Preceptor activities and preparation time in medical residency: a hospital-based survey

ABSTRACT

Introduction:  Preceptorship is a central element of medical residency, but there are gaps in formal assignments and the time required to prepare and execute teaching activities.

Objective:   To identify mandatory and optional preceptorship activities and estimate the time dedicated to their preparation and execution in a teaching hospital.

Methods:   This was an observational, cross-sectional study via an online survey of preceptors from COREME-accredited programs. The 44-item questionnaire covered profile, practice locations, and teaching/evaluation activities, as well as preparation/execution time. The analyses were descriptive.

Results:  68/322 preceptors (21.1%) from multiple specialties responded. The most frequent teaching activities were participation in clinical meetings, outpatient case discussions, and non-surgical skills teaching. Among the mandatory activities, outpatient case discussions, participation in clinical meetings, and non-surgical skills teaching prevailed. Class preparation required 2 to 6 hours; the preparation of clinical case discussions, on average 4 hours; and the development/administration of assessments, approximately 3 hours per month.

Conclusion:   The scope of preceptorship at the institution is varied and aligned with competency-based curricula; clinical case discussions, when mandatory, required the most preparation and implementation time. The findings provide a basis for determining the workload and organization of preceptorship activities in medical residency programs.

Keywords:
Preceptorship; Medical Residency; Medical Education; Workload; Clinical Competence

RESUMO

Introdução:  A preceptoria é elemento central da residência médica, porém há lacunas sobre as atribuições formais e o tempo necessário para preparo e execução das atividades docentes.

Objetivo:   Este estudo teve como objetivos identificar atividades regulamentares e opcionais da preceptoria e estimar o tempo dedicado ao seu preparo e à execução em um hospital de ensino.

Método:   Trata-se de um estudo observacional, transversal, via survey on-line realizado com preceptores de programas credenciados pela Coreme. O questionário (44 itens) abrangeu perfil, locais de atuação e atividades de ensino/avaliação, além de tempo de preparo/execução. As análises foram descritivas.

Resultado:  Responderam 68/322 preceptores (21,1%) de múltiplas especialidades. As atividades de ensino mais frequentes foram participação em reunião clínica, discussão de casos em ambulatório e ensino de habilidades não cirúrgicas. Entre as consideradas regulamentares, prevaleceram discussão de casos em ambulatório, participação em reunião clínica e ensino de habilidades não cirúrgicas. O preparo de aulas demandou de duas a seis horas; a preparação de discussões de casos clínicos, em média quatro horas; e a elaboração/aplicação de avaliações, cerca de três horas por mês.

Conclusão:  O escopo da preceptoria na instituição é variado e alinhado a currículos por competência; a discussão de casos clínicos, quando regulamentar, concentrou maior tempo de preparo e execução. Os achados fornecem substrato para o dimensionamento de carga e a organização das atividades de preceptoria na residência médica.

Palavras-chave:
Preceptoria; Residência Médica; Educação Médica; Carga de Trabalho; Competência Clínica

INTRODUCTION

Decree N. 80,281 of 1977 instituted Medical Residency (MR) and created the National Commission for Medical Residency (CNRM, Comissão Nacional de Residência Médica), but it was Law N. 6,932/1981 that established the detailed guidelines that define it as a postgraduate education modality aimed at physicians, in the form of a specialization course. It is characterized by in-service training, on an exclusive dedication basis, carried out in health institutions - university or not - under the supervision of physicians with high ethical and professional qualifications¹. It is the most effective model of training the specialist doctor², based on practical learning and continuous monitoring by a professional with full training in their area of expertise, who is called preceptor (from the Latin praeceptor, one who instructs), thus, all professionals responsible for monitoring students in the health area and who will provide care to patients, are considered preceptors³.

The main competencies of the preceptor include the supervision and guidance of the student, providing experiences that favor their socialization and development as technically qualified, ethical and empathetic professionals, able to exercise the profession⁴. It is also desirable that the preceptor, in addition to experience in their area of expertise, is trained in learning and evaluation methods⁴. Training in pedagogical strategies that involve active methodologies, people management, empathy development, and conflict management strengthens a structured curriculum that directly impacts the quality of residents who enter the job market⁵. The American Academy of Family Physicians (AAFP) recognizes that events aimed at improving pedagogical skills are fundamental to preceptorship excellence⁶.

