Defining the effective clinical preceptor: a conceptual framework for role modeling in medical education

Background: Role modeling by clinical preceptors is a critical component in the professional development of medical students, yet the attributes and contextual factors that contribute to preceptor effectiveness as role models remain underexplored. This study aimed to design a conceptual framework to better understand and enhance the effectiveness of clinical preceptors as professional models in medical education.

Methods: A four-stage, mixed methods, sequential explanatory design was employed. First, a literature review informed the development of a survey instrument focused on attributes of effective clinical preceptors. Second, a survey was administered to fifth- and sixth-year medical students and clinical preceptors at a medical school in Brazil, collecting perceptions of positive and negative preceptor attributes. Third, responses were analyzed and grouped by similarity and frequency. Finally, a conceptual framework was developed using a design thinking process, integrating survey findings and theoretical perspectives.

Results: A total of 222 participants (173 students and 49 preceptors) were surveyed, yielding 1,130 citations of attributes, resulting in the identification of 90 distinct attributes of effective preceptors. The most valued attributes included knowledge, empathy, didactics, patience, availability, kindness, willingness to teach, respect, and humility. These attributes were synthesized into a conceptual framework comprising three domains—contextual, subjective, and experiential—highlighting the interplay of intrinsic and extrinsic factors in preceptor effectiveness as role models.

Conclusion: The proposed framework provides a comprehensive approach to understanding the effectiveness of clinical preceptors as role models. It offers practical guidance for faculty development, curriculum planning, and further research on role modeling in medical education, with potential to enhance both teaching quality and professional identity formation among students.

1 Introduction

Medical education is a complex field that aims to provide society with informed, qualified and updated health professionals who prioritize patient care (Swanwick, 2019). Medical curricula are not uniformly organized and vary around the world, with differences related to aspects such as structure, duration, full registration point, and degrees awarded (Wijnen-Meijer et al., 2013).

In Brazil, students enter medical school directly after high school for a program that lasts six years. Typically, the curriculum includes four years of basic and clinical sciences, followed by a mandatory 2-year clinical rotation phase called “clerkship” (or internato), which covers approximately one-third of the total course load. Crucially, unlike in some North American or European systems where postgraduate training is required for licensure, the Brazilian system follows a different logic. Upon completing the 6-year undergraduate program, graduates register with the Brazilian Federal Council of Medicine. This registration grants full legal authorization for the new physician to practice medicine independently and unsupervised as a General Practitioner. Medical residency programs are optional and competitive postgraduate tracks intended solely for those seeking specialist certification, rather than being a requirement for basic medical practice (Wijnen-Meijer et al., 2013; Brasil. Ministério da Educação. Conselho Nacional de Educação, 2025).

Therefore, clinical rotations/internships are a critical phase for completing graduation-level training, where students improve and reframe the content learned through training in real practice scenarios, applying and integrating previously acquired medical knowledge and skills, and have the opportunity to exercise professional attitudes in environments supervised by a preceptor (da Cândido and Batista, 2019).

We consider “preceptor” here as a clinical professor or non-teaching professional who teaches groups of students or residents, with an emphasis on developing skills for clinical practice, contributing to the insertion and socialization of the undergraduate or recent graduate in the work environment (Botti and Rego, 2008). This professional usually serves as a model for the student, which may positively or negatively affect future physician training (Jochemsen-van der Leeuw et al., 2013; Nordi et al., 2022).

Role modeling in medical education began to stand out as a subject of study at the beginning of this century, when it came to be considered an important factor in the development of the professional identity of future doctors (Sarraf-Yazdi et al., 2021; Koh et al., 2023). According to Social Cognitive Theory, the choice of a model is based on several factors such as perceived similarity, competence, and relevance. Individuals may choose models with high status or prestige in their social group or who are seen as attractive or likeable. This process can lead to the acquisition of new behaviors, attitudes, and skills as well as the modification of existing ones. It can also influence the development of cognitive processes such as attention, memory and problem solving (Bandura, 1992). The learning environment and intrinsic motivation are also recognized as key drivers of professional growth and identity formation in health professions education (Di Domenico and Ryan, 2017).

