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ABSTRACT
INFORMAL COMMUNICATION AND PROPINQUITY

AMONG VOLUNTEER CLINICAL FACULTY
IN A MEDICAL SCHOOL

By

David M. Price

Purpose of the Study. Medical school administrators seek
cost-effective means of improving the flow of information to and among
volunteer clinical faculty (preceptors). To a greater or lesser extent,
role-related information is carried in informal, unofficial channels as
preceptors talk with each other and with other colleagues. If it could
be shown that certain formal characteristics of part-time clinical fac-
ulty were related to higher rates of informal communication about the
College and their role in it, and if it could be further established that
such increased communication were positively associated with the incidence
of desired perceptions or attitudes, then administrators could be guided
accordingly in the selection of clinical teachers and in the conduct of
training and support efforts.

One set of sudh formal characteristics define propinquity
(nearness in time or place) and include solo vs. group practice, relative
activity in professional associations, size of community, etc. Accord-
ingly, this study sought to answer two questions:

1. Are propinquity factors with respect to practice sete

ting and institutional affiliations associated with differences in self-

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David M. Price

reported communication behavior?

2. Are characteristics of self-reported communication be-
havior associated with differences in perceptions of role-related infor-
mation and information exchange, and with differences in the relative

salience of the preceptor role?

Conduct of the study. The population utilized was comprised
of part-time, volunteer clinical faculty appointed in the Department of
Family Medicine of the College of Osteopathic Medicine at Michigan State
University. All subjects were engaged in private, comprehensive family
practice and were on the staffs of accredited hospitals. Primary data
were gathered by mailed questionnaire. The questionnaire was developed
through a lengthy series of steps in an effort to assure the inclusion
of essential variables, an appropriate operational definition of vari-
ables, and general clarity of language and form.

Analysis of the survey data involved the generation by compu-
ter of a large number of tables, each involving the direct comparison
of two variables. The majority of variable pairings involved either a
propinquity measure and an informal communication measure or an informal
communication measure and a perception measure, as entailed by the cen-
tral purposes of the study. Some additional comparisons were made be-
tween propinquity variables and "control" variables. No measures of
actual knowledge or of performance were included as outcome criteria

against which to compare informal communication behavior.

Conclusions. In general, associations were found between key
propinquity factors and both the frequency and the duration with which

preceptors talked with other physicians about the College's preceptorship

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David M. Price

program. Further, frequency and duration of such informal communication
were found to be associated with more favorable perceptions of information
about the program and with perceived clarity of the College's expecta-
tions for preceptors.

Prominent among the study's sixteen specific conclusions were
these:

--Preceptors in group practice talk with other physicians about
the preceptorship program more frequently than do preceptors in solo prac-
tice.

--Preceptors in urban-suburban communities talk with other phy-
sicians about the preceptorship program more frequently than do preceptors
in rural-small town communities.

--Preceptors who spend considerable time in their hospitals
visiting patients talk both more frequently and for longer periods with
other physicians about the preceptorship program than do those who spend
less time in the hospital visiting patients.

--Preceptors active in board and/or staff committee work in
their hospitals have more frequent and longer conversations about the
preceptorship program during hospital meetings than do those who are
less active in hospital affairs.

--Preceptors more active in professional associations have
more frequent and longer conversations about the preceptorship program
at association meetings than do those who are less active.

--Preceptors who more frequently (or for longer durations) talk
informally with other physicians about the preceptorship program more
often have positive perceptions of the information available from all

sources about the preceptorship program and more often perceive that

David M. Price

being a preceptor enhances their professional competence and status,
relative to other professional roles.

--Preceptors who generally have longer conversations with other
physicians about the preceptorship program more often perceive that the
College has made clear its expectations and more often respond to unclari-
ty by working out "what should be done" in collaboration with other
physicians.

--Preceptors whose conversations with other physicians about
the preceptorship program are generally about "finding better ways to do
our job" (innovation function) more often perceive available role-related
information favorably than do those whose conversations are generally
about "clarifying what the College expects" (production function).

On the basis of these findings, several recommendations are
offered to those responsible for the conduct of community preceptorship
programs. Criteria for selection of preceptors might include participa-
tion in group practice, considerable time visiting hospitalized patients,
an active role in the hospital staff and activity in professional associ-
ations. Formal effort to enhance communication might take advantage of
and further stimulate already existant informal interchange by such means
as holding meetings on an area basis at local hospitals.

It is recommended that communication research concepts and tools
be further exploited for organizational analysis in medical education.
Subsequent research on informal communication and propinquity among
clinical faculty can probably involve the formulation and testing of

hypotheses.

INFORMAL COMMUNICATION AND PROPINQUITY
AMONG VOLUNTEER.CLINICAL FACULTY

IN A MEDICAL SCHOOL

By

David Mngrice

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
Department of Administration and Higher Education

1974

Copyright
DAVID McCLELLAN PRICE

1974

DEDICATION

to my father
ALVIN E. PRICE, M.D.
Clinical Assistant Professor Emeritus
Wayne State University

He has provided me an early and continuing
example of a really good physician.

ii

ACKNOWLEDGMENTS

I wish to express my sincere appreciation to my committee chair-
man, Vandel C. Johnson, Ph.D., for wise counsel and gentle encouragement.
The director for this dissertion, Richard Vincent Farace, Ph.D., of the
Department of Communication, provided step-by-step counsel that was both
skilled and unstinting. Other committee members gave much thoughtful
consideration to my task and the means of accomplishing it. They were
William A. Herzog, Ph.D., of the Department of Communication; James H.
Nelson, Ph.D., of the Department of Administration and Higher Education;
and Ronald W. Richards, Ph.D., of the Office of Medical Education Research
and Development (OMERAD).

To Myron S. Magen, D.O., Dean of the College of Osteopathic
Medicine and Gerald A. Faverman, MMA., Director of Research and Planning
for the College, I owe the freedom and encouragement to pursue this study
while employed as a half-time graduate assistant in their offices. For
enthusiastic interest and practical support, Robert C. Ward, D.O., Chair-
man of the Department of Family Medicine, and members of his staff are
much appreciated.

Among other persons who have significantly contributed to my
understanding of the outstanding issues and promising develOpments in
medical education are David S. Greenbaum, M.D., Richard B. Baldwin, D.O.,
Donald Neston, M.D., Margaret Z. Jones, M.D., Jack L. Maatsch, Ph.D.,

Ann C. Olmsted, Ph.D., Russell G. Camber, D.O., Arthur S. Elstein, Ph.D.,

iii

and Donald M. Gragg, MQD., Ph.D. The list could well include other per-
sons; my sense of grateful good fortune certainly does.

I am thankful for the generous and open responses of the
community physicians who hold clinical appointments in the Department of
Family Medicine, especially to those who welcomed me to their offices
for face-to-face interviews.

Patricia Grauer did an excellent job of preparing the manu-
script. Linda K. Glendening and Joseph Wisenbaker, of the School for
Advanced Graduate Studies, gave wise counsel and material assistance in
the preparation of appropriate computer programs. Robert A. Kern and
Gary.Anthony offered much help in the preparation of data for computer
analysis. Use of the Michigan State University computing facilities
was made possible though support, in part, from the National Science

Foundation.

iv

TABLE OF CONTENTS

LIST OF TABLES viii

LIST OF FIGURES xi
Chapter
I.

I. THE PROBLEM. . . . . . . . . . l

Practitioners Who Teach. . . . . . . .. 1

External Preceptorships. . . . . . . . 1

Significance for Administrators. . . . . . 4

Propinquity. . . . . . . . . . 5

Purpose of the Study . . . . . . . 6

An Organizational Communication Model . . . . 6

Assumptions. . . . . . . . . . . 8

Limitations . . . . . . . 8

Definitions of Key Terms . . . . . . . 10
Conduct of Current Study . . . . . . . 13
Overview . . . . . . . . . . . 13

II. REVIEW OF THE LITERATURE. . . . . . . . 15
A Basic Theoretical Approach . . . . . . 16
Basic Communication Concepts . . . . . . 19
Pressures to Communicate . . . . . . . 27
Propinquity. . . . . . . . . 33
.Attitudes and Perceptions . . . . . . . 41

III. METHODOLOGY . . . . . . . . . . . . 44
Population . . . . . . . . . . . 44
Questionnaire Contents . . . . . . . . 46
Questionnaire Administration . . . . . . 47
Design of the Questionnaire . . . . . . 47
Procedure for Analysis . . . . . . . . 49
Summary. . . . . . . . . . . . 50

IV. ANALYSIS: PROPINQUITY AND INFORMAL COMMUNICATION. . . 52
Profile on Propinquity and "Control" Variables . . 52
Practice Setting. . . . . . . . . 52

Activity in Hospitals . . . . . 53
Activity in Professional Associations . . . 56
"Control" Variables. . . . . . . . 57

Chapter

Comparison of Propinquity and "Control" Factors.

Solo and Group Practice. . . . . . .
Frequency . . . .. . . . . .
Function . . . . . . . . .

Size of Group Practice . . . . . . .
Number of Other Preceptors . . . . . .
Size of Community . . . . . . .

Proximity to Campus. . . . . . . .
Activity in Hospitals . . . . . .
Time Spent in Visiting Patients . . . .
Time in Hospital Meetings . . . .
Activity in Professional Associations . . .
Summary. . . . . . . . . .

V. ANALYSIS: INFORMAL COMMUNICATION AND PERCEPTIONS. .
Profile on Perception Variables. . . . .

Perception of Information . . . . .
Ideas for Improvement . . . . . .
Salience of the Preceptor Role . . . .
Frequency of Communication . . . . .
Frequency and Perception of Information . .
Frequency and Perception of Sources . . .

Frequency and Salience of Preceptor Role.

Frequency with Full-time Faculty and
Perception of Information . . . .

Frequency with Full-time Faculty and

Perception of Interest . . . .
Duration of Communication . . . . . .
Initiation of Communication. . . . . .
Function of Communication . . . . . .
Summary. . . . . . . . . . .

VI. CONCLUSIONS AND IMPLICATIONS. . . . . . .

Summary. . . . . . . . .
Background of the Study . . . . . .
Specific Purposes . . . . .

Theoretical Underpinnings and Prior Research.
Conduct of the Study. . . . . . .
Limitations of the Study. . . . . .
Main Conclusions . . . . . . .
Propinquity and Informal Communication . .
Informal Communication and Perceptions . .
Implications of Findings about "Control"
Variables . . . . . . .
Implications for Administrators. . . . .
Implications for Further Research . . . .

vi

Page

59
67
67
67
74
76
78
80
83
83
85
89
95

99
100
100
106
110
111
111
114
116

118

. 121

123
125
127
131

135
135
135
136
137
137
138
138
139
140

141

. 143

145

APPENDIX. . . .

BIBLIOGRAPHY. . .
Sources Cited .
General References

vii

147

155
155
160

Table
4.1
4.2

4.3

4.4
4.5
4.6
4.7
4.8
4.9
4.10

4.11

LIST OF TABLES

Profile of Preceptor Population: Practice Setting Variables

Profile of Preceptor Population: Activity in Hospitals

Hours in Hospital Meetings by Category of Self-Judged.
ActiVity . O I O O O O I O O O I

Profile of Preceptor Population: Activity in Associations.

Comparison of Activity in Professional Associations .
Profile of Preceptor Population: "Control" Variables .
"Control" Variables by Propinquity Variables . . .
Comparisons of "Control" Variables . . . .
Overall Frequency by "Control" Factors . . .
Solo and Group Practice According to Frequency

Solo and Group Practice By Location of Most Frequent
Conversations. . . . . . . . . . .

Solo and Group Practice By Function of Office Communication

Office Frequency By Office Function . . . . .
Size of Group By Frequency of Office Communication .
Group Size By Function of Office Communication . .

Number of Other Preceptors By Frequency of Office
Communication . . . . . . . . . .

Number of Other Preceptors By Function of Office
Communication . . . . . . . . .

Urban and Rural Preceptors By Overall Frequency .
Urban and Rural Preceptors By Location of Most

Frequent Conversations . . . . . .

viii

Page

.54

.63
.63
.65

.68

.71
.73
.74
.74

.75

.76

.77

.78

.79

Table Page
4.20 Overall Frequency According to Proximity to Campus . 81
4.21 Proximity to Campus By Frequency of Communication

with Full-time Faculty. . . . . . . . 82
4.22 Hours in Hospital to See Patients By Frequency. . . 83
4.23 Hours in Hospital to See Patients By Duration . . 84
4.24 Hours in Hospital to See Patients By Function . . . 84
4.25 Hospital Activity and Hours in Hospital Meetings

By Frequency . . . . . . . . . . . 86
4.26 Hospital Activity and Hours in Hospital Meetings

By Duration 0 O I O O O I C O 86
4.27 Hospital Activity and Hours in Hospital Meetings

By Initiation . . . . . . . . . . 87
4.28 Hospital Activity and Hours in Hospital Meetings

By Function . . . . . . . . . . . 88
4.29 Activity in Professional Associations by Frequency. . 90
4.30 Activity in Professional Associations by Duration . . 92
4.31 Activity in Professional Associations by Initiation . 93
4.32 Activity in Professional Associations by Function . . 94
5.1 Profile of Preceptor Population:Perception of

Information Sources and Interest . . . . . . 101
5.2 Profile of Preceptor Population: Ideas for Improvement. 107
5.3 Profile of Preceptor Population: Salience of Role . . 109
5.4 Overall Frequency of Communication By Perceptions of

Information . . . . . . . . . . . 112
5.5 Overall Frequency By Perceptions of Information Sources 115
5.6 Overall Frequency By Perception of College Interest . 116
5.7 Overall Frequency By Salience of Preceptor Role . . 117
5.8 Frequency with Full-Time Faculty By Perceptions of

Information . . . . . . . . . . . 119

ix

Table Page

5.9 Frequency with Full-time Faculty By Overall Frequency . 121

5.10 Frequency with Full-time Faculty By Perception of
College Interest . . . . . . . . . . 122

5.11 Perceptions of Information By Duration of Hospital
Conversations . . . . . . . . . . . 124

5.12 Perceptions of Information By Measures of Conversation
Initiation . . . . . . . . . . . 126

5.13 Perceptions of Information By Communication Function
in Two Locations . . . . . . . . . . 128

5.14 Suggestions for Improvement and Preferred Source By
Function of In—Office Communication . . . . . 130

LIST OF FIGURES

Figure Page
1.1 Organizational Communication Model. . . . . . 5

1.2 A Model for the Study of Propinquity and Informal
Communication . . . . . . . . . . . 7

xi

Chapter I

THE PROBLEM

Welsh

Medical schools typically make extensive use of practicing
physicians as teachers of patient care skills and role models for medi-
cal practice. Such clinical faculty are ordinarily engaged in full-time
private practice and teach only a relatively few hours each week. Though
officially appointed to their teaching roles, they do not attend regular,
departmental faculty meetings, serve on college committees or have of-
fices in the medical school facilities. Clinical faculty are, first and
foremost, practitioners; only secondarily, even peripherally, are they
teachers.

Thus, part-time clinical faculty do not ordinarily participate
in the principal communication networks through which "regular" faculty
members are inducted, informed and guided, and through which they offer
their contributions to policy formulation and curricular design. Be-
cause the relationship of part-time clinical faculty to the college and
its instructional programs is thus attenuated by time, distance and
professional identity, they tend to be poorly integrated into the infor-

mation systems of the College.1 The extent to which clinical faculty

 

1Sinclair, David C., Basic Medical Education, London: Oxford
University Press, 1972, p. 46; Merton, Robert K., George G. Reader and
Patricia L. Kendall, Th Student Ph sician, Cambridge: Harvard University
Press, 1957, pp.259-60; Weinerman, E. Richard, "Yale Studies in Ambula-
tory Medical Care." WWJNNW'S‘h
1

2

understand the particular objectives of the College's program, the
shape of its curriculum, the characteristics of its students and its
expectations for their roles is a matter of concern among those who
administer programs of clinical instruction.2 Although various efforts
to inform and involve adjunct personnel are typically mounted by depart-
ment leaders, virtually no research on communication with and among
clinical faculty is available for the guidance of medical school admin-

istrators.

External Preceptorships

In many medical schools, the "clinical exposure" of students
is carried out almost exclusively in hosPitals and clinics operated by
or administratively affiliated with the College itself. In such settings,
communication with and among clinical faculty is facilitated by the fact
that they are physically drawn into the medical education complex to
meet with students. Indeed, Reader cites this factor as a prime consid-
eration in arguing for teaching medicine in out-patient departments on
or near the campus.3 By contrast, in programs which rely upon community

facilities outside the medical school complex, clinical faculty are more

 

2Bowers, John 2., and Robert C. Parkin, "The Wisconsin Precep-
tor Program --.A Thirty Year Experiment in Medical Education," Journal
of Mgdigal Education, 32:610-612; Slaughter, Donald, "Clinical Clerk-
ships for Sophomore Medical Students," Journal of Medical Educ tion,
32:193-199; Herzberg, Frederick, Scott Inkley and William R. Adams,
"Some Effects on the Clinical Faculty of a Critical Incident Study of the
Performance of Students," Journal of Medic l Educ tion, 35:666-674,p.671.

3Reader, George 3., "Some of the Problems and Satisfactions
of Teaching Comprehensive'Medicine," Journ l of Medical Educ tion,
31:544-54.

disparate and have fewer opportunities for interchange with regular
faculty, departmental administrators and each other.

The proportion of clinical instruction carried out in such
external settings seems to be growing. Spurred by public demands for
more accessible and comprehensive health care, many medical schools are
hastening to produce more graduates prepared for and committed to what
is variously called general practice, family practice or comprehensive,
primary care.4 In turn, this effort is prompting greater emphasis on
giving students extensive experience with ambulatory patients.5 Fur-
ther, some medical schools are committed to placing students for a
major share of their clinical exposure in the offices of private physi-
cians or "preceptors." It is argued that such office-based practice
most nearly reflects "real world" experience for most would-be doctors
and affords them the role models, the kind of patient population and

the community setting which they need if they are to understand (and

 

4Anlyon, William G., "Chairman's Address," Journal of Mgdical
Education, 46:917-26; White, Kerr L., "Family Medicine, Academic Medi-

cine, and University Responsibility," Journal of the American Medical
Agsgclgtlgn, 185:192-6; Silver, George A., "Family Practice: Resusita-

tion or Reform?" Journal of the Amerlcgg Medical Association, 185:189-91.

5For arguments in favor of ambulatory teaching, see Fleming,
William L., "Teaching of the Family Physician's Approach by a Department

of Preventive Medicine," Journgl of the American Mgdical Association,
161:711-3; Smith, Hugo D., "Essays in Medical Education," American

Journal of the Disegses of Children, 110:185-8. For a comprehensive
review of ambulatory teaching programs, see Gragg, Donald M., "The Teach-
ing of Adult Ambulatory Patient Care in U.S. Medical Schools: Character-
istics of'Programs," Ph.D. dissertation, Michigan State University, 1973.

4

perhaps choose) family practice as a career.6

If participation of clinical faculty in information exchange
with each other and with College leadership is an endemic problem in
medical education, it may be assumed to be particularly acute among
clinical faculty of colleges with programs of highly decentralized,

"Community-based" clinical education.

Signlfigance for Administrators

Medical school administrators seek cost-effective means of
improving the flow of role-related information to and among volunteer
clinical faculty. Formal or official methods (memoranda, workshops,
site visits by administrators, etc.) are part of this effort to improve
communication. However, such institutionalized efforts comprise only
part of the information exchange available to preceptors. Volunteer
clinical faculty are also involved -- to a greater or lesser extent --

in informal and more-or-less spontaneous interchange with each other

 

6Reed, David E., "Twelve Years' Experience with a Comprehen-
sive Ambulatory Care Program," Journal of Medical Education, 45:1041-6;
Beloff, Jerome S., Meiko Korper, E. Richard Weinerman, "Medical Student
Response to a Program for Teaching Comprehensive Care," Journal of
Mgdlcgl Educgtlgn, 40:625-57; Cheplove, Max, "The Role of the Family
Practitioner in Medical Education," New York State Jggrnal 9f Mgdicing,
68:1128-31; Trowbridge, Mason, "Extramural Preceptorships -- A Return
to the Pre-Flexner Era of Medical Education?" New England Jogrngl of
Mgdiclng, 258:691-5; Dorn, Robert M., "Preceptors and Preceptorships:
The Teaching and Learning of Patient-oriented Care," Journal of the
Kansas Medicgl Sogiety, 68:428-31; YOung, L.E., "Personal Physicians,"
Jggrngl of the Amerlcgn'Medical Society, 187:928-33; "The Teaching of
Comprehensive Patient Care," Editorial, American Journal of Public
Health, March 1970, pp. 429-32.

5

and with non-faculty professional colleagues about their college and

its preceptorship program. However, it is not known whether such infor-
mal communication tends to satisfy the information needs of preceptors.
Moreover, it is not known what objective characteristics of preceptors
are related to high levels of informal communications. If it can be
shown that the amount of informal communication among preceptors about
role-related matters varies with certain formal characteristics, then
selection of preceptors according to these characteristics is a cost-

effective method of improving communication among them.

Propinquity

Propinquity, defined as nearness in place or time, is a char-
acteristic of individuals relative to other individuals, groups or insti-
tutions. Propinquity factors of particular interest in distinguishing
volunteer clinical faculty are:

a. practice partners

--solo practice
--group practice
--another preceptor in group
--no other preceptor in group
b. size of community (urban-suburban vs. rural-small town)
c. physical proximity to campus

d. activity (time spent) in hospital and professional
associations

All but the last of the above propinquity variables relate to
the "setting" within which preceptors (and other physicians) practice.
The term "practice setting" will be used to refer commonly to these

characteristics.

Purpose of the Sgudy
The purpose of the study is to describe the relationships of
these propinquity variables to informal communication behavior, and in
turn, the relationships of informal communication behavior to certain
perceptions or attitudes among one group of part-time, volunteer clini-
cal faculty. The study seeks to answer the following broad questions:
1. Are characteristics of practice setting and insti-
tutional affiliation (among one set of part-time
clinical faculty) associated with differences in
self-reported communication behavior?
2. Are characteristics of communication behavior (of
one set of part-time clinical faculty) associated
with differences in perceptions of the adequacy
of role-related information and opportunities for
information exchange, and to differences in the

relative salience of the preceptor role?

An Organizational Communication Model

Communications research, as applied to organizations, has
attempted to demonstrate that overt and measurable communication beha-
vior of individuals is correlated, on the one hand, with manipuable,
organizational variables (e.g., decentralization, means of coordination)
and, on the other hand, with organization output criteria (e.g., pro-
ductivity, employee satisfaction). To the extent that these correlations
can be demonstrated, predictive inferences may be suggested which en-
tail the operation of communication behaviors as intervening activities

between organizational arrangements and various criterion measures on

7

the basis of which institutional leaders make decisions. Thus, communi-

cations sdholars have developed theoretical models of the following

 

 

 

pattern7:
organizational I communication, . criterion
variable behavior measure

 

 

 

 

 

 

 

 

 

Figure 1.1
Organizational Communication Model

In this model, some administrative strategy or action is pre-
sumed to have an effect upon the communication behavior of system mem-
bers, and, in turn, upon system outputs. For example, it may be hy-
pothesized that more delegation of operational decisions (organization-
al variable) leads to increased communication about production matters
among lower level employees and to lower absenteeism rates (a criterion
measure). An "organizational variable" is one subject to direct mani-
pulation by organizational managers and a "criterion measure" is an
outcome of interest to organizational managers. Note that "communica-
tion behavior" is neither, but rather an intervening activity associated
with both.

