Stakeholder Groups’ Unique Perspectives About the Attending Physician Preceptor Role: A Qualitative Study

  • Jane B. LemaireEmail author
  • Erin Nicole Miller
  • Alicia J. Polachek
  • Holly Wong
Original Research



Attending physician preceptors are accountable to many stakeholder groups, yet stakeholders’ views about what the preceptor role entails have not been sufficiently considered.


To explore stakeholder groups’ unique perspectives of the preceptor role.


Qualitative study with a constructivist orientation.


Semi-structured interviews were conducted with 73 participants from two university teaching hospitals between October 2012 and March 2014. Participants included representatives from seven stakeholder groups: patients and their families, allied healthcare providers, bedside nurses, nurse managers, medical students, internal medicine residents, and preceptors.


An inductive thematic analysis was conducted where researchers coded transcripts, abstracted codes into themes, and then mapped themes onto six focus areas: role dimensions, role performance, stressors and rewards, mastery, fulfillment, and impact on others. Two authors then identified “recurrent themes” (emerging in two or more focus areas) and compared them across groups to identify “unique themes” (emerging from a maximum of two stakeholder groups). “Unique thematic emphases” (unique themes that would not have emerged if a stakeholder group was not interviewed) are described.

Key Results

Patients and their families emphasized preceptors’ ultimate authority. Allied healthcare providers described preceptors as engaged collaborators involved in discharge planning and requiring a sense of humor. Bedside nurses highlighted the need for role standardization. Nurse managers stressed preceptors’ need for humanism. Medical students highlighted preceptors’ emotional labor and their influence on learners’ emotional well-being. Residents emphasized preceptors’ responsibilities to multiple stakeholders. Preceptors described lifelong learning and exercising control over one’s environment.


Various stakeholder groups hold unique and nuanced views of the attending physician preceptor role. These views could broaden formal role guidance for medical education and patient care. This study generated real-world, practical examples of what stakeholders feel are important preceptor skills. These skills should be practiced, taught, and role modeled in this clinical setting.


health services research medical education–faculty development stakeholder engagement 



We would like to acknowledge Jaya Dixit, Kenneth Blades, Kristen Desjarlais-deKlerk, Laurie Vermeylen, and Jill de Grood for their role in data collection and analysis.


This study was funded by the Canadian Institutes of Health Research (grant number 123422), with a grant from the Faculty of Medicine, University of Calgary, and with in-kind support from W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary. Grant title: Exploring the Dimensions of the Medical Teaching Unit Preceptor Role.

Compliance with Ethical Standards

The local University Ethics Board approved the study.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_4950_MOESM1_ESM.docx (30 kb)
ESM 1 (DOCX 29 kb)