Studies on role modeling have analyzed and classified the attributes of clinical teachers as positive or negative, grouping them into categories related to patient care, teaching, and personal characteristics (Jochemsen-van der Leeuw et al., 2013; Passi et al., 2013). An important aspect to consider is that modeling usually occurs in an unintentional and unstructured manner, and may have unpredictable results (Radha Krishna et al., 2019).

The preceptor exerts a great influence on medical education, the transmission of values, and being a showcase for relational skills (dos Santos et al., 2020), contributing to the “hidden curriculum,” a construct that defines what is not explicit in the formal, disciplines-based education, and the result of the social interactions experienced during graduation, which is essential for the construction of the physician’s professional identity (Reuler and Nardone, 1994; Lehmann et al., 2018; dos Santos et al., 2020).

Preceptors must be aware of their role as a model so that the process has a positive influence (Cruess et al., 2008). Medical schools face great challenges in defining a model that combines desirable attributes for the training of future physicians. Despite the recognized importance of role modeling in medical education and its influence on professional identity formation, existing research has largely focused on cataloging the attributes of effective preceptors or describing the outcomes of role modeling in isolated contexts. However, there remains a significant gap in the literature regarding comprehensive, evidence-based frameworks that systematically integrate the diverse contextual, subjective, and experiential factors influencing preceptor effectiveness as role models.

Despite the recognized importance of role modeling, existing research has largely focused on cataloging lists of isolated attributes of effective preceptors. Current literature often lacks comprehensive frameworks that explain how these attributes interact with the pressure of healthcare environments and the individual subjectivity of the teacher. Most approaches do not sufficiently account for the complex interplay between institutional culture, individual characteristics, and lived experiences. Furthermore, the lack of operational definitions for these interactions limits the ability of medical schools to design targeted faculty development initiatives. Addressing this gap, our study aims to develop and validate a comprehensive framework for preceptor effectiveness as professional role models, using a mixed methods approach to capture the multifaceted nature of this phenomenon.

Making preceptors and students aware of the influence of modeling in the construction of professional identity and developing preceptors’ responsibility as models can contribute to a better performance of preceptorship, in the construction of the professional trajectory of doctors in training and in the quality of the healthcare provided by them (Cunha et al., 2023).

This study aimed to build a conceptual framework of preceptors’ effectiveness as professional models for students in medical training.

2 Materials and methods

This research was conducted using mixed methods with a sequential explanatory design (Schifferdecker and Reed, 2009; Cohen et al., 2017). This study was approved by the institutional Research Ethics Committee (CAAE: 60313822.0.0000.5052) and was conducted in the four stages described below.

2.1 Step 1–Review of the literature and preparation of the survey instrument

Initially, an exploratory review of the literature was conducted in the MEDLINE/PubMed and SciELO databases using search strategies that combined the main term role model, medical education, and attributes. Beside articles selected, two significant reviews were reviewed as the basis for the elaboration of a list of preceptors’ attributes related to their role as a professional model (Jochemsen-van der Leeuw et al., 2013; Passi et al., 2013). The papers highlighted the preceptor’s role as a professional model and listed attributes grouped into three categories based on the themes found: 20 clinical attributes, 16 teaching skills, and 15 personal qualities. After analyzing this list for synonymy and similarity, the researchers, by consensus, defined 21 attributes for inclusion in the survey questionnaire consisting of three question categories: (1) citations by open response, not predefined, of five positive and two negative attributes of an effective preceptor; (2) ranking, in order of relevance, of a chosen selection of 12 positive attributes drawn from a list of 21 collected by researchers from the literature; and (3) sociodemographic data.

