Teaching medical students in ambulatory settings in departments of internal medicine

Abstract

Clinical training in ambulatory settings is an increasingly prominent topic in medical education, but most descriptions of internal medicine programs in the literature concern training for residents. The authors undertook a survey of departments of internal medicine to obtain and assess information about requirements for ambulatory clinical experiences for medical students. The results show that few departments (24% of the 101 departments responding) required ambulatory care experiences for undergraduates. Most of the required programs had a goal of broad exposure to ambulatory-patient problems; almost none had special educational interventions to complement students' care of patients. The experiences that were incorporated into the clerkship in a single block of time were more favorably rated than the experiences that occurred intermittently throughout the clerkship. Inability to provide continuity-of-care experience was an important concern of the departments. Most programs had logistical problems, the most serious and frequently cited being the lack of faculty time for teaching. The authors raise concerns about the educational effectiveness of many existing programs and, given the problems with faculty involvement, about the long-term viability of these programs.

Perspectives on ambulatory programs: Barriers and implementation strategies

“…Several medical schools are doing this, but barriers and problems associated with establishing ambulatory clerkships have daunted many planners. 8 " 10 We discuss some of the issues involved in creating ambulatory programs as well as strategies several institutions have used to try to address them. Some obstacles are specific to certain initiatives and programs; most are well known to almost all planners of ambulatory activities.…”

The Market Pushes Education From Ward to Office, From Acute to Chronic Illness and Prevention

“…Whether for knowledge, skills, or attitudes, clinic assignments, long ago and even today, have been viewed to be of limited value by students, residents, and faculty. [34][35][36] Indeed, staff members thought that more was learned on the ward in making the diagnosis of acute illness than in the clinic in caring for the chronically ill. 37 Conventional faculty wisdom held that outpatient care did not require additional diagnostictherapeutic skills beyond those already learned on the ward, nor more clinical scientific knowledge than had already been acquired in the classroom. Moreover, what might be learned in the outpatient department could be later learned "on the job" in practice.…”

Evaluación de un módulo de docencia ambulatoria de enfermedades respiratorias en el currículo de pregrado de Medicina

“…Es así como en la práctica clínica actual, en el hospital se concentra la atención de los pacientes más graves y complejos, que requieren mayores recursos para su evaluación y tratamiento, y que son cada vez más representativos de las subespecialidades médicas y menos representativos de la práctica médica cotidiana [2][3][4][5] . La necesidad actual de contención de los costos de salud y las expectativas de los pacientes han llevado a acortar las estadías de los pacientes en el hospital, favoreciendo el manejo ambulatorio de la mayor parte de los problemas de salud de la población [6][7][8] .…”

“…En la actualidad, la educación médica de pregrado tradicional, centrada en la atención de pacientes hospitalizados, es considerada menos favorable para el aprendizaje de las competencias clínicas de los estudiantes y el ámbito ambulatorio ofrecería mayores ventajas [4][5][6][7]13,14 .…”