicine33,57,61
Nursing44
Pharmacy32
|
-Commitment to excellence in teaching 6,7,9,31,32,34,44-46
|
Moderate
|
Peer observed practice32,44
|
Nursing44
Pharmacy32
|
Preceptor self-evaluation survey45
|
Nursing45
|
Preceptee survey6
|
Nursing6
|
-Demonstrates respect for the learner 44,48,49,61
|
Moderate
|
Peer observed practice44,61
|
Medicine61
Nursing44
|
Preceptee survey48,56
|
Medicine48,56
|
Demonstrate reflective practice6,8,9,34
|
Moderate
|
Preceptee survey6
|
Nursing6
|
Effective provision of feedback7-9,28,34,38,44,54,57
|
Moderate
|
Peer observed practice 38,44
Peer observed simulation57
|
Nursing44
Medicine57
Pharmacy38
|
Preceptee survey28,38
|
Pharmacy28,38
|
Preceptor self-evaluation survey28,38
|
Pharmacy28,38
|
Demonstrate reflective practice 8,9,31,34
|
Moderate
|
Peer observed practice44
|
Nursing44
|
Preceptee survey6
|
Nursing6
|
-Facilitate critical thinking, problem solving and decision-making development6,9,32,34,43,55,57,59,61
|
Moderate
|
Peer observed practice32,61
Peer observed simulation57
|
Medicine57,61
Pharmacy32
|
Preceptor self-evaluation survey55
|
Pharmacy55
|
Preceptee survey6,55,59
|
Nursing6
Pharmacy55,59
|
-Encourage self-directed learning7,54,56,58
|
Moderate
|
Preceptee survey54,56
|
Medicine54,56
|
-Leadership and management skills7,27
|
Low-moderate
|
|
|
Skills of effective preceptors without indicators of performance identified.
|
GRADE CERQual Confidence in evidence
|
Assessment measure
|
Setting
|
-Organised and ability to prioritize34,35,44,45
|
Moderate
|
Peer observed practice35,44
|
Nursing44
Pharmacy35
|
Preceptor self-evaluation survey45
|
Nursing45
|
-Empathetic
29,32,34,43,49
|
Moderate
|
Peer observed practice32
|
Pharmacy32
|
-Ethical
33,34,44
|
Moderate
|
Peer observed practice33,44
|
Nursing44
Medicine33
|
-Approachable and flexible
28,32,44,47-49
|
Moderate
|
Peer observed practice32,44
|
Nursing44
Pharmacy32
|
Preceptee survey28,48
|
Medicine48
Pharmacy28
|
-Enthusiasm for teaching Preceptees
34,35,38,44,45
|
Moderate
|
Peer observed practice35,38,44
|
Nursing44
Pharmacy35,38
|
Preceptor self-evaluation survey38,45
|
Nursing45
Pharmacy38
|
Preceptee survey38
|
Pharmacy38
|
-Open to receiving feedback
28,34,38,48
|
Low
|
Peer observed practice38
|
Pharmacy38
|
Preceptor self-evaluation survey28
|
Pharmacy28
|
Preceptee survey28,48
|
Medicine48
Pharmacy28
|
Quality appraisal
The CASP Cohort checklist was used for the quantitative and validity testing papers, and the CASP Qualitative checklist was used for qualitative studies, descriptive studies and consensus building based on literature review and qualitative synthesis. The results of the CASP assessments tabled with a traffic light legend can be found in Additional file 4. Very few studies received green ratings across all categories. In the CASP Qualitative assessment, only two papers were green in all catagories(39, 41). Most commonly, articles did not contain enough information to make an assessment on the relationship between participants and researchers, ethical considerations, and data analysis. For the CASP Cohort assessment, there were no randomised controlled trials, and no studies received green ratings on all categories. Most commonly, articles did not have enough information regarding follow up of participants, or the length of follow-up of participants. Many articles did not have enough information to ascertain whether confounding factors were considered in the study design.