Early Emergency Department Exposure in Preclinical Medical Education: A Retrospective Survey of Perceived Immediate Gains and Longer-Term Educational Impact

Early Emergency Department Exposure in Preclinical Medical Education: A Retrospective Survey of Perceived Immediate Gains and Longer-Term Educational Impact | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Early Emergency Department Exposure in Preclinical Medical Education: A Retrospective Survey of Perceived Immediate Gains and Longer-Term Educational Impact Ziyu Zheng, Jianghui Liu, Yifeng Luo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9190723/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Early clinical exposure in the emergency department has been used to introduce preclinical students to clinical work, but existing studies have focused mainly on immediate reactions or specialty interest. This study examined retrospective perceptions of immediate gains and current perceptions of longer-term educational impact associated with a brief emergency department preceptorship. Methods A single-center, retrospective, cross-sectional survey was conducted among all identifiable former participants in an emergency department preceptorship delivered in 2015, 2016, 2017, 2018, 2019, 2020, 2024, and 2025. A study-specific questionnaire assessed process and preceptor support, retrospective immediate gains, current long-term impact, and four single-item outcomes. Descriptive statistics, Cronbach’s alpha, and Mann–Whitney U tests were used. Cohort comparisons between 2015–2020 and 2024–2025 were exploratory. Results Of 66 eligible participants, 50 completed the survey (75.8%). Mean (SD) scores were 4.03 (0.61) for process and preceptor support, 4.34 (0.57) for retrospective immediate gains, and 4.24 (0.60) for current long-term impact. Single-item mean (SD) scores were 4.12 (0.88) for influence on future specialty choice, 4.50 (0.75) for overall long-term educational value, 3.85 (1.20) for interest in emergency/critical care, and 4.46 (0.84) for recommendation to junior students. Agreement was high for preceptors’ explanations and opportunities to ask questions (both 92.0%), continued influence on later learning or professional development (95.6%), and recommendation to junior students (90.0%). Recommendation to junior students was higher in the 2024–2025 cohort than in the 2015–2020 cohort (4.85 [0.37] vs 4.20 [0.96], P = .005); no other between-cohort differences were statistically significant. Conclusions Participants retrospectively associated a brief emergency department preceptorship with perceived immediate gains and sustained educational relevance. Reported benefits were more consistent for workplace orientation and professional development than for specialty-related outcomes. early clinical exposure emergency department preclinical medical students workplace learning professional identity survey Figures Figure 1 Figure 2 Background The transition from preclinical study to workplace-based clinical learning remains a vulnerable phase of undergraduate medical education. Students entering clerkships commonly report difficulty translating preclinical knowledge into patient care, uncertainty about expectations, and limited confidence in navigating the clinical environment. Prior empirical work has shown that early patient contact may reduce the “shock of practice” and improve preparedness for clerkship, while readiness for early clinical work is influenced by prior clinical exposure and the quality of supervision[ 1 , 2 ]. Early clinical exposure may also shape how students begin to understand professional practice. Qualitative studies have shown that early encounters with patients and clinical teams can alter students’ views of professionalism, and that emotionally challenging clinical situations may contribute to professional identity formation [ 3 , 4 ]. Other studies of early placements have emphasized the importance of mentorship, role modelling, and participation in clinical communities in helping students make sense of medical work and their developing role within it [ 5 , 6 ]. The emergency department (ED) provides a distinctive setting for early clinical exposure. It brings together undifferentiated presentations, acute deterioration, interprofessional coordination, and time-pressured decision making within a single workplace. A national survey published in Teaching and Learning in Medicine found that many U.S. medical schools offered some form of emergency medicine exposure in the first two years of training, although the format and extent of that exposure varied[ 7 ]. In a structured preclerkship ED observership, students reported that the experience was worthwhile and identified preceptors as important role models[ 8 ]. ED observational experience has also been associated with increased student interest in emergency medicine and willingness to recommend similar experiences to peers[ 9 ]. Despite this literature, the evidence base for ED-based early exposure remains limited in two respects. First, existing studies have focused primarily on immediate reactions, observership experience, or specialty interest[ 7 – 9 ]. Second, less is known about whether a brief ED preceptorship undertaken before clerkship retains educational significance after learners progress into later stages of training. That question is relevant because the educational rationale for such programs differs if their value lies mainly in specialty recruitment rather than in broader orientation to clinical work and professional development. The present study therefore examined a longitudinally implemented ED preceptorship for Year 1 and Year 2 medical students using a retrospective survey design. The primary aim was to characterize participants’ retrospective perceptions of immediate gains and their current assessment of longer-term educational impact. A secondary, exploratory aim was to examine whether response patterns differed between earlier and more recent cohorts. Methods Study design and participants A single-center, retrospective, cross-sectional survey was conducted to examine retrospective perceptions of immediate gains and current perceptions of longer-term educational impact associated with an emergency department (ED) preceptorship for Year 1 and Year 2 medical students. Eligible participants were all students who completed the program in 2015, 2016, 2017, 2018, 2019, 2020, 2024, or 2025. The preceptorship was not offered from 2021 to 2023. A retrospective design was used because contemporaneous post-program data had not been collected when the program was initiated and because the study sought to capture both retrospective appraisals of immediate gains and current appraisals of longer-term educational significance. All former participants identifiable from program records were invited to complete an online follow-up questionnaire. The sampling frame comprised 66 individuals, of whom 50 provided analyzable responses. Data collection and survey measures The questionnaire collected respondent characteristics, including current stage of training, intended specialty, and whether a formal ED rotation or clerkship had subsequently been completed. Program-related variables included year of participation, academic year at participation, timing and duration of the preceptorship, presence of a fixed preceptor or team, receipt of a pre-program orientation, and observed or experienced activities during the placement. Additional items assessed memory clarity and the ability to recall a specific scene or person from the preceptorship. A study-specific retrospective questionnaire was used rather than an existing validated instrument. The quantitative component comprised three multi-item scales: process and preceptor support (6 items), retrospective immediate gains (8 items), and current long-term impact (8 items). Four conceptually distinct items were analyzed separately as single-item outcomes: influence on future specialty choice, overall long-term educational value, interest in emergency/critical care, and willingness to recommend the program to junior students. All evaluative items were rated