2.2 Step 2–Survey with students and preceptors about the perception of attributes

For data collection, a survey was carried out in a medical school at a private, non-profit university located in northeast Brazil. The inclusion criteria were as follows: being a fifth- or sixth-year student, or being a preceptor officially linked to the medical course studied and being 18 years old or older.

Participants were recruited through face-to-face contact or messaging applications. The sample was established for convenience, and all participants who agreed to participate by signing a free and informed consent form were included in the study.

Data collection was conducted using an electronic form sent to students and preceptors by the researchers. The information provided by the participants was encoded to preserve privacy. Data were archived to ensure redundancy and information security.

2.3 Step 3–Survey data analysis

The answers to the open questions were initially analyzed and grouped according to similarity (attributes with similar concepts, such as, for example, “caring about the patient” and “prioritizing the patient” were revised and grouped as “interest in the patient”) and synonymy (attributes with the same meaning, such as “patience” and “being patient” were recoded as “patience”) and written in a standardized way for better data analysis. Records of more than one characteristic per item were considered independent responses. This step was carried out by one of the researchers (FCX) and was later evaluated by the other two researchers (SMC and HLCS). The final terms of the attributes were defined after consensus and served as the basis for the construction of the conceptual structure.

The list of attributes collected from students and tutors was analyzed in terms of the frequency of each professional attribute, identifying the most and least frequent attributes. Measures of central tendency (mean, standard deviation, median, absolute, and relative frequencies) were used. In the analysis of the characteristics of the participants, tests were performed using the Mann–Whitney and Kruskal–Wallis tests, verification of non-adherence of data to the Gaussian distribution, Pearson’s chi-square test, and Fisher’s exact test. A significance level of 5% was considered statistically significant. Statistical analyzes were performed using the statistical program R (R Core Team, 2021).

2.4 Step 4–Elaboration of the conceptual framework

The elaboration of the conceptual framework was inspired by the design thinking process proposed by the Hasso Plattner Institute of Design (Plattner et al., 2015) and involved the participation of four researchers with experience in hospital and academic management, preceptorship, and medical education, including curriculum development and evaluation.

This methodology comprises a systematic approach in six phases: understanding, observing, defining, creating, prototyping, and testing. This process is nonlinear and iterative, and the focus may vary in phases and iterations, depending on the project objective. The Design Thinking process followed a double-diamond approach of divergent and convergent thinking. During the ideation phase, the four researchers (who combine expertise in medical education, psychology, and management) individually generated concepts based on the survey data (Step 3) and literature review. In the prototyping phase, we used affinity mapping to cluster these concepts. Disagreements regarding the categorization of attributes (e.g., whether “patience” was a personal trait or a pedagogical skill) were resolved through consensus meetings, using the raw qualitative data from students as a tie-breaker. The final prototype (The Framework) was iteratively refined to ensure it visually represented the dynamic flow between the domains.

Initially, the team (the four authors) defined the problem as “the effective preceptor” and explored possible solutions centered on his role as a model. In this phase, relevant aspects were considered based on the experience and theoretical knowledge of the researchers in addition to the elaboration of general assumptions, thus developing a collective perspective.

Using brainstorms, a large number of ideas, aspects, and concepts related to the preceptor and the determining, influential, and consequent factors of his/her professional practice, as well as the characteristics related to him/her, were regrouped and synthesized.

A conceptual map was constructed based on this discussion. The attributes collected in the survey carried out with preceptors and students in Steps 2 and 3 were arranged on cards and grouped with related concepts in the constructed map. This construction serves as the basis for elaborating a prototype of the conceptual structure.

3 Results

3.1 Survey results with preceptors and students

The university where the present study was conducted had a population of 400 students enrolled in the clerkship rotations of the medical curriculum during the period of data collection, and 80 preceptors (faculty or non-faculty members) were officially linked to the university. Of these, 173 (43.25%) students and 49 (61.25%) preceptors completed the questionnaire. The average age of the students was 24 years, whereas that of the preceptors was 47 years. Approximately 55% of the students were women, compared to 63% of the tutors. A more detailed description is provided in Table 1.

