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Commentary
February 14, 2000

The Market Pushes Education From Ward to Office, From Acute to Chronic Illness and PreventionWill Case Method Teaching-Learning Change?

Arch Intern Med. 2000;160(3):273-280. doi:10.1001/archinte.160.3.273

LOOKING BACK, clinical education, largely centralized in the hospital ward since the 1900s, has focused on the diagnosis and treatment of acute disease. Over these years, with various other pedagogical rationales, recurring efforts have been made to move more education from the ward to the clinic. These outpatient programs have been largely unsustained, sometimes resisted. But in the last decade, a market economy, decentralized technologies, and group organization of practice have moved more care outside the hospital, pressuring more education into ambulatory practices. This market move of education into an ambulatory mode brings educational challenges: (1) a reorientation of teaching and learning from acute to chronic illness and prevention; (2) a redirected use of the case method from diagnosis alone to patient-centered assessment and management; and (3) a commitment to the goals of care, ie, early diagnosis, prevention, and rehabilitation. Ambulatory teaching-learning practices also require changing roles of students, instructors, patients, and organizations. According to Cabot,1 dispensary work should stand for "heading off incipient disease, preventive work, care of chronics, teaching the public self care, medical education and social service."

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