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I congratulate Drs Girard and co-workers on making their ugly duckling fly. Ours could never get airborne properly.
I did not argue that a block ambulatory care rotation obviates (emphasis added) the need for a longitudinal clinical experience. I did say that block training was better than longitudinal training, given our experience. In an ideal world, a combination of the two, as Girard and co-workers emphasize, would be best. We could not achieve that ideal state in Hawaii, but maybe life is simpler in Portland. I plead innocent to naivete, but guilty (alas!) to realism.
Relations with patients do need time to develop, but we found that attitudinal and logistic problems often prevent this from happening effectively. On balance, it is better to have block training so residents can concentrate fully on outpatient problems, and also participate in the hospital care of their outpatients, than it is to impose a
Schatz IJ. The Need for Longitudinal Ambulatory Care Training-Reply. Arch Intern Med. 1986;146(1):208. doi:10.1001/archinte.1986.00360130250050
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