FP Report -- November 1998 Ambulatory care training data reveal pros, cons
Research on ambulatory care training swings from upbeat to "oops!"
On the up side, the scale and scope of ambulatory training are greater than expected.
Hospital-related and community-based ambulatory teaching sites train an average of three types of professionals, not just one. And training encompasses community-oriented primary care, self-directed learning, service projects, lectures, supervised patient care and rounds.
"The community impact of ambulatory care has been beneficial. It's increased staffing, resources and economic benefits at many sites," medical educator Sarena Seifer, M.D., of Seattle said at the Sept. 24-26 national initiatives meeting in Baltimore. "Besides, being able to teach is a retention tool."
On the down side, teaching sites have higher costs than other sites, and teachers have less time for patients. One study indicates nonteaching physicians see 12 1/2 patients per half-day, and teaching physicians see 11 1/2 patients on the half-day they teach. However, teachers' weekly productivity exceeds that of nonteachers.
Joseph Scherger, M.D., M.P. H., suggested, "Students can assist the office staff and the doctor. Students can save the doctor time that can be traded for teaching time."
Scherger is associate dean for clinical affairs at the University of California, Irvine's medical school; professor and chair of the family medicine department; and former AAFP director. He puts students to work. They bring the patient to an exam room, take the patient's history, and often do parts of the exam and present patients in the exam room. "The patients love hearing themselves presented," said Scherger. "I tell them, 'If Eileen misses anything, jump in.'"
He added, "If students aren't looked at as an asset to managed care, the problem isn't managed care, it's us."
FP Report is published by the AAFP News Department. Copyright © 1998 by American Academy of Family Physicians.
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