on a 5-point Likert scale, from 1 (strongly disagree) to 5 (strongly agree), with an additional response option of “could not recall/not applicable.” For item-level analyses, agreement was defined as a response of “agree” or “strongly agree.” Statistical analysis Likert responses were coded from 1 to 5. Responses marked as “could not recall/not applicable” were treated as missing, and no imputation was performed. Categorical variables were summarized as frequencies and percentages. For the multiple-response item on observed or experienced activities, counts and percentages were calculated for each activity category. Scale scores were calculated as the mean of nonmissing item responses within each scale and are reported as mean (SD). Internal consistency was assessed using Cronbach’s alpha. For cohort comparisons, respondents were grouped into an earlier cohort (2015–2020; Group A) and a more recent cohort (2024–2025; Group B). These comparisons were prespecified as exploratory analyses intended to examine whether response patterns varied by implementation period and recall interval, rather than to estimate temporal program effects. Between-group comparisons of scale scores and single-item outcomes were performed using two-sided Mann–Whitney U tests. A two-sided P value of < .05 was considered statistically significant. All analyses were conducted on an available-case basis; denominators therefore varied across item-level analyses. Statistical analyses were performed using IBM SPSS Statistics (version 28.0; IBM Corp., Armonk, NY, USA). Results Of the 66 eligible participants across eight program years, 50 completed the retrospective survey, corresponding to a response rate of 75.8% (Fig. 1 ). Respondents represented the 2015 (n = 9), 2016 (n = 3), 2017 (n = 4), 2018 (n = 8), 2019 (n = 4), 2020 (n = 2), 2024 (n = 13), and 2025 (n = 7) cohorts. At the time of the survey, 21 respondents (42.0%) were undergraduates, 9 (18.0%) were postgraduates, and 20 (40.0%) were practicing clinicians. The most commonly reported intended specialties were emergency/critical care (14/50, 28.0%) and surgery (13/50, 26.0%). Thirty-six respondents (72.0%) had completed a formal emergency department (ED) rotation or clerkship. Preceptorship participation occurred in Year 1 for 27 respondents (54.0%), Year 2 for 22 (44.0%), and another year for 1 (2.0%). Most placements took place in summer (30/50, 60.0%) or winter (19/50, 38.0%) and lasted 4–5 days (24/50, 48.0%) or 6–7 days (24/50, 48.0%). A fixed preceptor or team was reported by 34 respondents (68.0%), and 34 (68.0%) reported receiving a pre-program orientation. Memory of the preceptorship was described as clear or very clear by 33 respondents (66.0%), and 38 (76.0%) reported being able to recall a specific scene or person clearly (Table 1 ). Table 1 Characteristics of survey respondents and preceptorship experiences Characteristic n (%) Current training stage Undergraduate 21 (42.0) Postgraduate 9 (18.0) Practicing clinician 20 (40.0) Intended specialty Emergency/critical care 14 (28.0) Surgery 13 (26.0) Internal medicine 7 (14.0) Undecided 6 (12.0) Other 10 (20.0) Completed formal ED rotation/clerkship Yes 36 (72.0) No 14 (28.0) Academic year at participation Year 1 27 (54.0) Year 2 22 (44.0) Other 1 (2.0) Timing of preceptorship Summer 30 (60.0) Winter 19 (38.0) Unclear 1 (2.0) Duration of preceptorship 4–5 days 24 (48.0) 6–7 days 24 (48.0) > 7 days 2 (4.0) Fixed preceptor/team Yes 34 (68.0) No 8 (16.0) Unclear 8 (16.0) Pre-program orientation Yes 34 (68.0) No 9 (18.0) Unclear 7 (14.0) Memory clarity Clear/very clear 33 (66.0) Moderate 12 (24.0) Limited/unclear 5 (10.0) Able to recall a specific scene/person Clearly 38 (76.0) Vaguely 11 (22.0) Uncertain 1 (2.0) Data are presented as n (%). Percentages were calculated using all 50 respondents as the denominator. ED = emergency department. Reported activities during the preceptorship are summarized in Table 2 . Procedures or clinical interventions were reported most frequently (43/50, 86.0%), followed by history taking or assessment (41/50, 82.0%) and triage or pre-triage (40/50, 80.0%). Resuscitation or critical care was reported by 37 respondents (74.0%), doctor-patient communication by 32 (64.0%), shift handover by 28 (56.0%), case discussion or teaching by 27 (54.0%), and interprofessional teamwork by 26 (52.0%). Multiple responses were permitted. Table 2 Activities observed or experienced during the preceptorship. Activity n (%) Procedures or clinical interventions 43 (86.0) History taking or patient assessment 41 (82.0) Triage/pre-triage 40 (80.0) Resuscitation or critical care 37 (74.0) Doctor–patient communication 32 (64.0) Shift handover 28 (56.0) Case discussion or teaching 27 (54.0) Interprofessional teamwork 26 (52.0) Multiple responses were permitted. Data are presented as n (%). Percentages were calculated using all 50 respondents as the denominator. Internal consistency coefficients were .80 for process and preceptor support, .82 for retrospective immediate gains, and .74 for current long-term impact. In the full sample, mean (SD) scores were 4.03 (0.61) for process and preceptor support, 4.34 (0.57) for retrospective immediate gains, and 4.24 (0.60) for current long-term impact. Mean (SD) scores for the single-item outcomes were 4.12 (0.88) for influence on future specialty choice, 4.50 (0.75) for overall long-term educational value, 3.85 (1.20) for interest in emergency/critical care, and 4.46 (0.84) for recommendation to junior students (Table 3 ). Table 3 Scale scores and selected single-item outcomes according to cohort Outcome Items Cronbach α Total sample (n = 50), mean (SD) Group A (n = 30), mean (SD) Group B (n = 20), mean (SD) P value Process and preceptor support 6 0.80 4.03 (0.61) 3.90 (0.59) 4.22 (0.60) .06 Retrospective immediate gains 8 0.82 4.34 (0.57) 4.24 (0.65) 4.50 (0.39) .20 Current long-term impact 8 0.74 4.24 (0.60) 4.08 (0.67) 4.47 (0.39) .06 Influence on future specialty choice 1 — 4.12 (0.88) 4.07 (0.84) 4.20 (0.95) .52 Overall long-term educational value 1 — 4.50 (0.75) 4.35 (0.85) 4.70 (0.57) .16 Interest in emergency/critical care 1 — 3.85 (1.20) 3.61 (1.23) 4.20 (1.11) .08 Recommendation to junior students 1 — 4.46 (0.84) 4.20 (0.96) 4.85 (0.37) .005 Group A = 2015–2020 cohort; Group B = 2024–2025 cohort. The preceptorship was not offered from 2021 to 2023. P values compare Group A and Group B. Cronbach’s α is shown for multi-item scales only. The current long-term impact scale excluded the items on future specialty choice and overall long-term educational value, which were analyzed separately as single-item outcomes. For cohort comparisons, respondents were grouped as Group A (2015–2020; n = 30) and Group B (2024–2025; n = 20). Mean scores for recommendation to junior students were higher in Group B than in Group A, 4.85 (0.37) versus 4.20 (0.96), P = .005. No statistically significant between-cohort differences were observed for process and preceptor support, retrospective immediate gains, current long-term impact, influence on future specialty choice, overall long-term educational value, or interest in emergency/critical care (Table 3 ). Selected item-level agreement is presented in Fig. 2 . Within the process and preceptor support domain, 46 of 50 respondents (92.0%) agreed that preceptors explained clinical phenomena and workflow, and 46 of 50 (92.0%) agreed that they had opportunities to ask questions and receive responses. Agreement that the preceptorship content matched respondents’ knowledge level at the time was reported by 15 of 50 respondents (30.0%). Within the retrospective immediate gains domain, 42 of 50 respondents (84.0%) agreed that the preceptorship had been a valuable learning experience at the time. Within the current long-term impact domain, agreement was 43 of 45 (95.6%) for continued influence on later learning or professional development, 42 of 49 (85.7%) for continued usefulness in understanding clinical medicine even without choosing emergency medicine, 41 of 48 (85.4%) for strengthened professional identity, and 39 of 46 (84.8%) for overall long-term educational value. Agreement was