It is proposed that this abstract organizational communica-
tion model be utilized as a framework for the present study. Propin-
quity factors fit the criterion for organizational variables in that,
if used as criteria for the recruitment or retention of clinical facul-

ty, they become formal features of the organized system susceptible of

 

7Cf. Nix, Harold L. and Frederick L. Bates, "Occupational
Role Stresses," Rural Soclolggy, 27:7-17, p. 7.

8

direct control by institutional leaders.

By mapping onto this abstract framework the particular dimen-

sions of the proposed investigation, a graphic representation of the

present study may be rendered as shown in Figure 1.2.

Assaaptions

The essential assumptions which underlie this study and the

foregoing model are:

a. Actual and overt communication activity of indi-

C.

viduals can be measured and compared on the basis

of self-reported behavior.

. Certain perceptions on the part of volunteer

clinical faculty are valued by the administrators
of preceptorship programs and that these include
perceptions of available role-related information
as adequate, perceptions of role expectations as
clear, and perceptions of the role itself as sa-
lient or relatively significant.

Medical college administrators are able to adapt
as criteria for the identification and appointment
of preceptors certain objective factors, and that
these factors include the "practice setting" and
"activity in hospital or association" variables

as defined in this study.

Limltatlons

No measures of actual knowledge of College policies, proce-

dures or prescribed role definitions are included in the study. The

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10

outcome variables or criterion measures with which communication behavior
is compared are wholly limited to preceptors' perceptlgns of available
information, of information systems and of the role itself.

Moreover, it must be acknowledged that the present study does
not extend to measures of association between informal communication and
any direct data about preceptor effectiveness (performance criteria).

It should be noted that the model, as adopted for present pur-
poses (Figure 1.2), does not presume prediction or the demonstration of
causal relationships. This is an exploratory and descriptive, rather
than experimental, study.

Lastly, data was collected from preceptors in a single de-
partment of one medical school, all of Whom are engaged in a single

type of practice,

Definition of Key Terms
Clinical faculty is sometimes used to refer to all faculty in

clinical departments or all faculty engaged in the teaching of the
clinical skills involved in diagnosis and patient care. Throughout
these pages, however, the term is used to designate faculty members who
are practicing physicians engaged to teach part-time in clinical settings.

Preceptor refers to a sub-class of adjunct clinical faculty,
namely those practitioners who teach students in their own offices or
private clinics.

Pracaptorship pggggaa is a generic term covering all aspects
of the organized effort required of College personnel in order that
students may be afforded clinical experiences in the offices of family

physicians. The tenn is meant to embrace the broadest range of such

11

activities: goal formulation, orientation of preceptors, teaching,
student participation and evaluation.

Propinquity is nearness in time or place. It is used here
as the general designation for the set of variables differentiating the
papulation of preceptors according to certain characteristics of prac-
tice setting and relative activity in their hospitals and professional
associations.

Qroua pragtice refers to the practice setting circumstance of
some preceptors in which they share their offices with one or more other
physicians. The term does not distinguish any particular economic
arrangement (public corporation, partnership, etc.).

Solo practlce is the practice setting circumstance of some
preceptors in which they do aa£,share their offices with any other
physician.

Informal communication refers to those interactions of pre-

ceptors which are not a part of organized activities or deliberate mech-
anisms of the College itself. Such informal communications, though they
may be anticipated by College leaders, are not directly elicited or
facilitated by persons acting for the College. Examples of informal
interactions are personal conversations between two individuals in the
course of a common activity, a telephone call to another preceptor or

to a College official to seek clarification, and casual greetings-in-
passing. The term is aa; intended to include the submissions of reports,
discussions in the course of meetings called by the College authorities,

or ccnmversations between preceptors and administrators during site visits

by administrators .

12

Rola-related information is any information which has as its
referent some aspect of the preceptor role or the College's preceptor
program or experiences of persons occasioned by the conduct of their
function as preceptors.

angant-function is one of the subsets of informal communica-
tion variables. It refers to the purposes or uses of communication in
an interaction between two or more persons mutually concerned with the
referent of the message(s). The three classes of content-function to
be used here are (a) getting the job done (production), (b) exploring
alternative means of getting the job done (innovation), and (c) main-
taining the relationships which comprise the common social system
(maintenance).

Percaptions is the general term comprising the third set of
variables in the study. The meaning of the term as it is used here is
close to (if not synonymous with) that of "attitudes." Whereas the
first set of variables (Pr0pinquity) describes the relative closeness
in time and place of preceptors to other physicians, and the second
set (Informal Communications) describes certain overt, interpersonal
behaviors, this set is meant to describe the internal states or affec-
tive orientations of the preceptors toward selected "objects." These
objects are (a) the totality of role-related information available to
them, (b) the means by which they receive this information, and (c)
the salience (relative importance or value) of the preceptor role.

Some of these terms, as well as other concepts upon which
their meanings rest, receive further definition and elaboration in the

following chapter. The precise operational definitions of those terms

13

which are labels for variables will be further specified in the course

of reporting and analyzing the data (Chapters IV and V).

Conduct of Current Study

Primary data for the current study was gathered by mailed
questionnaire from preceptors in the Department of Family Medicine of
the College of Osteopathic Medicine at Michigan State University. Ex-
cluded from the total list of eighty-eight preceptors were three who do
limited teaching in campus classrooms and four who practice in the
University's Health Service. Of the eighty-one remaining, all are in
the private practice of comprehensive, family medicine.

A more limited fund of data, introduced here largely for
illustrative purposes, was gathered during a preliminary phase of open-

ended interviews with ten of the preceptors.

Overview

Chapter II is devoted to a survey of theoretical and research
literature of relevance to the present study. This survey is organized
in five parts, three of which correspond with the three major sets of
variables as illustrated in Figure 1.2. Chapter III, entitled "Method-
ology," further specifies the population surveyed, the steps taken to
develop a questionnaire and the means of analysis.

Chapters IV and V are devoted to a report and analysis of the
findings. In Chapter IV, a profile of the entire papulation on the
propinquity and "control" variables is presented, "control" variables
are compared with propinquity variables and propinquity variables are

compared with informal communication variables. Chapter V contains a

l4

profile of the population on the perception variables and analysis of
the comparisons of informal communication variables with perception
variables.

Finally, the investigator's conclusions, reflections and

recommendations comprise Chapter VI.

Chapter II

REVIEW OF THE LITERATURE

No single theoretical heritage suffices as underpinning for
studies in organizational communication. One is obliged to reach into
several fields for both conceptual and empirical grounding.1 The reader
will notice, however, that the two streams of theory most frequently
cited in these pages are general systems theory, especially as elaborated

by James G. Miller,2 and field theory, prominently associated with such

3 4

seminal thinkers in social psychology as Kurt Lewin and Leon Festinger.
This review of theoretical and empirical literature is organ-
ized in five sections, including three which relate directly to the three
sets of variables in this study. The first section focuses upon general
systems theory as a general conceptual framework. The second surveys

literature relative to communication concepts either implicit or ex-

plicit in this study.

 

Thayer, Lee, "Communication and Organization Theory" in Dance,
Frank E.X. (ed.), Human Communication Theory, N.Y.: Holt, Rinehart and
Winston, Inc., 1967. p. 72.

2See especially "Living Systems: Basic Concepts," Behavioral
Scienca 10:193-237, 1965.

3See especially Flald Theory in Social Science, N.Y.: Harper,l951.
4See especially Theory ang Eageriment in Social Communication,

Ann Arbor: University of Michigan Press, 1950. A valuable secondary source
on the work of Lewin and Festinger is Deutsch, Morton, and Robert M.
Krauss, Theories in Social Psychology, N.Y.: Basic Books,1965. pp. 37-76.

15

16

Next, a transitional section briefly reviews literature bearing
upon generalizations about pressures to communicate which have been said
to devolve upon members of human social systems. The fourth section
proceeds to consideration of that particular set of formal characteris-
tics which is of particular importance here, namely propinquity factors.
Empirical studies which demonstrate associations between distance or
affiliation and social interaction comprise most of the citations in
this section.

The fifth section corresponds with the third set of variables
shown in Figure 1.2, i.e., perceptions or attitudes as related to pro-

pinquity and communication variables.

A Basic Theoretical Fraaework

Terms such as "communication" and "information" have been used
in many different ways and often interchangably. Such usage is quite
adequate to most purposes of general discourse. However, it is essential
to the development of coherent theory and scientific precision that
certain distinctions be made. Moreover, it is desirable that definitions
for such basic terms be stipulated in such a way that application is
possible across a wide range of referents and at various levels of
organization.

A most promising approach to this task -- a central one for
any "young" science -- is that of general systems theory. Its most
prominent expositor, as applied to the social sciences, is James G.

Miller:

17

General systems theory is a set of
related definitions, assumptions,

and propositions which deal with
reality as an integrated hierarchy

or organizations of matter and energy.

A "system,"

most simply described, is a set of interdependent
elements. The word "interdependent" implies that each element or com-
ponent is constrained or conditioned by the state of the other elements.
The word "set" suggests common properties. It also suggests that, for
something to be called a system, it must have "at least one measure of
the sum of its units which is larger than the sum of that measure of
its units." This is to say that a system is a configuration, a gestalt,
as well as a mere collection of parts. Miller's forceful example is
that a man with his head is much more than a man's body plus his separ-
ate head.6

General systems theory conceives of the universe as composed
of systems nested within systems, in which each system is embedded in
a larger system in relation to which it is a subsystem. "Such a con-
cept can be applied, for instance, to cells within tissues, to organs
within an organism, to companies within an industry, to nations within

an alliance.7

 

5
0p. cit., p. 193.

6
Ibid., p. 201.

7Berrien, Kenneth F., General and Social Systems, New

Brunswick, N.Y.: Rutgers University Press, 1968. p. 15.

18

Briefly, the principal advantages of general systems theory
are three in number. First, it permits the generation of propositions
which may be applied over the wide ranges of levels of organization.
That is, the molecule, the cell, the organ, the individual, the group,
the society are all systems and, as such, may be analyzed in terms of
a common set of concepts. The outcome of value is ease of generaliza-
tion across system levels.8 Second, widely disparate ayaaa of systems
may be compared and contrasted in reference to dimensions which they
share. This is possible because systems may be living or non-living,
conceptual or material, and so forth.9 Third, in contrast to many
social science theories, general systems theory is non-prescriptive and
avoids-reductionism. That is, rather than approaching a system -- let
us say, a department in a medical school -- with some preconception of
an ideal state for that system or some "key" to the analysis of system
function, the investigator working from a general systems orientation
can be rather more descriptive and inclusive.10 These advantages are
presumed to pay off in terms of traditional scientific values such as

objectivity, precision and susceptibility of empirical verification.

 

81bid., pp. 214-7.
9
Ibid., p. 214.
0Farace, Richard V., and Hamish M. Russell, "Some Communication

Implications of Major Organizational Theories," mimeographed, Department
of Communication, Michigan State University, 1971. 14-8.

19
Basic Communication Concepts

Miller says that even more basic to the understanding of gen-
eral systems theory than the concept of "system" are the concepts of
"matter," "energy" and "information." Relying on the known relations
of matter and energy, including the principle of the conservation of
energy, Miller typically uses the joint term.matter-energy to signify
the most basic physical "stuff" that may be said to flow between systems
or system components, without specifying the form or structure or type
of f1ow.11

Information is that matter-energy which exhibits pattern or
form.12 By contrast, unpatterned or random matter-energy is mere "noise."13
It is important to note two features of this definition of "information."
The notion of information as patterned matter-energy presumes a perceiver
of that pattern; only when system members actually detect a form in the
matter-energy can it be properly labeled "information." Moreover, "in-
formation" in this sense is a much simpler concept than.”information"
as we ordinarily use it. "Information" need not have "meaning." "Mean-
ing " is the significance of information to a system which possesses
it.14 Thus, telegraphic signals are "information" whether or not the
person at the receiving point knows Morse code. It is enough that he or

she recognizes a pattern in the pulses.

 

11Op. cit., p. 193.

121pm, p. 193-4.

13
Ibid., p. 199.

14
Ibid., p. 193.

20

Communication, according to Miller, is ”the change of informa-
tion from one state to another over space," or information processing.
This is the process engaged in when one transmits sounds via electrical
impulses over a telephone line or even projects his voice to another
across a room. ". . . .informational patterns can be processed over
space and the local matter-energy at the receiving point can be organized

to conform to, or comply with, this information."16

The concept implied
here is one of a referent common to both sender and receiver. Build-
ing upon Miller‘s exposition, David K. Berlo succinctly defines "com-
munication" as "a process involving the transfer of matter-energy that
carries symbolic (i.e., referential) information."17

Thus "communication” is seen to be a sub-set of "information."
Matter-energy moving in a system has "information value" only to the
extent that system. members perceive patterning or form. In turn, in-
formation has "communication value" only as system members have agreed-
upon referents for the pattern.

Note that these terms are defined in such a way that the per-
ceptions of receivers are key criteria for proper classification. On
the other hand, it should be clear that no solipsistic implication is

intended; it is not denied that "real" information may be in my environ-

ment without my attending to it or actively and momentarily perceiving

 

15
Ibid., p. 198.

16Ibid., p. 199.

17"Human Communication: The Basic Proposition," mimeograph.

Department of Communication, Michigan State University, 1970. pp. 2-3.

21

it. Indeed, a most useful pair of distinctions have been offered by
information theorists which explicate the commonplace observation that
there is typically more information in a given system than any of its
members may apprehend in a given moment.

The first of these distinctions is between absolute and ala-
tributed information. "Absolute" information refers to the total amount
of information available in a system, whereas "distributed" information
refers to the homogeneity of information among members of the system.18
The distinction permits one to probe beyond, let us say, a complaint
that "not enough information is available," to whether the problem is
a genuine lack on the part of the system as a whole or simply a maldis-
tribution of available information resources within the system.

The second distinction is between information which is avail-

able in the environment and that which is ultimately utilized by an

 

individual or organization.19 The distinction highlights the ubiquitous
use of "filters" or "screens" or (when they become explicit or deliber-
ate) "decision rules" by which system members accept some information
and reject or ignore other information.

A relationship between these two distinctions is clear: the
distribution of information in a system will depend, in part, upon the
decision rules by which various system members screen out that informa-

tion deemed "useless" or "irrelevant."

 

18Brillouin, Leon, Science and Information Theory, Englewood

Cliffs, N.J.: Prentice-Hall, Inc., 1967. pp. 265-6.

19Reindl, Max H., "Propositions on Information Management of
Innovation Processes in Organizations," unpublished doctoral disserta-
tion, Michigan State University, 1970, pp. 36-9.

22

Consideration of distribution leads to a still more funda-
mental notion in General Systems Theory. It is the concept of entro ,
the tendency of the matter-energy in a system to disperse chaotically or
randomly. Familiar in physics as the Second Law of Thermodynamics, the
concept of entropy signifies the disorder, disorganization or lack of
patterning which is the most probable outcome of unconstrained movement

of elements in a system.20

Recalling the definition of information as
”patterned matter-energy," the formal relationship between entropy and
information is clear: information decreases as entropy increases. 'Miller
cites evidence from the calculations of physicists and information theo-
rists to support his contention that this relationship is more than merely
formal or statistical and that it applies equally to large and small

21
systems.

Building upon Miller's utilization of "entropy,” Berlo formed
the closely related concept of uncertainty and gave it a "central" im-
portance in his analysis of communication functions. A system may be
said to be characterized by certainty to the extent to which "all alter-
native events within the system can be articulated, and some probability
attached to each." In other words, "the more organized a system is,
the more predictable it is." Uncertainty, then, is a measure of dis-

order or lack of structure or unpredictability.22

 

20
Miller, op. cit., p. 195.

21
Ibid., pp. 196-8.

22
Berlo, David K., "Essays on Communication," mimeographed,

Department of Communication, Michigan State University, 1970, p. III - l.

23

Again following Miller, Berlo stipulates a negative relation
between information and uncertainty: "the more information that is
transmitted, the clearer the pattern of the system becomes . . . and
the more predictable it is."23 Thus, more information is required to
render predictable an uncertain system. Moreover, it may be said that
the function of information is to reduce uncertainty.

Communication function or content-function has been considered
from several perspectives by various authors. Two of the most fully
deve10ped and most promising are reviewed here. The first of these is

24 A

Russell Ackoff's content-free, but message-centered approach.
message (set of "signs") produces responses in a receiver, thus effect-
ing an alteration in his/her "purposive state." On the basis of this
theoretical assumption, Ackoff proposes a set of categories into which
messages may be indexed according to how they (are supposed to) change
the receiver. He offers the following taxonomy: "information" changes
the probabilities of choice, "instruction" changes the efficiencies of
alternatives for action, and "motivation" changes the values of out-
comes and thereby the basis for selecting among them.

Berlo would apparently have us believe that Ackoff's analytic

frame has nothing whatever to do with the participants in the communica-

tion exchange.25 Actually, when taken in the context of his "behavioral

 

23
Ibid 0

24”Towards a Behavioral Theory of Communication," Management
Science, 4:218-34, 1957.

250p. cit., p. III-2.

24

theory” with its emphasis on the "purposive state," Ackoff's analysis

is not so simple-mindedly message-bound and participant-free.26 However,
to say this is to suggest that, while no "straw-man," neither is Ackoff's
categorization as scientifically advantageous as Berlo suggests. Indeed,
Farace and McDonald find Ackoff's alternative wanting on just these

grounds.

Two serious problems are encountered in
these message-centered approaches. The
first is that where Operationalization
has been carried out and studies con-
ducted, the amount of variance explained
in various dependent measures has been
relatively small. Second, the techniques
for categorizing or generating messages
have not been worked out very effectively.

Berlo offers the fullest of several discussions of functional
categories based upon human purposes, rather than upon the messages
themselves. He characterizes the difference in approach succinctly:

Instead of asking what messages do to
people, we can look at what peOple do
to messages. Instead of asking what
effect communication has, we can ask

what uses people make of it, what

purposes it serves for both participants.28

Berlo's three categories of function are production (getting

the job done), innovation (finding new ways to do it), and maintenance

 

26See Buckley, Walter, Sociology and Modern Systems Theory,
Englewood Cliffs, N.J.: Prentice Hall, Inc., 1967. p. 120-1.

27Farace, Richard V. and Donald McDonald, "New Directions in
the Study of Organiztion Communication," to be published in Personal

Psychology, Spring 1974.

28Berlo, op. cit., p. III-4.

25

(of the system and its members).29

It will be recognized that these are
the variable categories introduced, and later defined, in Chapter I.

The Egggaaglga function is perhaps the most familiar. Communi-
cation is used for production purposes when it is used to give instruc-
tions, review performance and set down expectations for what and how
much and by what methods therpredetermined end is to be reached. Pro-
duction communication, in short, has to do rather directly with "getting
the job done" -- it being presumed that "the job" has been defined in
advance.

The innovation function comes into play as persons begin to
search for new ways of doing things or for new things to do. Innovation
communication is "exploratory" behavior, "antagonistic to productivity"
in the short run, but essential for long-term survival.31

The maintenance function is the use of communication to keep
the system (classroom, nation, dyadic relationship) and its components
(sub-groups, "power elites," individuals) intact. Maintenance communi-
cation is different than either production or innovation communication
in that it contributes to system survival or system enhancement, rather
than directly to system output. Moreover, maintenance is a somewhat
more complex function than theuother two. Berlo distinguishes three

sub-categories: maintenace of self-concept, maintenance of interpersonal

relations, and maintenance of the social system (including rules or

 

291bid., pp. III-lO-lZ.

30Ibid., p. III-10. See also Farace and McDonald, 0p.cit.,
p. 16.

l
3 Ibid.

26
nonms governing production, innovation and maintenance communication).32
All three functions are crucial to any system, at least in the
long run.33 The scientific utility of these functional discriminations
is that systems and their components may be characterized and distin-
guished on the basis of the relative frequency or prevalence of each of
these three functions at any given time. Moreover, correlations between
function and various other measures of organizational outcome may be
attempted to gain knowledge about the relative effectiveness and effici-
ency of alternative information distribution patterns, message forms

and interaction "styles."34

Thus, Farace, and Connelly report a study
relating communication behaviors distinguished by Berlo's function
.categories to self-reported work satisfaction among employees in a

35 and McDonald used sociometric data to

large commercial organization,
identify liaison persons in each of three communication networks corre-

sponding to these same functional designations.36

 

32Ibid., p. III-ll. See also Farace and MdDonald, 0p.cit.,

p. 17.

33
Ibid.

34Farace and McDonald, op. cit., pp. 22-3.

35
Farace, Richard V. and Richard A. Connelly, "Organizational
Communication Correlates of Herzberg's Theory of WOrk Satisfaction,"

mimeographed, Department of Communication, Michigan State University, 1970.

36McDonald, Donald, Communication Roles and Communication Con-
tent in a Bureaucratic Setting. Ph.D. dissertation, Michigan State
University, 1970.

27
Pressures to Communicate

An interesting convergence of systems theory and field theory
may be seen in the importance afforded in each to the notion of un-
predictability. Miller's treatment of "entropy" and Berlo's discussion
of the ”central concept of uncertainty" were introduced in the preceding
section. In both cases, the function of information was said to be the
reduction of unpredictability.

Similarly, Festinger asserts that individuals require support
for their perceptions in social reality. That is, persons confronted
with ambiguity in their environment will seek to "anchor" their judgments
by seeking consensus in a reference group. To accomplish this, accord-
ing to Festinger, persons "will initiate communications either to ascer-
tain what others believe or to influence others' beliefs in the direction
of their own."37

Lewin noted that gay social situations are particularly "cogni-
tively unstructured," leading to uncertainty among system members. In
such unstructured situations, according to Lewin, persons may be very
cautious about initiating communications. However, presuming that stay-
ing in the new system is a positive goal, individuals will be actively
atuned for any information which has the effect of clarifying what they
may expect and thus reducing tension-producing uncertainty.38

Thus, for the field theorists, as for those working within a

general systems framework, less thoroughly organized or predictable

systems will tend to be characterized by greater rates of information

 

37
Op. cit., p. 5.

38Deutsch and Krauss, op. cit., pp. 45-8.

 

tr
in
SY

en

fr
re.
co

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thl
me:
me:
pre
tr:
am
in
EXE
Opf
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Pr:

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28

transfer. Lewin's concepts of the social-psychological impetuses to
information exchanges fit well within the more general pr0position of
systems theory that matter-energy "flows" between interdependent compon-
ents in response to environmental inputs and internal stresses.39

In addition to the general pressure to Communicate arising
from the internal needs of individuals to secure their beliefs in "social
reality," Festinger generated a series of propositions about forces to
communicate which derive from group membership. Of particular interest
for present purposes is his hypothesis that pressure on members to com-
municate to others in the group concerning a given item is related to
the relevance of that item to the functioning of the group.40 "Cohesive-
ness," in this context, means the resultant of all the forces acting on
members to remain in the group. Thus, while there may be little or no
pressure on a given individual to communicate about an "item X" in a
transitory or casual social group, such pressure may be considerable in
another group in which consensus has consequences for group locomotion or
in which the forces to remain part of the group are stronger.41 For
example, a physician may perceive the same magnitude of discrepancy in
Opinion among fellow members of a spontaneously formed conversational
grouping in the hospital cloakroom and among the members of his group
practice. According to Festinger's hypotheses, that same physician will

be under greater pressure to communicate in the second than in the first

 

39Katz, Daniel, and Robert Kahn, The Social Psychology of

Organlzations, N.Y.: John Wiley and Sons, 1966. pp. 14-26.
40"Informal Social Communication," Psychological Review,
57:271-282, 1950. pp. 274.