Together with the need to establish well-designed medical residency programs, it is essential to invest in the training of preceptors as a basis for training specialists in residency. The American Society of Family Medicine recommends protected time in the preceptors’ workload intended exclusively for teaching⁶. In Brazil, Ribeiro et al. (2023), presented an instrument to evaluate residency programs in family medicine and observed variables such as the expected time for the pedagogical exercise of the preceptorship and receiving financial incentives for this activity⁷, but there is no information on what would be the regulatory (or mandatory) and voluntary (developed for specific motivation) activities of a preceptor. The general objective of this study is to identify the set of mandatory and optional activities that constitute the practice of preceptorship in Medical Residency programs of a teaching hospital. The specific objectives are: (i) to estimate the preparation time and the execution time per activity; (ii) to describe the proportion of preceptors who perform each activity; (iii) to quantify the number of mandatory or optional activities per preceptor.

METHODS

Reporting design and guidelines

This was a primary, observational, cross-sectional study conducted in a university teaching hospital. The report follows the recommendations for survey-based research by ASE⁸.

Scenario and period

Data collection was carried out between April and July 2023 in Medical Residency (MR) programs linked to the institution Medical Residency Commission (COREME).

Participants and eligibility criteria

All specialist physicians registered as preceptors in COREME’s MR programs (clinical and surgical) were invited. Responses from preceptors from areas other than medicine were excluded.

Recruitment and collection procedures

Those eligible received a Google Forms link by email containing the Informed Consent Form (ICF) and the self-administered questionnaire. Each invitation remained open for response for up to seven days; non-responders received up to two subsequent reminders. Participation occurred at a single time and no incentives were offered.

Instrument and variables

The questionnaire (44 items, predominantly closed) included: demographic characteristics (age, gender, length of professional experience), program specialty, workplaces (outpatient clinic, infirmary, surgical center, emergency room/emergency care) and type of hospital where the preceptorship was performed. The hospital with registration of the MR program was considered accredited and the one with a cooperation bond for the supervised practice of the resident was considered to be affiliated. Information was collected on the employment relationship (public tender at the educational institution, statutory teacher, CLT worker or hiring as a legal entity) and on the possible receiving of financial benefits for the preceptorship (payment of overtime, specific additional, rubrics in the workload or bank of hours). The scope of preceptorship activities included: (1) participation in clinical meetings; (2) teaching classes; (3) case discussion in an outpatient clinic; (4) case discussion in a clinical meeting; (5) discussion of a scientific article; (6) teaching surgical skills; (7) teaching of non-surgical skills (management in ICU and clinical ward); (8) Undergraduate Thesis supervision; (9) performance evaluation; (10) discussion group supervision; (11) scientific methodology guidance; (12) supervision of symposia and seminars; (13) participation in practice tests; (14) program management activities; (15) mentoring; (16) preparation of theoretical test and application of practical test; (17) Skills Lab Activity. For each activity, the preceptors indicated whether their participation in the MR program was mandatory and/or whether they performed it optionally. The preparation time and the execution time of these activities were reported in intervals (categories), and not as continuous measures.

Outcomes

The primary outcome was the mandatory participation in each activity (proportion of preceptors who reported it as a requirement of the program). Secondary outcomes included: (i) types of activities performed on an optional basis; (ii) preparation and execution times (in intervals) by activity; (iii) number of activities performed by the preceptor.

Target population size and sampling.

At the beginning of the data collection, there were 322 medical preceptors registered with COREME, all of whom were invited to participate (census attempt). The final sample corresponded to the answers obtained (convenience sampling of the respondents).

Statistical analysis

Categorical variables were described as absolute and relative frequencies, time variables (in intervals) as frequency distributions, and measures of central tendency/dispersion appropriate to the level of measurement (e.g., median and interquartile range when relevant). Where applicable, 95% confidence intervals were presented. Inferential hypothesis tests were not planned.

Ethical aspects

The study was approved by the Research Ethics Committee (CAAE: 66511023.0.0000.5133). Participation was voluntary, with electronic acceptance of the ICF before the beginning of the questionnaire. There was no collection of identifiable data in the analytical database.

RESULTS

Sample and specialties

A total of 68/322 preceptors (21.1%) responded, covering 24 specialties. The most represented were: Orthopedics and Traumatology, 9/68 (13.2%); Internal Medicine, 5/68 (7.4%); Obstetrics and Gynecology, 5/68 (7.4%); and, with 4/68 (5.9%) each, General Surgery, Nephrology and Radiology and Diagnostic Imaging. The other specialties had ≤3/68 (≤4.4%) each. The general characteristics are shown in Table 1.

