Feltovich J, Mast T A, Soler N G
Department of Medicine, Southern Illinois University School of Medicine, Springfield 62702.
Acad Med. 1989 Jan;64(1):36-41. doi: 10.1097/00001888-198901000-00015.
Clinical training in ambulatory settings is an increasingly prominent topic in medical education, but most descriptions of internal medicine programs in the literature concern training for residents. The authors undertook a survey of departments of internal medicine to obtain and assess information about requirements for ambulatory clinical experiences for medical students. The results show that few departments (24% of the 101 departments responding) required ambulatory care experiences for undergraduates. Most of the required programs had a goal of broad exposure to ambulatory-patient problems; almost none had special educational interventions to complement students' care of patients. The experiences that were incorporated into the clerkship in a single block of time were more favorably rated than the experiences that occurred intermittently throughout the clerkship. Inability to provide continuity-of-care experience was an important concern of the departments. Most programs had logistical problems, the most serious and frequently cited being the lack of faculty time for teaching. The authors raise concerns about the educational effectiveness of many existing programs and, given the problems with faculty involvement, about the long-term viability of these programs.
门诊环境中的临床培训在医学教育中日益成为一个突出的话题，但文献中对内科项目的大多数描述都涉及住院医师培训。作者对内科学系进行了一项调查，以获取并评估有关医学生门诊临床经验要求的信息。结果显示，很少有科室（在回复的101个科室中占24%）要求本科生有门诊护理经验。大多数必修课程的目标是让学生广泛接触门诊患者问题；几乎没有课程有专门的教育干预措施来辅助学生对患者的护理。在一个时间段内集中安排在临床实习中的经验比在整个临床实习期间断断续续安排的经验得到的评价更高。无法提供连续护理经验是各科室的一个重要担忧。大多数项目都存在后勤问题，最严重且经常被提及的是缺乏教师教学时间。作者对许多现有项目的教育效果表示担忧，并且鉴于教师参与存在的问题，对这些项目的长期可行性也表示担忧。