Allbid.

 

de

tn

so
va
th

be

C0.

1102

Pa'

29
of the two situations.

There is a rather large and fascinating body of literature on
socialization in organizations. To what extent may the socialization
process be considered a pressure to communicate or a partial "explan-
ation" for such informal interchange as may exist among lower members
of the social system? The answer is not clear.

Parsons defined socialization as "the acquisition of the re-

"42 Etzioni

quisite orientations for satisfactory functioning in a role.
defines it as "the mechanism through which the existing consensus struc-
ture and communications practices are transferred to new generations of
participants.”43 Merton, in a much quoted formulation, designates
socialization as "the processes by which people selectively acquire the
values and attitudes, the interests, skills, and knowledge -- in short,
the culture -- current in the groups of which they are, or seek to
become, a member."44
Etzioni distinguishes between the patterns of socialization in
coercive, utilitarian, and normative organizations. Because he identi-
fies universities, hospitals and research organizations as "the least

normative of the normative organizations,"45 it is not clear what

patterns of consensus, communication and socialization to expect among

 

42Parsons, Talcott, The Social System, Glencoe, Ill.: The Free
Press, 1951. p. 205.

43Etzioni, Amitai, A Cppparative Analysis of Complex Organiza-
tions, Glencoe, 111.: The Free Press, 1961. p. 150.
44Merton, et a1, 0p.cit., p. 287.

450p. cit., p. 146.

30

volunteer clinical faculty on the basis of Etzioni's theory. Several
papers discussing socialization as explicity applied to medical education
yield much interesting insight, but nothing which may be taken as evi-
dence supporting expectations of a particular rate or direction of in-
formation exchange among practicing physicians or physician-teachers.
Indeed, one medical sociologist declares that much expressive socializa-
tion is "unorganized" in professional organizations.46

With these caveats duly noted, it seems fair to say that Etzioni
(as well as other students of socialization) would identify the Family
Medicine preceptorship program at Michigan State University as a pre-
dominently normative organization. The salient criteria would seem to
be voluntary membership and the fact that the preceptors' function is
more to introduce students to the physician's role than to inculcate a
specific set of instrumental skills. On this assumption it is relevant
to extrapolate several hypotheses about patterns of communication in
normative organizations from the theories of Etzioni and others. There
will be a fair amount of horizontal communication to complement and
support the downward communication of goals. Moreover, communication
gaps will be relatively less frequent than in coercive or utilitarian

organizations, because status levels are less differentiated, alienation

 

46Kendall, Patricia, "Medical Education as Social Process,"
a paper presented to the American Sociological Association, 1960, and
cited by Etzioni, op. cit., p. 141. See also Bloom, S.W., "Sociology
of Medical Education: Some Comments on the State of the Field," Milbank

Memorial Fund Quarterly, 43:143-83.

31

is lower, and consensus is higher between leaders and lower participants.47

Nevertheless, confident prediction of patterns of communication
behavior based upon the nature of the social group is elusive as applied
to the population under study here. Bureaucratic theory (including
that which takes bureaucratic concepts as touchstones) may be of limited
value in the analysis of professional organizations. The presumption
persists, even in the analysis of the most normative of normative organ-
izations (e.g., ideological political organizations), that policy deci-
sions are made at the top. In fact, professional organizations often
consist of a number of groupings , each working out policy matters in
their own way, each implementing their own professional values, and
negotiaping with designated leaders and with each other on points of
stress-producing disagreement.

Such a perspective suggests that certain pressures to communi-
cate may derive from informal social structures "mediating between indi-

['49

viduals (or task groups) and large formal organizations, and also

that a relative lack of downward communication from organization leaders

 

47
Op. cit., p. 140-1.

8Bucher, Rue, and Joan Stelling, "Characteristics of Profess-

ional Organizations," ournal of Health and Social Bapavior, 10:3-15.

49
Merton, Robert K., Social Theory and Social Spructure (Rev.

Ed.) Glencoe, I11.: The Free Press, p. 106.

32

may leave much potential conflict hidden or unacknowledged, thereby

lessening pressures toward communication among system members and sub-

groups.

On the other hand, Katz and Kahn assert that an assymmetry of
communication needs of superiors and subordinates leads to an increase

in lateral communication among subordinates.

Horizontal exchange can be an escape
valve for frustration in communicating
upward and downward; and sometimes it
can operate to accomplish some of the
essential business of the organization.51

Similarly, Burns found informal "lateral communication essen-

tial to the proper functioning of the vertical system” in his study of

departmental managers in a British factory.52 Thus, "the ground at a

lower level was prepared for likely action" (emanating from top levels).53

Still another perspective emerges from Davis' study of execu-

tives within the "Jason Company."

Formal and informal communications sys-
tems seem to be jointly active, or jointly
inactive. Where formal communication was
inactive. . ., the grapevine did not rush
in to fill the void. . .; insteadSAthere
simply was lack of communication.

 

0‘Mouzelis, Nicos P., Organization Bureapgracy: An Analysis
of Modern Theories London: Routledge and K. Paul, 1967. p. 161.
51
Op. cit., p. 247.

52Burns, Tom, "The Directions of Activity and Communication in

a Departmental Executive Group," Human Relations, 7:73-97, p. 96.

53Ibid.

 

Davis, Keith, "Management Communication and the Grapevine,"
Harvard Business Raview, 31:43-49, p. 45.

33

The same conclusion has been expressed in pithy fashion by a
prominent sociologist: "If communication fails in one direction, it

will fail in the others."55

Propinquity

Against the background of the foregoing general considerations
about various pressures to communicate, somewhat more detailed atten-
tion may now be given to the "force to communicate" of particular
relevance to this present study. In Chapter I, "propinquity" was defined
as proximity in time or space.

Physical proximity is apparently universally acknowledged by
theorists in the behavioral sciences to be a factor in determining who
will talk with whom. Thus, Schein's discussion of the psychological
dynamics of informal group formation in organizational settings allows
for the operation of "formal factors," including physical location.56
Homans, a sociologist and proponent of Exchange Theory, speaks of
"almost inevitable interactions" occasioned by the mere fact of persons
being "thrown together by physical geography."57 Another sociologist,

however, makes clear that the effect of propinquity is indirect, rather

than direct.

 

55Homans, George C., The Human Gropp, N.Y.: Harcourt, Brace
and World, 1950. p. 462.

56Schein, E.H., Organizational Psychology, Englewood Cliffs,
IV.J.: Prentice-Hall, Inc., 1970 (Second Edition). p. 82a3.

57Op. cit., p. 97.

34

Each social world, then, is a culture

area, the boundaries of which are set

neither by territory nor by formal

group membership, but by the limits

of effective communication.58

This seeming contradiction of other commentators is grounded

in the point that technology has limited the effect of geographical dise
persion.59 Shibutoni does not acknowledge, however, that much of the
technology remains limited by distance factors even as it is distance-
1imiting. Thus, the telephone, while permitting a user to free himself
from gross limitations of distance factors, is still more likely to be
used for local calls than long-distance calls and for low-toll, as
opposed to high-toll, "long distance" calls.60 Thus, rather than being
obviated by "distance binding" technologies, propinquity factors are
"merely" modified, rendered more complex and, where they are a factor
(as in the present study), made less powerful as bases for confident
prediction.

From the point of view of general systems theory, proximity

is "a necessary but not sufficient condition for system formation."61

 

58Shibutani, T., "Reference Groups as Perspectives," American
Jgurnal of Sociolggy, 60:562-70, 1955. p. 566.

59Ib1d.

60Zipf, G.K., "Some Determinants of the Circulation of Infor-
mation," American Journal of Psychology, 59:401-21, 1946.

61Berrien, op. cit., p. 23.

35
"Boundaries," defined abstractly as that which separates one system from
another, have the function of filtering inputs and outputs.62 This
means that any transmission of information across a boundary entails
resistance and, inevitably, some modification in or transformation of

the information itself.63

To the extent, then, that sending a message
to another person at some distance entails "breaking through" system
boundaries, the sending will be correspondingly more difficult, less
effective and, hence, less likely of even being attempted.

The homeostatic principle,64

that any force which disrupts a
system will be countered by other forces which tend to restore it to

a steady state, favors small communication loops. Smaller circuits
mean quicker feedback and closure.

Size of loop, especially when system boundaries are crossed,
is a major theoretical determinent of direction in communication flow
and of the character of habitual patterns of interaction.65 J.G. Miller
cites many examples of the importance of physical propinquity to system
structure and process, and is careful to apply this observation equally
to biological and social systems.

G.A. Miller applied this generalization to communication in

social systems as follows:

 

621bid., p. 32.

63Ibid., p. 22-3.

64Katz and Kahn, op. cit., p. 23.
65Ibid., p. 235.

660p. cit., p. 207-8.

36

When a large number of people belong
to the group, it is reasonable to assume
that the likelihood of messages passing
from one person to another is inversely
proportional to the distance between
them. The greater the distance, the
lower the traffic density.67
Miller's reasoning is supported by an array of empirical stud-
ies conducted on widely varying populations and social settings. In a
study of the thirty-seven workers in an office of a large corporation,
Gullahorn found that distance was the "most important factor in deter-
mining the rate of interaction between any two employees."68 From a
study in another kind of organizational center, an academic one, Lund-
berg, et al report similar effects of physical proximity.69
A number of studies have demonstrated that personal inter-
action among residential neighbors is largely a product of proximity.
Merton studied a large housing development in New Jersey and concluded
that "quite apart from other factors, sheer propinquity played a major
part in determining the patterns of personal interaction."70 Other

empirical studies with findings in support of a large role for resi-

dential propinquity utilize a variety of methodologies, designs and

 

67Lan ua e and Communication, N.Y.: McGraw-Hill, 1951. p. 262.

68Gullahorn, J.T., "Distance and Friendship Factors in the
Gross Interaction Mix," Sociometgy,15:123-34, 1952. p. 134.

69Lundberg, C., V. Hertzler, and L. Dickson, "Attraction
Patterns in a University,"'Sociometry12:158-69, 1949.

7OMerton, Robert K., "The Social Psychology of Housing," in
Dennis, W. (ed.), Current Treads in Social Paychology, Pittsburgh:
University of Pittsburgh Press, 1948. p. 204-5.

37
particular populations.71

Barnlund and Harland reviewed empirical studies that support
Miller's theoretical arguments about propinquity factors and concluded
that:

An inverse relationship has been found be—
tween the physical distance separating per-
sons and the likelihood of communication
between them, with interaction increasing
as distance decreases, unless there are
physical barriers that intervene . .

It must be acknowledged that the last phrase of this other-
wise forceful generalization is, on reflection, a serious limitation of
generalizability. The situation under consideration by "office land-
scapers" or architects is quite different than the one under investi-
gation in the present study. Support for the generalizations reported
here appears to be quite sufficient to allow confident prediction in
the case, let us say, of full-time university faculty whose offices are
located in a given wing of an academic building. However, when the

population of interest is widely scattered in a variety of types and

arrangements of primary work places, an exploratory investigation seems

 

71Powell, R.M., "Sociometric Analysis of Informal Groups --
Their Structure and Function in Two Contrasting Communities," Sociometry

 

15:367-00, 1952; Caplow, T., and R. Forman, "Neighborhood-Interaction

in a Homeogeneous Community," American'Sociological;Review, 15:357-66,
1950; Festinger, L., S.-Schacter and K. Back, Social PreSSures in Infor-
mal Groups: A Study of Human Factors in Housing, Stanford, California:
Stanford University Press, 1963; Blake, R., C. Rhead, B. Wedge and

J. Morton, “Housing Architecture and Social Interaction,"‘Sociometpy,
19:133-9, 1956.

72Barnlund and Harland, "Propinquity and Prestige as Determin-
ants of Communication Networks, " Sociometry, 26: 467-79, 1963, p. 468.

38

more prudent than an experimental design.

It is interesting to note that the effects of propinquity upon
informal communication are often assumed by medical educators and other
physicians in their arguments favoring group practice. Thus, Boan cites
as the principal advantage of group practice the "curbstone consulting"
which it facilitates.73 Young asserts that group practice leads to

"74 It has been observed

teamwork and "stimulating professional company.
that changes in the nature of medical care, particularly specialization,
will increasingly make inter-physician communication common among solo
practitioners.75 This observation does not constitute a contradiction
of the generalizations about group practice. In any case, as common
as such beliefs may be, empirical studies of these assertions apparently
have yet to be published.

By contrast, the other primary work place of physicians has
received a goodly amount of attention. There are many studies of physi-
cian behavior in hospitals. Wenrick, ap_al, mapped sociometric inter-

actions of staff physicians in four midwestern hospitals on the basis

of informal case discussions, formal consultations, and social

 

3
Boan, J.A., Group Practice, Toronto: Royal Commission on
Health Services, 1966. p. 14.

74Op. cit., p. 932.

75Welf, Stewart C., and Ward Darley, Medical Education and
Practice, Evanston, 111.: American Association of Medical Colleges,
1965. p. 72-3.

39
interactions.76 The physicians most frequently nominated were then
interviewed to determine how they differed as a group from their colleagues.
Among the findings were that the "informal educators" tend to spend more
time at their hospitals, serve on more hospital committees and belong
to more professional associations than their colleagues. Moreover,
thirty-two of the thirty-nine physicians so identified were either in-
ternists or surgeons, and not one was a general practitioner.77 The
authors do not report the percentages of specialists in their total
population.

Coleman, Katz and Menzel report on a series of studies using
similar techniques to trace the flow of innovation information and
adoption of new drugs.78 Their principal finding was that interpersonal
relations among physicians seemed to be the most important factor in the
adOption of innovation. Further, they identified both hospitals79 and
shared offices80 as the primary physical contexts in which such informal
communication took place.

.A 1969 study conducted by telephone interviews among full-time

faculty of a medical school sought to discover the relative importance

 

76‘Wenrick, J.W., F.C. Mann,‘W.C. Morris and A.J. Reilly, "In-
formal Educators for Practicing Physicians," J urnal of Medical Education,
46:299-305, 1971.

77Ibid., p. 203.

78Coleman, James S., Elihu Katz and Herbert Menzel, Medipal
Innovation: A Diffusion Study, N.Y.: Bobbs-Merrill Co., Inc., 1966.
791b1d., p. 145.

801bid., p. 156.

40

of different sources for information regarding changes in medical educa-

tion. Again, face-to-face, personal contact was the most frequently

cited means of learning about new developments.81

There is evidence in a study of a research center at a uni-
versity that there is little strictly social, as opposed to business,
communication among professional colleagues and that it has little
effect on the perceptions of each other by participants. The investiga-
tor concludes that work-related communication tends to influence social
communication, rather than vice-versa.82 The implication seems to be
that research designs for the study of inter-member communication in
professional groups may omit social relations as a separate variable
without much risk of losing significant information.

Lastly, from a theoretical, management point of view, March

and Simon identify sheer prOpinquity ("exposure to contact") as one of
three factors affecting the frequency of interaction in a group.83
Further, in terms that echo Miller's systems theory propositions, they

hypothesize that the greater the communication efficiency, the greater

will be the communication channel usage.

 

81Saul, Ezra V., and Suzanne Bryder, "One Faculty's Sources of
Information Regarding Changes in Medical Education," qurnal of Medical

W, 44:1091-4, 1969. p. 1093.
82Smith, Alfred 6., Communications and Status: The Dypamics of

J28 search Center, Eugene, Oregon: University of Oregon Press,l966. p.39-45.

83March, James G., and Herbert Simon, Organizations, N.Y.:
John Wiley and Sons, 1958. p. 68-71.

841b1d., p. 167-9.

41

Attitudes and Perceptions

Organizations so structured that members
can deal realistically and effectively
with their tasks will provide powerful
sources of social and psychological
satisfaction.
Physical decentralization in an organization, according to
Berelson and Steiner, tends to be associated wit "more different
and often more discordant understandings and points of view" among
organization members and, also, with greater toleration of such differ-
ences of perception.86 This assertion, based on an extensive review of
sociological research, is consistent with the medical school studies of
Merton and his associates. They speak of a "phenomenon of observability"
which operates among physicians practicing in groups. Working under the
close scrutiny of their medical peers, physicians in group practice tend
to be more "conducive to ready conformity" with whatever professional
norms may be current.87
Bloom found that volunteer clinical faculty perceived problems
of communication as a cause of serious problems far less often that did
full-time faculty.88 Berelson and Steiner have written that members

most closely identified with their organization, while more likely to

conform to its norms, are also more likely to criticize, though their

 

85Lawrence, Paul R., and Jay W. Lorsch, Organization and En-
vironment, Homewood, 111.: Richard D. Irwin, Inc., 1969. p. 17.

Berelson, Bernard, and Gary A. Steiner, Human Behavior: An
Inventory of Scientific Findings, N.Y.: Harcourt, Brace and World, Inc.

870p. cit., p. 77.

88Bloom, Samuel W., "The Medical School as a Social System,"
Milbank Memppial Fund Qpartarly, Vol. 49, No. 2, April 1971. p. 130-1.

42

criticism tends to deal with means, rather than ends.89

Katz and Kahn conclude that the information needs of lower
level organization members can be at least partially satisfied by hori-
zontal (peer) communication in the relative absence of regular and
reliable communication from the leadership.90 On the basis of this claim,
it seems reasonable to expect reported levels of satisfaction with all
work-related information to be almost as high for system.members who
enjoy high levels of horizontal (peer) communication as for those who
have better "pipelines" to the t0p echelons and, hence, more access to
"authoritative" information.

This reasoning would be supported by the work of Hovland and
Weiss who have demonstrated that the so-called "sleeper effect" in
information credibility depends upon the more rapid decay over time of

the effects of the source than of the content.91

On the other hand,
Cartwright cautions that more research is needed to determine whether
the effect of source decays when the source and the receiver maintain
a concrete relationship.92
Farace and Connelly studied the attitudes toward available

work-related information and perceptions of the information system of

employees in a large commercial establishment who had been categorized

 

89
Op. cit., p. 379.

900p. cit., p. 243-5.

91Hovland, C.I., and W. Weiss, "The Influence of Source Credi-

bility on Communication Effectiveness," Public Opinion Qaarperly 15:135-50,
1952.

2

9 Cartwright, Darwin, "Power: A Neglected Variable in Social
Psychology" in Bennis, Warren G., K.D. Benne and R. Chin, The Planning
of Change, N.Y.: Holt, Rinehart and Winston, 1966. p. 416.

43
as "work satisfied" or ”work dissatisfied" on the basis of Frederick
Herzberg's theory of work satisfaction. "Work satisfied" employees re-
ported more timely attention to their work problems by supervisors (pro-
duction information), more favorable assessments of information about
plans and policies (innovation information), and more attention to per-

sonal, as well as work, problems by supervisors (maintenance communica-

tion).93

Support for Mouzelis' dictum that "bad communication does not
necessarily lead to conflict"94 may be drawn from.Habbe's findings in a
questionnaire survey (fifworkers in two industrial plants. In the plant
in which fifty-five percent of the workers agreed that the company "does
a good job of telling you what's going on and what's being planned"
there was a "wish to know more" than in the other plant where only eight-
een percent of the workers felt that their company was communicating ade-
quately to its employees. Habbe's conclusion is that "supplying more
information to employees creates the desire for more information."95 It
would seem that a respondent's "need to know" may be both satisfied by

the leaders' messages and further stimulated by them.

 

93Op, cit., p. 11-16.

94
Op. cit., p. 161.

95Habbe, 8., "Communicating with Employees," Studies in Per-
sonnel Policy, No. 129. N.Y.: National Industrial Conference Board, 1952,
p. 39, cited by Guetzkow, Harold, "Communications in Organizations," in
March, James G. (ed.) Handbook of Organizations, Rand McNally and Co.,
1965, p. 540.

Chapter III

METHODOLOGY

This chapter outlines the methods used to investigate the prob-
lem described in Chapter I. First, the population utilized is described.
Next, an overview of the contents of the questionnaire is proVided and
the means of administering it is summarized.

The process followed in developing the final questionnaire is
described next. Lastly, the methods used to analyze the questionnaire

data are described.

Population

The present investigation was conducted by surveying volunteer
clinical faculty in the Department of Family Medicine of the College of
Osteopathic Medicine at Michigan State University. Members of this par-
ticular set of clinical faculty are all appointed by the University's
Board of Trustees at the ranks of Clinical Assistant Professor or Clinical
Associate Professor.

With a few exceptions (all of which were excluded from the
study), these preceptors are engaged in the private practice of compre-
hensive, primary care to entire families. All have membership on the
staff of an accredited general hospital.

This p0pu1ation is scattered over much of the southern half
of Michigan's lower peninsula, except that few are located in Detroit or

44

45
its immediate suburbs. Preceptors practice in both urban-suburban and
rural-small town settings. They are staff members of hospitals which
are both large and small, exclusively osteopathic and mixed D.O.-MgD.
They practice alone or in offices shared with other physicians. Some
have practices almost exclusively office-based and others spend many
hours each week treating hospitalized patients. Some do general surgery
and obstetrics; others refer patients requiring such care to specialists.
While all are members of the statewide professional organization and
nearly all are members of constituent district chapters, they vary widely
in their relative activity in these associations.

Students are assigned singly to spend one afternoon each week
in a preceptor's office for a period of five weeks. Initial assignment.
is made part way through the first year when students have acquired only
the most rudimentary skills in the diagnosis of various pathologies, but
are already engaged in intensive classroom study of physical diagnosis,
history taking, interviewing and other basic clinical skills. The
College's integrated curriculum is founded in part upon the educational
principle of early reinforcement of didactic learnings in the actual set-
ting in which they will be ultimately utilized. .Additionally, it is
argued, early exposure to the setting, patient population and role models
of family practice affords beginning students a kind of "reality test"
for their professional aspirations and concepts of "what it is like to
be a doctor." Thus preceptors are expected to provide an experiential
introduction to the person and work of the family physician, as well as
some supervised practice in the exercise of newly acquired skills involv-

ing physical examination and doctor-patient interaction.

46
There were eighty-eight preceptors at the time of the survey.
Of these, four were excluded from the study because they practiced in
the University's Olin (Student) Health Center. .Another three were ex-
cluded on grounds that, in addition to being preceptors, they had class-
room teaching responsibilities on the campus and were, thus, strikingly
unlike other volunteer clinical faculty at Michigan State University or

elsewhere. Hence, the population actually surveyed numbered eighty-one.

Questionnaire Contents

The questionnaire used to gather data for this study contains
items designed to elicit information corresponding with the three sets
of variables outlined in Chapter I (see Figure 1.2). Thus, there are
questions about the various propinquity variables (solo or group prac-
tice, distance from campus, time spent in hospitals, etc.). Secondly,
there are questions about informal communication with other physicians
(frequency, duration, initiation and content-function). The third
general set of questions was designed to elicit attitudes toward avail-
able role-related information, perceptions of the program's information
distribution system and the relative saliency or value of "being a
preceptor."