Table 1
General characteristics of preceptor physicians (n = 68) ^*

Variable	Category	n	%
Age, years	Mean ± SD	45.1 ± 7.8	-
Gender	Male	39	57.4
	Female	29	42.6
Length of experience in the specialty (years)	< 10	17	29.3
	10-20	18	31.0
	> 20	23	39.7
Time working as a preceptor (years)	< 10	37	54.4
	10-20	20	29.4
	> 20	11	16.2
Hospital where they work	Accredited	63	95.5
	Affiliated	5	4.5
Workplace †	Outpatient Clinic	56	82.4
	Infirmary	46	67.6
	Surgical Center	34	50.0
	Emergency Room/ Emergency care	9	13.2
Type of employment relationship	Public tender (teaching hospital)	53	77.9
	Contract	8	11.7
	Other	7	10.4
Financial incentive for preceptorship	Yes	10	14.7
	No	58	85.3

• Source: data collected from the research instrument
• Notes: † Multiple responses (percentages can add up to >100%).
• * Complete list of specialties (n): Orthopedics and Traumatology (9), Obstetrics and Gynecology (5), Internal Medicine (5), Radiology/Imaging (4), General Surgery (4), Nephrology (4), Otorhinolaryngology (3), Anesthesiology (3), Plastic Surgery (3), Gastroenterology (3), Pediatrics (3), Pulmonology (3), Intensive Care Medicine (2), Endocrinology/Metabology (2), Hematology/Hemotherapy (2), Neonatology (2), Ophthalmology (2), Rheumatology (2), Cardiology/Echocardiography (2), Dermatology (1), Endoscopy (1), Hepatology (1), Infectious Diseases (1), Urology (1).

Participants’ characteristics

The mean age was 45 ± 7.8 years (range 30-61), and 57.4% were male. Regarding the length of experience, 39.7% had >20 years in the specialty, while 54.4% had worked as preceptors for <10 years. Most of them worked as a preceptor in more than one care setting, mainly outpatient clinics (82.4%) and infirmary (67.6%). 95.5% worked in an accredited hospital and 4.5% in an affiliated one. The employment relationship by public tender in the teaching hospital was reported by 77.9%, contract by 11.7% and others by 10.4%. Four preceptors were university teachers and three were volunteer teachers. 14.7% (10/68) reported some financial incentive for the preceptorship (specific rubric and/or bank of hours).

Preceptorship activities

Among all teaching activities (Table 2), the number of activities performed per preceptor ranged from 1 to 17 (mean 8). The most frequent activities were participation in clinical meetings, discussion of an outpatient clinic case and teaching of non-surgical skills. For activities considered mandatory, the number ranged from 0 to 15 (average 4). The most prevalent ones were outpatient case discussion, participation in clinical meetings, and teaching of non-surgical skills. Among the optional ones, which ranged from 0 to 15 (mean 4), the following stood out: discussion of articles, teaching classes, participation in the clinical meeting and case discussion at this meeting.

Table 2
Preceptorship activities: participation, obligation, and optionality (n = 68).

Activities	Participates n	Participates %	M/O n	M/O %	Optional n	Optional %
1) CM Participation	59	87.0	39	57.0	20	30.0
2) Teaching classes	40	59.0	18	28.0	22	32.0
3) Discussion of OUT clinical case	54	79.0	41	60.0	13	19.0
4) Discussion of the clinical case in CM	50	74.0	30	44.0	20	30.0
5) Scientific article discussion	47	69.0	17	25.0	30	44.0
6) Teaching of surgical skills	34	50.0	21	31.0	13	19.0
7) Teaching of non-surgical skills	52	76.0	35	51.0	17	25.0
8) UT supervision	26	38.0	6	8.0	20	30.0
9) Performance evaluation	36	53.0	18	26.5	18	26.5
10) DG supervision	20	29.0	4	6.0	16	23.0
11) SM supervision	15	22.0	7	10.0	8	12.0
12) Symposium and seminar guidance	23	34.0	8	12.0	15	22.0
13) Participation in practice tests	15	22.0	6	9.0	9	13.0
14) MRP Management	29	43.0	15	22.0	14	21.0
15) Mentoring	18	26.5	7	10.0	11	16.5
16) TT preparation; PT application	1	1.0	NA	NA	NA	NA
17) Skills Lab Activity	1	1.0	NA	NA	NA	NA

• Source: data collected from the research instrument
• Legend: CM: clinical meeting; M/O: mandatory/obligatory; OUT: outpatient clinic; UT: undergraduate thesis; DG: discussion group; SM: scientific methodology; MRP: medical residency program; TT: theoretical test; PT: practical test. Notes: Values expressed in n and %. The “M/O” (mandatory/obligatory) and “Optional” columns refer to the program rule, regardless of individual participation. Activities 16 and 17 were not included in the mandatory/optionality (NA) survey. Percentages calculated on N = 68.