TABLE 1

Table 1. Sociodemographic characteristics of respondents.

When asked to name five positive preceptor attributes, 1,130 responses were obtained. These responses were then grouped by similarity and synonymy by the authors who obtained a set of 90 attributes as the final result.

The five attributes most valued by preceptors were knowledge, empathy, didactics, ethics, and availability. The five attributes most frequently reported by students were didactics, knowledge, empathy, patience, and willingness to teach. A list of all the attributes mentioned is provided in the Supplementary material.

After calculating the average of the responses for each group, the attributes that were above average in the group with all participants and by category are listed in Table 2.

TABLE 2

Table 2. Attributes cited by students and preceptors, ranked in order of citations.

3.2 Elaboration of the conceptual framework prototype

Theoretical concepts from the literature and the attributes collected in the survey were aggregated into three large macro dimensions, conceptual structures that are decisive for the preceptor’s effectiveness as a professional model, thus called: “contextual dimension,” “subjective dimension,” and “personal and professional experience” as a product of the intersection of these two macro dimensions.

The contextual macro dimension considers clinical environment, available resources, and stakeholder expectations. The performance of a preceptor in a hospital environment has different challenges and opportunities than a preceptor in primary care. Likewise, access to a variety of resources, such as state-of-the-art equipment and a medical library, will hypothetically influence the effectiveness of preceptorship and the expectations of students, managers, and patients, and may also influence students’ level of awareness of the skills required for their development and the preceptor’s ability to enable such reach.

The subjective macro dimension considers preceptors’ personal characteristics and attributes, such as their values, personality styles, communication skills, teaching approach, and motivation. The preceptor’s effective communication contributes to building relationships with the students and transmitting information clearly and concisely. Likewise, a preceptor who has a positive and encouraging approach to teaching will be more effective than a preceptor who is judgmental and demotivating. These dimensions operate with the nature, time, and characteristics of the preceptor’s personal and professional experiences. In our proposed model, life experience is precisely at the intersection of the two macro-dimensions; thus, it is itself a determining dimension.

Role modeling is influenced by extrinsic factors, such as a safe environment, resources, and personal and professional development, as well as intrinsic factors represented by the preceptor’s attributes, clinical competence, and teaching and communication skills.

This construction served as the basis for elaborating the prototype of the conceptual structure shown in Figure 1.

FIGURE 1

Figure 1. Conceptual framework of the effective clinical preceptor as a role model.

To move beyond a descriptive narrative and provide a functional tool for faculty development and assessment, we established operational definitions for the framework’s components. These definitions clarify the boundaries between the extrinsic forces of the environment and the intrinsic attributes of the educator, anchoring the abstract concepts into observable indicators. Box 1 outlines these operational definitions and the indicators for each domain presented in Figure 1.

BOX 1 Key definitions of the domains.

Operational definitions of the framework domains

1. Contextual dimension (extrinsic factors)

• Definition: The set of structural, political, and environmental forces inherent to the health institution that externally regulate the preceptor’s performance. These are factors largely outside the individual’s direct control but which shape the learning atmosphere.

• Operational indicators: Availability of physical and technological resources; quality of the practice setting (e.g., overcrowding, safety); institutional culture regarding hierarchy and psychological safety; and established academic processes (assessment protocols, clear learning objectives).

2. Subjective dimension (intrinsic factors)

• Definition: The internal psychosocial landscape of the preceptor. It encompasses the individual traits, values, and acquired skills that the preceptor brings into the relationship with the student and patient.

• Operational indicators: Personal values (ethics, humility); personality styles; emotional intelligence (empathy, patience); and specific actionable skills such as communication clarity and pedagogical approach (didactics).

3. Experiential dimension (intersection)

• Definition: The cumulative synthesis of professional and personal history over time. It represents the maturity through which the preceptor filters contextual pressures using subjective resources.

