Pediatrics · Medical Literature
Effect of structured preceptorship on clinical reasoning of pediatric residents in Indonesia: a randomized controlled trial.
Abstract
Diagnostic errors contribute to patient safety risks, often arising from cognitive failures in clinical reasoning. Preceptorship is thought to improve residents' clinical reasoning. The aim of this study was to evaluate the effect of a preceptorship program on clinical reasoning among pediatric residents. This randomized controlled trial was conducted from March 2025 to May 2025 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. All pediatric residents were randomly allocated into two groups. The intervention group received a scheduled preceptorship program, while the control group continued with standard supervision. After 8 weeks, clinical reasoning skills were assessed using the Script Concordance Test (SCT). Data were analyzed using comparation test. End-of-program questionnaires were also reported. Total 41 residents completed the study. Baseline characteristics did not differ between groups (p>0.05). Mean overall SCT scores ranged from 55% to 90% of the maximum possible score. Among 14 topics, hematology & oncology was the only topic that showed a significant difference in SCT scores between the intervention group (median, 14.28; interquartile range [IQR], 12.78-15.08) and the control group (median, 12.75; IQR, 11.49-13.63). Participants reported that preceptorship made learning more structured and interactive but noted barriers including busy preceptor schedules and lack of standardized teaching materials. The preceptorship program resulted in a significant improvement in only one topic, which may reflect suboptimal implementation of the intervention. Despite this, participants reported positive perceptions, indicating good acceptability. More intensive and consistent preceptorship may be required to achieve measurable improvements in clinical reasoning.
Clinical relevance
Does a structured, scheduled preceptorship program improve clinical reasoning skills—as measured by the Script Concordance Test—among pediatric residents compared with standard supervision alone? __SNAPSHOT__ {"studyDesign":"Randomized controlled trial (RCT)","setting":"Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; single-center academic tertiary referral hospital","sampleSize":"n=41 pediatric residents who completed the study (group sizes not reported in abstract; allocation ratio not specified)","population":"Pediatric residents at a single Indonesian academic medical center; baseline characteristics balanced between groups (p>0.05 for all reported comparators)","intervention":"Structured, scheduled preceptorship program over 8 weeks, covering 14 pediatric subspecialty topics; described as making learning 'more structured and interactive'","comparator":"Standard supervision (usual-care clinical teaching without a formalized preceptorship schedule)","primaryOutcome":"Clinical reasoning skills assessed by the Script Concordance Test (SCT) across 14 pediatric topics, scored as percentage of maximum possible score and reported per-topic as median with interquartile range","followUp":"8 weeks (duration of the intervention period; no post-intervention follow-up reported beyond end-of-program assessment)","fundingSource":"Not reported"}
Key findings
A total of 41 residents completed the trial. Overall SCT scores across both groups ranged from 55% to 90% of the maximum possible score; absolute group-level mean or median scores for the overall SCT are not reported beyond this range. Among 14 subspecialty topics tested, only hematology & oncology showed a statistically significant between-group difference: the intervention group scored higher (median 14.28, IQR 12.78–15.08) than the control group (median 12.75, IQR 11.49–13.63). The p-value, effect size, and confidence interval for this difference are not reported in the abstract. The maximum possible score for the hematology & oncology topic is not stated, precluding calculation of a meaningful percentage difference. No significant between-group difference was detected in the remaining 13 topics. NNT cannot be calculated from the data provided. No adverse events were reported (this was an educational, not clinical, intervention). End-of-program questionnaire data indicated positive resident perceptions of the preceptorship program.
Practice implications
This RCT established that an 8-week structured preceptorship program produced a statistically significant improvement in SCT scores in only 1 of 14 pediatric subspecialty topics (hematology & oncology) compared with standard supervision; it did not demonstrate a broad improvement in overall clinical reasoning as operationalized by the SCT. The study does not establish that structured preceptorship meaningfully improves clinical reasoning across the scope of pediatric residency training. The findings apply specifically to Indonesian pediatric residents training at a single academic center and should not be extrapolated to other residency systems, countries, or clinical specialties without further evidence. The clinical importance of the isolated hematology & oncology difference cannot be fully assessed because the maximum topic score and between-group difference magnitude (as a percentage) are not reported, and no p-value or confidence interval is provided. The authors themselves attribute the limited effect to suboptimal implementation (busy preceptor schedules, lack of standardized teaching materials). Resident-reported acceptability was high, suggesting the intervention format is feasible. Practice (preceptorship structure in residency programs) should not be changed based on this single, small, single-center trial; confirmation in larger, multi-center trials with standardized implementation fidelity is required. Note: this summary is based on the abstract only, which limits full methodological appraisal. __LIMITATIONS__ Small sample size (n=41 completers), severely limiting statistical power to detect differences in 14 separate topic analyses and raising concerns about Type II error for the 13 non-significant topics,Single-center design at one Indonesian tertiary hospital substantially limits generalizability to other programs, healthcare systems, or countries,Short follow-up (8 weeks only); no long-term assessment of clinical reasoning retention or downstream patient safety outcomes,Abstract does not report p-values, confidence intervals, or effect sizes for the one significant finding, nor for the overall SCT comparison, precluding full quantitative appraisal,Maximum possible score for each topic is not stated, making the magnitude of the hematology & oncology difference impossible to contextualize,Described as analyzed by 'comparation test'—the specific statistical test(s) used are not identified in the abstract, raising uncertainty about the appropriateness of non-parametric analyses,No blinding of assessors or residents to group allocation is described, introducing performance and detection bias,SCT is a surrogate educational outcome; the study does not assess whether improved SCT scores translate to reduced diagnostic error rates or improved patient outcomes,Multiple comparisons across 14 topics without reported correction for Type I error inflation (e.g., Bonferroni or Benjamini-Hochberg adjustment), raising the possibility that the single significant result is a chance finding,Implementation fidelity of the preceptorship intervention is acknowledged to have been suboptimal, limiting conclusions about whether a well-implemented program would produce broader benefits,Funding source is not reported; potential conflicts of interest cannot be assessed __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ An 8-week structured preceptorship program for Indonesian pediatric residents improved SCT-measured clinical reasoning in only 1 of 14 subspecialty topics (hematology & oncology) compared with standard supervision, with no significant difference across the remaining 13 topics. The trial is underpowered, single-center, and limited to a surrogate educational outcome with acknowledged implementation gaps, and multiple-comparisons inflation cannot be excluded for the lone significant result. This study alone is insufficient to justify restructuring residency preceptorship programs; larger, methodologically rigorous multi-center trials with standardized implementation are needed before this approach can be considered evidence-based practice.