Another small set of questions was included as "controls."
Three variables outside the design of the study have a potential for
confounding or distorting the data, particularly as regards perceptions
of the adequacy of role-related information and the information distri-
bution system. They are:

--length of time in the preceptorship program

--visit(s) to the‘preceptor's office by an official of
the College

47

--attendance of the preceptors at meetings for
preceptors on the campus.

The investigator believed that these variables are not system-
atically related to the basic propinquity variables. Nevertheless,
measures were taken on these potentially confounding variables in an
attempt to safeguard the validity of the findings.

The questionnaire itself is reproduced as an appendix to this

dissertation.

Qpestionnaire Administration

The questionnaire was administered by mail, together with a
self-addressed return envelope. In an effort to assure a large percent-
age of returns, a cover letter signed by the chairman of the Department
of Family Medicine introduced the project and the investigator to the
preceptors and appealed for their cooperation.

Telephone calls to the offices of the subjects who were slow

to respond were made by the investigator two weeks after mailing.

Design of the Qaeationnaira

Development of the questionnaire proceeded through several
stages as follows:

Full-time faculty "brain-storming" session. Six members of the
full-time faculty of the Department of Family Medicine met with the in-
vestigator to "brain-storm" factors which they felt might be associated
with high levels of informal communication among preceptors and with
positive attitudes toward the program and role-related information. At
the time of the session, five of the six faculty participants were newly

arrived at the University from the private practice of comprehensive

 

 

 

C]

"R
am
ET;

48
family medicine.

Full-time faculpy questionnaire. Eight physician members of
the Department were then surveyed to produce data from their own recent
experience as family practitioners regarding the principal dimensions
(variable groups) of the study. This step yielded helpful guidance
both for the design of the project (definition and selection of vari-
.ab1es) and the shaping of questionnaire items.

Open-ended interviews with preceptors. Face-to-face interviews
of forty-five minutes to one hour in length were conducted with ten
subjects selected from the population of preceptors. Interviewees were
selected at random from each of four general localities chosen to
correspond with the propinquity factors which could be determined ob-
jectively by the investigator (3010 vs. group practice, urban vs.
rural-small town and proximate to campus vs. remote from campus). Of
particular significance in this stage were the perceptions and verbal
formulations of the interviewees which helped operationalize previously
indistinct variables (e.g., proximity to campus).

Models from similar study. The wording of many specific items
was guided by models available in a study of communication practices in
a large, complex organization.1

Review of fipal_pppgp_gpaip. The adequacy of the items emerging
from the foregoing stages was further assured by submitting them to the

critique of four physician-faculty members and an experienced researcher

 

1Berlo, D.K., RuV. Farace, RmA. Connelly and H.M. Russell,
"Relationships Between Supervisor-Subordinate Communication Practices
and Employee Turnover, Attendance and Performance Evaluations." 'Mimeo-
graphed, Department of Communication, Michigan State University, 1971.

49
in organizational communication.

Follow-up interviews. As a final check upon the validity of
the questionnaire, follow-up interviews were held with five of the re-
spondents. The principal objective in these interviews was to ascertain
the degree to which reSpondents in fact interpreted items in the manner

intended by the investigator.

Procedure for Analysis

Data produced by the questionnaire survey were analyzed by
means of direct comparison of appropriate pairs of variables. Compari-
sons between two variables, both of which had categorical values, pro-
duced contingency tables with frequencies and percentages in the several
cells and totals in both dimensions. Comparisons between two variables,
one of which had categorical values and the other of which had continu-
ous values, produced means and standard deviations for each category
and for the total p0pu1ation.

These procedures were accomplished by utilizing two computer
programs. For comparisons of two variables both of which had categori-
cal values, the program used was ACT (version 3), on file at the Computer
Institute for Social Science Research (CISSR) at Michigan State Univer-
sity. The ACT program generates contingency tables with both frequen-
cies and percentages. For comparisons of two variables, one of which
'had categorical values and the other or which had continuous values,
the program used was the MSU STAT System, Version 3.05B. Both programs

are written for Michigan State University's CDC 6500 computer.

50

In general, the choice of variables for pairing and comparison
followed from the principal purposes of the present investigation as
set forth in Chapter I. That is, propinquity variables were compared
with informal communication variables and informal communication vari-
ables were compared with perception-attitude variables. Additionally,
"control" variables were compared with the propinquity variables, as
mandated by the design of the study.

More specific explanations of and rationale for the choice
of particular measures for pairing, in instances where several related
measures were available, may be found in the text accompanying the
presentation and discussion of data in Chapters IV and V.

In coding questionnaire responses, all uncompleted items were
tabulated separately ("no response") and percentages calculated for
them. This procedure was followed on the assumption that a respondent's
failure to complete an item may be a significant, though denotatively
indistinct, response and should not be "lost" in percentages calculated
only on completed items. Also coded as "no response" were the few
responses spoiled by respondents' failure to comply with instructions.

A number of items listed responsesoptions which read "Other
(please specify): ." In those instances in which respondents
utilized this option, the investigator coded their responses in the

"standard" categories whenever they seemed alearly to fit.

Mar

The present investigation was conducted by a mailed question-
naire survey of 81 volunteer clinical faculty (preceptors) in the De-

partment of Family Medicine, College of Osteopathic Medicine, Michigan

51

State University. All subjects are in the private practice of compre-
hensive, family medicine, are staff physicians in accredited general
hospitals, and are members of osteopathic professional associations. All
have similar responsibilities toward similar students. They differ on
other formal characteristics of interest in this study, such as the
geographical and associative aspects of their private practice settings.
The questionnaire was developed in a series of steps utilizing
full-time faculty members recently engaged in private practice, models
drawn from analogous studies, and open-ended interviews with a subset
of the population. Several follow-up interviews were conducted as a
partial check upon the questionnaire's validity.
Analysis of the survey data involved the generation by compu-
ter of a large number of tables, each involving the direct comparison
of two variables. The majority of the variable pairings followed direct-
ly from the purposes of the study as stipulated in Chapter I, namely
the exploration of possible associations between propinquity factors and
informal communication factors, and between informal communication fac-

tors and perception-attitude factors.

Chapter IV

ANALYSIS: PROPINQUITY AND INFORMAL COMMUNICATION

Questionnaires were returned by 70 (86%) of the 81 preceptors
in the population utilized for the study. One respondent returned his
partially completed questionnaire with a letter explaining that he was
so new to the program that he found it impossible to respond to many
items. When inspection revealed that many more than half of the in-
formal communications and attitude questions were unanswered that ques-
tionnaire was eliminated. Thus, 69 respondents, or 85% of those sur-

veyed, were finally included in the analysis.

Profile on Prppinqui§y_and "Cgpprol" Variables

Practice Setting. Totals for the reSpondents show that 44 of
the 69, or 64%,are in group practice. One reSpondent noted that he and
the physician with whom he shared an office were never present in the
office at the same time. Because the principal purpose of this study is
to investigate relationships between physical proximity and informal
peer communication, this respondent was recorded as a solo practitioner.

Those respondents in group practice were asked to indicate how
many of the other physicians with whom they shared an office were also
preceptors. Sixteen had no other preceptor practicing in their office,
16 had one other, 8 had two others and four had three or more. Includ-

ing the solo practitioners, 59% of the preceptors have no other preceptor

52

53

sharing their office. Of those who have at least one other preceptor
"close at hand” in their offices through most of each typical working
day, 23% have one other and 18% have two or more others.

Forty-two (61%) of the preceptors identified the communities
in which their offices are located as "urban-suburban," while 27 (39%)
judged their practice settings to be "rural-small town."

Eighty-one percent say it takes them more than one-half hour
to drive to the University campus.

Percentages for all the values of these practice setting vari-

ables are displayed in Table 4.1.

Activity in Hospitals. Respondents vary widely in the extent
to which their practice includes hospital visitation of patients.
Asked, "On~the average, how much time do you spend in the hospital each
week when you go there for the purpose of seeing patients?" they re-
port as few as 2.5 hours and as many as 27.5 hours. (Responses of
"2-3 hours per week" were recorded as 2.5 hours, etc.) The mean for
all respondents was 12.7 hours per week, with a standard deviation of
5.48.

Two measures were taken on another kind of activity in hospi-
tals, namely involvement in policy formulation and operational super-
vision. First the preceptors were asked, "Relative to other members of
your (principal) hospital's staff, would you describe yourself as 'more
active than most' in the affairs of the ho3pital?" Forty-three percent
answered, "yes -- more active." The same percentage judged themselves
to be "about average" and the rest (14%) said they were "less active"

than most. The preceptors were then asked to estimate the number of

54

Table 4.1

Profile of Preceptor Population: Practice Setting Variables

PRACTICE PARTNERS

Solo practice 36%
group practice 64%
--2-doctor group 38%
--3-doctor group 13%
--4-doctor group 13%

OTHER PRECEPTORS IN PRACTICE

no other 59%
--solo 36%
-—group 23%

some other 41%
—-one other 23%
--two others 12%
--three or more 6%

SIZE OF COMMUNITY

urban - suburban 61%
rural — small town 39%

PROXIMITY T0 CAMPUS
(driving time in good weather)

1/2 hour or less 19%
more than 1/2 hour 81%

55

hours per month they spent in hospital board or committee meetings,
excluding regular meetings for the entire staff. Answers ranged from
none to 18 hours. The mean was 5.4 hours per average month, with a

standard deviation of 3.60.

Table 4.2
Profile of Preceptor Population: Activity in Hospitals

TIME SPENT IN HOSPITAL FOR PURPOSE OF VISITING PATIENTS

range 2.5-27.5 hrs./wk.
mean 12.7 hrs./wk.
standard deviation 5.47

ACTIVITY IN HOSPITAL AFFAIRS (relative to other members of staff)

more active than most 43%
about average 43%
less active than most 13%

TIME SPENT IN HOSPITAL BOARD OR COMMITTEE MEETINGS

range 0-18 hrs./mo.
mean 5.4 hrs./m0.
standard deviation 3.61

Because the self-judgments about relative "activity" and the
reported hours spent in hospital board and committee meetings were
intended as complementary measures on the same dimension, it is interest-
ing to note their relationship. The results of this comparison are

shown in Table 4.3.

56

Table 4.3

Hours in Hospital Meetings By Category of Self-judged Activity

 

Relative activity Hours Spent in Boardpapd Committee Meetings
Mean Stan. Dev.

more active than most 7.4 3.82

about average 4.3 2.65

less active than most 2.4 1.89

It will be seen that there is a regular and positive relation-
ship between these two measures. This result indicates that, in subse-
quent comparisons with communication variables, similar findings may
be expected for these two measures on what is essentially one variable

(activity in hospital affairs).

Activity in Professional Associations. The respondents vary
rather widely in their relative activity in the principal professional
associations. Measures were taken on both district (local) and state-
wide osteopathic associations. The most frequent response for both
items was to the option "attend most meetings, but little or no committee

wor ." The results are shown in Table 4.4.

Table 4.4

Profile of Preceptor Population: Activity in Associations

 

District State

don't attend 16% 22%

attend, but little or no committee 38% 57%
work

attend, serve on committees 29% 17%

officer or chairman of major 17% 4%

committee

57

That respondents tend to be mutually active or inactive at both

district and state levels is demonstrated by Table 4.5.

Table 4.5
Comparison of Activity in Professional Associations

Category of Activity

in State Association District Associations
don't attend cmte. officer
attend no cmte. work chm,
don't attend (n=11) 53% 8% 0% 0%
attend, no cmte. (n=26) 27% 51% 8% 33%
attend, cmte. work (n=20) 20% 28% 50% 0%
officer or chairman (n=l3) 0% 13% 42% 67%
n=15 n=39 n=12 n=3

”Control" Variables. Three measures were taken on factors out-
side the design of the study (neither propinquity variables, informal
communications variables nor perception-attitude variables). These
factors were identified as having a potential for confounding or dis-
torting the findings, particularly as regards associations between pro-
pinquity factors and perceptions of the adequacy of role-related infor-
mation and of the information distribution system. Although the in-
vestigator did not believe that these variables were systematically
related to the basic propinquity variables, measures were taken on each
of them as a check on this belief. The three "control" factors are:

--length of time in the preceptorship program

--visit(s) to the preceptor's office by an official
of the college

--attendance of the preceptors at meetings for
preceptors on the campus.

58

Though the purpose for including these measures prompts their
being labelled "control" variables, it will be seen that they describe
the population in terms of individuals' formal participation in the
preceptorship program.

A profile of the population on "control" factors is shown
in Table 4.6. In general terms, 71% have been preceptors for more than
one year and only 10% for less than six months. One out of every four
preceptors has been visited in his office by an official of the college.
Slightly more than half of the reSpondents have attended at least one of

the meetings for preceptors held at the University campus.

Table 4.6
Profile of Preceptor Population: "Control" Variables

LENGTH OF TIME IN PRECEPTOR PROGRAM

less than 6 months 10%
6 - 12 months 20%
more than one year 71%

VISITS TO PRECEPTOR'S OFFICE BY COLLEGE OFFICIAL

no visits 74%
one visit 10%
two visits 12%
three or more 4%

ATTENDANCE AT MEETINGS FOR PRECEPTORS

attended no meetings 46%
attended one meeting 20%
attended two meetings 23%
attended three or more 10%

Note: In this and many subsequent tables, percentage figures do not
always add to 100%. This is due to rounding error.

59

gppparison of Propinquity and "Control" Factors

It is possible that the first preceptors in this still relative-
ly new program were selected from among physicians in group practice and
that, later, the selection process was "biased" in the direction of
physicians in solo practice. It is also conceivable that early preceptors
were appointed from those closest at hand, with the College obliged to
look farther afield as the program grew and more preceptors were needed.
To determine whether such relationships exist, a set of contingency
tables was generated.

Table 4.7 reveals that there apa relationships between length
of time in the preceptorship program and the several propinquity vari-
ables. The proportion of subjects in group practice is larger for those

who have been in the program.for more than one year than it is for
those who have been in the program for one year or less. The proportion
of subjects whose offices are in urban areas is larger for those who
have been in the program for more than one year than it is for those who
have been in the program for one year or less. Although the diff-
erences are not as large as those in the latter two comparisons, the
proportion of preceptors whose offices are more than one-half hour's
driving time from the campus is larger for those who have been in the
program for more than one year than it is for those who have been in the
program for one year or less. In no case are the differences so large as
to constitute a reversal of proportions between the respective categories
of propinquity factors or a deviation or more than four percent from
the means for the entire population.
Table 5.6 also shows comparisons of the same set of three

propinquity variables with the number of times an official of the College

60

 

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61

visited respondents' offices. The preceptors were asked for the number
of visits and their responses coded in four categories (0, 1, 2, 3, or
more). However, because so few preceptors had apy visits (18), a more
intelligible display results from collapsing the categories into just
two categories, "no visits" and "one or more visits." No relationship
is apparent between number of visits and either the solo vs. group vari-
able or the proximity variable. On the other hand, whereas rural-small
town preceptors comprise 39% of the total population, they account for
61% of all visits to preceptors' offices by College officials.

The third "control" or formal participation variable is attend-
ance at meetings for preceptors. According to Table 4.7, solo and group
practitioners attended "no meetings" and "two or more meetings" in num-
bers proportionate to their distribution in the entire population. Solo
practitioners are somewhat overrepresented in the category of those who
attended one meeting, a finding consistent with their similar diSprOpor-
tion.among preceptors newer to the program. (It is apparent from data
presented in the following pages that length of time in the program is
clearly associated with attendance at meetings.)

On the other hand, rural-small town preceptors are over-
represented among those who had attended no meetings and underrepresented
among those who had attended two or more meetings. A slight majority
of those reporting that they attended no meetings are preceptors prac-
ticing in rural areas or small towns, though such preceptors comprise
39% of the total population. The same finding is illustrated by
analyzing the same data from another perspective. Sixty-four percent
of all urban-suburban preceptors, as opposed to 37% of all rural-small

town preceptors, attended any meetings. Again, 43% of urban-suburban

62

preceptors, as opposed to 19% of rural-small town preceptors, attended
two or more meetings.

Lastly, with respect to proximity to campus, the proportions
in which those closer at hand attended meetings for preceptors is not
significantly different from their proportions in the population as
a whole.

It is interesting to note, in this connection, that the pre-
ceptors from rural and small town areas do not necessarily have farther
to drive when they come to the College's on-campus facilities than do
preceptors from urban-suburban areas. The proportion of all respondents
who must drive more than one half hour is exactly the same (19%) for
both groups. However, it must be acknowledged that, had the "cutting
point" for the proximity variables been set higher (e.g. one hour driv-
ing time), the proportions pay have been different.

In summary, then, comparisons were made of the three "control"
variables with each of three propinquity variables. The purpose of
these comparisons was to discover whether distribution of Subjects on
the prOpinquity variables for each level of the "control" variables
was. disproportional to their distribution in the p0pu1ation as a whole.
Several instances of such disproportion were revealed. The size of
community (urban vs.rural) variable appears to be associated with all
three "control" variables. Length of time in the program (a "control"
variable) appears to be associated with the three propinquity variables
with which it was compared.

Thus, rural-small town preceptors were more likely to have been

in the program a shorter time and to have attended fewer meetings for

63

preceptors on the campus, but also were much more likely to have been
favored by College officials in terms of site visits to their offices.
Those preceptors who have been in the program for more than one year
are somewhat more likely to be in group practice, to practice in urban-
suburban communities and (to a lesser extent) to practice at some
distance from the campus.

These findings of relationships between "control" variables
and propinquity variables raise questions about relationships among
the "control" variables themselves, and about relationships between

the control variables and informal communication behavior.

Table 4.8

Comparisons of ”Control" Variables

length of time in program

 

less than 6-12 more than
6 mo. mos, one year
VISITS FROM COLLEGE OFFICIALS
no visits 71% 71% 75%
one visit 14% 7% 10%
2 or more visits 14% 21% 15%
ATTENDANCE AT MEETINGS
no meetings 86% 64% 35%
one meeting 14% 21% 21%
2 or more meetings 0% 14% 44%
totals 10% 20% 70%

Data in Table 4.8 suggest no patterns beyond what one might antici-
pate from study of Table 4.7. Those who have more recently come into
the program (within the last year) have been visited somewhat more often
by College officials. Also, there is a regular and progressive relation-

ship between length of time in the program and attendance at meetings.

64

Given the relationships between "control" variables and some
propinquity variables, and since the central task of this chapter is to
explore relationships between propinquity and informal communication be-

havior, some analysis of comparisons between the "control" variables

and informal communication behavior is desirable. The informal communi-
cation variable labelled "overall frequency" is utilized for purposes of
these comparisons. The choice of a single "representative" measure

seems justified on two grounds. First, it is the most "general" informal
communication measure in the study, in the sense that it does not relate
to behavior occuring in a specified location. Second, it is the informal
communication measure most often used for subsequent comparisons in both
this and the following chapter. Table 4.9 presents comparisons between
overall frequency and the three "control" variables.

Relative to their proportion in the total population, preceptors
who have been in the program for one year or less are overrepresented
among those who say they "almost never" talk with other physicians about
the preceptorship program. However, among those who gp_have such commun-
ication, preceptors relatively new to the program talk with other physi-
cians almost daily in a proportion exceeding their proportion in the
population and communicate less frequently in a proportion far lower
than their proportion in the population.

Preceptors who have been visited in their offices by College
officials are prOportionately underrepresented among those who talk
relatively infrequently ("almost never" or "once a month"), proportion-
ately represented among those talk about "once a week" and overrepre-
sented among those who talk "almost daily." The general pattern of

distributions is very similar to that for response with respect to

65

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66

length of time in the program, an observation consistent with the pre-
viously noted relationship between these two "control" variables.

With reSpect to the comparison between overall frequency and
attendance at meetings, Table 4.9 shows a virtually identical percentage
distribution between those who have attended no meetings and those who
have attended at least one meeting for preceptors at both extremes of
the overall frequency dimension. Combined responses for the "once a
month" and "once a week" category yield percentages closer to distribu-
tions in the total population (41% attending no meetings and 59% attend-
ing at least one meeting).

In sum, analysis of comparisons between "control" variables
and overall frequency reveals that those preceptors who are relatively
new to thesprogram and preceptors who have had visits by College officials
tend! to communicate more frequently than their fellow preceptors. ‘More-
over, it is rural-small town preceptors who have tended to join the
program more recently and to have been visited by representatives of
the College. These associations, particularly, must be born in mind
when assessing the legitimacy of inferences from this study.

The remainder of the chapter is devoted to analysis of con-
tingency tables generated to compare propinquity variables and informal
communication variables. .Again, the propinquity variables are:

--Practice partners
--solo vs. group practice
--number of other physicians in the group
--Number of other preceptors in group
"Size of community (urban-suburban vs. rural-small town)

--Proximity to the campus (1/2 hour or less driving
time in good weather vs. more than 1/2 hour driving

time)
--Activity in hospitals and associations.

67

W

Freguency. The principle communication behavior variable to
be compared with the solo vs. group and the group size variables is,
of course, frequency of work-related conversations in the office or on
the telephone. However, it is important to simultaneously consider data
about frequency of interchange in the other settings in which physicians
come together. In this way, one may investigate the possibility that
frequency measures for different conversational contexts merely cancel
each other out. To this end, the solo vs. group variable was compared
also with communication frequency during patient visitation in the
hospital, during hospital meetings and during professional association
meetings, as well as with a general frequency variable. The results
of. these multiple comparisons are summarized in Table 4.10.

Analysis of the comparison of in-office peer communication
with the solo-group variable reveals that 45% of preceptors practicing
in groups talk with other physicians about the preceptor program at
least once a month while in their offices, as opposed to 28% of preceptors
in solo practice. The virtually equal percentages for those reporting
"more than once a week" conversations must be treated with caution, due
to the fact that these percentages represent only two subjects in each
column. It will be seen that combination of the last two rows reveals
that 12% of solo practitioners and 20% for group practitioners have such
conversations in their offices weekly or more often.

For the second frequency variable included in Table 4.10,
the percentages reveal that, while in the hospital to visit patients,
3010 and group practitioners behave almost exactly the same with respect

to peer communication about the preceptor program.

68

Table 4.10
8010 and Group Practice According to Frequency
OFFICE. Question: In your office or on your telephone, about how

frequently do you usually talk with other physicians about the pre-
ceptorship program?

Solo Group
almost never 72% 55%
once a month 16% 25%
once a week 4% 11%
more than once a week 8% 9%

HOSPITAL ROUNDS. Question: In the past month, can you recall having
any conversations with other physicians about thegpreceptorship pro-
gram while you were in the hospital to see patients?

8010 Group
no 44% 45%
yes, once or twice 52% 50%
yes, three or more times 4% 5%

HOSPITAL MEETINGS. Question: At hospital staff or committee meetings,
how frequently do you talk with anyone about the,preceptor program?

8010 Group
almost never 75% 75%
once a month 20% 16%
more than once a month 4% 9%

ASSOCIATIONS. Question: Before or after osteopathic association meet-
ings, how frequently do you talk with anyone about the preceptorship
program?