• Operational indicators: Years of clinical practice (clinical expertise); history of specific pedagogical training (educational expertise); and the developmental stage of the preceptor’s own professional identity.

4. Role modeling effectiveness (outcome)

• Definition: The successful integration of the three dimensions, resulting in a preceptor who functions simultaneously as a competent clinician, an effective educator, and a humanistic role model.

• Operational indicators: The observable ability to demonstrate high-quality patient care while explicitly articulating clinical reasoning to students (teaching) and maintaining respectful interpersonal relationships (humanism).

4 Discussion

Performing the role of clinical professors is challenging (Ramani and Leinster, 2008) and the literature demonstrates the importance of role modeling in physician education (Harden and Crosby, 2000; Ramani and Leinster, 2008; Jochemsen-van der Leeuw et al., 2013; Passi et al., 2013), especially in the construction of professional identity (Lehmann et al., 2018; Sassi et al., 2020).

Analysis of attribute discrepancies: Our survey data revealed revealing nuances in how students and preceptors perceive the ideal role model, highlighting a divergence between “content” and “transmission.” As detailed in Table 2, while preceptors ranked “Knowledge” as their primary attribute (35 citations), students prioritized “Didactics” (92 citations) above all else, even slightly surpassing “Knowledge” (84 citations). This suggests that for learners, clinical competence (Intrinsic Factor) is assumed to be present; their primary concern lies in the preceptor’s ability to translate that complex knowledge into accessible learning (Teaching Skills). This aligns with the “Educational” domain of our framework, emphasizing that possessing expertise is insufficient for role modeling if the pedagogical bridge—didactics—is absent.

The role of emotional support vs. professional norms: A striking disparity was observed regarding the attribute of “Patience.” It was the fourth most cited attribute by students (72 citations) but appeared only 4 times among preceptors’ priorities. This stark contrast likely reflects the vulnerability of the student within the “Contextual Dimension” (hierarchical relationships). Students, navigating the uncertainty of clinical training, view patience as a critical safety net that allows for mistakes and growth. Conversely, preceptors emphasized “Ethics” (15 citations) significantly more than students (7 citations implied), suggesting a focus on the “Structural/Political Perspective” of professionalism and normative behavior. This dichotomy reinforces the need for our framework’s “Subjective Dimension,” which must account for both the emotional safety requested by students and the ethical standards upheld by faculty.

Convergences on humanization: Despite these differences, both groups converged on the centrality of “Empathy,” ranking it in the top three attributes (110 total citations; 82 by students, 28 by preceptors). This shared valuation validates the “Human Perspective” of our framework, confirming that regardless of the hierarchical position (student or teacher), the relational quality of the interaction is the bedrock of effective role modeling. The quantitative results from our survey thus provide empirical support for the theoretical intersection of Intrinsic Factors (empathy as a skill) and the Subjective Dimension (values and culture) proposed in Figure 1.

Several studies have described specific aspects of role modeling, such as the attributes of a good preceptor (Jochemsen-van der Leeuw et al., 2013; Bahmanbijari et al., 2017; Ahmady et al., 2022; Khawar et al., 2022), its influence on the construction of professional identity (Wilson et al., 2013; Cruess et al., 2015; Koh et al., 2023), and its relationship with professionalism (Birden et al., 2013; Berger, 2014; Byszewski et al., 2015) among other approaches. In this study, we seek to elaborate a systematization in which the preceptor’s effectiveness as a model is analyzed from different perspectives based on the proposition of a conceptual model, which can be explained as follows.

The effectiveness of the preceptor as a role model determines the quality of their teaching-healthcare actions involving students, patients and their families, peers, and other members of professional teams and the organizations themselves, with educational repercussions in healthcare and interpersonal relationships.

