Patients' receptivity towards medical student participation has been examined predominantly from the patient and/or the medical student perspective. Few studies have investigated the preceptor's perspective. The study examined preceptors' experience with patients declining medical student participation in clinical care and identified preceptor-related factors associated with this experience. Preceptors (n = 42) were recruited from a Family Medicine educational presentation and completed a survey assessing encounters with patients declining medical student participation, methods for obtaining patient consent, and self-rated clinical education skills. Forty-eight percent and 62% of preceptors have "sometimes" or "often" had patients decline student involvement due to student's status and in the context of a gynecological/urological exam, respectively. Fifty-eight percent "never" or "seldom" obtain patient consent with the student outside the exam room, while 46% "often" or "always" have the student directly inform patients about his/her involvement. Being a faculty preceptor (versus resident preceptor) (r = 0.463, p = 0.026) and feeling uncomfortable talking to patients about students performing the exam (r = -0.482, p = 0.020) were associated with patients declining student participation for a genital exam. Findings indicate that preceptors encounter patients declining medical student involvement in general and sensitive exam scenarios. In addition, patients are more likely to decline student participation when preceptors are faculty members and less comfortable discussing student involvement.