lower for influence on future specialty choice (35/49, 71.4%) and increased interest in emergency/critical care (30/48, 62.5%). Forty-five of 50 respondents (90.0%) indicated that they would recommend the program to junior students. Discussion This study examined how former participants appraised a brief ED preceptorship after they had progressed beyond the preclinical phase. Endorsement was strongest for items related to understanding clinical work, professional development, and later learning, whereas endorsement was lower for specialty-related outcomes. Recommendation of the program to junior students was the only outcome that differed significantly between cohorts. The overall response pattern is more consistent with an orienting function than with an early technical-skills curriculum. Respondents more often endorsed items concerning physicians’ responsibilities, communication, teamwork, uncertainty, and later adaptation to clinical training than items implying technical readiness. This aligns with studies of the transition to clerkship showing that students’ difficulties are not limited to knowledge application; they also involve understanding expectations, negotiating team roles, and making sense of the clinical environment[ 1 , 2 , 10 , 11 ]. The present findings therefore place the preceptorship closer to early workplace orientation than to preclinical skills training. The process data further suggest that educational value depended on interpretation as much as on exposure. Agreement was high for preceptors’ explanations and opportunities to ask questions, whereas only a minority agreed that the content matched their knowledge level at the time. This combination indicates that the placement remained useful even when the clinical environment exceeded students’ formal stage of training. Earlier ED observership studies reported a similar reliance on preceptors as role models and mediators of experience, particularly in settings where students had limited direct participation in care[ 8 , 9 ]. In the present study, the placement appears to have been made educationally accessible through guided observation rather than through close alignment with preclinical knowledge. Findings related to professional formation also merit attention. Respondents frequently endorsed continued influence on later learning, strengthened professional identity, and continued usefulness for understanding clinical medicine. Qualitative work on early clinical exposure has described similar processes: early encounters can make professionalism more concrete, emotionally difficult situations can prompt identity work, and clinical placements can shape learners’ sense of legitimate participation in medicine[ 3 – 6 ]. Narrative work from the ED has likewise shown that students notice tensions between compassion, teamwork, efficiency, and ethical conduct in this setting[ 12 ]. Although the present study does not establish how such processes occurred, it suggests that participants located the value of the preceptorship in how it made clinical work intelligible and professionally consequential. Specialty-related outcomes were narrower. Influence on future specialty choice and increased interest in emergency or critical care were endorsed less often than overall long-term educational value. Earlier ED shadowing studies emphasized changes in attitudes toward emergency medicine and willingness to pursue further exposure[ 8 , 9 ]. In the current sample, the educational significance of the placement was not primarily specialty-specific. This distinction clarifies the study’s contribution to the early clinical exposure literature: rather than extending evidence on specialty recruitment, it suggests that brief ED-based exposure may retain educational significance because it supports early orientation to workplace learning and professional development. The cohort comparison should be interpreted cautiously. Recommendation to junior students was higher in the more recent cohort, but other between-cohort differences were small and did not reach conventional thresholds for statistical significance. Because the analysis was exploratory and the design was retrospective, these comparisons do not provide evidence of temporal program effects. Differences in recall interval, current training stage, and response propensity offer equally plausible explanations. Several limitations constrain the strength of inference. The study relied on retrospective self-report and did not include contemporaneous post-program data, prospective follow-up, an unexposed comparison group, or objective measures of later performance. The questionnaire was developed for this evaluation rather than adopted from a previously validated instrument; accordingly, the validity evidence available for score interpretation was limited to conceptual item grouping and internal consistency. The study was conducted at a single institution, and respondents with clearer memories or more favorable views of the program may have been more likely to participate. Although the survey was anonymous, social desirability bias and nonresponse bias cannot be excluded. For these reasons, the findings should be interpreted as evidence of perceived educational significance rather than demonstrated educational effect. Within those limits, the findings have practical implications for the design of early ED exposure. The data do not support treating a brief preceptorship as a compressed substitute for clerkship. They are more consistent with a different educational purpose: structured entry into clinical work before formal workplace learning begins. In practical terms, that purpose appears to depend less on maximizing exposure volume than on explicit orientation, stable preceptor relationships, and opportunities for guided interpretation. Future evaluation would be strengthened by combining contemporaneous post-placement measures with later follow-up and by examining which aspects of the experience remain salient after students enter clerkship. Conclusions A brief ED preceptorship in the preclinical years was associated, in this sample, with enduring educational relevance that extended beyond specialty interest. Its apparent contribution lay in helping students interpret the work, relationships, and responsibilities of clinical practice before they were required to participate in them more fully. Declarations Ethics approval and consent to participate This study was reviewed by the Ethics Committee of the First Affiliated Hospital, Sun Yat-sen University, and was determined to be exempt from full review as a minimal-risk retrospective survey of an educational program. An electronic informed consent statement was presented on the first page of the survey, and only participants who agreed were able to proceed to the questionnaire. All methods were carried out in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Authors’ information Not applicable. Funding No specific funding was received for this study. Author Contribution ZZY conceived the study, coordinated data collection, performed the analysis, and drafted the manuscript. LJH contributed to study design, interpretation of the findings, and critical revision of the manuscript. LYF contributed to study design, supervision of the educational program, and critical revision of the manuscript. All authors read and approved the final manuscript. Acknowledgements The authors thank the former participants who completed the survey and the faculty members who contributed to the ED preceptorship program. Data Availability The datasets generated and analyzed during the current study are not publicly available because the sample was drawn from a single institution and the survey dataset may permit indirect identification of participants. De-identified data are available from the corresponding author on reasonable request and subject to institutional approval. References Bosch J, Maaz A, Hitzblech T, Holzhausen Y, Peters H. Medical students' preparedness for professional activities in early clerkships. BMC Med Educ. 2017;17(1):140. Godefrooij MB, Diemers AD, Scherpbier AJ. Students' perceptions about the transition to the clinical phase of a medical curriculum with preclinical patient contacts; a focus group study. BMC Med Educ. 2010;10:28. Liu CI, Tang KP, Wang YC, Chiu CH. Impacts of early clinical exposure on undergraduate student professionalism-a qualitative study. BMC Med Educ. 2022;22(1):435. Lonn A, Weurlander M, Seeberger A, Hult H, Thornberg R, Wernerson A. The impact of emotionally challenging situations on medical students' professional identity formation. Adv Health Sci Educ Theory Pract. 