Solo Group

almost never 64% 66%
once every 3-4 meetings 20% 16%
at least once every meeting 8% 16%

(no response) ( 8%) ( 2%)

69

Table 4.10 (cont'd.)

OVERALL. Question: On the average, during periods when you have a
student, how frequently do you talk with other physicians about the
preceptorship program?

Solo Group
almost never 36% 25%
once a month 20% 14%
once a week 32% 41%
almost daily 8% 16%

(no response) ( 4%) ( 5%)

70

One of every four preceptors in either group reported utiliz-
ing hospital staff or committee meetings as opportunity for frequent
conversations with other physicians. Of those who did, a higher per-
centage of preceptors in group practice report that such conversations
occur more than once a month.

Similarly, with respect to interchange about the preceptorship
program in the course of professional association meetings, the percent-
age of those reporting that they "almost never" have such conversations
is virtually equal for the two groups. Once again, a higher percentage
of the preceptors in group practice record reSponses in the category
representing the highest frequency of communication.

The last communication frequency variable shown in Table 4.10
is an overall or general variable, not referring to behavior in a par-
ticular setting or social context. Moreover, questionnaire items em-
phasized that subjects were to respond in terms of communication fre-
quency during periods when they actually had a student coming to their
office. Thus, the rates are predictably lower for those saying they
"almost never" talk with other physicians about some aspect of the
program. The distribution of responses over the four categories of this
communication frequency variable is consistent with the results of the
other frequency measures. The "no" and "aLmost never" reSponses on the
foregoing variables were virtually equal in the two groups, except for
the in-office frequency variable. A roughly similar percentage spread
exists between the in-office frequency and the overall frequency

variables in the "almost never" category. Similarly, the larger

71
percentages of group practice preceptors reporting frequent communication
on the overall variable is consistent with responses on the other con-
text-specific variables.
A second kind of question was put to the subjects in an effort
to further explore possible associations between propinquity variables
and informal communication about their role as preceptors. This question

was:

Where do you most frequently have
conversations with other physicians

about the College or the preceptor

program? (Please place a "l" by the
most frequent location and a "2" by
the second most frequent location.)

Responses to this question are shown in the following table.

Table 4.11

Solo and Group Practice By Location of Most Frequent Conversations

 

most freguent 2nd most frequent

solo rou solo group
in office or on phone 12% 48% 16% 23%
in hospital 52%: 36% 16% 39%
at association meetings 16% 2% 24% 18%
at College's campus 8% 2% 4% 0%
other 4% 2% 8% 2%
(no response) ( 8%) ( 9%) (32%) (18%)

The table shows clearly a pattern consistent with the data
analyzed above. Preceptors who share an office with other physicians
report that their office. is the most frequent site of conversations
about the College or the preceptorship program to a degree far in excess
of that reported by preceptors practicing alone (48%, as opposed to 12%).
The dominant first choice of solo practitioners and the clear second

choice of group practitioners is the hospital. Most of those who

72

recorded responses in the "other" category wrote in "none" or put a
string of zeros next to the response options. One respondent, however,
reported social gatherings as his second most frequent place of con-
versation. The disproportionately large percentage of solo practition-
ers who failed to record a second most frequent location may mean that
they, more than those in group practice, could not as readily think

of a second location where they had a noteworthy number of conversations
about the preceptorship program.

Function. Subjects were asked, "When you talk about the
preceptorship program with other physicians in your office or on your
telephone, what do you most frequently talk about?" Respondents could
choose among five response options:

—-c1arifying what the College expects
--genera1 topics, sharing experiences
--finding better ways to do our job

--other (please specify):

 

--don't have such conversations
The first three of these response options serve as the opera-
tional definitions of the three levels of the function variable: Pro-
duction,.Maintenance, and Innovation. The same wording was used con-
sistently each time function measures were taken throughout the ques-
tionnaire. In every case, on this and each other function measure,
responses to "other" could be fit into one of the three function

categories.

73

Table 4.12

Solo and Group Practice By Function of Office Communication

'solo rou
production 12% 14%
maintenance 28% 55%
innovation 20% 9%
no such conversations 32% 23%
(no response) ( 8%) ( 6%)

According to this data, the in-office conversations of pre-
ceptors in group practice serve maintenance purposes (at least as de-
fined above) to a larger extent than is true for preceptors in solo
practice. Solo practitioners among the preceptors report a larger
proportion of innovation communication. It must be borne in mind that
these particular data do not say anything about the amount of communica—
tion in any of these categories of function. The figures in Table 4.12
reflect only the proportion of respondents in each group who choose a
given category as best characterizing the nature of his most typical
in-office peer communication, regardless of the amount of that communi-
cation.

This latter observation raises an interesting question about
the relationship of in-office frequency to in-office function, especi-
ally given the demonstrably high in-office frequency rates for preceptors
in group practice. Unfortunately, the high percentage of preceptors
who say they "almost never" talk with other physicians in their offices
about the program renders comparative data suspect on the grounds of
small cell size. What data there are show maintenance communication
as the dominant category for all levels of frequency and a higher pro-
portion of innovation communication among those who communicate most

frequently in their offices.

74

Table 4.13

Office Frequency by Office Function

 

 

 

Production Maintenance Innovation
once a month (n=15) 0% 87% 13%
once a week (n=5) 20% 80% 0%
more than once a week (n=6) 0% 67% 33%

Size of Group Practice
Closely related conceptually to the distinction between solo
and group practice is the question of group size, i.e., the number of
other physicians with whom a preceptor shares an office. The following
is restricted to those frequency variables on which clear differences

emerged in the comparison of preceptors in solo and group practices.

Table 4.14
Size of Group By Frequency of Office Communication
OFFICE. Question: In your office or on you telephone, about how fre-

quently do you usually talk with other physicians about the preceptor-
ship program?

 

 

2-doctor 3-doctor 4-doctor

group group group
almost never 58% 56% 44%
once a month 23% 33% 22%
once a week 15% 0% 11%
more than once a week 4% 11% 22%

OVERALL. Question: 0n the average, duringpperiods when you have a student,
how frequently do you talk with other physicians about some aspect of
the preceptorship program?

 

 

“2—doctor 3—doctor- -4-doctor
rou groupV_ group,
almost never 35% 22% 0%
once a month 4% 44% 11%
once a week 42% 22%. 55%
almost daily 12% 11% 33%
(no response) ( 8%) ( 0%) ( 0%)

n=26 n=9 n=9

75

Because of the incidence of very small cell size in this
table, no confident conclusions can be made from these data. The data
do indicate a positive relationship between group size and the highest
rates of communication frequency.

Table 4.15 compares group size and the function of in—office
communication about the preceptorship program. Again, the function
variable does not measure amount of conversation, but only the pre—
dominant nature of respondents' communication, irrespective of the

frequency or duration of such communication.

Table 4.15
Group Size by Function of Office Communication

2—doctor 3-doctor 4-doctor

 

groups groups or larger
clarifying what the College expects 12% 11% 22%
general topics, sharing experiences 58% 56% 44%
finding better ways to do our job 4% 11% 22%
no such conversations 23% 22% 0%
(no response) ( 4%) ( 0%) (11%)
n=26 n=9 n=9

A far higher proportion of respondents in all categories
report maintenance communication ("general topics, sharing experiences")
as the most frequent in—office communication function. The rather
regular, positive relationship of group size and the choice of innova—
tion as the most frequent function is rendered most tentative by the
fact that there are only one, one and two responses respectively, in

the cells of that row.

76
Number of Other Preceptors
Within the group practices represented in this population,
the number of officially appointed preceptors ranges from one to four.
Twenty-eight of the 44 preceptors in group practice have another pre-
ceptor as a practice partner; 16 preceptors in group practice are the

only members of their groups holding a College appointment.

Table 4.16
Number of Other Preceptors By Frequency of Office Communication

no other 1 other 2 others 3 others

almost never 56% 50% 63% 50%
once a month 25% 19% 25% 50%
once a week 6% 25% 0% 0%
more than once a week 12% 6% 13% 0%

n=l6 n=l6 n=8 n=4

The data presented in Table 4.16 show that preceptors who have
just one other preceptor in their group talk about theypreceptorship
program considerably more frequently than do those with two or three
other preceptors in their group. Even those with no other preceptors
in their group reported more frequently such in-office communication.

It should be borne in mind that these data do not reflect the frequency
of preceptors talking with other preceptors, but with physicians gen-
erally. The study included no measures of inter-preceptor communication
per se.

Table 4.17 shows that the greatest proportion of members in
each preceptor category chose the operational definition of the main-
tenance variable ("general topics, sharing experiences") as the best

characterization of their most frequent conversations with other

77

physicians in their offices. None of the preceptors with three other
preceptors in their groups reports innovation as the most frequent
content—function. Combination of the last two propinquity categories
yields a figure of eight percent for innovation communication choice
of those preceptors practicing with two or three other preceptors. The
resulting picture is one of a negative association between number of
preceptors and the choice of innovation as the most frequent communication
function.
Table 4.17
Number of Other Preceptors By Function of Office Communication

no_9ther 1 other 2 others 3 others

production* 19% 6% 13% 25%
maintenance 38% 69% 50% 75%
innovation 13% 6% 13% 0%
no such conversations 25% 13% 25% 0%
(no response) ( 6%) ( 6%) ( 0%) ( 0%)

n=16 n=16 n=8 n=4

*For the exact wording of response options as they appeared in
the questionnaire see Table 4.15. These operational defini-
tions for levels of the function variables were used consis-
tently throughout the questionnaire, each time a separate
measure was taken on communication function.

When the data for frequency and function are considered
together it will be seen that the preceptors with no other or only one
other preceptor in their groups both talked more frequently while in

their offices and more often talked mostly about how they might do

their jobs better.

78

Size of Community
For this propinquity variable, the informal communication
variables of interest are overall Or general frequency and the locations

of most frequent communication.

Table 4.18
Urban and Rural Preceptors By Overall Frequency
Question: On the average, during periods whenfiyou have a student, how

frequently do you talk with other physicians about some aspect of the
preceptorship program?

 

urban rural-
suburban small town
almost never 26% 33%
once a month 17% 15%
once a week 45% 26%
almost daily 12% 15%
(no response) ( 0%) ( 3%)

According to the data in Table 4.18, preceptors in urban-
suburban practice settings have somewhat more frequent conversations
with other physicians during periods when they have students than do
preceptors in rural and small town settings. The proportions of the
two groups reporting monthly and daily rates is quite similar; the
difference between the two groups is in the relative proportions re-
porting that they have such conversations about once a week.

Asked "ypapa_do you most frequently have conversations with
other physicians about the College or the preceptorship program?"

the preceptors responded as indicated in Table 4.19.

79
Table 4.19

Urban and Rural Preceptors By Location of Most Frequent Conversations

 

 

 

 

 

most frequeng' 2nd most frequent combined
urban rural urban rufal urban rural
in office 29% 44% 14% 30% 43% 74%
in hospital 45% 37% 31% 30% 76% 67%
at assn. mtgs. 7% 7% 24% 15% 31% 22%
at campus 5% 4% 2% 0% -- --
other 5% 0% '5% 4% —- --
(no response) (10%) ( 7%) (24%) (22%) -- —-

This table reveals that substantially more often than urban-
suburban preceptors, rural-small town preceptors find their offices the
most frequent location of conversations with other physicians about the
College or the preceptor program. Three out of every four rural pre-
ceptors identified their offices as one of the first two most frequent
locations for such conversations. Fewer than half of the urban-suburban
preceptors did so.

It would be wrong to suppose that the slightly higher percentage
of urban preceptors who identify their hospitals as the most frequent
location reflects a heavier use of hospitals by urban preceptors. Other
comparisons in the study show that rural preceptors spend an average of
2.8 hours per week more than urban preceptors in the hOSpital for the
principal purpose of patient care and that they spend more time talking
with other physicians while there (3.4 hours per week, as opposed to
2.7 hours per week). While urban preceptors report more time spent in
hospital board or committee meetings, the differences on this measure

are less striking (5.6 per month for urban, 5.1 per month for rural).

80

The row in Table 4.19 reporting percentages for association
meetings shows one of every four urban-suburban preceptors saying that
such meetings are the second most frequent location for conversations
about the program, as opposed to a smaller percentage for rural-small
town preceptors. This finding is consistent with the different
patterns of activity in the associations for the two groups. Ninety
percent of the urban preceptors, as opposed to 74% of the rural pre-
ceptors, attend district association meetings. Twenty-four percent of
the urban preceptors, as opposed to 7% of the rural preceptors, serve on

committees of the state-wide association.

Proximity to Campus

The proximity to campus variable was operationalized as "1/2
hour or less driving time" vs. "more than 1/2 hour." For the Lansing-
East Lansing area, in which the University is located, a radius of 1/2
hour driving time would include all of the metropolitan area (urban,
suburban, and "satellite".sma11 towns). Moreover, for the vast majority
of persons living within 1/2 hour's driving time radius, a telephone
call to the campus would be a local (non-toll) call.

For this propinquity variable, the informal communication
variables of particular interest are most frequent locations of con-
versations with other physicians, frequency of communication with full-
time faculty, and overall or general frequency. It should be borne in
mind, while considering the following figures, that preceding compari-
sons revealed no disproportions between proximate and more remote pre—

ceptors in terms of their formal participation in the preceptor program

81

(length of time in the program, visits from College officials, attend-
ance at on-campus meetings.)

The interest here is to discover whether those closer to the
campus more often communicate about the preceptorship program and,
particularly, whether their proximity is associated with more frequent
use of the College facilities for such conversations and whether they
report more recent conversations with full-time faculty members.

Table 4.20 shows the responses by proximity to the question
"On the average, during periods when you have a student, how frequently

do you talk with other physicians about some aspect of the preceptorship

 

 

program?"

Table 4.20

Overall Frequency According to Proximity to Campus

1/2 hour or less more than 1/2 hour
almost never 62% 21%
once a month 8% 18%
once a week 31% 39%
almost daily 0% 16%
(no response) ( 0%) ( 5%)

n=13 n=56

Unfortunately, there were relatively few respondents from
within the 1/2 hour driving time radius (n=13) due to the exclusion
of some nearby preceptors from the study. The figures must therefore
be interpreted with caution. According to Table 4.20, those preceptors
from farther away more frequently talked with other physicians about

the College and the preceptorship program.

82

The preceptors were also asked, ”When was the last time you
talked with a full-time faculty member in the Department of Family
Medicine about the preceptorship program?" A comparison of these
responses and the measure on proximity to campus reveals no large diff-
erences between proximate and more remote preceptors, as shown in the

next table.

Table 4.21

Proximity to Campus by Frequency of Communication with Full-Time Faculty

 

112 hour or less more than 112 hour
never 31% 36%
2 months or more ago 38% 39%
less than 2 months ago 31% 25%
n=13 n=56

Comparison of responses to questions about where conver-
sations most frequently take place and the proximity to campus variable
are of particular interest only in respect to those who identified the
College's campus as the most frequent location. Nine percent of the
preceptors more remote from the campus mentioned the campus as the most
frequent location for conversations with other physicians about the
preceptorship program. None of those from the more proximate areas
did so. Again, those farther away identify the campus as the second

most frequent location more often than do those closer to the campus

83

(21% and 15%, respectively.)

Activity in thngospital
Two separate aspects of the preceptors' relative activity in
their hospitals were included in the study. One focused upon the time
preceptors spend in their hospitals visiting patients. The other
focused upon the preceptors' involvement in hospital board and committee
work. Measures of informal peer communication were taken relative to
each aspect of hospital activity. The following two sections report on

these findings.

Time Spent Visiting Patients. Preceptors were asked to estimate
how much time they spend at the hospital each week when they go there
"for the purpose of visiting patients." The responses were recorded in
hours per week. Means were calculated for each level of three informal
communication variables: frequency, duration and function. The results
of these comparisons are presented in the following series of three

tables.

Table 4.22

Hours in Hospital to See Patients By Frequency

Question: In the past month, can you recall having any conversations with
other physicians about the preceptorship program while in the hospital
to see patients?

hrs./wk. in hospital
to seeypatients

no (n=3l) 11.9
yes, once or twice (n=35) 13.3
yes, three or more times (n= 3) 13.3

total (n=69) 12.7

84

Table 4.22.reveals that those who can recall having at least
one conversation about the preceptorship program within the last month
spent, on the average, almost 1 1/2 hours per week more in the hospital
visiting patients. No difference resulted between those who had one

or two conversations and those who had three or more.

Table 4.23
Hours in Hospital To See.Patients By Duration

Question: Did at least one of these conversations (in the hospital dur—
ing the past month) last more than five minutes?

hrs./wk. in hospital
to see patients

no (n=10) 12.4
yes (n=23) 13.8
can't remember (n= 4) 14.3
(had no such conversations) (n=32) 11.8
total (n=69) 12.7

These data show that those who recall having conversations of
at least five minute's duration spend almost 1 1/2 hours per week more
in the hospital seeing patients than those who say they had no conver-

sations of that length.

Table 4.24
Hours in Hospital To See Patients By Function

Question (for those who report conversations in the hospital within the
past month): What did you talk about?

hrs./wk. in hospital
to see patients

 

clarifying what the College expects (n=9) 12.3
general topics, sharing experiences (n=24) 13.3
finding better ways to do our job (n=5) 15.5

(no such conversations) (n=31)

total (n=69) 12.67

85

According to the data in Table 4.24, those identifying the
innovation function as the best characterization of their recent conver-
sations in the hospital spent more time in the hospital visiting patients
than did those in either other category. Also, those reporting main-
tenance as the function of their conversations spent more time than

those reporting production.

Time in Hospital Meetings. Two propinquity variables were
included by which to measure relative activity in the affairs of the
hospital. Preceptors were asked, "Relative to other members of your
(principal) hospital's staff, would you describe yourself as 'more
active than most' in the affairs of the hospital?” They were also
asked "Excluding regular meetings for the entire staff, about how much
time do you presently spend in hospital board or committee meetings in
an average 2333p?" A comparison of these two propinquity variables was
analyzed in the opening pages of this chapter and a positive relation-
ship was found between them. Whether these two measures On what is
essentially the same variable will yield similar results in comparisons
with communications variables may be seen in the following series of
tables. The communications variables are frequency, duration, initiation
and function.

According to Table 4.25, there is a regular and positive re-
lationship between the preceptors' description of themselves as more or
less active in hospital affairs and the frequency of their communication
about the preceptorship program in hospital meetings. All preceptors
describing themselves as "less active" than most say that they "almost

never" talk with others in hospital meetings about the preceptorship

86

Table 4.25

Hospital Activity and Hours in Hospital Meetings by Frequency

Question: At hospital staff or committee meetings, how frequently do
you talk with anyone about the preceptorship program?

 

 

more active about less hrs./mo.
than most average active in meetings*
almost never 60% 83% 100% 5.0
once a month 30% 10% 0% 6.7
more than once a month 10% 7% 0%
n=30 n=30 n=9

*These figures, it should be remembered, are for
time spent in hospital board and committee meetings,
excluding regular meetings for the entire staff.

Table 4.26
Hospital Activity and Hours in Hospital Meetings By Duration
Question: When you talk about the preceptorship program with physicians

at hospital staff and committee meetings, how long do these conversations
generally last?

 

 

more active about less hrs./mo.
thag most avgrage 'aCtive in meetingg
don't talk 37% 27% 33% 4.9
less than 5 min. 30% 47% 56% 5.1
more than 5 min. 27% 17% 11% 6.9
(no response) ( 7%) (10%) ( 0%) 4.9

n=30 n=30 n=9,

87

program. Those who report occasional conversations of this kind spend
more time (1.7 hours per month more) in hospital board or committee
meetings, than those who "almost never" have such conversations. How-
ever preceptors who talk about the program approximately once a month
are not distinguished from those who talk about it "more than once a
month."

These data do not show the same negative relationship between
"activity" and those who "don't talk" as was so evident in Table 4.25.
This is curious, inasmuch as the duration item immediately followed the
frequency item in the questionnaire. However, there.i§_a regular
and negative association between activity and the shorter conversations,
and a regular and positive association between activity and the longer
conversations. Also, those who report conversations of longer duration
(n=l4) also report 35% more time per month spent in hospital board and

committee meetings than do those who report shorter conversations (n=28).

Table 4.27
Hospital Activity and Hours in Hospital Meetings By Initiation
Question: Who generally starts these conversations (at hospital meetings)?

more active about less hrs./mo.
_£han most average active ’in'meetings

don't talk 37% 27% 33% 4.9
less than 5 min. 30% 47% 56% 5.1
more than 5 min. 27% 17% 11% 6.9
(no response) ( 7%) (10%) ( 0%) 4.9

n=30 n=30 n=9

88

Only six respondents said other persons generally started the
conversations about the preceptorship program which arose before or
after hospital/board committee meetings. The largest proportion of
those in each activity category said that initiation was about equal.
According to these data, no clear pattern of relationship exists between
initiation and self-judged activity. However, there is a clear differ-
ence on the sister variable, hours in hospital meetings. Those saying
that "others start" spend 16% more time in hospital board and committee
meetings than do those who say "about equal" and 29% more than those

who say "I start."

Table 4.28
Hospital Activity and Hours in Hospital Meetings By Function

Question: What do you talk about in these conversations (before or
after hospital board or committee meetings)?

 

 

more active about less hrs./mo.
than most average active in meetings
production* (n=9) 7% 20% 11% 3.0
maintenance (n=24) 43% 23% 44% 6.7
innovation (n=12) 13% 23% 11% 5.9
no such conversations (n=11) 20% 13% 11% 6.0
(no response) (n=l3) 17% 20% 22% 3.7
n=30 n=30 n=9

*Production, maintenance and innovation functions
were represented in the questionnaire by the
following phrases, respectively: "clarifying what
the College expects," "general topics, sharing
experiences," and "finding better ways to do
our job."

89

Those preceptors who judge themselves to be of "about average"
activity in hospital affairs, report a rather balanced distribution over
the three function levels. A larger proportion of them characterized
their communication as having to do with production and innovation than
is true for either the more active or the less active. The largest
mean number of hours spent in hospital board and committee meetings
(6.7 hrs./mo.) is associated with those respondents who characterize
their conversations in hospital meetings as "general topics, sharing
experiences" (maintenance communication). Those who say they talk
about "clarifying what the College expects" (production communication)
report the lowest mean number of hours in meetings (3.0 hrs./mo.),

far below the mean for the entire population (5.4 hrs./mo.).

Activity in Professional Associations

The last of the propinquity variables in this study is rela-
tive activity (and, hence, proximity in time and space.‘with other
physicians) in the principal professional organizations. In Michigan,
the general professional society open to all osteopathic physicians is
the Michigan Association of Osteopathic Physicians and Surgeons (MAOP&S).
The state association has constituent local affiliates organized on a
county basis, some covering several counties. In the first section of
this chapter, a table was presented showing that respondents tend to
be mutually active or inactive in both of their associations.

The informal communication variables with which the activity

in associations variables were compared are frequency, duration, initi-

ation and function.

90

Table 4.29

Activity in Professional Associations By Frequency

Question: Before or after osteopathic association meetings, how fre-
quently do you talk with anyone about the,preceptorship program?

almost never (n=45)

don't
attend

82%

once every 3-4 mtgs. (n=12) 0%

at least once every mtg.

(n=9)

(no response)

almost never

once every 3-4 mtgs.

at least once every mtg.

