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
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
Fields SA, Usatine R, Steiner E. Teaching Medical Students in the Ambulatory Setting: Strategies for Success. JAMA. 2000;283(18):2362–2364. doi:10.1001/jama.283.18.2362
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