Community preceptor perspectives on recruitment and retention: The CoPPRR study

BACKGROUND AND OBJECTIVES: Medical schools are increasingly challenged to recruit and retain community-based preceptors. Physicians experience various incentives and deterrents to teaching medical students while providing patient care. Self-determination theory (SDT) posits people act in response to internal and external motivations and suggests autonomy, competence, and relatedness are basic psychological needs for well-being and integrity. The applicability of SDT to explain why physicians become or remain a preceptor is uncertain. This study explores physicians’ motivations for precepting medical students within the framework of SDT. METHODS: Focus groups were conducted at seven institutions chosen to represent national diversity using a semistructured interview guide based on SDT. Community-based family physicians discussed benefits and barriers to precepting. Interviews were recorded, transcribed, and coded using open codes. Thematic analysis was performed utilizing the conceptual framework of SDT emphasizing the domains of autonomy, competence, and relatedness. RESULTS: Feeling competent about their medical practice and teaching skills, reporting connectedness to the institution and students, and having autonomy over their teaching increased preceptor motivation to teach. Concerns about clinical workload demands, negative teaching experiences, and institutional bureaucracy decreased motivation. CONCLUSIONS: Preceptors choose to become and remain preceptors based on a combination of intrinsic motivating factors and effective external motivators. SDT appears to be a useful framework for assessing and responding to the needs of community-based family medicine preceptors and may be a useful guide for medical educators and policy makers seeking to identify and implement effective strategies to recruit and retain community preceptors to work with medical students.