Such modeling is influenced by extrinsic factors, which represent the impact of an environment that promotes learning, collaboration, and patient safety; the existence of available resources, such as time, space, materials, and technologies; the organizational culture, including the values, norms, and expectations of health and educational institutions; the values attributed to education, professional growth, and teamwork; and the degree of development of the health systems in which teaching-healthcare practice takes place.

The clinical environment is an important factor in effective teaching and learning in clinical education, including both physical and human factors and it has a significant impact on the quality of clinical education (Ramani and Leinster, 2008; Benamer et al., 2023). Similarly, organizational culture and values (faculties of medicine and health services) have an impact on the quality of clinical teaching (Lomis et al., 2021).

However, role modeling is closely influenced by intrinsic factors such as their ability to provide high-quality care, their competence in imparting knowledge and skills, identifying learning needs, planning appropriate educational activities, providing constructive feedback, and their communication skills, related to the ability to listen carefully, ask relevant questions, provide clear explanations, and convey information in an understandable way.

Ilic et al. (2016) showed that students tend to predominantly value the transfer of knowledge to the detriment of research and the role of the preceptor as a model when compared to the view of clinical professors, who prioritize attributes related to professionalism.

Sutkin et al. (2008) concluded that attributes based on relationship aspects are more relevant than cognitive skills. Kreber (2002) pointed out that excellent professors are those who, in addition to motivating their students, present complex concepts in an understandable way, adding disciplinary knowledge as a basis for essential clinical skills.

In our study, students and clinical professors valued both relational and cognitive aspects. However, in a more qualitative analysis, we noticed that the students were “self-centered” insofar as they chose attributes of the preceptor such as patience and willingness to teach, while the professors pointed out attributes according to their role, such as ethics and availability to students and patients. Modeling the roles of an effective preceptor in our proposal is defined as the product of the interrelation between these major fields. To guide this analysis, our model uses the four-frame model of leadership as a reference, as proposed by Bolman and Deal (2017). We consider that by simultaneously exercising the roles of education, healthcare and behavior modeling, the preceptor assumes a leadership figure in the three dimensions. This reference suggests that leadership can be analyzed through four different perspectives, called “frames,” structural, human, political, and symbolic, which, in our reading, would influence the preceptor’s effectiveness according to the context and situations of practice. In our model, the contextual dimension is intrinsically related to structural and political perspectives, whereas the subjective dimension is related to symbolic and human perspectives.

4.1 Contextual dimension

A structural perspective emphasizes the importance of organizational processes in the preceptor’s action, requiring the definition of clear objectives, proposing efficient teaching and healthcare systems, and establishing rules and procedures for coexistence and conduct, in addition to the conditions of the various practice scenarios and the existence of continuous training programs, among other factors.

Teaching in a clinical environment usually occurs during patient care performed with the student, with challenges such as time constraints, simultaneous performance of other service activities, unpredictability of what will be addressed by students, different student levels, difficulties related to patients, lack of incentives for teaching, and inappropriate physical environments (Ramani and Leinster, 2008).

One way to improve the use of this experience is the existence of shared social spaces where students can reflect on the behavior of teachers and other colleagues. This strategy can favor the modeling of self-care behavior and destigmatise vulnerability by observing models that feel comfortable with their own limits, asking for help, and reassuring each other (Uys et al., 2023). Thus, the contextual dimension, from a structural perspective, involving organizational rules and structures, educational and clinical physical settings, teaching methods, and assessment methods, influences interpersonal relationships and role modeling itself (Sarikhani et al., 2020).

A political perspective proposes that the organizations and institutions where the preceptor works are arenas of power, where conflicts can occur in search of resources and positions. Effective mentorship considers interests and different coalitions within the organization, knowing how to navigate power dynamics, building alliances, dealing with clashes, and building consensus in decision-making.

Doctors have been socialized to respect and reproduce a hierarchy of power since the beginning of medical school. Under more traditional models of power, students are expected not to question the judgments of seniors but to endure severe treatment to prove that they are worthy of being in the profession. This fear-mediated situation impacts students’ experience, interfering with the quality of training, patient safety, and the way they perceive modeling (Crowe et al., 2017).

