Teaching clinical medicine in the ambulatory setting. An idea whose time may have finally come.

New England Journal of Medicine (Impact Factor: 54.42). 02/1986; 314(1):27-31. DOI: 10.1056/NEJM198601023140105
Source: PubMed

ABSTRACT 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.

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    ABSTRACT: Academic medical centers (AMCs) are under pressure to increase ambulatory medical education, but their capacity for such teaching is limited. Health maintenance organizations (HMOs) are a large and growing institutional setting that could participate in clinical education. Until now, relatively few HMOs and AMCs have reached agreements about teaching, because traditional suspicions have blocked collaboration. Responding to a case prepared as the basis of discussion, about 450 academics and HMO medical directors explored the barriers to and incentives for cooperation between AMCs and HMOs in clinical education. The two groups identified different issues as barriers to collaboration, leaving considerable room to negotiate agreements. AMCs, especially, need to be prepared to offer meaningful academic and financial inducements to attract HMOs to participate in teaching.
    Academic Medicine 07/1990; 65(7):427-32. DOI:10.1097/00001888-199007000-00001 · 3.47 Impact Factor
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    ABSTRACT: Objective: Patients’ attitude towards medical students’ presence during treatment depends on the cultural values of the society. This study was conducted to find out the patients’ receptiveness in our society to be involved in teaching process for medical students during consultation in out patient department of a teaching hospital in Karachi Pakistan. Methodology: This cross sectional study was conducted in the surgical Out Patient Department (OPD) at Dow University Hospital from May 2012 to June 2012. Four hundred and eleven patients consented for participation through non probability purposive sampling, in which 279 patients were from morning clinics in the presence of students for clinical teaching, while 132 patients participated through evening clinics of surgery, when students were not present for comparison in specific dimensions of care for patients’ satisfaction. Results: Majority of patients 293 (71%) agreed with the teaching of students during consultation and they feel they are contributing in future doctor’s teaching, only 24% patients disagreed. Fifty two percent of patients who disagreed reported interference in privacy, 34% reported interference in consultation and 43% felt it resulted in prolong waiting time due to teaching. Conclusion: Majority of the patients agree to be part of teaching for medical students and this study can be used to assess the educational interventions designed to improve the patient based teaching.
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    ABSTRACT: During the 1992–1993 academic year at the Medical College of Georgia, 60 students (33%) participated in a 1‐month Ambulatory Care Block rotation as part of their 3‐month Medicine Clerkship. Sixty‐percent of the students’ time was spent in General Internal Medicine and 40% in the subspecialties of Medicine and in Dermatology. Interactive conferences on topics germane to ambulatory care have been developed. Because the program has been well received by faculty and students, it will be expanded in the 1993–1994 academic year to include all 180 third‐year students as they participate in the Medicine Clerkship.
    Teaching and Learning in Medicine 11/2009; 5(4):210-213. DOI:10.1080/10401339309539624 · 1.12 Impact Factor