2023;28(5):1557–78. O'Doherty D, Culhane A, O'Doherty J, Harney S, Glynn L, McKeague H, Kelly D. Medical students and clinical placements - a qualitative study of the continuum of professional identity formation. 2021(1475-990X (Electronic)). Orsmond P, McMillan H, Zvauya R. It's how we practice that matters: professional identity formation and legitimate peripheral participation in medical students: a qualitative study. BMC Med Educ. 2022;22(1):91. Zun LS. 1st- and 2nd-year medical student exposure to emergency medicine. Teach Learn Med. 2002;14(3):164–7. Penciner R. Emergency medicine preclerkship observerships: evaluation of a structured experience. 2009(1481–8043 (Electronic)). Gharahbaghian L, Hindiyeh R, Langdorf MI, Vaca F, Anderson CL, Kahn JA, Wiechmann W, Lotfipour S. The effect of emergency department observational experience on medical student interest in emergency medicine. J Emerg Med. 2011;40(4):458–62. Small RM, Soriano RP, Chietero M, Quintana J, Parkas V, Koestler J. Easing the transition: medical students' perceptions of critical skills required for the clerkships. Educ Health (Abingdon). 2008;21(3):192. Wenrich M, Jackson MB, Scherpbier AJ, Wolfhagen IH, Ramsey PG, Goldstein EA. Ready or not? Expectations of faculty and medical students for clinical skills preparation for clerkships. Med Educ Online 2010, 15. Santen SA, Hemphill RR. A window on professionalism in the emergency department through medical student narratives. Ann Emerg Med. 2011;58(3):288–94. Additional Declarations No competing interests reported. Supplementary Files Studyquestionnaire.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 03 May, 2026 Reviewers agreed at journal 25 Apr, 2026 Reviewers invited by journal 15 Apr, 2026 Editor assigned by journal 13 Apr, 2026 Editor invited by journal 25 Mar, 2026 Submission checks completed at journal 25 Mar, 2026 First submitted to journal 25 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9190723","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626034024,"identity":"f50e4d1e-f87d-4443-96e0-45bb9b772804","order_by":0,"name":"Ziyu Zheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYDACCQglx8DA2HgATRC/FmOglgbStCQ2AAnitMjPbj728Mufw+lr2w8Dbflz2N7gAPPB2zwMdnm4tDDOOZZuLMNzOHfbmcSGA4xthxM3HGBLtuZhSC7GpYVZIsdMWkICqOUASEvD4QSDAzxm0jwMB8BOxQbYJPK/SUsYHE43O/8Q5jD+b3i18EjksEl+SDicYHYDaAsD22HGDQd42PBqkZBIM5NmOJBuuO0G0JbEtvTEmYfZjC3nGCTj1CI/I/mZ5I8/1vJm59MfPvjwx9qe73jzwxtvKuxwagEHAQ9DM4SVAGIwg1gGeNQDAeMPhjoYuw6fwlEwCkbBKBihAAD11l0CnbpNUwAAAABJRU5ErkJggg==","orcid":"","institution":"First Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":true,"prefix":"","firstName":"Ziyu","middleName":"","lastName":"Zheng","suffix":""},{"id":626034025,"identity":"471e14cc-9eaa-4bd3-8632-d16a77b78e9f","order_by":1,"name":"Jianghui Liu","email":"","orcid":"","institution":"First Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Jianghui","middleName":"","lastName":"Liu","suffix":""},{"id":626034026,"identity":"675abc99-35c7-4ae5-ad28-612790249824","order_by":2,"name":"Yifeng Luo","email":"","orcid":"","institution":"First Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Yifeng","middleName":"","lastName":"Luo","suffix":""}],"badges":[],"createdAt":"2026-03-22 11:09:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9190723/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9190723/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107617498,"identity":"f3a86b23-ade5-49eb-805e-58bca3ce1884","added_by":"auto","created_at":"2026-04-23 09:20:58","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":188444,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNumbers of preceptorship participants and survey respondents by year.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBars represent annual numbers of students who participated in the preceptorship and who completed the retrospective survey. The preceptorship was not offered from 2021 to 2023.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9190723/v1/16dc8486455326014afbff99.jpeg"},{"id":107617499,"identity":"bc7f4655-f556-441b-b204-e2769ed7643c","added_by":"auto","created_at":"2026-04-23 09:20:58","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":396381,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAgreement with selected process and educational outcome items.\u003c/strong\u003e\u003cbr\u003e\n \u003cem\u003eAgreement was defined as a response of “agree” or “strongly agree.” Percentages are shown. Denominators varied across items because responses marked “could not recall/not applicable” were excluded from item-level calculations.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9190723/v1/a8992c7280c84416209dfcd2.jpeg"},{"id":107706860,"identity":"acd8ade4-9e3c-4e63-8e9c-a4389eafed30","added_by":"auto","created_at":"2026-04-24 09:18:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":864406,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9190723/v1/5453284d-0640-4abd-830c-6b44c1f4fd8b.pdf"},{"id":107617463,"identity":"bfba5b48-d8ed-4a90-be60-9c8420b4920d","added_by":"auto","created_at":"2026-04-23 09:20:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":97655,"visible":true,"origin":"","legend":"","description":"","filename":"Studyquestionnaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9190723/v1/25f1a2e3129621a5b8d193b5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Early Emergency Department Exposure in Preclinical Medical Education: A Retrospective Survey of Perceived Immediate Gains and Longer-Term Educational Impact","fulltext":[{"header":"Background","content":"\u003cp\u003eThe transition from preclinical study to workplace-based clinical learning remains a vulnerable phase of undergraduate medical education. Students entering clerkships commonly report difficulty translating preclinical knowledge into patient care, uncertainty about expectations, and limited confidence in navigating the clinical environment. Prior empirical work has shown that early patient contact may reduce the \u0026ldquo;shock of practice\u0026rdquo; and improve preparedness for clerkship, while readiness for early clinical work is influenced by prior clinical exposure and the quality of supervision[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly clinical exposure may also shape how students begin to understand professional practice. Qualitative studies have shown that early encounters with patients and clinical teams can alter students\u0026rsquo; views of professionalism, and that emotionally challenging clinical situations may contribute to professional identity formation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Other studies of early placements have emphasized the importance of mentorship, role modelling, and participation in clinical communities in helping students make sense of medical work and their developing role within it [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe emergency department (ED) provides a distinctive setting for early clinical exposure. It brings together undifferentiated presentations, acute deterioration, interprofessional coordination, and time-pressured decision making within a single workplace. A national survey published in Teaching and Learning in Medicine found that many U.S. medical schools offered some form of emergency medicine exposure in the first two years of training, although the format and extent of that exposure varied[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In a structured preclerkship ED observership, students reported that the experience was worthwhile and identified preceptors as important role models[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. ED