Table 5. Challenges to Teaching in the Ambulatory Setting and Solutions Generated by Participants.

Challenge	Solution
Time constraints/competing priorities (relative value units, notes, research, family)	•Utilize SNAPPS and Five Microskills as techniques to streamline precepting time, making the encounter more efficient •Orient the learner to the patient's reasons for the visit ahead of time so that the learner can become familiar with the medical concern
Preceptor takes ownership over the patient and undermines the learner's role	•Obtain feedback from the learner about one's performance as preceptor •Ensure that the learner is addressing the patient as much as possible, including discussion of plan and giving prescriptions •Utilize body language, such as allowing the learner to enter the room first, directing the patient's questions to the learner, and stepping out of the line of sight between the patient and the learner
Lack of independence for the learner	•SNAPPS naturally encourages independence in learning; preceptor can encourage appropriate independence in management •Five Microskills' “getting a commitment” can foster independent thinking and at times boost confidence; “probe for supporting evidence” provides an opportunity to identify potential reasons for lack of independent thought/action
Lack of preceptor confidence in own knowledge, skills, and/or experience	•Role-model appropriate question asking and turning to literature to answer clinical questions •Utilize own experience as a clinician
Lack of learner knowledge, interest, or experience	•Both SNAPPS and Five Microskills build learner knowledge over time •Stress learning of small chunks of information rather than expecting the learner to become an expert after one session •Engage the learner to find out what interests him/her, and direct the learning towards that area
Unpredictable chief complaints/ cannot always prepare for content of encounters	•Fall back on medical education topics common to all patient scenarios, such as physical exam, communication, preventive health, and psychosocial care
Patient refuses learner involvement in his/her care	•Contact the patient ahead of time to alert him/her that a learner will be participating in the medical care •Stress the quality, experience, and effectiveness of the learner as a caretaker •Prepare the learner ahead of time to ensure his/her role as a knowledgeable caretaker