Methods: The descriptive, qualitative, multiple-case study design, guided by the cognitive task analysis (CTA) research, was used to gain insights into how 18 preceptors, situated in three health care facilities, provided clinical instruction to undergraduate nursing students. The two-step procedure characterizing CTA entailed direct observation of preceptors while teaching students and face-to-face interviews. Observation notes and interview data were analyzed using two different modes of interpretation: pattern identification and data thematization.
Results: Pursuing from the 18 observation field notes and interviews, a number of teaching behaviors were captured, reflecting the preceptors’ conceptions of how students learn best in a clinical environment. Four core teaching constructs were identified: (1) learning relationship, (2) competency-building, (3) advocacy, and (4) meaning-making. While teaching concentrated on competence-building and enabling students, the meaning-making practices were subordinated, even omitted by the majority of the participants. In-depth analysis of the preceptors’ conceptions of teaching and practices led to the salient features of learner-centered clinical teaching.
Conclusion: Clinical teaching is critical when considering the preparation of students in a complex teaching environment. Four conceptions of teaching emerging from the study, ‘partnership, enabling, advocacy, and meaning making' constitute the constructs of the preceptor pedagogy and of clinical teaching curriculum that focuses on learners and learning. While concentrating efforts on competence development is certainly critical, the need for developing clinical reasoning skills, stands out as a major recommendation from this study. Since the preceptorship model is ubiquitous in most practice disciplines, the study may be replicated in other health professional disciplines. Such practices will intensify advocacy for a better preparation of the future health professionals.