observational experience has also been associated with increased student interest in emergency medicine and willingness to recommend similar experiences to peers[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite this literature, the evidence base for ED-based early exposure remains limited in two respects. First, existing studies have focused primarily on immediate reactions, observership experience, or specialty interest[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Second, less is known about whether a brief ED preceptorship undertaken before clerkship retains educational significance after learners progress into later stages of training. That question is relevant because the educational rationale for such programs differs if their value lies mainly in specialty recruitment rather than in broader orientation to clinical work and professional development. The present study therefore examined a longitudinally implemented ED preceptorship for Year 1 and Year 2 medical students using a retrospective survey design. The primary aim was to characterize participants\u0026rsquo; retrospective perceptions of immediate gains and their current assessment of longer-term educational impact. A secondary, exploratory aim was to examine whether response patterns differed between earlier and more recent cohorts.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participants\u003c/h2\u003e \u003cp\u003eA single-center, retrospective, cross-sectional survey was conducted to examine retrospective perceptions of immediate gains and current perceptions of longer-term educational impact associated with an emergency department (ED) preceptorship for Year 1 and Year 2 medical students. Eligible participants were all students who completed the program in 2015, 2016, 2017, 2018, 2019, 2020, 2024, or 2025. The preceptorship was not offered from 2021 to 2023.\u003c/p\u003e \u003cp\u003eA retrospective design was used because contemporaneous post-program data had not been collected when the program was initiated and because the study sought to capture both retrospective appraisals of immediate gains and current appraisals of longer-term educational significance. All former participants identifiable from program records were invited to complete an online follow-up questionnaire. The sampling frame comprised 66 individuals, of whom 50 provided analyzable responses.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection and survey measures\u003c/h3\u003e\n\u003cp\u003eThe questionnaire collected respondent characteristics, including current stage of training, intended specialty, and whether a formal ED rotation or clerkship had subsequently been completed. Program-related variables included year of participation, academic year at participation, timing and duration of the preceptorship, presence of a fixed preceptor or team, receipt of a pre-program orientation, and observed or experienced activities during the placement. Additional items assessed memory clarity and the ability to recall a specific scene or person from the preceptorship.\u003c/p\u003e \u003cp\u003eA study-specific retrospective questionnaire was used rather than an existing validated instrument. The quantitative component comprised three multi-item scales: process and preceptor support (6 items), retrospective immediate gains (8 items), and current long-term impact (8 items). Four conceptually distinct items were analyzed separately as single-item outcomes: influence on future specialty choice, overall long-term educational value, interest in emergency/critical care, and willingness to recommend the program to junior students. All evaluative items were rated on a 5-point Likert scale, from 1 (strongly disagree) to 5 (strongly agree), with an additional response option of \u0026ldquo;could not recall/not applicable.\u0026rdquo; For item-level analyses, agreement was defined as a response of \u0026ldquo;agree\u0026rdquo; or \u0026ldquo;strongly agree.\u0026rdquo;\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eLikert responses were coded from 1 to 5. Responses marked as \u0026ldquo;could not recall/not applicable\u0026rdquo; were treated as missing, and no imputation was performed. Categorical variables were summarized as frequencies and percentages. For the multiple-response item on observed or experienced activities, counts and percentages were calculated for each activity category.\u003c/p\u003e \u003cp\u003eScale scores were calculated as the mean of nonmissing item responses within each scale and are reported as mean (SD). Internal consistency was assessed using Cronbach\u0026rsquo;s alpha. For cohort comparisons, respondents were grouped into an earlier cohort (2015\u0026ndash;2020; Group A) and a more recent cohort (2024\u0026ndash;2025; Group B). These comparisons were prespecified as exploratory analyses intended to examine whether response patterns varied by implementation period and recall interval, rather than to estimate temporal program effects. Between-group comparisons of scale scores and single-item outcomes were performed using two-sided Mann\u0026ndash;Whitney U tests. A two-sided P value of \u0026lt; .05 was considered statistically significant. All analyses were conducted on an available-case basis; denominators therefore varied across item-level analyses. Statistical analyses were performed using IBM SPSS Statistics (version 28.0; IBM Corp., Armonk, NY, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 66 eligible participants across eight program years, 50 completed the retrospective survey, corresponding to a response rate of 75.8% (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Respondents represented the 2015 (n\u0026thinsp;=\u0026thinsp;9), 2016 (n\u0026thinsp;=\u0026thinsp;3), 2017 (n\u0026thinsp;=\u0026thinsp;4), 2018 (n\u0026thinsp;=\u0026thinsp;8), 2019 (n\u0026thinsp;=\u0026thinsp;4), 2020 (n\u0026thinsp;=\u0026thinsp;2), 2024 (n\u0026thinsp;=\u0026thinsp;13), and 2025 (n\u0026thinsp;=\u0026thinsp;7) cohorts. At the time of the survey, 21 respondents (42.0%) were undergraduates, 9 (18.0%) were postgraduates, and 20 (40.0%) were practicing clinicians. The most commonly reported intended specialties were emergency/critical care (14/50, 28.0%) and surgery (13/50, 26.0%). Thirty-six respondents (72.0%) had completed a formal emergency department (ED) rotation or clerkship. Preceptorship participation occurred in Year 1 for 27 respondents (54.0%), Year 2 for 22 (44.0%), and another year for 1 (2.0%). Most placements took place in summer (30/50, 60.0%) or winter (19/50, 38.0%) and lasted 4\u0026ndash;5 days (24/50, 48.0%) or 6\u0026ndash;7 days (24/50, 48.0%). A fixed preceptor or team was reported by 34 respondents (68.0%), and 34 (68.0%) reported receiving a pre-program orientation. Memory of the preceptorship was described as clear or very clear by 33 respondents (66.0%), and 38 (76.0%) reported being able to recall a specific scene or person clearly (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of survey respondents and preceptorship experiences\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent training stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (42.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (18.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePracticing clinician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (40.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntended specialty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency/critical care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (28.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (26.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (14.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndecided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (12.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (20.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompleted formal ED rotation/clerkship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (72.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (28.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic year at participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (54.