Clinical meetings

87% stated that they participated in clinical meetings, preferably held during working hours. Regarding the periodicity, 70.7% reported weekly meetings, 15.5% monthly, 8.6% biweekly and 5.2% daily. The typical duration was 2 hours (range 1-4 hours).

Time dedicated to activities

Teaching classes required 2-6 hours of preparation. For clinical case discussions (outpatient and meeting), the most frequently reported preparation time was ~4 hours (range 1-12 hours). In the discussion of articles, over a 30-day period, the preceptors reported approximately 1 hour for selection, 1 hour for critical analysis, 2 hours for preparing the presentation and 3 hours for preparing the discussion. The supervision activities (papers, discussion groups, methodology, symposia and seminars) took approximately 1 hour/month per activity. The evaluations (preparation of theoretical test and application of practical tests) required ~3 hours/month. Figure 1 shows the 95% confidence intervals of the average time dedicated to each activity by the preceptors.

Figure 1
95% Confidence interval (CI) of the average time spent by preceptors in residency program activities (n = 68).

DISCUSSION

Legislation and literature recognize the centrality of the preceptor in the training of residents in Brazil¹. However, there are still gaps in the institutional definition of attributions and, above all, in the allocation of protected time for teaching; when it exists, its application is heterogeneous and not always formalized in university hospitals⁹.

Mandatory activities varied widely (0 - 15 per preceptor), with a higher frequency of outpatient case discussion, clinical meetings, and teaching of non-surgical skills. The predominance of actions in the workplace is expected, but the average of four mandatory activities and the heterogeneity observed suggest an asymmetry between expectations and actual conditions of practice. The still insufficient institutional recognition of the preceptor’s pedagogical competences¹⁰ and the care overload, which restricts full pedagogical performance⁷, contribute to this scenario.

The high rate of participation in meetings and case discussions supports the importance of the teaching-learning process and formative feedback; however, it lacks preparation conditions (time to define performances, reflection on choosing and applying teaching strategies, selection of evidence, organization of agendas and processes). The lower frequency of mentoring and formative evaluation indicate opportunities to strengthen the need to institute programmatic evaluation and longitudinal follow-up of the resident with feedback⁷ and opportunities for course correction.

In this scenario, institutional and governmental policies should define attributions, ensure pedagogical training, and structure evaluation methods by competencies, valuing preceptorship⁵. By dimensioning activities and preparation/execution times, the findings offer a basis for allocating pedagogical load, designing incentives, and reducing asymmetries between programs - central topics for access, permanence, training, evaluation, and retention.

The study maps in detail the mandatory and optional scope, and estimates the time dedicated to teaching, contributing to the management of the preceptorship. It also shows that 14.7% of the participants reported benefits, predominantly bank of hours, demonstrating an opportunity for improvement in recognition policies⁹.

The heterogeneity of the regulation of preceptorship practice between services - self-attributed by the respondents - may diverge from institutional norms and COREME. This reinforces the need for local governance instruments that explain what, how, and how much each activity requires (competency matrices, minimum loads, priorities) and provide protected time for longitudinal educational tasks, without care impairment^6),(9.

The time analysis indicates relevant effort outside of direct service (preparation of classes, selection of articles, conduction of discussions). In productivist contexts, the absence of formal recognition shifts teaching to “invisible hours”, with the risk of wearing and loss of pedagogical quality. International experiences associate protected time and distribution of non-clinical tasks with teacher retention and better conditions for educational innovation, guiding agreements with maintainers and managers ^7),(9.

Limitations

(i) self-assigned “regulatory/mandatory” classification; (ii) categorical measurement of time; (iii) response rate of 21.1% with possible self-selection bias; and (iv) absence of external validation of the list of activities. Surveys with physicians can achieve higher returns, recommending caution in generalization¹¹.

Practical implications

Explain attributions and results by activity; dimension load with protected time to plan, teach and evaluate; qualify clinical meetings with objectives and feedback record; and to expand on-the-job evaluations (e.g., Mini-CEX, DOPS, EPAs) with collegiate decisions aligned with the program competencies. As a result, it is recommended to monitor these processes with operational indicators (planned vs. executed teaching hours; participation and frequency of clinical meetings; volume of recorded feedback), as well as to explore, in multicenter studies, associations between preceptorship organization, resident performance, and quality of care. Such measures tend to raise the quality of training and favor the retention of specialists in SUS (Brazilian Public Health System) services, in line with the social responsibility of medical residency^5),(9.

