Meeting an expanding educational role for ambulatory care services

The mid-1980s have been marked by a growing shift in the locus of health care delivery: from the in-patient setting to ambulatory care programs. As a result of cost containment strategies--exemplified by the diagnosis related group method for hospital reimbursement--the ambulatory care network has assumed responsibility for many patients with advanced or complicated diseases. This increased responsibility is in addition to preventive services, health maintenance, and routine care of acute and chronic conditions. This shift not only requires expansion of the current system for delivery of primary care services, but will also increase the role that organized ambulatory care programs will have to play in the education of health professionals. On the basis of a ten-year experience in utilizing two county funded neighborhood health centers for primary care training of family practice residents and medical students, undergraduate and postgraduate medical education programs are discussed in terms of the changes they impose on ambulatory care program organization (e.g., staffing, space, patient assignment and consent), proposed financing, and agreements with educational institutions. The increased administrative burden of training programs is offset by benefits which include staff satisfaction, enhanced quality of care, and an increase in the pool of appropriately trained physicians.