Ambulatory education: Expanding undergraduate experience in medical education a CDIM commentary

Stagnaro-Green, Alex; Packman, Charles H.; Baker, Elizabeth A.; Elnicki, D. Michael

doi:10.1016/s0002-9343(99)80128-4

Cited by 8 publications

(4 citation statements)

References 25 publications

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“…All analyses were conducted in a fashion that assured student anonymity. 2 Tests for general association were used for discrete variables and Student t tests for continuous variables. PՅ.05 was considered to be statistically significant.…”

Section: Participants and Methodsmentioning

confidence: 99%

“…Recognition that the actual practice of medicine occurs mostly in an outpatient setting, the effect of managed care on reducing the number of patients available for teaching within the inpatient services, and the burden of increased direct patient care imposed on medical school faculty have all contributed to the move-ment of medical education out of the university hospital. [1][2][3][4][5] Reviews of the learning experiences of students in the ambulatory setting, as well as guidelines for medical education in community-based practices, have been published. [6][7][8] However, whether this transition of medical education to the community will provide students with knowledge and skills comparable to the knowledge and skills acquired by students trained in university settings is just beginning to be explored.…”

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confidence: 99%

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A Comparison of Performance Between Third-Year Students Completing a Pediatric Ambulatory Rotation on Campus vs in the Community

Malloy

Speer

1998

Arch Pediatr Adolesc Med

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Objective:To compare the performance of third-year medical students who completed the ambulatory component of their pediatric rotation in a community setting with the performance of third-year medical students who had their ambulatory experience on campus.Methods: As part of a pilot project to implement a thirdyear Multidisciplinary Ambulatory Clerkship, 61 thirdyear medical students spent 12 weeks rotating through the primary care disciplines of family medicine, internal medicine, and pediatric practitioners' offices at sites distant from the university campus while 127 students remained on campus for their ambulatory experiences in these disciplines. The components of the overall pediatric grade consisted of a clinical performance evaluation in the ambulatory setting (4 weeks), a clinical performance evaluation on a 4-week inpatient rotation, and a grade from a multiple-choice final examination. Results:The overall mean±SD final pediatric grade of students receiving their ambulatory pediatrics experience in the Multidisciplinary Ambulatory Clerkship was 86.5±3.4 compared with 88.0±3.4 for students receiv-ing their ambulatory experience on campus (P<.007). This difference was accounted for by performance on the written final examination. Multidisciplinary Ambulatory Clerkship students had a mean±SD score of 78.9±8.3 and a failure rate of 18% compared with a mean score of 83.7±8.1 and failure rate of 3.9% for students who remained on campus for their ambulatory experience (P<.001 for both comparisons). No differences were noted between the 2 groups on their clinical performance evaluations for their ambulatory or inpatient experiences.Conclusions: These data suggest a difference in the learning experience between students receiving their pediatric ambulatory experience in the community vs on campus. Differences in exposure to structured learning experiences that occurred more frequently on campus might account for some of the difference in final examination results. Development of a standardized, structured learning experience across community sites would seem to be an appropriate means of enhancing learning in the community setting.

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Section: Participants and Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

A Comparison of Performance Between Third-Year Students Completing a Pediatric Ambulatory Rotation on Campus vs in the Community

Malloy

Speer

1998

Arch Pediatr Adolesc Med

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“…D uring the last decade, there has been increasing pressure to move a significant portion of the undergraduate clinical curriculum from the inpatient setting into the community setting (Biddle, Siska, & Erney, 1994;Lesky & Hershman, 1995;Stagnaro-Green, Packman, Backer, & Elnicki, 1995). The shift to ambulatory education has been driven by many forces.…”

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confidence: 99%

The Impact of the Location and Structure of an Ambulatory Rotation on Cognitive Knowledge and Performance

Solomon

Rosebraugh²,

Speer³

et al. 1999

Eval Health Prof

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With the increasing shift to community-based ambulatory education, it is essential to gain a better understanding of the impact of these changes. To assess the impact of the location and structure of an ambulatory internal medicine clerkship rotation on cognitive knowledge and clinical performance, students were assigned to one of the following: (a) a multidisciplinary ambulatory clerkship (MAC), (b) the office of a community-based general internist, or (c) a university-based internal medicine ambulatory clinic. The groups were compared on the internal medicine clerkship examination and preceptor ratings controlling for introduction to clinical medicine course performance via analysis of covariance. MAC students were rated lower than the other two groups by their preceptors. There were no other statistically significant differences. The structure and location of the rotation had little impact on cognitive knowledge. The impact of the structure of the rotation on clinical performance is less clear suggesting that further research is needed.

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“…1998;152:806-811 A S THE training of medical students is directed more into the community and ambulatory setting, it becomes more important for academic medical centers responsible for setting learning objectives and evaluation standards to ascertain what is considered important by community physicians and to determine how preceptor expectations may relate to actual student performance. [1][2][3][4][5] Depending on how closely these expectations and actual student performance are related, modifications of either the expectations of the preceptors or the provision of more-structured learning experiences to help students attain the expected level of performance may be necessary.…”

mentioning

confidence: 99%

The Relationship Between Preceptor Expectations and Student Performance on 2 Pediatric Objective Structured Clinical Examination Stations

Malloy

Perkowski

Callaway

et al. 1998

Arch Pediatr Adolesc Med

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Ambulatory education: Expanding undergraduate experience in medical education a CDIM commentary

Cited by 8 publications

References 25 publications

A Comparison of Performance Between Third-Year Students Completing a Pediatric Ambulatory Rotation on Campus vs in the Community

A Comparison of Performance Between Third-Year Students Completing a Pediatric Ambulatory Rotation on Campus vs in the Community

The Impact of the Location and Structure of an Ambulatory Rotation on Cognitive Knowledge and Performance

The Relationship Between Preceptor Expectations and Student Performance on 2 Pediatric Objective Structured Clinical Examination Stations

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