(no response)

0%

(18%)

n=ll

don't

attend

87%
7%
0%

( 7%)

n=15

District AssociatiOns

 

 

 

attend, no attend, do officer or
cmte. work cmte. work cmte. chm.
81% 60% 25%
15% 20% 33%
4% 15% 42%
( 0%) ( 5%) ( 0%)
n=26 n=20 n=12

State Associations

 

 

 

attend, no attend, do officer or
cmte. work cmte. work cmte. chm.
72% 33% 67%
15% 25% 33%
8% 42% 0%
< 5%) ( oz) ( oz)
n=39 n=12 n=3

91

Table 4.29 shows a rather regular and positive relationship
between activity in professional associations and frequency of communi-
cation about the preceptorship program, except for the officer and
committee chairman (most active) category.

In Table 4.30, the proportion of those respondents reporting
conversations of more than five minutes' duration rises with each
category of activity, from least to most. This regular and positive
relationship is true for activity in both district and state associa—
tions.

No clear relationship is discernible in Table 4.31 between
activity in professional associations and initiation. Those who do
attend association meetings much more often report that initiation is
"about equal" than they report that it is generally started by themselves
or by their colleagues.

Table 4.30 shows that, in most categories of relative activity,
respondents chose "general topics, sharing experiences" (maintenance)
as the best characterization of the content—function of their conversa-
tions at association meetings. In general, for the levels of activity,
the proportion of those electing the maintenance response equals or
exceeds the proportion electing production and innovation combined.

No shifting of function is discernable as the relative activity of
those who attend the associations increases from those who are just

members to those active in the committee structure and again to those

who are in leadership positions.

92

Table 4.30
Activity in Professional Associations By Duration
Question: When you talk about the preceptorship program with other
physicians before or after an osteopathic association meeting, how
long do these conversations generally last?
District Association

don't attend, no attend, do officer or
attend cmte. work cmte. work cmte. chm.

 

less than 5 min. (n=l9) 9% 31% 25% 42%
more than 5 min. (n=15) 0% 12% 25% 58%
don't talk (n=l9) 36% 31% 35% 0%
(no response) (n=16) (55%) (27%) (15%) ( 0%)

n=11 n=26 n=20 n=12

State Association

don't attend, no attend, do officer or
attend‘ cmte. work cmte. work cmte. chm.

less than 5 min. 13% 28% 33% 67%
more than 5 min. 0% 21% 50% 33%
don't talk 33% 33% 8% 0%
(no response) (53%) (18%) ( 8%) ( 0%)

n=15 n=39 n=12 =3

93

Table 4.31

Activity in Professional Associations By Initiation

Question: Who starts these conversations (before or after an association

District Association

attend, no attend, do officer or
cmte. work cmte. work cmte. chm.

 

15% 0% 8%
0% 15% 17%
35% 35% 75%
31% 20% 0%
(19%) (30%) ( 0%)
n=26 n=20 n=12

StatefiAssociation

.attend, no attend, do officer or

cmte. work cmte. work cmte. chm.

 

meeting)?
don't

attend

others start (n=5) 0%

I start (n=6) 9%

about equal (n=25) 0%

don't have such conversations 18%

(n=14)

(no response) (n=l9) (73%)
n=11
don't

attend

others start 0%

I start 7%

about equal 7%

don't have such conversations 40%
(no response) (47%)

n=15

10% 8% 0%
8% 8% 33%
36% 67% 67%
18% 8% 0%
(28%) ( 8%) ( 0%)
n=39 n=12 n=3

94

Table 4.32

Activity in Professional Associations By Function

Question: What do you talk about in these conversations (before or

after association meetings)?

production* (n=8)
maintenance (n=l9)
innovation (n=7)
don't have (n=17)

(no response) (n=18)

production
maintenance
innovation
don't have

(no response)

District Association

 

 

 

 

 

 

 

don't attend, no attend, do officer or

attend cmte. work cmte. work cmte. chm.
0% 0% 25% 25%
9% 27% 20% 58%
0% 15% 5% 17%
27% 35% 25% 0%
(64%) (23%) (25%) ( 0%)

State Association

don't attend, no attend, do officer or

attend cmte. work cmte. work cmte. chm.
0% 10% 25% 33%
7% 26% 50% 67%
7% 13% 8% 0%
40% 20% 8% 0%
(47%) (26%) ( 8%) ( 0%)
n=15 n=39 n=12 n=3

*For the exact wording of response items as they
appeared in the questionnaire, See Table 4.24.

95

Summary

A profile of the population on the propinquity and "control"
variables was presented in a series of tables (Table 4.1 through Table
4.6). It was pointed out that the so-called "control" factors may
also be viewed as describing the population in terms of its members'
participation in formal aspects of the preceptorship program.

Propinquity factors were then compared with "control" factors.
Size of community (rural vs. urban) was found to be related to each of
the "control" variables. Length of time in the program was found to
be related to each of the propinquity variables. As a result of these
findings, the "control" variables were compared with overall frequency
of informal communication. Length of time in the preceptorship program
and number of visits by College officials were both found to be posi-
tively related to overall frequency.

Preceptors in solo practice and preceptors in group practice
are virtually identical in the proportions in which they report that
they talk informally about the preceptorship program with other phy-
sicians encountered during hospital rounds, in hospital staff meetings
and in professional association meetings. However, those in group
practice report in significantly higher proportions that they have such
conversations in their offices -- and, correspondingly, report higher
levels of communication frequency on an overall frequency measure.

One in every two preceptors in group practice identified their offices
as the.most frequent location for conversations with other physicians
about the preceptorship program, as opposed to one in eight of the

preceptors in solo practice.

96

Relative to their counterparts in solo practice, preceptors
in group practice more often said that in-office discussion of the
preceptorship program was mainly about maintenance matters ("general
topics, sharing experiences"). A smaller percentage of group prac-
titioners than solo practitioners characterized such in—office con—
versations as having mostly to do with innovation ("finding better
ways to do our job").

For the second propinquity variable, size of group practice,
a positive relationship is apparent between the number of physicians in
the group and the highest frequency ("almost daily" or "more than
once a week"). Size of group practice is also associated with the
frequency with which the subjects characterize their in-office communi-
cations as "finding better ways to do our jobs." Confidence about
both of these findings is conditioned by the rather small numbers of
preceptors in the larger group.

The third propinquity variable, number of other preceptors
in the group, is closely related to group size in concept. However,
an exactly opposite finding emerges from analysis of these data. Pre-
ceptors with no other or only one other preceptor in their group both
talked more frequently in their offices about the program and more
often talked mostly about how they might do their jobs better, as
compared with those in groups with two or three other preceptors.

When preceptors from urban and suburban areas were compared
with preceptors from rural and small towns, the urban preceptors re-
port somewhat more frequent communication during periods when they have

a student in their offices, less frequently identify their offices as

97

the location of most conversations and more often say that professional
associations are the second-most frequent site of their discussions
about the preceptorship program with other physicians. 'This latter
finding is consistent with the urban preceptors' more frequent attend-
ance at meetings of district (local) professional associations.

With respect to proximity to campus, respondents living
within a 1/2 hour driving time radius report less overall frequency
of communication with other physicians about the preceptorship program,
no large difference with respect to frequency of interaction with
full-time faculty and no instances of the campus being identified as the
second most frequent location of conversations with other physicians
about the preceptorship program (as oppoSed to 9% for those farther
away than 1/2 hour driving time).

Propinquity with respect to the hospital as a work-site for
preceptors was measured by asking how much time they spend in the
hospital when they go there for the purpose of seeing patients.

There is a positive association between this variable and
communication frequency, and between this variable and duration of
conversations. Those identifying the nature of their conversations
as innovation report more time devoted to visiting hospitalized patients
than those choosing the maintenance option, who, in turn, devote more
time to hospital rounds than those saying that their conversations were
about clarifying College expectations (production).

Those who judge themselves to be "more active in the affairs
of the hospital" more often report frequent conversations and longer
conversations about the preceptorship program in the context of hospi-

tal meetings. However, the "more active" and "less active" subjects

98

were not much different with respect to the initiation of these con-
versations or their content function. Responses of those saying that
their level of activity in hospital affairs is "about average" report
the lowest percentage of self-initiated conversations and the most
"balanced" distribution on the function variable.

A second measure of relative activity in hospital affairs was
hours per month spent in hospital board or committee meetings. On this
measure, positive relationship was discovered for frequency, duration,
conversations started by others and maintenance communication.

The final propinquity variable examined was activity in the
principal professional associations. Relative activity in the associ-
ations (attendance and committee work) was found to be positively
associated with frequency and duration, but not associated in any way
with initiation or function.

Analysis and reporting of findings continues in Chapter V.
The main focus of that chapter is on comparison of informal communi-

cation variables with perceptions and attitudes.

Chapter V

ANALYSIS: INFORMAL COMMUNICATION AND PERCEPTION

Most of the last chapter was devoted to comparisons of pro-
pinquity factors and informal communication factors. Correspondingly,
the present chapter is principally devoted to comparisons of those
same informal communications factors with measures on the study's

attitudinal variables.

The informal communications variables and the discrete mea-

sures taken on each are:

frequency (variously operationalized in different measures)
--in the office (including office telephone)
--in the hospital while there to see patients
--at hospital staff or committee meetings
--at professional association meetings
--overall (not specific as to location or social context)
——with full-time faculty

duration
--in the hospital while there to see patients
--at hospital staff or committee meetings
--at professional association meetings

initiation
--at hospital staff or committee meetings
--at professional association meetings

function
—-in the office (including telephone)
--in the hospital while there to see patients
--at hospital staff or committee meetings
--at professional association meetings

This chapter is organized according to these informal communi-

cations variables. In each instance, comparisons between selected

99

100

measures on the informal communication variables and appropriate per-
ception-attitude variables are analyzed.

Before moving to the first of these comparisons, however,
data for the entire population on the perception-attitude variables
are presented in a series of three tables. The accompanying text in-
cludes illustrative comments of the respondents gleaned both from the

questionnaires and from face-to-face interviews.

Profile on Perception Variables

Perception of Information. The data in Table 5.1 provide a
profile on the entire population according to their responses on six
questionnaire items. The questions were designed to elicit views on
the information available to preceptors about the preceptorship pro-
gram and on the means by which they received, or would prefer to re-
ceive, such information.

With respect to the amount and timing of information, approxi-
mately one—fourth said they "get adequate information" and another one-

fourth said they "don't get information.' Nearly one half said they

get information, but that the information they get is "too little and
too late." One rural preceptor in group practice said he "would like
to know a lot more." Among the specific things he would like to know
about are the satisfaction of students with the program and the effect
of preceptors' evaluations in the overall evaluations of students by

the College. However, another preceptor in rural, group practice said
he was thoroughly satisfied with the amount and timing of information

available to him, explaining, "I just get on the phone. All I have to

do is make my needs known."

101

Table 5.1
Profile of Population: Perception of Information, Sources and Interest
AMOUNT, TIMING. Question: How do you feel about the total amount of

information available to you from all sources about the preceptorship
program -- and when you get it?

don't get information 26%
get it, but too little and too late 46%
get adequate information 23%
(no response) ( 4%)

QUALITY. Question: How do you feel about the accuracy and usefulness
of the information which you get from all sources about the preceptor-
ship program?

it's accurate and useful 43%

it's accurate, but often not useful in 16%
my situation

it's useful, but I often doubt its accuracy 9%

it is neither useful nor accurate 3%

(no response) (29%)

CLARITY. Question: How clear is it to you what the College expects
you to do as a preceptor?

it's really not very clear 16%
not clear, but I decided myself what 33%
is needed

not clear, but other physicians and I together 13%
have worked out what should be done

the College has made it sufficiently clear 35%

(no response) ( 3%)

SOURCE VALUE. Question: Which ONE of the following sources of informa-
tion has been most valuable in your role as a preceptor?

journals and formal presentations at 10%
conventions

mailings from the College 23%

full-time faculty members and/or Director 12%
of Education at your hospital

other physician colleagues and students 38%

other 10%

(no response) ( 7%)

102

Table 5.1 (cont.)

PREFERRED SOURCE. Question: Where and how would you most prefer to get
your information about the preceptorship program and the College's
expectations for your role?

 

the present arrangement is sufficient 22%

more, better presentations by officials 12%
at general meetings

small discussion and problemesolving sessions 19%

visit to my office by College representative 33%

other (please specify) 1%

(no response) (13%)

COLLEGE INTEREST. Question: How do you feel about the interest of the
College leaders in your experiences and perspectives as a preceptor?

they have shown no sign of interest 17%
I assume they are interested, but they 43%
haven't done much to allow me to
make my input

they're definitely interested and have 28%
welcomed receiving my suggestions
(no response) (12%)

A preceptor in an urban, group practice for whom being a preceptor
is very important declared that the amount of information is "adequate
because I don't need much," adding "I have very little, but I don't
much care." It is interesting to note, however, that this same pre-
ceptor is very active in his hospital and reported a moderate fre—
quency of conversations with other physicians about the preceptorship
program.

Those commenting particularly about timing said that the major
problem was not knowing in advance what the students have covered in
their on-campus classes. They complain that, whereas they can find
this out from the students, too much time is lost doing so after the

students arrive in their offices.

103

Forty-three percent of the respondents judged available in-
formation from all sources to be "both accurate and useful." Sixteen
percent said "it's accurate, but often not useful in my situation."
Several preceptors said that they had been sent "lots of information"
early in the program, but that it had not been "germaine" or was "too
limiting." One preceptor could recall receiving something rather re-
cently in the mail, but couldn't recall what it had been. Only two
preceptors said that available information was "neither useful nor
accurate." Nine percent found it useful, but said they often doubt
its accuracy. With respect to accuracy, one preceptor commented in an
interview that "The bigwigs tell us what they want us to hear." A
rather large proportion of the total (29%) declined to answer this
particular question. One wrote an explanatory comment in the margin:
"receive so little information as to be unable to give a good answer."
Another preceptor, one who marked the "accurate and useful" option,
had responded in an earlier interview with a shrug and a diffident "I
have no reason to fault it." In interviews, several preceptors stressed
their preference for "official and direct" communication from an
"authorized individual."

The "clarity" variable is complex. One response option was
simply "it's really not very clear" what the College expects of its
preceptors. Sixteen percent chose this option. The next two response
options also say it is not clear what the College expects, but go on to
present alternative ways of responding to that lack of clarity. Thirty-
three percent said it is "not clear, but I decided myself what is

needed." Thirteen percent said it is "not clear, but other physicians

 

104

and 1 together have worked out what should be done." Thirty-five
percent said "the College has made it sufficiently clear."

One preceptor who chose the "not very clear" option had said
in a preliminary interview, "I Lhiflk I know what to do, but it's not
too clear. It would be helpful to have things spelled out." Another
who responded similarly on the questionnaire had said in a preliminary
interview:

I'm not sure what the College expects of

me. For example, am I supposed to go so

far as to allow students to "glove up"

for minor (office) surgery? The students

seem satisfied (with what I do), but is

the College?
Interestingly, this comment came from a man whose office is close to
the campus and who reports that an important source of information about
the program is full-time faculty encountered in the hospital and at
district professional association meetings.

Asked which source of information has been most valuable, the
largest proportion (38%) said "other physicians and students." Twelve
percent said full-time faculty and/or the Director of Education at
their hospital (who, depending on the hospital and the individual, may
represent a strong link between the College and local communities). Of
those identifying the more formal sources as most valuable, 10% said
journals and presentations at conventions, while 23% said mailings from
the College. One of those who said that journals and formal presenta-
tions at conventions had been most valuable explained in a marginal
note that he received "very little communication from the College."

His answer fits with the fact that he reports that he "almost never"

talks with other physicians at the hospital or at association meetings

and, in spite of the fact that he has another preceptor practicing

105

with him, reports "no such conversations" in his office within the
previous month. All of the ten percent who indicated that their most
valuable source was "other" than any of the options presented explained
that their own personal experience was the source most helpful to them.

With respect to where and how they would prefer to get their
information about the preceptorship program and the College's expecta-
tions for their role, 22% said that "the present arrangement is suffi-
cient." Twelve percent want "more, better presentations by College
officials at general meetings." One-third of all respondents would
prefer a visit to their offices by a representative of the College.

One in five would most like to have small disucssions and problem—
solving sessions.

One preceptor who indicated on his questionnaire that "the
present arrangement is sufficient" would prefer that the College "print
something up and send it out. One can't go to meetings all the time."
This response is from a solo practitioner with very little hospital
practice (1 hr./wk.) who is "less active" than most in the affairs of
his hospital and does not attend district association meetings. By
contrast, several of those favoring small discussion and problem-solv-
ing sessions stress the importance of "give and take" among colleagues
(having, in other contexts, attested to its importance on a wholly
voluntary and informal basis in their own practices). One of these
said that he thought such periodic sessions ought to be mandatory for
preceptors, adding that he "can't see how (the program) can carry on
without it."

Another preceptor wants feedback from students as guidance

for his own growth. He suggests "evaluation of physicians by students

106

and then discussion with physicians about the student recommendations
and criticisms."' The question about preferred source of information
prompted the following on the questionnaire of a preceptor from a
rural-small town, group practice some distance from the University:

I would like a general education pro-

gram for preceptors, giving a condensed

review of what the students receive at

the College. (I want this) for two

reasons: (1) it updates my knowledge,

and (2) it would give me better insight

into the students' thinking and know-

ledge.

Asked about the interest of College leaders in their experi-

ence and perspectives as preceptors, the largest proportion (43%)
responded that "I assume they are interested, but they haven't done
much to allow me to make my input." Seventeen percent said "they have
shown no sign of interest" and 28% said "they're definitely interested
and have welcomed receiving my suggestions." In an interview, one said
that "professionals in education don't want to listen to men in the
field." Another offered that it is "hard to say . . . I think so, I
don't know how much value the preceptor's contribution makes (to the
whole educational program). I don't know how they know what I'm doing."
One of those who said "they're definitely interested" had told in an
interview (in response to the same question) about the time he came

unannounced to the College facilities. "The minute I identified myself

to the secretary, I was ushered in and talked with the dean over coffee."

Ideas for Improvement. Four items in the questionnaire had to
do with ideas for the improvement of the preceptorship program. Table

5.2 presents the resulting data.

107

Table 5.2

Profile of Preceptor POpulation: Ideas for Improvement

Have you ever had any specific ideas about
how the preceptorship program could be im-
proved?

yes
no, not at this time
(no response)

If yes:

8.

Have you shared your idea(s) with other
physicians?

no

only briefly
considerable discussion
(no response)

. Have you ever communicated your idea(s)

to any full-time faculty of the Depart-
ment of Family Medicine?

yes
no
(no response)

Briefly outline your suggestions in the
space below. (written suggestions cate-
gorized by general nature of those sub-

mitted by each respondent).

administration of preceptorship program

conception or "philosophy" of program
selection of preceptors

criteria for student admissions

(no response)

percent

tota1+

64%
32%
( 4%)

10%

35%

19%
(36%)

19%
44%
(36%)

26%
25%
3%
3%
(44%)

percent

ideas

16%
54%
30%

30%
70%

46%
44%
5%
5%

108

Sixty-four percent of the respondents said they did have
specific ideas or suggestions. Qf phage, 16% said they had not shared
them with other physicians, 54% said they had shared them "only briefly"
and 30% said they had had "considerable discussion" with other physi-
cians about their suggestions. Asked whether they had ever communicated
their suggestions to any full-time faculty member of the Department of
Family Medicine, 30% said they had and 70% said they had not.

These latter two items were included in the questionnaire as
a gauge of system openness. On this basis, it is apparent that a very
high percentage (84%) of those with specific suggestions have offered
them for discussion, at least briefly, with other physicians, whereas
a much smaller proportion (30%) have in any way communicated those
ideas to the persons with responsibility for shaping or managing the
program.

Respondents were asked to write their suggestions on the
questionnaire. Each reapondent's ideas were then categorized aa_a
yhpla, yielding a single value for each respondent irrespective of the
number of suggestions listed. Most of the respondents offered mostly
or most emphatically suggestions about either the administration (oper-
ation, management) of the program (46%) or the conception or "philoso-
phy" of the program (44%). Five percent (two preceptors) wrote
suggestions deemed by the investigator as mostly concerned with the
selection of preceptors and another 5% had ideas mostly about criteria
for student admissions, a concern which has bearing upon the preceptor-

ship program but goes well beyond it also.

109

Table 5.3

Profile of Preceptor Population: Salience of Role

Which of the following affiliations contributes more

to your growth in clinical competence as a family
-practitioner?

being a preceptor

participation in professional associations
neither contributes much

(no response)

.Again, which of the following affiliations contributes

Inore to your growth in clinical competence as a family
'practitioner?

being a preceptor

consultation and educational programs at my hospital
neither contributes much

(no response)

Which of the following affiliations do you think
contributes more to your patients' regard for you?

being a preceptor

my position(s) in the hospital staff
neither contributes much

(no response)

457.

25%

297.
( 1%)

23°.
67%
7%

( 3%)

22°.

17%

557.
( 67o)

110

Salianga pi Ehé Pippappor Role. Table 5.3 presents the last

three items on the questionnaire. Each compares participation in the
preceptorship program with some other role and asks which role contri-
butes most in a given respect.

Asked which affiliation contributes more to growth in clinical
competence as a family practitioner, 45% said "being a preceptor" and
25% said participation in professional associations, while 29% said
neither did. Asked the same question about a comparison with consulta-
tion and educational programs at their hospitals, 23% thought being a
preceptor contributed more, as opposed to 67% for the hospital affilia-
tion, while 7% thought neither did. Asked which affiliation contributes
more to their patients' regard for them, 22% said "being a preceptor,"
17% said "my position(s) in the hospital staff" and 55% said that
neither contributes much.

One preceptor, highly placed in his hospital leadership, chose
"being a preceptor" over the hospital affiliation as contributing more
to his growth. In a preliminary interview, he had said, "Some of us
enjoy teaching and the College allows us to do it. We're not just
tolerated, as GP's often are in other places." A preceptor who had
judged the preceptor role as "contributing more" in all respects but
hospital consultation and education said in an interview that being a
preceptor "keeps me sharp" and "I know that the students report to each
other about which preceptors are good." A rural preceptor said about
his patients, "I think they think, 'you must be pretty good or they
wouldn't send students out here.‘ " On the other hand, another wrote
on his questionnaire an explanation of his choice of the "neither

contributes muc " Option to the last question:

111

(My patients) don't know, nor do they
care, about what committees I'm on, etc.
The patients' regard for the doctor is
based primarily upon rapport, interest,
time and the results of person-to-person
contact -- in short, the "doctor-patient
relationship."

Freguency of Communication

Measures of communication frequency are compared with various per-
ception-attitude variables in the next series of five tables. Only two
measures of frequency are utilized for this purpose, as opposed to the
multiple frequency measures utilized in Chapter IV. In the preceding
chapter, the principle purpose was to systematically compare each pro-
pinquity variable with communication measures most closely related to
it. Thus, for example, relative activity in the affairs of the hospital
was compared with communication behavior in hospital staff and committee
meetings. In the present context, however, it suffices to utilize
communication measures which are not situation- or context-specific,
when they are available, since the perception-attitude variables also

measure preceptors' judgments about their overall experience.

