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Contempo Updates
May 10, 2000

Teaching Medical Students in the Ambulatory SettingStrategies for Success

Author Affiliations

Author Affiliations: Departments of Family Medicine, Oregon Health Sciences University, Portland (Drs Fields and Steiner); and University of California, Los Angeles (Dr Usatine).

 

Contempo Updates Section Editors: Thomas C. Jefferson, MD, Contributing Editor; Stephen J. Lurie, MD, PhD, Contributing Editor.

JAMA. 2000;283(18):2362-2364. doi:10.1001/jama.283.18.2362

Because of recent societal and economic pressures, many patients who would have once been hospitalized are now receiving care in the ambulatory setting.1 Medical schools, which also have been affected by these trends, have responded by shifting undergraduate training away from the inpatient setting, thus reversing a century-old practice in medical education. Furthermore, the outpatient setting is increasingly valued in its own right as a training ground in basic clinical skills. Historically, the first 2 preclinical years of medical training were focused exclusively on basic science knowledge, involving little more than classroom and laboratory work. Many US medical schools are revising their curricula to include clinical experiences much earlier in the curriculum, generally in the form of preceptorships with community-based physicians in the ambulatory setting.2,3 There is often a centralized, longitudinal curriculum integrated with the preceptorship, which may emphasize communication skills, the medical interview, biopsychosocial medicine, clinical reasoning, physical diagnosis skills, population-based medicine, and ethics.2,3

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