Abstract
BackgroundEffective teaching requires an understanding of both what (content knowledge) and how (process knowledge) to teach. While previous studies involving medical students have compared preceptors with greater or lesser content knowledge, it is unclear whether process expertise can compensate for deficient content expertise. Therefore, the objective of our study was to compare the effect of preceptors with process expertise to those with content expertise on medical students' learning outcomes in a structured small group environment.MethodsOne hundred and fifty-one first year medical students were randomized to 11 groups for the small group component of the Cardiovascular-Respiratory course at the University of Calgary. Each group was then block randomized to one of three streams for the entire course: tutoring exclusively by physicians with content expertise (n = 5), tutoring exclusively by physicians with process expertise (n = 3), and tutoring by content experts for 11 sessions and process experts for 10 sessions (n = 3). After each of the 21 small group sessions, students evaluated their preceptors' teaching with a standardized instrument. Students' knowledge acquisition was assessed by an end-of-course multiple choice (EOC-MCQ) examination.ResultsStudents rated the process experts significantly higher on each of the instrument's 15 items, including the overall rating. Students' mean score (±SD) on the EOC-MCQ exam was 76.1% (8.1) for groups taught by content experts, 78.2% (7.8) for the combination group and 79.5% (9.2) for process expert groups (p = 0.11). By linear regression student performance was higher if they had been taught by process experts (regression coefficient 2.7 [0.1, 5.4], p < .05), but not content experts (p = .09).ConclusionsWhen preceptors are physicians, content expertise is not a prerequisite to teach first year medical students within a structured small group environment; preceptors with process expertise result in at least equivalent, if not superior, student outcomes in this setting.
Highlights
Effective teaching requires an understanding of both what and how to teach
By linear regression we found no effect of content expertise on performance
When we studied the effects of content and process expertise separately we found that process expertise was associated with a small, but significant, improvement in learning outcomes, whereas content expertise was not
Summary
Effective teaching requires an understanding of both what (content knowledge) and how (process knowledge) to teach. The objective of our study was to compare the effect of preceptors with process expertise to those with content expertise on medical students’ learning outcomes in a structured small group environment. In 1994 Davis et al [9] published another study that appeared to contradict their earlier work and suggested that the benefit of content expertise disappears when highly structured cases are used. Other groups confirmed this new finding and it was proposed that highly structured cases may reduce the knowledge gap between expert and non-expert preceptor and/or reduce the dependency of students’ learning on their preceptors’ knowledge [10,11]
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