An agenda for residency training in ambulatory care.

The successful practice of internal medicine in the ambulatory setting must take into consideration a number of factors that differ qualitatively and quantitatively from those important to practice on the hospital ward. The physician's intellectual ability, understanding of pathophysiology, and competence in physical examination are indispensable to practicing in both settings. However, due to the nature of presenting problems, the availability of time, and the role of patient cooperation, the application of these skills and knowledge and the decision-making process differ in the two settings. The recognition of these factors by the resident is likely to enhance his understanding of his therapeutic role, further his capacity to provide care to a diverse spectrum of patients, and promote greater satisfaction for himself and his patients. These considerations are especially important because most practicing internists spend most of their clinical time in the ambulatory settings.