Teaching medical students in ambulatory settings in departments of internal medicine

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.