A survey of undergraduate internal medicine education in ambulatory settings.

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.