  1. 1.
    Borden WB, Mushlin AI, Gordon JE, Leiman JM, Pardes H. A new conceptual framework for academic health centers. Acad Med. 2015;90(5):569–73.CrossRefGoogle Scholar
  2. 2.
    West DC, Robins L, Gruppen LD. Workforce, learners, competencies, and the learning environment: Research in medical education 2014 and the way forward. Acad Med. 2014;89(11):1432–5.CrossRefGoogle Scholar
  3. 3.
    Sutkin G, Wagner E, Harris I, Schiffer R. What makes a good clinical teacher in medicine? A review of the literature. Acad Med. 2008;83:452–466.CrossRefGoogle Scholar
  4. 4.
    Steinert Y, Mann K, Centeno A, et al. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8. Med Teach. 2006;28:497–526.CrossRefGoogle Scholar
  5. 5.
    Hoffman KG, Donaldson JF. Contextual tensions of the clinical environment and their influence on teaching and learning. Med Educ. 2004;38:448–454.CrossRefGoogle Scholar
  6. 6.
    Bates J, Ellaway RH. Mapping the dark matter of context: A conceptual scoping review. Med Educ. 2016;50:807–816.CrossRefGoogle Scholar
  7. 7.
    Michtalik HJ, Yeh H-C, Pronovost PJ, Brotman DJ. Impact of attending physician workload on patient care: A survey of hospitalists. JAMA Intern Med. 2013;173:375–377.CrossRefGoogle Scholar
  8. 8.
    Lemaire JB, Wallace JE, Sargious PM, Bacchus M, Zarnke K, Ward DR, Ghali WA. How attending physician preceptors negotiate their complex work environment: a collective ethnography. Acad Med. 2017;92(12):1765–73.CrossRefGoogle Scholar
  9. 9.
    Bacchus M, Ward DR, Grood J, Lemaire JB. How evidence from observing attending physicians links to a competency-based framework. Med Educ. 2017 Jun 1;51(6):633–44.CrossRefGoogle Scholar
  10. 10.
    Tavakol M, Sandars J. Quantitative and qualitative methods in medical education research: AMEE Guide No 90: Part II. Med Teach. 2014;36:838–848.CrossRefGoogle Scholar
  11. 11.
    Berg BL, Lune H. Qualitative research methods for the social sciences. 8th ed. Boston, MA: Pearson; 2012.Google Scholar
  12. 12.
    Neuman WL. Social research methods: qualitative and quantitative approaches. 7th ed. Boston, MA: Allyn and Bacon; 2011. 631 p.Google Scholar
  13. 13.
    Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field methods. 2006 Feb;18(1):59–82.CrossRefGoogle Scholar
  14. 14.
    Sandelowski M. Sample size in qualitative research. Research in nursing & health. 1995 Apr 1;18(2):179–83.CrossRefGoogle Scholar
  15. 15.
    Biddle BJ. Recent developments in role theory. Ann Rev Sociol. 1986 Aug;12(1):67–92.CrossRefGoogle Scholar
  16. 16.
    Royal College of Physicians and Surgeons of Canada. The CanMEDS Framework. Accessed August 22, 2018.
  17. 17.
    Ten Cate O, Chen HC, Hoff RG, Peters H, Bok H, van der Schaaf M. Curriculum development for the workplace using entrustable professional activities (EPAs): AMEE guide no. 99. Med Teach. 2015;37:983–1002.CrossRefGoogle Scholar
  18. 18.
    Goudy E, Jackson M, den Otter R, Bater M. The journey to include patient and family voices. Healthcare Management Forum. 2015;28(2):61–64.CrossRefGoogle Scholar
  19. 19.
    Atwal A, Caldwell K. Do all health and social care professionals interact equally: a study of interactions in multidisciplinary teams in the United Kingdom. Scandinavian Journal of Caring Sciences. 2005;19(3):268–73.CrossRefGoogle Scholar
  20. 20.
    Reeves S, Rice K, Conn LG, Miller KL, Kenaszchuk C, Zwarenstein M. Interprofessional interaction, negotiation and non-negotiation on general internal medicine wards. Journal of Interprofessional Care. 2009;23(6):633–45.CrossRefGoogle Scholar
  21. 21.
    Zwarenstein M, Rice K, Gotlib-Conn L, Kenaszchuk C, Reeves S. Disengaged: a qualitative study of communication and collaboration between physicians and other professions on general internal medicine wards. BMC health services research. 2013 Dec;13(1):494.CrossRefGoogle Scholar
  22. 22.
    Stone S, Ellers B, Holmes D, Orgren R, Qualters D, Thompson J. Identifying oneself as a teacher: the perceptions of preceptors. Med Educ. 2002;36(2):180–5.CrossRefGoogle Scholar
  23. 23.
    Hafferty FW, Gaufberg EH, O’Donnell JF. The role of the hidden curriculum in. Virtual Mentor. 2015;17(2):130.CrossRefGoogle Scholar
  24. 24.
    Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016; 50(1):132–49.Google Scholar
  25. 25.
    Cook AF, Arora VM, Rasinski KA, Curlin FA, Yoon JD. The prevalence of medical student mistreatment and its association with burnout. Acad Med. 2014;89(5):749–754.CrossRefGoogle Scholar
  26. 26.
    Jenkins TM, Kim J, Hu C, Hickernell JC, Watanaskul S, Yoon JD. Stressing the journey: Using life stories to study medical student wellbeing. Adv Health Sci Educ. 2018.
  27. 27.
    Holden LM. Complex adaptive systems: Concept analysis. J Adv Nurs. 2005;52:651–657.CrossRefGoogle Scholar
  28. 28.
    Report: Complex adaptive systems: Research Scan. London, UK: The Health Foundation, 2010 August.Google Scholar
  29. 29.
    Lesser CS, Lucey CR, Egener B, Braddock CH, Linas SL, Levinson W. A behavioral and systems view of professionalism. JAMA. 2010 Dec 22;304(24):2732–7.Google Scholar
  30. 30.
    Aase I, Hansen BS, Aase K. Norwegian nursing and medical students’ perception of interprofessional teamwork: a qualitative study. BMC Med Educ. 2014 Dec;14(1):170.Google Scholar
  31. 31.
    Wilkes M, Kennedy R. Interprofessional health sciences education: it’s time to overcome barriers and excuses. JGIM.2017 32(8):858–859.CrossRefGoogle Scholar
  32. 32.
    Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Hammick M, Koppel I. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2008 Jan 23;1(1).Google Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Jane B. Lemaire
    • 1
    • 2
    Email author
  • Erin Nicole Miller
    • 3
  • Alicia J. Polachek
    • 2
  • Holly Wong
    • 2
  1. 1.Division of General Internal Medicine, Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
  2. 2.W21C Research and Innovation Center, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
  3. 3.Division of Endocrinology and MetabolismUniversity of OttawaOttawaCanada

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