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (44.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTiming of preceptorship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSummer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWinter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (38.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of preceptorship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (48.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (48.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (4.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFixed preceptor/team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34 (68.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (16.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (16.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-program orientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34 (68.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (18.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (14.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMemory clarity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClear/very clear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (66.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (24.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimited/unclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAble to recall a specific scene/person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClearly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (76.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaguely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (22.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUncertain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eData are presented as n (%). Percentages were calculated using all 50 respondents as the denominator.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eED\u0026thinsp;=\u0026thinsp;emergency department.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eReported activities during the preceptorship are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Procedures or clinical interventions were reported most frequently (43/50, 86.0%), followed by history taking or assessment (41/50, 82.0%) and triage or pre-triage (40/50, 80.0%). Resuscitation or critical care was reported by 37 respondents (74.0%), doctor-patient communication by 32 (64.0%), shift handover by 28 (56.0%), case discussion or teaching by 27 (54.0%), and interprofessional teamwork by 26 (52.0%). Multiple responses were permitted.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eActivities observed or experienced during the preceptorship.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedures or clinical interventions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (86.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory taking or patient assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (82.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriage/pre-triage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (80.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResuscitation or critical care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (74.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctor\u0026ndash;patient communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (64.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShift handover\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (56.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase discussion or teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (54.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterprofessional teamwork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (52.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eMultiple responses were permitted. Data are presented as n (%). Percentages were calculated using all 50 respondents as the denominator.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eInternal consistency coefficients were .80 for process and preceptor support, .82 for retrospective immediate gains, and .74 for current long-term impact. In the full sample, mean (SD) scores were 4.03 (0.61) for process and preceptor support, 4.34 (0.57) for retrospective immediate gains, and 4.24 (0.60) for current long-term impact. Mean (SD) scores for the single-item outcomes were 4.12 (0.88) for influence on future specialty choice, 4.50 (0.75) for overall long-term educational value, 3.85 (1.20) for interest in emergency/critical care, and 4.46 (0.84) for recommendation to junior students (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eScale scores and selected single-item outcomes according to cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCronbach α\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal sample (n\u0026thinsp;=\u0026thinsp;50), mean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGroup A (n\u0026thinsp;=\u0026thinsp;30), mean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGroup B (n\u0026thinsp;=\u0026thinsp;20), mean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcess and preceptor support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.03 (0.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.90 (0.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.22 (0.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetrospective immediate gains\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.34 (0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.24 (0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.50 (0.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent long-term impact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.24 (0.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.08 (0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.47 (0.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfluence on future specialty choice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.12 (0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.07 (0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.20 (0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall long-term educational value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.50 (0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.35 (0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.70 (0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterest in emergency/critical care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.85 (1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.61 (1.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.20 (1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecommendation to junior students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.46 (0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.20 (0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.85 (0.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eGroup A\u0026thinsp;=\u0026thinsp;2015\u0026ndash;2020 cohort; Group B\u0026thinsp;=\u0026thinsp;2024\u0026ndash;2025 cohort. The preceptorship was not offered from 2021 to 2023. \u003cem\u003eP\u003c/em\u003e values compare Group A and Group B. Cronbach\u0026rsquo;s α is shown for multi-item scales only. The current long-term impact scale excluded the items on future specialty choice and overall long-term educational value, which were analyzed separately as single-item outcomes.