A resurgence of general interest in teaching clinical medicine in ambulatory-care settings has occurred for several reasons, including changes in the case mix in teaching hospitals, the new responsibilities of house officers and attending physicians brought about by the current payment systems for health care, the increased expectations of patients that medical care will be "personal," the progressive limitations imposed on the education of medical students by the shorter lengths of stay sought by hospitals under the diagnosis-related-groups system of payment, and the growing need for well-trained primary care physicians that has resulted from the increase in medical care organizations. In this paper, I review earlier attempts to emphasize ambulatory care, to identify the pitfalls that new efforts in this direction should avoid. I also compare inpatient and ambulatory-care teaching to provide a basis for understanding the educational goals that can be achieved more easily in each setting. In addition, I suggest major changes in the flow and use of clinical-practice funds and hospital payments so that they can become possible sources of the financing and organization of an expanded effort to teach clinical medicine in ambulatory-care settings.
This article has been cited by other articles:
Jospe, N., Kaplowitz, P. B., McCurdy, F. A., Gottlieb, R. P., Harris, M. A., Boyle, R.
(2001). Third-Year Medical Student Survey of Office Preceptorships During the Pediatric Clerkship. Arch Pediatr Adolesc Med
155: 592-596
[Abstract][Full Text]
Pessar, L. F.
(2000). Ambulatory Care Teaching and the Psychiatric Clerkship. Acad. Psychiatry
24: 61-67
[Abstract][Full Text]
Epstein, R. M., Cole, D. R., Gawinski, B. A., Piotrowski-Lee, S., Ruddy, N. B.
(1998). How Students Learn From Community-Based Preceptors. Arch Fam Med
7: 149-154
[Abstract][Full Text]
Frank, S. H., Stange, K. C., Langa, D., Workings, M.
(1997). Direct Observation of Community-Based Ambulatory Encounters Involving Medical Students. JAMA
278: 712-716
[Abstract]
Kassirer, J. P.
(1996). Redesigning Graduate Medical Education -- Location and Content. NEJM
335: 507-509
[Full Text]
Lesky, L. G., Hershman, W. Y.
(1995). Practical Approaches to a Major Educational Challenge: Training Students in the Ambulatory Setting. Arch Intern Med
155: 897-904
[Abstract]
Packman, C. H., Krackov, S. K., Groff, G. D., Cohen, J.
(1994). The Rochester Practice-Based Experience: An Experiment in Medical Education. Arch Intern Med
154: 1253-1260
[Abstract]
Schatz, I. J.
(1993). Changes in Undergraduate Medical Education: A Critique. Arch Intern Med
153: 1045-1052
[Abstract]
Sargent, J. R., Osborn, L. M.
(1990). Resident Training in Community Pediatricians' Offices: Not a Financial Drain. Arch Pediatr Adolesc Med
144: 1356-1359
[Abstract]
Lesky, L. G., Borkan, S. C.
(1990). Strategies to Improve Teaching in the Ambulatory Medicine Setting. Arch Intern Med
150: 2133-2137
[Abstract]
Andersen, R. M., Lyttle, C., Kohrman, C. H., Levey, G. S., Neymarc, K., Schmidt, C.
(1990). National Study of Internal Medicine Manpower: XVII.Changes in the Characteristics of Internal MedicineResidents and Their Training Programs, 1988-1989. ANN INTERN MED
113: 243-249
[Abstract]
Fincke, B. G., Gaehde, S. A., Rubins, H. B.
(1990). The Medical Day Hospital: A New Concept in Ambulatory Medical Education. Arch Intern Med
150: 533-536
[Abstract]
Andersen, R. M., Lyttle, C., Kohrman, C., Levey, G., Glen, C.
(1989). National Study of Internal Medicine Manpower: XV. A Decade of Change in Residency Training in Internal Medicine. ANN INTERN MED
110: 922-929
[Abstract]
Lawhorne, L., Ringdahl, D.
(1989). Cyanocobalamin Injections for Patients Without Documented Deficiency: Reasons for Administration and Patient Responses to Proposed Discontinuation. JAMA
261: 1920-1923
[Abstract]
Flaherty, J. A.
(1988). A New Golden Standard for Residency Training. Arch Intern Med
148: 2343-2343
[Abstract]
Sahler, O. J. Z., Lysaught, J. P., Greenberg, L. W., Siegel, B. S., Caplan, S. E., Nelson, K. G.
(1988). A Survey of Undergraduate Pediatric Education: Progress in the 1980s?. Arch Pediatr Adolesc Med
142: 519-523
[Abstract]
Reuben, D. B., McCue, J. D., Gerbert, B.
(1988). The Residency-Practice Training Mismatch: A Primary Care Education Dilemma. Arch Intern Med
148: 914-919
[Abstract]
Perkoff, G. T.
(1988). Graduate Medical Education Confronted. JAMA
259: 402-404
[Abstract]
BROOK, R. H., FINK, A., KOSECOFF, J., LINN, L. S., WATSON, W. E., DAVIES, A. R., CLARK, V. A., KAMBERG, C., DELBANCO, T. L.
(1987). Educating Physicians and Treating Patients in the Ambulatory Setting: Where Are We Going and How Will We Know When We Arrive?. ANN INTERN MED
107: 392-398
[Abstract]
KOSECOFF, J., BROOK, R. H., FINK, A., KAMBERG, C., ROTH, C. P., GOLDBERG, G. A., LINN, L. S., CLARK, V. A., NEWHOUSE, J. P., DELBANCO, T. L.
(1987). Providing Primary General Medical Care in University Hospitals: Efficiency and Cost. ANN INTERN MED
107: 399-405
[Abstract]
Thompson, H. C.
(1987). Can Pediatrics Meet the Challenge of Social Ill Health?. Arch Pediatr Adolesc Med
141: 884-887
[Abstract]
Riesenberg, D.
(1987). The Teaching Nursing Home: A Golden Annex to the Ivory Tower. JAMA
257: 3119-3120
[Abstract]
Goldberg, H. I., Cohen, D. I., Hershey, C. O., Hsiue, I-L., Porter, D. K., McLaren, C. E.
(1987). A Randomized Controlled Trial of Academic Group Practice: Improving the Operation of the Medicine Clinic. JAMA
257: 2051-2055
[Abstract]
Colwill, J. M.
(1986). Education of the Primary Physician: A Time for Reconsideration?. JAMA
255: 2643-2644
[Abstract]
Previous