Frequency and Perception of Information. Table 5.4 presents data
resulting from comparisons of the variable named "overall frequency"
with three perception of information variables. With respect to the
question about the amount and timing of information, it will be seen
that 35% of those who say that they "almost never" talk with other
physicians about the preceptorship program also say that they "don't
get" information about the program. This figure represents a larger

prOportion of those saying they "don't get it" than is true of any of

112

Table 5.4

Overall Frequency of Communication* By Perception of Information

AMOUNT, TIMING. Question: How do you feel about the total amount of
information available to you from all sources about the preceptorship
program -- and when you get it?

almost once once almost
never a mo. a wk. daily

don't get it (n=18) 35% 27% 19% 22%

get it, but too little and too late 45% 55% 54% 33%
(n=32)

get adequate information (n=16) 20% 18% 23% 44%

(no response) (n=3) ( 0%) ( 0%) ( 4%) ( 0%)

QUALITY. Question: How do you feel about the accuracy and usefulness
of the information which you get from all sources about the preceptor-
ship program?

almost once once almost
never a mo. a wk. daily

accurate and useful (n=30) 45% 45% 38% 66%

accurate, but often not useful (n=11) 15% 18% 23% 0%

useful, but I often doubt its 5% 9% 12% 11%
accuracy (n=6)

neither accurate nor useful (n=2) 5% 0% 4% 0%

(no response) (30%) (27%) (23%) (22%)

CLARITY. Question: How clear is it to you what the College expects you
to do as a preceptor?

almost once once almost
never a mo, a wk. daily

it's really not very clear (n=ll) 35% 0% 8% 11%

not clear, but I decided myself what 25% 73% 27% 22%
is needed (n=23)

not clear, but other physicians and I 5% 9% 19% 22%

together have worked out what
should be done (n=9)

College has made it sufficiently 30% 18% 42% 44%
clear (n=24)
(no response) ( 5%) ( 0%) ( 4%) ( 0%)

n=20 n=1l n=26 n= 9

113

the other categories. Similarly, of those saying that they communicate
"almost daily" with other physicians, the percentage of those saying
that they "get adequate information" is higher than for any other group.
On the whole, the picture is one of progressively higher evaluations

of available information by each category of communication frequency,
from least frequent to most frequent.

Again, in the case of the comparison of overall frequency with
perceptions of the accuracy and usefulness (quality) of available in-
formation, the most favorable evaluation is rather definitely associated
with the category representing those who talk informally with other
physicians "almost daily" during periods when they have students. Sixty-
six percent of these preceptors say they find the information available
to them both useful and accurate. However, in this case, the relation-
ship is not regular and progressive, as it was in the previous compari-
son with the amount and timing variable. Those who report informal
communication "once a month" and "once a week" are not less critical
of the adequacy of available information than those who say they
"almost never" talk with other physicians. It is interesting to note
that the most frequent communicators were more inclined to doubt the
accuracy of information (perhaps reflecting their greater exposure to
informal and, therefore, "unofficial" information).

On the clarity variable, the preceptors in the highest frequency
categories report that they perceive the College as having made "suffi-
ciently clear" what is expected in percentages substantially higher
than those who communicate informally less often. Those who "almost

never" talk with other physicians about the preceptorship program have,

114

by far, the largest proportion who say "it's really not very clear."
Interestingly, those reporting that they talk with other physicians
about the preceptorship program "once a month" also report that they
have decided themselves' what needs doing in a proportion three times
that of any other group. There is a positive relationship between fre-
quency and the choice of the response option "not clear, but other phy-

sicians and I together have worked out what should be done."

Frequency and Perception of Sources. Table 5.5 presents the

results of comparisons between the overafl.frequency variables and two
measures of perceptions of information sources. In the first instance,
preceptors were asked to identify the source (or combination of two
similar sources) which had proved "most valuable in (their) role as a
preceptor." No pattern of association between these two variables
emerges from this comparison.

Asked where and how they would prefer to get their information,
the preceptors' responses are, again, not clearly associated with their
relative frequency of informal communication with other physicians about

matters related to their role as preceptors.

Eyeguency gnd Perception of Interest. The comparison presented

in Table 5.6 is between overall frequency and perception of the interest
of College leaders in the preceptors' experiences and perspectives.

No clear associations can be inferred from these data. The preceptors
in the "almost daily" category have the lowest proportion of those
saying that College leaders have shown no interest, but they have not
more often said that College leaders are "definitely" interested.

Moreover, the most critical group are those who talk with other physicians

 

 

 

 

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115

Table 5.5

Overall Frequency* By Perceptions of Information Sources

SOURCE VALUE. Question: Which one of the following sources of informa-
tion has been most valuable in your role as preceptor?

almost once once almost
ngvgr a mo. a wk, daily

journals, formal presentations (n=7) 15% 9% 8% 11%

mailings from the College (n=16) 25% 45% 15% 22%

full-time faculty, hosp. dir. of educ. 10% 9% 12% 22%
(n=8)

physician colleagues and students 30% 36% 50% 33%
(n=26)

other (n=7) 15% 0% 8% 11%

(no response) (n=5) ( 5%) ( 0%) ( 8%) ( 0%)

PREFERRED SOURCE. Question: Where and how would you most prefer to
get your information about the preceptorship program and the College's
expectations for your role?

almost once once almost
never a mo. a wk. daily
present arrangement is sufficient 20% 27% 23% 22%
(n=15) _
more, better presentations by officials 10% 18% 8% 22%
(n=8)
small problem-solving sessions (n=13) 25% 18% 15% 22%
visit to my office by College rep. 30% 18% 35% 33%
(n=23)
other 0% 0% 4% 0%
(no response) (15%) (18%) (15%) ( 0%)

n=20 n=ll n=26 n= 9

*for operational definition, see Table 5.4.

116

Table 5.6
Overall Frequency* By Perception of College Interest
INTEREST OF COLLEGE. Question: How do you feel about the interest of
College leaders in your experiences and perspectives as a preceptor?

almost once once almost
pever a mo, a wk. daily

they have shown no sign of interest 15% 18% 23% 11%
(n=12)
I assume they are interested, but they 40% 36% 46% 56%

haven't done much to allow me to
make my input (n=30)

they're definitely interested and have 30% 36% 19% 33%
welcomed my suggestions (n=l9)
(no response) (15%) ( 9%) (12%) ( 0%)

=20 n=ll n=26 n= 9

*for operational definition, see Table 5.4.

as frequently as "once a week."

Freqpency;pnd Salience of Preceptor Role. Table 5.7 compares
overall frequency with three measures of the relative salience of the
preceptor role. In the first of these salience items, preceptors were
asked whether being a preceptor contributed more than participation in
professional associations to their growth in clinical competence. There
is a clear relationship between frequency of informal communication and
the choice of "being a preceptor," except that those who "almost never"
talk with other physicians seem not to fit the pattern. An explanation
might lie in a comparison between overall frequency and the measures of
activity in the association. Unfortunately, no such comparison was made.
It is noteworthy that the "almost never" category has the largest

percentage of those saying "neither contributes much." In any case,

117

Table 5.7
Overall Frequency* By Salience of Preceptor Role
Question: Which of the following affiliations contributes more to your
growth in clinical competence as a family practitioner?

almost once once almost
never a mo. a wk. daily

being a preceptor (n=31) 45% 18% 38% 78%
participation in prof. ass'ns. (n=17) 15% 55% 27% 11%
neither contributes much (n=20) 40% 18% 35% 11%
(no response) (n-l) ( 0%) ( 9%) ( 0%) ( 0%)

Question: Which of the following affiliations contributes more to your
growth in clinical competence as a family practitioner?

almost once once almost
never p mo. a wk. daily

being a preceptor (n=18) 15% 9% 19% 44%

consultation and educational program 65% 82% 73% 56%
at my hospital (n=46)

neither contributes much (n=5) 15% 0% 8% 0%

(no response) ( 5%) ( 9%) ( 0%) ( 0%)

Question: Which of the following affiliations do you think contributes
more to your patients' regard for you?

almost once once almost
ngygr a mo, a wk. daily

being a preceptor (n=15) 35% 18% 8% 44%
my position(s) in hospital staff (n=12) 10% 27% 19% 22%
neither contributes much (n=38) 55% 36% 65% 33%
(no response) ( 0%) (18%) ( 8%) ( 0%)

n=20 n=ll n=26 n=9

*for operational definition, see Table 5.4.

118

the percentages of those for whom being a preceptor is more important
is 18% for those in the "once a month" category, 38% for those in the
"once a week" category and 78% for those in the "almost daily" category.

A similar finding emerges from the comparison of overall fre-
quency and the second salience variable, this one focusing on "being a
preceptor" versus "consultation and educational programs at my hospital."
The percentages saying that being a preceptor contributes more to growth
in clinical competence are only half as large as in the previous case.
Yet the same pattern is apparent. Again, those in the "almost never"
category have the largest percentage saying that neither contributes
much. Except for those preceptors in the "almost never" category, the
percentage of those identifying the preceptor role as most important
rises steeply with increased overall frequency of communication.

On the third salience variable, the regular, progressive
increases in percentages identifying the preceptor role as most important
is not present. However, the data still show that the largest percentage
choosing the "being a preceptor" option is in the "almost daily" cate-
gory. Again, despite the relatively high percentage of the "almost
never" category choosing the preceptor role as most important, a very

high percentage of this group also says that "neither contributes much."

Frequency witthull-time Faculty and Perception of Information.
Table 5.8 compares a measure of frequency of communication with full-
time faculty and three perception of information variables. The group
saying they have "never" talked with a full-time faculty member" have,
by far, the highest percentage of those saying they "never get" informa-

tion (42%, as against 6% and 26%). Overall the group most favorable

119

Table 5.8
Frequency with Full-Time Faculty* By Perceptions of Information
AMOUNT, TIMING. Question: How do you feel about the total amount of
information available to you from all sources about the preceptorship

program -— and when you get it?

2 mos. or less than
never more ago 2 mos. agp

don't get it (n=18) 42% 6% 26%
get it, but too little and too late (n=32) 50% 39% 48%
get adequate information (n=16) 4% 44% 26%
(no response) (n=3) ( 4%) (11%) ( 0%)

QUALITY. Question: How do you feel about the accuracy and helpfulness
of the information which you get from all sources about the preceptor-
ship program?

2 mos. or less than
never more ago 2 mos. ago

accurate and useful (n=30) 17% 61% 56%

accurate, but often not useful (n=ll) 21% 17% 11%

useful, but I often doubt its accuracy 13% 6% 7%
(n=6)

neither accurate nor useful (n=2) 4% 0% 4%

(no response) (n=20) (46%) (17%) (22%)

CLARITY. Question: How clear is it to you what the College expects you
to do as a preceptor?

2 mos. or less than
never more ago 2 mos. ago

it's really not very clear (n=ll) 21% 6% 19%

not clear, but I decided myself what 50% 17% 30%
is needed (n=23)

not clear, but other physicians and I 17% 22% 4%

together have worked out what
should be done (n=9)

the College has made it sufficiently 8% 50% 48%
clear (n=24)

(no response) (n=2) ( 4%) ( 6%) ( 0%)

n=24 n=l8 n=27

*Question: When was the last time you talked with a full-time
faculty member in the Department of Family Medicine about the
preceptorship program?

120

in its evaluation of the amount and timing of information is the group
saying they talked with a full—time faculty member some time ago.

Only one individual (4%) of the "never" group rated the amount of
information as adequate.

Again, with respect to "quality" of available information, it
is the middle group that gives the highest overall evaluation. Almost
half of those who say they "never" have talked with a full-time faculty
member declined to answer this question (perhaps because 42% of them
had just finished saying that they "don't get" information). However,
even with the smaller proportion spread over the response options, this
"never" group still registered higher proportions than the other groups
in the "not useful" and "doubtful accuracy" categories.

0n the clarity variable, those who say they have "never"
talked with a full-time faculty member have, by a wide margin, the low-
est proportion of those saying that the College has made its expectations
clear (8%, as opposed to 50% and 48% for the other two groups). It has
the highest percentage of the three groups for preceptors saying that
they have responded to the lack of clarity by figuring things out by
themselves (50%, compared to 17% and 30%). Again, preceptors who
talked with a full-time faculty member two months or more ago have the
least unfavorable view of available information.

It is interesting to note that the third category of the
clarity variable ("not clear, but other physicians and I together have
worked out what should be done") has only one preceptor who has talked
with a full-time faculty member within two months, as opposed to four

each for the other two groups. This is a clue to the fact that those

121

who communicate most frequently with physicians about the preceptorship
program are not necessarily those who also communicate most frequently

with full-time faculty. The following table demonstrates this fact.

Table 5.9
Frequency with Full-Time Faculty By Overall Frequency
overall, with Othergphysicians frequencyiwith full-time faculty

2 mos. or less than

 

never more ago 2 mos. ago
almost never 29% 22% 33%
once a month 17% 17% 15%
once a week 46% 28% 37%
almost daily 4% 22% 15%
(no response) ( 4%) (11%) ( 0%)

No general pattern of relationship can be seen in Table 5.9
between these two variables, except for the ones which could have been
anticipated from the foregoing comparisons of the two frequency measures
with the same set of perception of information measures. The preceptors
who have communicated two months or more ago with full—time faculty are
those who register the largest percentage of most frequent overall
communication with other physicians, a finding consistent with their
generally more favorable perceptions of information. The very low
incidence of "almost daily" communication with other physicians by those
who have never talked with any full-time faculty member is consistent
with their generally heavier representation in the less favorable cate-

gories on the perception of information variables.

Frequency with Full-Time Faculty and Perceptionfiof Interest.
Table 5.10 compares frequency with full-time faculty and perceptions of

the interest of College leaders in the experiences and perspectives of

122

preceptors. Once again, a larger percentage of those who have talked
with full-time faculty two months or more ago have the most favorable
perception of available information. Those who have never talked with

a full-time faculty member register the smallest percentage in the
category representing the most favorable perception, but not the largest

percentage with the most unfavorable perception.

Table 5.10

Frequency with Full-Time Faculty* By Perception of College Interest.

PERCEPTION 0F COLLEGE INTEREST. Question: How do you feel about the
interest of College leaders in your experiences and perspectives as
a preceptor?

2 mos. or less than

 

 

never more ago 2 mos. ago
they have shown no sign of interest 17% 11% 22%
(n=12)
I assume they are interested, but 46% 39% 44%

they haven't done much to allow
me to make my input (n=30)
they're definitely interested and 17% 50% 22%
have welcomed receiving my
suggestions (n=l9)
(no response) (n=8) (21%) ( 0%) (11%)
n=24 n=18 n=27

*for operational definition, see Table 5.8.

The group with the largest percentage of most favorable per-
ceptions is the group which reports talking with full-time faculty two
months or more ago. It is interesting to recall in this connection that
no clear association was apparent between overall frequency and percep-

tion of College interest (see Table 5.6 and accompanying text).

123

DuratiOn of Communication

Three separate measures of duration were included in the study,
each focusing specifically upon communication behavior in a specified
situation: during hospital rounds, at hospital staff and committee meet-
ings, and at meetings of professional associations. For purposes of
comparing the duration variable with perception of information variables,
and in the interests of such parsimony of analysis as seems possible in
a study of this kind, only one of these duration measures is utilized.
This procedure seems justified on the basis that clear relationships
were found in comparisons of all three duration measures and the appro-
priate propinquity variables with which they were compared (see Tables
4.23, 4.26, and 4.30). The choice of which duration variable to use for
present purposes was based upon the number of preceptors answering each
question. The duration measure with the largest number of responses
was the one associated with informal communication of preceptors while
in the hospital to see patients.

According to the data presented in Table 5.11, preceptors who
recall conversations of more than five minutes' duration more often re-
ported that they "get adequate information" and somewhat less frequently

criticize available information as "too little and too late.‘ The pro-
portions of those who talked for more than five minutes are not differ-
ent for those who characterized available information as "accurate and
useful" or "neither accurate or useful." However, those who report
having longer conversations substantially less often expressed doubts

about its accuracy than those who report shorter conversations (9% and

20%, respectively). Also, 22% of those who talked for more than five

124

Table 5.11
Perceptions of Information By Duration of Hospital Conversations
AMOUNT, TIMING. Question: How do you feel about the total amount of

information available to you from all sources about the preceptorship
program -- and when you get it?

less than more than

5 minutes 5 minutes
don't get it 20% 17%
get it, but too little and too late 60% 52%
get adequate information 10% 22%
(no response) (10%) ( 9%)

QUALITY. Question: How do you feel about the accuracy and helpfulness
of the information which you get from all sources about the preceptor-
ship program?

less than more than

5 minutes 5 minutes
accurate and useful 40% 43%
accurate, but often not useful 0% 22%
useful, but I often doubt its accuracy 20% 9%
neither accurate nor useful 0% 0%
(no response) (40%) (26%)

CLARITY. Question: How clear is it to you what the College expects
you to do as a preceptor?

less than more than
5 minutes 5 minutes
it's really not very clear 30% 17%
not clear, but I decided myself what is needed 40% 22%
not clear, but other physicians and I together 10% 26%
have worked out what should be done
the College has made it sufficiently clear 20% 30%
(no response) ( 0%) ( 4%)

n=10 n=23

125

minutes report that available information is, while accurate, "often
not useful," whereas none of the preceptors reporting shorter conversa-
tions did so.

With respect to clarity, differences between those who report
shorter and longer conversations emerge in every category. A substanti-
ally larger proportion of those who recall conversations of more than
five minutes' duration report that "the College has made (its expecta-
tions) sufficiently clear" and a substantially smaller proportion say
"it's hot really very clear" what the College expects. A far higher
proportion of those who had longer conversations (26% as opposed to 10%
for those having shorter conversations) say that, while expectations
are not clear, they have worked out what should be done in collaboration

with other physicians.

Initiation of Communication

Two measures on the initiation variables were included in the
study. For initiation of conversations in the context of hospital meet-
ings, a relationship seemed present on one measure of activity in hos-
pital affairs, but not on the other. For initiation of conversations
taking place at professional association meetings, no relationship was
found. Accordingly, both initiation measures are utilized for purposes
of exploring possible relationships between initiation and perception
of information variables.

Table 5.12 presents the resulting data. With respect to the
perceptions of amount and timing of information available from all
sources, a favorable perception is reported by a larger proportion of

those saying that others generally start the conversations than of

126

Table 5.12
Perceptions of Information By Measures of Conversation Initiation
AMOUNT, TIMING. Question: How do you feel about the total amount of

information available to you from all sources about the preceptorship
program -- and when you get it?

hospital meetings association meetings

I others about I others about

start start egual start start egual

don't get it 17% 15% 15% 11% 7% 32%
get it, but too little, 677. 547. 487. 637. 53% 58%

too late

get adequate info. 17% 31% 33% 26% 33% 11%
(no response) ( 0%) ( 0%) ( 4%) ( 0%) ( 7%) ( 0%)

CLARITY. Question: How clear is it to you what the College expects you
to do as a preceptor?

 

hpspital meetings association:geeting§_
I others about I others about
start start egual start start egual
it's really not very 17% 15% 15% 11% 7% 16%
clear
not clear, but I decided 0% 31% 33% 47% 7% 42%
myself what is
needed
not clear, but other phy- 50% 0% 11% 11% 27% 16%
sicians and I togeth-
er worked it out
the College has made it 33% 46% 41% 32% 53% 21%
sufficiently clear
(no response) ( 0%) ( 8%) ( 0%) ( 0%) ( 7%) ( 5%)

n=6 n=13 n=27 n=19 n=15 n=19

127

those who say "I start." .Those saying that they typically initiate
conversations are more heavily represented in the category of those who
say they get information, but get it "too little and too late." These
relationships hold for both measures of initiation.

For the clarity variable, once again a favorable perception
of available information was more often registered by those who say that
others generally initiate conversations. No other clear relationships
are apparent on both initiation measures. It must be acknowledged that
the very small number of preceptors reporting that they initiate con-
versations before or after hospital meetings (column 1 in Table 5.12)

renders even this cautious analysis a rather tentative undertaking.

Function of Communication

0f the four measures taken on the function variable, two were
selected for comparison with perception of information variables. They
are the ones associated with communication behavior in the hospital
while there to see patients and in preceptors' offices. The selection
was made on the grounds that the largest number of preceptors responded
to these items and the concurrent factor that these two locations were
clearly identified as the most frequent sites of conversations with
other physicians about the preceptorship program.

In the analysis which follows, associations will be deemed to
exist only in those instances in which similar differences are observed
on.pp£h_measures of communication function.

According to the data in Table 5.13, those preceptors char-
acterizing their conversations as primarily serving to clarify the

College's expectations (production) more often than preceptors in other

128

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ma.m oHan

129

categories say (1) that they get information, but too little and too
late, (2) that they often doubt its accuracy and (3) that they have
found the College's expectations unclear and have responded by deciding
on their own "what is needed." On the other hand, those who character-
ized their conversations as "finding better ways to do our job" (innova-
tion) have a generally more positive view of available information and
information distribution than do those in the other two categories.
Specifically, none of them express doubts about the accuracy of avail—
able information and the highest proportion of them say the College
has made its expectations sufficiently clear. In no categories of any
of the three perception of information variables do those in the main—
tenance category register notably higher or lower proportions than those
in both of the other function categories.

Table 5.14 compares suggestions for improvement of the pre-
ceptorship program and also preferences for sources of information
about the program with categories of content—function. There are no
notable differences among the preceptors in each of the function cate-
gories with respect to whether or not they have specific ideas for
improving the program. However, those in the production category much
more frequently than the others offered ideas judged by the investiga-
tor to be mostly about how the program's administration (operation,
management) might be improved, whereas those in the maintenance category
more often than the others listed suggestions having mostly to do with
the basic conception or "philosophy" of the program. Interestingly,
though all three categories of preceptors said they had suggestions,
those in the production category actually bothered to write them out

more often than those in the maintenance category and far more often

130

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ANHHV Axmav ARC v Amocommmu ocv
No NM No assoc
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NHH New NNN msoammom wca>aomuaoaoowa Hanan
Nmm NmH NHH mamaofimmo hp encapsucomoua nouuoo .ouoa
NHH Nmm gum ucowowmmsm a“ uaoawwcmuum uammmum ago

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m.oonHoo ago was adumoum manmuoummooua mnu unoow
Gown—850mg.“ Mach uom cu along so.» canoes
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NC No No scammwavm ucmpsum you mfiuouauo
No No No muouamomum mo coauomaom
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NNN New wmm awuwoua masmuouaoooua mo cowumuumwaaawm

"msoaaom no can“
-uomoumo macaumowwsm cmuufius .mmwa mmnH

ANo V ANo V ANHHV Ammcoemou oaV
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N3 NE N3 was.

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uuouaoomum any so: usonm mood“ camaooam
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mwa Houumn wcaumnm mcoamduoomxo
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coauoowcsaaoo ooammo-cH mo coauocsm mm mousom consummum was ucm8m>0MmaH now macaumowwSm

«H.m manna

131

than those in the innovation category.

With respect to where and how they would prefer to get their
information, preceptors in the innovation category less often than the
others perceived the "present arrangement (as) sufficient" or small
problem-solving sessions as a preferable means of getting information.
Rather, they said they preferred more and better presentations by
College officials in general meetings. "A visit to my office by a

College representative" was deemed most preferable by a large proportion

Frame-“1‘1

(44%) of those in the production category, by a lesser proportion (33%)
of those in the innovation category and by only 11% of those in the

maintenance category.

