Feltovich J, Mast T A, Soler N G
Department of Medical Education, Southern Illinois University School of Medicine, Springfield 62708.
Res Med Educ. 1987;26:137-41.
Only a small percentage of schools at this point require an ambulatory care experience. Those which are increasing their experiences seem to be doing it out of necessity rather than educational efficacy. The existence of ambulatory experiences outside of internal medicine does not seem to be a factor in whether internal medicine departments have or are increasing their ambulatory experiences. Of the programs which do exist most have a goal of broad exposure to ambulatory patient problems; very few have special educational interventions to support or complement student's patient care. The existing programs overwhelmingly occur in school clinics rather than private clinics, and most suffer some serious logistic problems. The most frequently cited problem was lack of faculty time for teaching. It appears that in most cases students have been fitted into existing clinics or patterns of teaching, with insufficient effort given to achieving the maximal educational benefit for the student. Teaching students, particularly at the junior clerk level, requires committed faculty time, which is clearly a commodity in short supply. On the basis of this survey, there is reason to be concerned about both the educational effectiveness of existing student ambulatory teaching programs in internal medicine and whether such programs will manage to survive.
目前只有一小部分学校要求有门诊护理实习经历。那些增加此类实习经历的学校似乎是出于必要，而非出于教育效果的考量。内科以外的门诊实习经历的存在与否，似乎并非内科科室是否拥有或正在增加其门诊实习经历的一个因素。在现有的项目中，大多数的目标是让学生广泛接触门诊患者问题；很少有项目有特殊的教育干预措施来支持或补充学生的患者护理工作。现有的项目绝大多数都在学校诊所而非私人诊所开展，并且大多数都存在一些严重的后勤问题。最常被提及的问题是缺乏教师教学时间。在大多数情况下，似乎是学生适应现有的诊所或教学模式，而在为学生实现最大教育效益方面投入的精力不足。教授学生，尤其是初级职员级别的学生，需要教师投入大量时间，而这显然是一种稀缺资源。基于这项调查，有理由对现有内科学生门诊教学项目的教育效果以及此类项目能否存续感到担忧。