If we consider minority groups within medicine, gender, race, or ethnicity, we can observe that there is also interference from these aspects in modeling. In general, female students consider preceptors of men and women as role models, whereas male students only consider physicians of the same gender as models. Furthermore, male models are described as qualitatively more admirable than female models in both groups (Lindberg, 2020).

With regard to class and racial issues, students who make up minorities may be more distressed by witnessing cases of disdain and mistreatment of patients, especially when they identify with them, being more affected and more likely to resist the so-called hidden curriculum and the modeling that exists therein (Lawrence et al., 2018; Nemiroff et al., 2023).

4.2 Subjective dimension

From a human perspective, effective preceptorship emphasizes people and relationships within organizations. Preceptors who adopt this perspective are attentive to the satisfaction and wellbeing of individuals, whether patients, family members, students, or other team members, promoting a healthy and collaborative work environment, recognizing their needs and motivations, and striving to create positive interpersonal relationships and a favorable organizational climate.

Role modeling is the main method by which preceptors teach the humanistic aspects of medical care and can occur through different styles and strategies (Weissmann et al., 2006). Preceptors with greater social and emotional competence may be better role models for these behaviors and may increase students’ academic performance. These preceptors can also promote improvement in interpersonal relationships, professionalism and moral sensitivity, increasing trust in clinical interactions (Omid et al., 2018). On the other hand, the absence of these skills can significantly affect the attitude and behavior of medical students, leading to impaired patient care (Aslam et al., 2022).

Finally, a symbolic perspective analysis of the preceptor’s effectiveness considers the importance of meanings, values, and symbols in institutional culture. This perspective considers that people create their own interpretations of reality based on their experiences and cultural backgrounds. Blumer’s theory of symbolic interactionism (Blumer, 1986) affirms the role of social relations in the construction of concepts and in the modeling of attitudes, based on the senses and meanings arising from interactions in the environment.

Preceptors use their personal charisma to provide a sense of enthusiasm and commitment to their students and patients. They pay close attention to the cultural and unique aspects that shape the organization and environments and use these to create a sense of shared purpose and identity (McLean et al., 2023). They are often perceived as visionary and inspirational (van Lankveld et al., 2021) and can motivate people to work toward a common goal (van Lankveld et al., 2021; McLean et al., 2023; Spaans et al., 2023).

4.3 Experience

Considering the preceptor’s experience as the intersection of subjective and contextual dimensions, the way he perceives the context and is affected by it goes through his personal characteristics, beliefs, and values, which in turn are accommodated in the context. Experience over time contributes to professional expertise (Norman et al., 2018); therefore, an experienced preceptor uses his competence in patient care to strengthen his influence as a model with students (Harden and Crosby, 2000).

Likewise, a preceptor with developed leadership traits may be more effective in managing relevant educational and clinical experiences (Mianda and Voce, 2017). Ultimately, the development of a preceptor’s expertise is a continuous process in which the ability to identify and deal with factors related to contextual and subjective dimensions over time will make the preceptor more effective in his care, educational role, and interpersonal relationships (Drew and Pandit, 2020).

4.4 Role model effectiveness

Thus, we can examine the role of modeling from two points of view. In the preceptor’s point-of-view, modeling is one of his/her roles. One could cite the model of the twelve roles of a good teacher in medical education (Harden and Crosby, 2000). This model was later refined, maintaining the functions of a health professional, teacher and personal behavior model (Harden and Lilley, 2018).

Other authors also cite the ability to perform a good role model as a characteristic of a good clinical teacher, leading to the development of tools to assess the role of model and strategies to improve this function (Jochemsen-van der Leeuw et al., 2014; Goldie et al., 2015; Said et al., 2019; Mohammadi et al., 2020).