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor cohort comparisons, respondents were grouped as Group A (2015\u0026ndash;2020; n\u0026thinsp;=\u0026thinsp;30) and Group B (2024\u0026ndash;2025; n\u0026thinsp;=\u0026thinsp;20). Mean scores for recommendation to junior students were higher in Group B than in Group A, 4.85 (0.37) versus 4.20 (0.96), \u003cem\u003eP\u003c/em\u003e = .005. No statistically significant between-cohort differences were observed for process and preceptor support, retrospective immediate gains, current long-term impact, influence on future specialty choice, overall long-term educational value, or interest in emergency/critical care (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSelected item-level agreement is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Within the process and preceptor support domain, 46 of 50 respondents (92.0%) agreed that preceptors explained clinical phenomena and workflow, and 46 of 50 (92.0%) agreed that they had opportunities to ask questions and receive responses. Agreement that the preceptorship content matched respondents\u0026rsquo; knowledge level at the time was reported by 15 of 50 respondents (30.0%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWithin the retrospective immediate gains domain, 42 of 50 respondents (84.0%) agreed that the preceptorship had been a valuable learning experience at the time. Within the current long-term impact domain, agreement was 43 of 45 (95.6%) for continued influence on later learning or professional development, 42 of 49 (85.7%) for continued usefulness in understanding clinical medicine even without choosing emergency medicine, 41 of 48 (85.4%) for strengthened professional identity, and 39 of 46 (84.8%) for overall long-term educational value. Agreement was lower for influence on future specialty choice (35/49, 71.4%) and increased interest in emergency/critical care (30/48, 62.5%). Forty-five of 50 respondents (90.0%) indicated that they would recommend the program to junior students.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined how former participants appraised a brief ED preceptorship after they had progressed beyond the preclinical phase. Endorsement was strongest for items related to understanding clinical work, professional development, and later learning, whereas endorsement was lower for specialty-related outcomes. Recommendation of the program to junior students was the only outcome that differed significantly between cohorts.\u003c/p\u003e \u003cp\u003eThe overall response pattern is more consistent with an orienting function than with an early technical-skills curriculum. Respondents more often endorsed items concerning physicians\u0026rsquo; responsibilities, communication, teamwork, uncertainty, and later adaptation to clinical training than items implying technical readiness. This aligns with studies of the transition to clerkship showing that students\u0026rsquo; difficulties are not limited to knowledge application; they also involve understanding expectations, negotiating team roles, and making sense of the clinical environment[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The present findings therefore place the preceptorship closer to early workplace orientation than to preclinical skills training.\u003c/p\u003e \u003cp\u003eThe process data further suggest that educational value depended on interpretation as much as on exposure. Agreement was high for preceptors\u0026rsquo; explanations and opportunities to ask questions, whereas only a minority agreed that the content matched their knowledge level at the time. This combination indicates that the placement remained useful even when the clinical environment exceeded students\u0026rsquo; formal stage of training. Earlier ED observership studies reported a similar reliance on preceptors as role models and mediators of experience, particularly in settings where students had limited direct participation in care[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In the present study, the placement appears to have been made educationally accessible through guided observation rather than through close alignment with preclinical knowledge.\u003c/p\u003e \u003cp\u003eFindings related to professional formation also merit attention. Respondents frequently endorsed continued influence on later learning, strengthened professional identity, and continued usefulness for understanding clinical medicine. Qualitative work on early clinical exposure has described similar processes: early encounters can make professionalism more concrete, emotionally difficult situations can prompt identity work, and clinical placements can shape learners\u0026rsquo; sense of legitimate participation in medicine[\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Narrative work from the ED has likewise shown that students notice tensions between compassion, teamwork, efficiency, and ethical conduct in this setting[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Although the present study does not establish how such processes occurred, it suggests that participants located the value of the preceptorship in how it made clinical work intelligible and professionally consequential.\u003c/p\u003e \u003cp\u003eSpecialty-related outcomes were narrower. Influence on future specialty choice and increased interest in emergency or critical care were endorsed less often than overall long-term educational value. Earlier ED shadowing studies emphasized changes in attitudes toward emergency medicine and willingness to pursue further exposure[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In the current sample, the educational significance of the placement was not primarily specialty-specific. This distinction clarifies the study\u0026rsquo;s contribution to the early clinical exposure literature: rather than extending evidence on specialty recruitment, it suggests that brief ED-based exposure may retain educational significance because it supports early orientation to workplace learning and professional development.\u003c/p\u003e \u003cp\u003eThe cohort comparison should be interpreted cautiously. Recommendation to junior students was higher in the more recent cohort, but other between-cohort differences were small and did not reach conventional thresholds for statistical significance. Because the analysis was exploratory and the design was retrospective, these comparisons do not provide evidence of temporal program effects. Differences in recall interval, current training stage, and response propensity offer equally plausible explanations.\u003c/p\u003e \u003cp\u003eSeveral limitations constrain the strength of inference. The study relied on retrospective self-report and did not include contemporaneous post-program data, prospective follow-up, an unexposed comparison group, or objective measures of later performance. The questionnaire was developed for this evaluation rather than adopted from a previously validated instrument; accordingly, the validity evidence available for score interpretation was limited to conceptual item grouping and internal consistency. The study was conducted at a single institution, and respondents with clearer memories or more favorable views of the program may have been more likely to participate. Although the survey was anonymous, social desirability bias and nonresponse bias cannot be excluded. For these reasons, the findings should be interpreted as evidence of perceived educational significance rather than demonstrated educational effect.\u003c/p\u003e \u003cp\u003eWithin those limits, the findings have practical implications for the design of early ED exposure. The data do not support treating a brief preceptorship as a compressed substitute for clerkship. They are more consistent with a different educational purpose: structured entry into clinical work before formal workplace learning begins. In practical terms, that purpose appears to depend less on maximizing exposure volume than on explicit orientation, stable preceptor relationships, and opportunities for guided interpretation. Future evaluation would be strengthened by combining contemporaneous post-placement measures with later follow-up and by examining which aspects of the experience remain salient after students enter clerkship.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eA brief ED preceptorship in the preclinical years was associated, in this sample, with enduring educational relevance that extended beyond specialty interest. Its apparent contribution lay in helping students interpret the work, relationships, and responsibilities of clinical practice before they were required to participate in them more fully.