Summary

A profile of the entire preceptor population on the perception-
attitude variables was presented in a series of three tables. The
accompanying text included many illustrative comments of respondents,
gleaned both from the questionnaires and from ‘notes taken in face-to-
face interviews.

The balance of Chapter V was wholly devoted to comparisons
between informal communication variables and the various perception
variables. This part of the chapter was organized by headings corres-
ponding to the major informal communication variables, on some of which
multiple measures had been taken: frequency, duration, initiation and
content-function.

The two most general frequency measures, overall frequency
with other physicians and frequency with full-time faculty, were

utilized for present purposes, on grounds that the perception variables

132

also measure preceptors' judgments about their overall experience.

Nine perception variables were compared with.the overall
frequency variable. In general terms, positive associations were
apparent between overall frequency of communication with other physicians
and favorable perceptions of (l) the amount and timing of available in-
formation, (2) the quality of available information and (3) the clarity
of the College's expectations of preceptors. Clear associations were also
found between overall frequency (on the part of those who reported at
least ppm; interchange with colleagues) and the proportions of those
who said that being a preceptor "contributed more" in personal terms
than did other professional roles. No relationships were clear in
comparisons of overall frequency with (1) choices of the most valuable
source of role-related information, (2) preferred source or (3) per-
ceived interest of College leaders in preceptors' perspectives and
experiences.

With respect to frequency of communication with full-time
faculty, those who have never talked with a full-time faculty member
most often reported the least favorable responses on each of four
perception variables. However, those in the category representing the
highest frequency do not register the pppp favorable perceptions in
proportions as high as those in the category representing a middle
range of frequency. This finding must be interpreted in the light of
a comparison between overall frequency with other physicians and fre-

quency with full-time faculty. The latter comparison shows that those

in the middle range category of frequency with full-time faculty report

the highest rate of overall frequency with other phySicians. The

133

overall variable had already proven to be strongly associated with the
perception of information variables (though not with the perception of
interest variable).

To gauge possible relationships between duration of communica—
tion and perceptions of information, the most frequently answered of the
three duration measures was selected for comparison. Those whose con-
versations generally last more than five minutes, compared with those
who report shorter conversations, (l) more often reported that they get
an adequate amount of information, (2) more often criticize the useful-
ness of the information they get, (3) lggg often say that they doubt the
accuracy of the information, (4) more often say that the College has
made its expectations clear and (5) more often say they have collabor-
ated with other physicians in working out "what should be done" as
preceptors.

Both measures of initiation of communication included in the
study were compared with the perception of amount and timing variables
and with the perception of clarity variable. Those saying that their
conversations about the preceptorship program are generally started by
others more often report favorable responses on both perception vari-
ables.

Two of the four function measures in the study were selected
for comparison with perception variables. In general terms, those
characterizing their conversations as having to do mostly with innova-
tion report favorable views of available role-related information in
larger proportions than either those in the maintenance or those in the

production categories. On the other hand, those who report that most

134

of their conversations are concerned with trying to figure out what is
expected of them (production) more often report less favorable views of
information than either of the other two groups.

No differences are apparent between the three function cate-
gories with regard to whether or not preceptors report having specific
ideas about how the preceptorship program might be improved. However,
those in the production category much more often than the others offered
ideas having to do with how the program should be administered, whereas
those in the maintenance category more often made suggestions about the
basic design or "philosophy" of the program. Receiving information via
a visit to their offices was preferred by a large proportion of those
in the production category, by a lesser proportion of those in the
innovation category and by a considerably smaller proportion of those
in the maintenance category. Those in the innovation category less
often than the others perceived "the present arrangement (as) sufficient"
and more often favored presentations by College officials in general
meetings.

The next and final chapter reports the investigator's conclus-

ions, recommendations and observations.

Chapter VI

CONCLUSIONS AND IMPLICATIONS

This concluding chapter consists of four main sections: (1)
background considerations and questions which gave rise to the present
study, and the Specific problems, limitations and conduct of the in-
vestigation; (2) the main conclusions of the study; (3) some implica-
tions of the conclusions for medical school administrators; and (4) some

recommendations for subsequent research.

Summagy

Background of the stud . Part-time clinical faculty tend to
be poorly integrated into the information systems of their medical schools.
They are, first and foremost, community practitioners; only secondarily,
even peripherally, are they teachers. Physically removed from the medi-
cal school environs, they do not ordinarily particpate in the formal
and informal communication networks through whith "regular" faculty are
inducted, informed and guided, and through which faculty contributions
to policy formulation and curricular design are made.

‘Medical school administrators seek cost-effective means of
improving the flow of information to and among volunteer clinical faculty.
Formal or official methods (memoranda, worksh0ps, site visits by admini-
strators, etc.) are part of this effort to improve communication. Vol-
unteer clinical faculty are also involved -- to a greater or lesser ex-

tent -- in informal or unofficial interchange with each other and with

135

136
non-faculty professional colleagues about their College and its program
of off-campus clinical education.

If it could be shown that certain formal characteristics of
part-time clinical faculty were related to higher rates of informal
communication about the College and their role in it, and if it could
be further established that such increased communication were positively
associated with the incidence of desired perceptions or attitudes, then
administrators could be guided accordingly in the selection of clinical
teachers and in the conduct of training and support efforts.

Formal and readily determined characteristics of physicians
who are clinical faculty members, or who might be considered for appoint-
ment, prominently include certain features of their practice setting and
patterns of professional activity. .Are they in solo or group practice?
If they are in group practice, how many other physicians are in the
group? Is the practice located in an urban area or a rural area? How
far is the practice from the medical school campus? To what extent does
the nature of the practice include care of hospitalized patients? How
much time does the clinical faculty member, or potential clinical faculty
member, devote to hospital board and committee work? How active is he
or she in the principal professional organizations?

.Answers to these questions yield a measure of the relative
propinquity, or nearness in place and time, of physicians with other
physician colleagues. Moreover, answers to questions of this sort are

easily determined and involve relatively little subjective judgment.

Specifip pupposes. Accordingly, this present study sought to

answer two broad questions with reSpect to one set of volunteer, part-

137

time clinical faculty in a college of medicine:

1. Are propinquity factors with respect to practice setting
and institutional affiliations associated with differences in self-re-
ported communication behavior?

2. Are characteristics of self-reported communication behavior
associated with differences in perceptions of role-related information
and information exchange, and with differences in the relative salience

of the preceptor role?

Theoretical undeppinnings and prior research. General systems

theory, especially as developed by James G. Miller, was adopted as a
basic theoretical framework within which to elaborate the basic communi-
cation concepts explicit or implicit in this study. The centrality of
the notion of unpredictability in both general systems theory and field
theory was noted, and the contribution of field theorists to an under-
standing of social-psychological pressures to communicate were reviewed.
Both theoretical literature and empirical studies about propinquity as

a factor in social interaction were reviewed, drawing upon commentary
from a variety of disciplines and research in a variety of social settings.
Lastly, those few studies which have compared communication behavior with
perceptions of information and other attitudinal outcomes of social

interaction were reviewed.

Conduct of the study. The population utilized was comprised of
part-time volunteer clinical faculty, or preceptors, appointed in the
Department of Family Medicine of the College of Osteopathic Medicine at
Michigan State University.

Primary data were gathered by mailed questionnaire. The

138

questionnaire was developed through a lengthy series of steps in an effort

to assure the inclusion of essential variables, an appropriate operation-

al definition of variables and general clarity of language and form.
.Analysis of the survey data involved the generation by com-

puter of a large number of tables, each involving the direct comparison

of two variables. The majority of variable pairings involved either a

propinquity measure and an informal communication measure or an informal

communication measure and a perception.measure, as entailed by the cen-

tral purposes of the study. Some additional comparisons were made in

an effort to explore possible associations between propinquity variables

and several "control” variables.

Limitations of the study. No measures of actual knowledge or
of performance were included as outcome criteria against which to com-
pare informal communication behavior.

Data were gathered from volunteer clinical faculty in a single
department of one medical school, all of whom are engaged in a single
type of practice.

The demonstration of causal relationship is beyond the sc0pe

of the study. It is exploratory and descriptive only.

in Conclusions

Conclusions emerging from the analysis of questionnaire data
are sumarized in the following sixteen statements. They are grouped
under two sub-headings, correSponding to the two broad purposes of

fldssUMy.

139
Ppopinguity and Infprmal Communication

1. Preceptors in group practice talk with other physicians
about the,preceptorship program more frequently than do preceptors in
solo practice.

2. This difference of solo and group practitioners in overall
frequency of communication may be accounted for by the differences in
frequency of communication which takes place in the preceptors' offices.

3. Preceptors in larger (urban-suburban) communities talk
with other physicians about the preceptorship program somewhat more fre-
quently than do preceptors in smaller (rural-small town) communities.

4. Preceptors whose offices are located within l/2 hour's
drive from the University campus talk with full-time faculty about the
preceptorship program only slightly more often than do those farther
away and have pp; more often used the campus as an important locus for
conversations about the program.

5. Preceptors who spend considerable time in the hospital
visiting patients talk both more frequently and for longer periods with
other physicians about the preceptorship program than do those who
spend less time in the hospital visiting patients.

6. Preceptors active in board and/or staff committee work in
their hospitals have more frequent and longer conversations about the
preceptorship program during hOSpital meetings than do those who are
less active in hOSpital affairs.

7. Preceptors more active in professional associations have
more frequent and longer conversations about the preceptorship program

at association meetings than do those who are less active.

140

Informal CommuniCationrand'Perceptions.

8. Preceptors who more frequently talk informally with other
physicians about the preceptorship program more often have positive
perceptions of the information available to them from all sources
about the preceptorship program.

9. Preceptors who more frequently talk with other physicians
about the preceptorship program more often perceive that being a
preceptor enhances their professional competence and status, relative
to other professional roles.

10. Preceptors who more frequently talk with other physicians
about the preceptorship program do pp£.more often have favorable per-
ceptions of the College's interest in their experiences and perspectives
as a preceptor.

ll. Preceptors who more frequently talk with other physicians
about the preceptorship program do .ppp meaningfully differrfrom
preceptors who communicate less frequently with respect to identifica-
tion of those sources deemed most valuable or with respect to those
sources deemed preferable.

12. Preceptors who have never talked with a full-time faculty
member in their department more often have unfavorable perceptions of
available information and more often have unfavorable perceptions of
the College's interest in their experiences and perspectives as a
preceptor.

l3. Preceptors who generally have longer conversations with
other physicians about the preceptorship program more often have favor-

able perceptions of available information.

141

14. Preceptors who generally have longer conversations with
other physicians about the preceptorship program more often perceive
that the College has made clear its expectations and more often respond
to unclarity by working out "what should be done" in collaboration with
other physicians.

15. Preceptors whose conversations with other physicians about
the preceptorship program are generally about "finding better ways to
do our job" (innovation) more often perceive available role-related in-
formation favorably than do those whose conversations are generally
about "clarifying what the College expects" (production).

16. Preceptors whose informal communication with other physi-
cians about the preceptorship program was characterized as having to do
mostly with "clarifying what the College expects" (production) more
often prefer receiving information via a visit to their offices by a
College representative than do those in the innovation category and
much more often than those in the maintenance ("general topics, sharing

experiences") category.

Implications of Findings about "Control" Variables

Throughout this dissertation, the term "control" has consist-
ently appeared in quotation marks. This practice was adopted to signify
that, although this term is conventionally associated with experimental
designs, it is used here in the context of a descriptive study. This
caveat notwithstanding, the rationale for including "control" factors
in the study was to provide some check upon implications drawn from
associations between propinquity factors and informal communication,

in the event that "control" factors should turn out to be associated

143
with propinquity factors.

Some such associations between "control" factors and propin-
quity factors have emerged from the analysis. Length of time in the
preceptorship program is related to each of the several propinquity
variables with which it was compared. Thus, preceptors in group prac-
tice, preceptors practicing in urban areas and preceptors whose offices
are located more than one-half hour's drive from the campus have been
in the program longer, on the average. Moreover, because length of
time in the program seems to be associated with overall frequency of
communication, conclusions about relations between such overall fre-
quency of communication and the several propinquity variables must be
assessed accordingly.

Because of the finding that the highest frequency of communi-
cation is disproportionately associated with preceptors who have been
in the program for one year or lggg, conclusions about the higher fre-
quency of communication among preceptors practicing in groups would
seem to be further strengthened. Moreover, the conclusion that urban
preceptors talk more frequently about the preceptorship program emerged
despite any supposed "advantage" accruing to rural preceptors as a
"result" of being new to the program and receiving more visits.

Communication effects which may be speculatively attributed
to the "control" or formal participation variables should be viewed
within the perspective of data on the overall proportions of the "con-
trol" factors. Only twenty-six percent of the preceptors in the entire
population have had a visit from a College representative and only 30%

have been in the program for one year or less. Given the assumption

143

of causal relationship for the associations between "control" variables
and overall frequency of communication, a much larger proportion of
those newer to the program and receiving visits from College officials

might conceivably have overturned some of this study's conclusions.

Implications for Administrators

 

Administrators responsible for the design and conduct of commun-
ity preceptorship programs in general medicine would be well advised
to stimulate informal communication among volunteer clinical faculty.

The frequency and duration of such informal interchange is clearly
associated with favorable perceptions of available information, with
the perceived clarity of the College's expectations and with the per-
sonal salience of the preceptor role.

Furthermore, the informal communication of community physicians
who volunteer as part—time clinical faculty may be seen as a kind of
contribution to the College, just as is their time actually spent with
students. The data in this study indicate that, in private offices,
in hospital corridors, in meeting rooms and in convention halls, pre-
ceptors are -- to greater or lesser degrees -- taking time to talk
with one another and with non-preceptor colleagues about the College's
program and their own part in it. The phrase "taking time" is signi-
ficant. When these physicians talk about the preceptorship program,
they are taking time from some other activity or pursuit and freely
"giving time" to the College and its interests.

When such communication takes place in preceptors' offices
or the corridors of their hospitals, as most of it does, it very clearly

represents a giving of time which could be directly invested in the

144
production of additional income. Such "opportunity costs" represented
by the informal communication of volunteer clinical faculty deserve to
be assessed as genuinely valuable. Moreover, as a kind of contribution
to the College and to the medical education enterprise, such an in-
vestment should be protected, nurtured and responded to in kind by
College leaders.

These data provide some significant clues to ways in which
informal communication among clinical faculty may be furthered by
medical school leaders.

First, to the extent consistent with other criteria, more
preceptors might be selected from among physicians in group practice.

Second, a criterion for selection might be a relatively large
amount of time spent in the hospital for purposes of visiting patients.

Third, a criterion for selection might be a relatively active
role in the affairs of the hospital.

Fourth, a criterion for selection might be a relatively active
role in the principal professional associations.

Fifth, already appointed clinical faculty members who are
relatively active in their hospitals, with respect both to patient care
and institutional leadership, might be identified for particular
attention in efforts to disseminate information.

Sixth, formal programs of orientation, in~service education
and problem-solving could be mounted on an area basis in community

hospitals to exploit and further stimulate the informal communication

already existant in these settings.

145
Seventh, visitation by preceptorship program administrators
or other full-time faculty members to the offices of clinical faculty

might be concentrated particularly among those preceptors who are

known to be less active in their hospitals and/or in professional

associations.

Implications for Further Research

The present study should afford encouragement to students of
medical education and professional organizations generally.

First, a high percentage of returns was returned by a popula-
tion of private physicians, an outcome not often achieved. Success in
this instance was probably due to the relatively small size of the
population, the identification of the subjects with the institution and

the access afforded by the College leaders.

Second, the finding of generally clear associations in a
descriptive study suggests that subsequent investigators may more con-
.fidently risk the formulation and testing of hypotheses by inferential
statistics, e.g., the chi—square or similar tests.

Third, these data indicate that hospital affiliation is a
highly salient factor for this population of physicians in general,
faunily practice. This crucial dimension might have been altogether
missed by this investigator, had he not conducted preliminary surveys
and :interviews before constructing his instrumentation. Early assump-
tions; and much advice had suggested that the patient care responsi-

bilitzies and, by inference, the communication ambit of these family

Praetflltioners would be much more limited to office practice.

146

Fourth, the concepts.and other tools of communication research
have an applicability to research in medical education.which is fore-
shadowed in the present study. Descriptive investigations and case
studies of this kind will further explore the operation of communica-
tion behavior as intervening activity between organizational arrange-
ments subject to manipulation or influence by institutional leaders
and the various criterion measures on the basis of which those same
institutional leaders make decisions among alternative policies or
practices. Beyond such relatively unsophisticated methodologies as
represented here are more powerful research tools, such as network
analysis, now being developed and tested by communications researchers.
If the present study, in any substantial way, encourages medical educa-
tors to exploit communication research approaches to organizational

analysis, it will have served no mean purpose.

APPENDIX

l.

2.

3.

QUESTIONNAIRE
FOR PRECEPTORS IN FAMILY MEDICINE

What is your name?

 

my name

How long have you been in the preceptorship program?
less than 6 months

_____6 - 12 months

_____more than one year

How many times has an official of the College visited you in your
office?

 

No. of visits

How many meetings for preceptors have you attended at the campus?

 

No. of meetings
Do you share an office with another physician?

no

 

yes

If Yes:

—

a. How many others?

 

No. of others

b. How many of the others are preceptors?

 

No. of other preceptors
Please check the response which best describes the location of your
office.
urban-suburban

rural-small town

147

7.

10.

11.

12.

148

How long does it take you to drive to the MSU campus in good weather?
1/2 hour or less

more than l/2 hour

'In your office or on your telephone, about how frequently do you

usually talk with other physicians about the preceptorship program?
almost never

once a month

 

once a week

 

more than once a week
When you talk about the preceptorship program with other physicians in
your office or on your telephone, what do you most frequently talk
about?

clarifying what the College expects

general topics, sharing experiences

finding better ways to do our job

other (please specify):

 

don't have such conversations

On the average, how much time do you spend in the hospital each week
when you go there for the purpose of seeing patients?

 

hrs./wk.

When you are in the hospital to see patients, about how much time do
you usually spend talking with other physicians each week about any-
thing whatever?

 

hrs./wk.
In the past month, can you recall having any conversations with other
physicians about the preceptorship program while you were in the
hospital to see patients?

no

 

yes, once or tw1ce

yes, three or more times

13.

14.

15.

149
If Yes:
a. What did you talk about?
_____clarifying what the College expects
general topics, sharing experiences
_____finding better ways to do our job

other (please specify):

 

b. Did at least one of these conversations last more than five minutes?

no

 

yes
can't remember
Relative to other members of your (principal) hospital's staff, would
you describe yourself as "more active than most" in the affairs of
the hospital?
yes - more active

about average

no - less active

 

Excluding regular meetings for the entire staff, about how much time
do you presently spend in hospital board or committee meetings in
an average month?

 

hrs./month

At hospital staff or committee meetings, how frequently do you talk
with anyone about the preceptor program?

almost never
once a month

more than once a month

150

16. When you talk about the preceptorship program with physicians at
hospital staff or committee meetings, how long do these conversations
generally last?

don't talk
less than 5 min.
more than 5 min.
17. Who generally starts these conversations?

others start

I start

 

about equal
18. What do you talk about in these conversations?

clarifying what the College expects

 

general topics, sharing experiences
finding better ways to do our job

other (please specify):

 

don't have such conversations

19. How active are you in your district osteopathic medical association
at this time?

_____don't attend
attend some meetings, but no or little committee work
attend most meetings, serve on committees
_____officer or chairman of major committee(s)
20. How active are you in the state-wide association (MAOP&S)?
_____don't attend
attend some meetings, but no or little committee work
attend most meetings, serve on committees

officer or chairman of major committee(s)

21.

22.

23.

24.

25.

151

Before or after osteopathic association meetings, how frequently do
you talk with anyone about the preceptorship program?

almost never

_____pnce every 3 - 4 meetings
at least once every meeting

When you talk about the preceptorship program with other physicians
before or after an osteopathic association meeting, how long do these
conversations generally last?
,_____less than 5 min.
.____Jmore than 5 min.
._____don't talk
Who generally starts these conversations?

others start

I start

about equal

 

don't have such conversations
What do you talk about in these conversations?

clarifying what the College expects

 

general topics, sharing experiences
finding better ways to do our job

other (please specify):

 

don't have such conversations

Where do you most frequently have conversations with other physicians
about the College or the preceptorship program? (Please putua "l" by
the most frequent location and a "2" by the second most frequent loca-
tion.)

in my office or on my telephone

 

in the hospital

 

at osteopathic association meetings

 

at the College's facilities on campus

 

other (please specify):

 

 

152

26. Which ONE of the following sources of information has been most valu-
able in your role as a preceptor?

journals and formal presentations at conventions
mailings from the College

full-time faculty members and/or the Director of Education at
your hospital

other physician colleagues and students

other (please specify):

 

27. How clear is it to you what the College expects you to do as a pre-
ceptor? (Choose the one answer which best fits your perceptions.)

it's really not very clear
not clear, but I decided myself what is needed

not clear, but other physicians and I together have worked out
what should be done

the College has made it sufficiently clear

other (please specify):

 

 

28. On the average, during periods when you have a student, how frequently
do you talk with other physicians about some aspect of the preceptor-

ship program?

_____almost never
once a month
once a week

_____almost daily

29. When was the last pime you talked with a full-time faculty member in
Department of Family Medicine about the preceptorship program?

never
less than 2 months ago

2 months or more ago

30.

31.

32.

153

How do you feel about the total amount of information available to you
from all sources about the preceptorship program -- and when you get
it?

don't get information

get it, but too little and too late

get adequate information

How do you feel about the accuracy and usefulness of the information
which you get from all sources about the preceptorship program?

it's accurate and useful

it's accurate, but often not useful in my situation

 

it's useful, but I often doubt its accuracy
it is neither useful nor accurate

Have you ever had any specific ideas about how the preceptorship
program could be improved?

yes
_____no, not at this time
If Yes:
a. Have you shared your idea(s) with other physicians?

no

 

only briefly
considerable discussion

b. Have you ever communicated your idea(s) to any full-time faculty
member of the Department of Family Medicine?

yes

no

 

c. Briefly outline your suggestions in the space below.

 

 

 

 

154

33. How do you feel about the interest of College leaders in your experi-

ences and perspectives as a preceptor?
they have shown no sign of interest

I assume they are interested, but they haven't done much to
allow me to make my input

they're definitely interested and have welcomed receiving my
suggestions

34. flpgre and how would you most prefer to get your information about the

preceptorship program and the College's expectations for your role?
(Check one only.)

the present arrangement is sufficient
_____more, better presentations by officials at general meetings
_____sma11 discussion and problem-solving sessions
_____a visit to my office by College representative

other (please specify):

 

35. Which of the following affiliations contributes more to your growth

36.

37.

in clinical competence as a family practitioner?

being a preceptor

 

consultation and educational programs at my hospital
neither contributes much

Again, which of the following affiliations contributes more to your
growth in clinical competence as a family practitioner?

being a preceptor
participation in professional associations
neither contributes much

Which of the following affiliations do you think contributes more
to your patients' regard for you?

being a preceptor
my position(s) in the hospital staff

neither contributes much

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