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

New England Journal of Medicine (Impact Factor: 55.87). 02/1986; 314(1):27-31. DOI: 10.1056/NEJM198601023140105
Source: PubMed


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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    • "There is a pressure over health care providers and hospital managers in changing climate of health services to evaluate the services in view of patient’s expectations and their mismatch can result in patient’s dissatisfaction.6,7 These days medical education has been shifted more to the out patient settings (ambulatory teaching) from hospitals8 but there is a perception that due to concerns of patient’s discomfort; many hospitals are reluctant to participate in medical education of the students especially in outpatient settings. Presence of students during consultation in out patient clinics results in increasing waiting time for consultation and perception of interference in privacy and consultation process.4,9 "
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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.
    Pakistan Journal of Medical Sciences Online 04/2013; 29(2):454-7. DOI:10.12669/pjms.292.3186 · 0.23 Impact Factor
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    • "However, many Medical Faculties/Institutes of Family Medicine have developed guidelines for their academic teaching practices. Studies have shown that teaching in ambulant care settings is beneficial [4], [5] and even valued as advantageous compared to medical education in the hospital. [6], [7] Current modifications to medical education in Germany generally demand a higher amount of practical training for undergraduates. "
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    ABSTRACT: In Germany, family physicians (FPs) are increasingly needed to participate in undergraduate medical education. Knowledge of FPs' motivation to teach medical students in their practices is lacking. To describe a novel questionnaire that assesses the motivation of FPs to teach undergraduates in their practices and to show the results of a subsequent survey using this instrument. The questionnaire was developed based on a review of the literature. Previously used empirical instruments assessing occupational values and motivation were included. A preliminary version was pretested in a pilot study. The resulting 68-item questionnaire was sent to 691 FPs involved in undergraduate medical education. Reliability was assessed and subgroups were analyzed with regard to differences in motivation. A total of 523 physicians in n = 458 teaching practices participated (response rate 75.7%). 'Helping others' and 'interest' were revealed as the predominant motives. Responses showed a predominantly intrinsic motivation of the participating FPs. Their main incentives were an ambition to work as a medical preceptor, to generally improve undergraduate education and to share knowledge. Material compensation was of minor importance. Time restraints were indicated as a barrier by some FPs, but were not a general concern. German FPs involved in medical education have altruistic attitudes towards teaching medical students in their practices. Motivational features give an important insight for the recruitment of FP preceptors as well as for their training in instructional methods.
    PLoS ONE 09/2012; 7(9):e45846. DOI:10.1371/journal.pone.0045846 · 3.23 Impact Factor
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    • "1975; Mendenhall eta/. 1979); changes in the financing of medical care (Perkoff 1986; Schroeder et a / . 1986); and changes in the utilization of hospital and ambulatory services (Perkoff 1976). "
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    ABSTRACT: In an academic medical centre between 1980 and 1985, the attitudes, preferences and career goals of house officers in a primary medical care residency training programme were assessed at entry and at the end of each house officer year. Primary care trainees who went on to practise in a general medicine setting were compared to primary care trainees who subsequently received subspecialty training and also to traditional internal medicine trainees. House officers in the primary care programme generally maintained attitudes and preferences central to the practice of primary care, and scored significantly higher than traditional track house officers on attitudes and preferences compatible with the practice of medicine in a primary care setting. However, primary care house officers who later went into subspecialty training received scores similar to those of traditional track house officers on practice preferences relating to specialty care. There were no significant differences between primary care and traditional track house officers on standard measures of knowledge and clinical skill.
    Medical Education 10/1987; 21(5):441-9. DOI:10.1111/j.1365-2923.1987.tb00393.x · 3.20 Impact Factor
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