About 90 percent of medical care takes place in an ambulatory setting, and the average physician appointment is about 15 minutes, according to Patricia Carney, PhD, author of three of the studies. Teaching and learning in the ambulatory care setting have been described as inefficient, variable and unpredictable. Inserting medical student teaching into that environment is different than having a captive audience at the patient's bedside and medical educators are continually evaluating ways to assure that doctors-to-be have the kind of experiences they need.
"DMS has significant and long experience with the challenges of teaching in the ambulatory setting," notes Martha Regan-Smith, MD, lead author of one of the articles. "It was the first (in 1989) medical school to implement a clinical curriculum in which more than 40% of its required clerkship curriculum [when students gain experience with patients in medical settings] was in the ambulatory setting. Prior to 1989, the clerkship curriculum was like others in that most all of the required clerkships were taught in hospital using inpatientsonly community and family medicine was taught in an outpatient setting. After 1989, all clerkships had at least a portion of their clerkship taught in the outpatient setting."
Several studies have revealed teaching in outpatient clinics has a negative impact on preceptor productivity, and a teaching model that fully integrates the learner into the practice and the process of care has not yet been developed. In one article, however, DMS authors present a promising model of ambulatory teaching that was piloted in
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