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was reviewed by the Ethics Committee of the First Affiliated Hospital, Sun Yat-sen University, and was determined to be exempt from full review as a minimal-risk retrospective survey of an educational program. An electronic informed consent statement was presented on the first page of the survey, and only participants who agreed were able to proceed to the questionnaire. All methods were carried out in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAuthors\u0026rsquo; information\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo specific funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eZZY conceived the study, coordinated data collection, performed the analysis, and drafted the manuscript. LJH contributed to study design, interpretation of the findings, and critical revision of the manuscript. LYF contributed to study design, supervision of the educational program, and critical revision of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors thank the former participants who completed the survey and the faculty members who contributed to the ED preceptorship program.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available because the sample was drawn from a single institution and the survey dataset may permit indirect identification of participants. De-identified data are available from the corresponding author on reasonable request and subject to institutional approval.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBosch J, Maaz A, Hitzblech T, Holzhausen Y, Peters H. Medical students' preparedness for professional activities in early clerkships. BMC Med Educ. 2017;17(1):140.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGodefrooij MB, Diemers AD, Scherpbier AJ. Students' perceptions about the transition to the clinical phase of a medical curriculum with preclinical patient contacts; a focus group study. BMC Med Educ. 2010;10:28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu CI, Tang KP, Wang YC, Chiu CH. Impacts of early clinical exposure on undergraduate student professionalism-a qualitative study. BMC Med Educ. 2022;22(1):435.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLonn A, Weurlander M, Seeberger A, Hult H, Thornberg R, Wernerson A. The impact of emotionally challenging situations on medical students' professional identity formation. Adv Health Sci Educ Theory Pract. 2023;28(5):1557\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Doherty D, Culhane A, O'Doherty J, Harney S, Glynn L, McKeague H, Kelly D. Medical students and clinical placements - a qualitative study of the continuum of professional identity formation. 2021(1475-990X (Electronic)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrsmond P, McMillan H, Zvauya R. It's how we practice that matters: professional identity formation and legitimate peripheral participation in medical students: a qualitative study. BMC Med Educ. 2022;22(1):91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZun LS. 1st- and 2nd-year medical student exposure to emergency medicine. Teach Learn Med. 2002;14(3):164\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePenciner R. Emergency medicine preclerkship observerships: evaluation of a structured experience. 2009(1481\u0026ndash;8043 (Electronic)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGharahbaghian L, Hindiyeh R, Langdorf MI, Vaca F, Anderson CL, Kahn JA, Wiechmann W, Lotfipour S. The effect of emergency department observational experience on medical student interest in emergency medicine. J Emerg Med. 2011;40(4):458\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmall RM, Soriano RP, Chietero M, Quintana J, Parkas V, Koestler J. Easing the transition: medical students' perceptions of critical skills required for the clerkships. Educ Health (Abingdon). 2008;21(3):192.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWenrich M, Jackson MB, Scherpbier AJ, Wolfhagen IH, Ramsey PG, Goldstein EA. Ready or not? Expectations of faculty and medical students for clinical skills preparation for clerkships. Med Educ Online 2010, 15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanten SA, Hemphill RR. A window on professionalism in the emergency department through medical student narratives. Ann Emerg Med. 2011;58(3):288\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"early clinical exposure, emergency department, preclinical medical students, workplace learning, professional identity, survey","lastPublishedDoi":"10.21203/rs.3.rs-9190723/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9190723/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEarly clinical exposure in the emergency department has been used to introduce preclinical students to clinical work, but existing studies have focused mainly on immediate reactions or specialty interest. This study examined retrospective perceptions of immediate gains and current perceptions of longer-term educational impact associated with a brief emergency department preceptorship.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA single-center, retrospective, cross-sectional survey was conducted among all identifiable former participants in an emergency department preceptorship delivered in 2015, 2016, 2017, 2018, 2019, 2020, 2024, and 2025. A study-specific questionnaire assessed process and preceptor support, retrospective immediate gains, current long-term impact, and four single-item outcomes. Descriptive statistics, Cronbach\u0026rsquo;s alpha, and Mann\u0026ndash;Whitney U tests were used. Cohort comparisons between 2015\u0026ndash;2020 and 2024\u0026ndash;2025 were exploratory.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf 66 eligible participants, 50 completed the survey (75.8%). Mean (SD) scores were 4.03 (0.61) for process and preceptor support, 4.34 (0.57) for retrospective immediate gains, and 4.24 (0.60) for current long-term impact. Single-item mean (SD) scores were 4.12 (0.88) for influence on future specialty choice, 4.50 (0.75) for overall long-term educational value, 3.85 (1.20) for interest in emergency/critical care, and 4.46 (0.84) for recommendation to junior students. Agreement was high for preceptors\u0026rsquo; explanations and opportunities to ask questions (both 92.0%), continued influence on later learning or professional development (95.6%), and recommendation to junior students (90.0%). Recommendation to junior students was higher in the 2024\u0026ndash;2025 cohort than in the 2015\u0026ndash;2020 cohort (4.85 [0.37] vs 4.20 [0.96], \u003cem\u003eP\u003c/em\u003e = .005); no other between-cohort differences were statistically significant.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eParticipants retrospectively associated a brief emergency department preceptorship with perceived immediate gains and sustained educational relevance. Reported benefits were more consistent for workplace orientation and professional development than for specialty-related outcomes.\u003c/p\u003e","manuscriptTitle":"Early Emergency Department Exposure in Preclinical Medical Education: A Retrospective Survey of Perceived Immediate Gains and Longer-Term Educational Impact","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 09:20:46","doi":"10.21203/rs.3.rs-9190723/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-03T12:44:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238120247682712249088750345118111889063","date":"2026-04-25T04:01:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-15T05:49:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-13T09:14:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-25T15:40:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-25T11:18:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-25T10:36:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d098f86-9d0f-4113-a932-322c6683e8fe","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-03T12:44:17+00:00","index":73,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T09:20:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 09:20:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9190723","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9190723","identity":"rs-9190723","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}