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July 1985

Ambulatory Care Training: The Myth and the Reality

Author Affiliations


From the Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu.

Arch Intern Med. 1985;145(7):1255-1256. doi:10.1001/archinte.1985.00360070133022

The conventional wisdom is that residents learn best by going to the outpatient clinic one-half day each week for three years. There are several theoretic advantages to this system: it provides sufficient time to develop an ongoing relation with the patient; it is a useful experience in the long-term care of those with chronic disease; it permits the residents to follow up their inpatients as outpatients. Because such a program is considered the best method available for learning ambulatory care, evidence that this is the predominant outpatient exposure for residents often is required by funding and accrediting bodies.

Most practicing internists were trained in this style at the "brown bench" clinics of municipal or veterans' hospitals, or in the similar but slightly more pristine environment of university medical centers. About ten years ago, however, it became clear that the resident experience in outpatient clinics had been insufficient to prepare many

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