To Teach or Not to Teach: Incentives and Barriers Impacting Clinical Preceptorship in Family Medicine

Clinical rotations are critical for medical education.^1,2 It is essential to have physician teachers (preceptors).² US medical schools are experiencing increasing difficulty recruiting⁴ and retaining preceptors.⁴ Family medicine is an important component of most institutions’ clinical rotations.^5,6 The University of Colorado School of Medicine (CUSOM) switched to a longitudinal integrated clerkship (LIC) with the class of 2025. Students have a half day of family medicine clinic weekly during their clinical year.¹⁷ We sought to understand motivations of current, past, and potential family medicine preceptors to ensure we maintain necessary clinical sites. We planned to use this data to guide discussions surrounding recruitment and retention of preceptors.

A cross-sectional survey on teaching perspectives was distributed to 376 family medicine physicians associated with CUSOM who were active or past preceptors, or were associated with practices that historically had taken students. There were no parameters set on how long ago a site or provider may have taken learners to be included. The survey was distributed by the Dean of Education via email in May 2024 and closed in July 2024. After receiving institutional review board exemption (#23-1127), we administered this survey (Table 2) in Qualtrics using skip logic to tailor questions to teaching status. Response scales included check-one response, check-all-that-apply, and open-ended comments. The survey was reviewed by family physicians and two expert reviewers.

For single-choice, closed-ended survey questions, we calculated descriptive statistics. For the open-ended questions, we adopted a thematic analysis approach. Two study leads created themes matching responses. They compared theme definitions and appropriateness for the first 10 free-response questions to ensure standardization. Three leads then matched each free-text response to appropriate themes, and we then analyzed the data for the thematic frequency.

A total of 228/376 (60.7%) family physicians completed the survey (Table 1). Practice scope and practice affiliation of the survey participants varied as is reported in Table 1. The majority (75.0%) of survey participants were current preceptors. Twenty-eight participants (12.2%) were former preceptors and eleven (4.8%) had not been preceptors.

Intrinsic factors were the most common motivators for preceptors (Table 3). Of those currently teaching, the most common motivations include “love for teaching/enjoyment” (76.6%), “sense of duty to the profession” (67.8%), and “relationships with students” (58.5%).  A significant percentage (41.5%) of current preceptors had considered no longer clinically teaching. A free-response question explored what could motivate preceptors to continue teaching. A summary of the response themes is shown in Table 4. Dedicated time for teaching without impacting productivity was the most common theme (80.0%). One participant stated:

“Carved out time. A full, busy clinic day is too difficult to manage while also taking good, necessary time to teach and guide a student.”

Eleven of the 39 participants who are not currently teaching have never taught. Their reasons for not teaching included extrinsic barriers (Table 3). The most common was lack of time (51.3%).

Participants who stated that they had stopped teaching clinically were queried regarding their reasoning. A thematic summary of the responses is shown in Table 4. The time demands of teaching was the most cited reason (50.0%). One participant explained:

“Having medical students takes significant time. On days that I had a student, I found myself either being behind, not finishing notes, not doing inbasket, or doing a very poor job teaching ...”

Participants who had never taught were asked what could motivate them to teach (Table 4). Time dedicated to teaching without impacting productivity was the most common theme (69.2%). The other common themes were direct financial compensation (26.9%), changes in the way students or preceptors are scheduled (11.5%), faculty development on efficiency (11.5%), and job logistics (11.5%).

Our study evaluated the motivations of family physicians when deciding whether to serve as preceptors. The love of teaching was the most frequently-cited reason for teaching followed by duty to the profession, and relationships. These motivators may also be influenced by the pool of physicians being those who were or had been affiliated with teaching. Financial incentives ranked last as a motivating factor (2.9%), differing from current literature.^7,12,20 However, 32.3% of current preceptors said that financial compensation would motivate them to continue teaching, 33.3% of nonpreceptors noted the lack of financial compensation as a factor in their decision not to teach, and 26.9% listed it as a potential motivating factor to begin teaching.

Our finding that time is the greatest barrier to preceptor recruitment and retention aligns with current research.^4,7,13 Dedicated time for teaching was mentioned by 80% as a motivating factor to continue teaching, 50% as a reason they stopped teaching, and 69% as a potential motivating factor to begin teaching.

While 60.6% of survey recipients completed the survey, there is the potential for nonparticipation bias. We have considered that those who did not respond may be those most constrained by time or possibly less invested in the mission of the school. The number of respondents that selected specific themes limits our ability to assess differences based on demographic variables such as gender and age or practice settings with statistical significance. While we anticipate that the LIC model reduces time burden on preceptors who previously had students daily, this survey was completed just after a curriculum transition which makes positive and/or negative impact difficult to assess and limits our study’s generalizability to other medical schools. Given the broad scope of family medicine, there may be limited generalizability to other specialties.

Recruiting and retaining family medicine preceptors is a challenge for medical schools across the country. Our findings align with existing research that physicians largely balance intrinsic motivators with extrinsic barriers, however our study showed less emphasis on financial incentives. The largest motivator is the love of teaching, and the largest barrier is lack of time. Literature on efficient precepting is growing from bedside teaching and broadening student responsibilities to creative patient scheduling.¹⁹ We plan to work closely with department leadership to discuss opportunities to reduce the time barrier placed on family medicine preceptors.