CONCLUSION

The observed preceptorship activities reflect the focus on work-based teaching and are consistent with the competency-based training of the evaluated programs. The discussion of clinical cases, when mandatory, was the one that most demanded time for preparation and execution. These findings provide a practical basis for future studies of workload dimensioning and organization of preceptorship educational activities in medical residency programs.

References

• ¹ Brasil. Decreto n^o 80.281, de 5 de setembro de 1977. Regulamenta a Lei n^o 6.215, de 30 de junho de 1975, que dispõe sobre a concessão de bolsas de estudo no exterior para formação e especialização de técnicos, e dá outras providências. Diário Oficial da União; 6 set 1977. Seção 1 [acesso em 23 de agosto de 2025]. Disponível em: Disponível em: https://www.planalto.gov.br/ccivil_03/decreto/1970-1979/d80281.htm
  » https://www.planalto.gov.br/ccivil_03/decreto/1970-1979/d80281.htm
• ² Carvalho Filho AM. Training in medical residency: the preceptors’ view. Rev Bras Educ Med. 2022;46(2)1-10.
• ³ Pedrinelli A. O que é um preceptor? In: Guerra TEM, Santos ALG, Fontenelle CRC. Manual do preceptor da Sociedade Brasileira de Ortopedia e Traumatologia. 4a ed. São Paulo: Sbot; 2022. 44-48 [acesso em 23 de agosto de 2025]. Disponível em: Disponível em: https://d1xe7tfg0uwul9.cloudfront.net/sbot.org.br/wp-content/uploads/2023/03/Manual_do_Preceptor_4Ed.pdf
  » https://d1xe7tfg0uwul9.cloudfront.net/sbot.org.br/wp-content/uploads/2023/03/Manual_do_Preceptor_4Ed.pdf
• ⁴ Mulcahey MK, Waterman BR, Hart R, Daniels AH. The role of mentoring in the development of successful orthopaedic surgeons. J Am Acad Orthop Surg. 2018 July 1º;26(13):463-71.
• ⁵ Bartlett AD, Um IS, Luca EJ, Krass I, Schneider CR. Measuring and assessing the competencies of preceptors in health professions: a systematic scoping review. BMC Med Educ. 2020 May 24;20(1):165 (1-9).
• ⁶ Griesbach S. Joint guidelines for protected nonclinical time for faculty in family medicine residency programs. Fam Med. 2021;53(6):443-52.
• ⁷ Ribeiro LG, Cyrino EG, Pazin-Filho A. Aprimorando a qualidade de programas de residência em medicina de família e comunidade. Rev Saude Publica. 2023;57(1):1-10.
• ⁸ Wilson AB, Bay BH, Byram JN, Carroll MA, Finn GM, Hammer N, et al. Journal recommended guidelines for survey-based research. Anat Sci Educ. 2024 Oct;17(7):1389-91.
• ⁹ Empresa Brasileira de Serviços Hospitalares. Diretrizes para o exercício da preceptoria nos hospitais universitários da Rede Ebserh. Brasília: Ebserh; 2023 [acesso em 23 de agosto de 2025]. Disponível em: Disponível em: https://www.gov.br/ebserh/pt-br/ensino-e-pesquisa/preceptoria/diretriz-anexo-da-port-509_pres.pdf
  » https://www.gov.br/ebserh/pt-br/ensino-e-pesquisa/preceptoria/diretriz-anexo-da-port-509_pres.pdf
• ¹⁰ Minor S, Huffman M, Lewis PR, Kost A, Prunuske J. Community Preceptor Perspectives on Recruitment and Retention: the CoPPRR study. Fam Med . 2019 May;51(5):389-98.
• ¹¹ Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997 Oct;50(10):1129-36.

• 9
  Evaluated by double blind review process.
• SOURCES OF FUNDING
  The authors declare no sources of funding.
• DATA AVAILABILITY DECLARATION
  Research data are available in the body of the document.

• Chief Editor:
  Rosiane Viana Zuza Diniz.

• Associate Editor:
  Jorge Guedes.

Data availability

Research data are available in the body of the document.

Publication Dates

• Publication in this collection
  25 May 2026
• Date of issue
  2026

History

• Received
  09 Oct 2025
• Accepted
  19 Jan 2026