From the perspective of students, modeling is one way to improve self-efficacy (Bandura, 1997). Considering Bandura’s theory, we can cite four main sources of self-efficacy beliefs: personal experience, vicarious experience, verbal persuasion, and physiological and affective states. Of these, vicarious experiences are directly related to modeling. Visualizing people similar to yourself performing successfully generally increases the belief in efficacy, as well as the perception of failures in others can lower one’s own judgment about your capabilities, harming your efforts (McGaghie, 2015).

When analyzing the results of our work, we obtained important modeling characteristics related to the role of the preceptor as a professional model (knowledge, commitment, punctuality, ethics, and proactivity), educational model (didactics, willingness to teach, and interest), and personal behavior model (empathy, patience, availability, kindness, respect, humility, understanding, and interpersonal relationships) which can be found in previous studies (Jochemsen-van der Leeuw et al., 2013; Passi et al., 2013).

4.5 Consequences of modeling

Encouraging preceptors to develop modeling awareness and understanding of how their actions influence student education can help them be more explicit about the behaviors they wish to model, leading to a positive impact on students’ professional and character development (Mohammadi et al., 2020).

In this sense, the model can influence the formation of professional identity in aspects such as personal care and wellbeing, career choice, acquisition of knowledge and skills, professional satisfaction, readiness to express feelings and personal characteristics such as humility, compassion, empathy and respect (Koh et al., 2023), leading to a major development in student professionalism (Passi and Johnson, 2016). Good modeling can contribute to the quality of care, training of new physicians, and the way they relate to patients and teams.

4.6 Strengths and implications for further research and practice

Our proposal provides insights into the role-modeling process of preceptorship. The uniqueness of our model is that it considers various driving dimensions, influencing factors, and interrelationships in addition to their consequences. Several limitations must be acknowledged. First, the study was conducted at a single private institution in Northeast Brazil, which may limit the generalizability of the findings to public universities or different cultural contexts. Second, the use of convenience sampling for the survey may have introduced selection bias, as preceptors more engaged with education might have been more likely to respond. Third, while Design Thinking provides a robust method for conceptual generation, it inherently involves subjective interpretation by the researchers. Finally, although validated through literature and consensus, the proposed framework has not yet undergone confirmatory factor analysis or external validation in other centers, which remains a necessary step for future research.

5 Conclusion

This study aimed to build a conceptual structure of the preceptor’s effectiveness as a professional model for students in medical training. Such reflection can contribute to the understanding of the attributes of the clinical professor of medicine, the determinants of this practice, the attributes of positive and negative models, and how students, patients, and organizations respond to their effectiveness. We suggest that medical schools need to improve the development of academic staff–faculty and students–to deal with role modeling in clinical practice. Awareness of the modeling process can help students develop and improve their clinical skills, decision-making, and reflective practice. For teachers, we hope our model helps to improve their professional behavior, broadening their reflection on their set of personal values and beliefs and their impact on teaching, as well as on their own life experiences and how they shaped them as teachers, with a possible impact on the overall quality of their teaching action.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The studies involving humans were approved by the Universidade de Fortaleza Research Ethics Committee. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

FX: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Visualization, Writing – original draft, Writing – review & editing. EF: Formal analysis, Validation, Visualization, Writing – review & editing. SM: Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. HC: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.

Funding

The author(s) declared that financial support was received for this work and/or its publication. Universidade de Fortaleza–Graduate Program of Medical Sciences provided institutional support for this study.

Acknowledgments

We would like to thank the medical students, their faculty and clinical preceptors and the Dean of the Medical School at Universidade de Fortaleza for their contribution during the survey phase of the study. Useful suggestions given by Antonio Brazil Viana Junior, for statistical support, and professors Rosa Lívia Freitas de Almeida, Renata Rocha Giaxa and Olivia Andrea Alencar Costa Bessa during the design phase are acknowledged.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declared that generative AI was not used in the creation of this manuscript.

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Supplementary material

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