Ambulatory medical education: teachers' activities, teaching cost, and residents' satisfaction

To assess faculty activities and costs in supervising ambulatory patient care at a family practice clinic, and to assess resident satisfaction with access to ambulatory care teaching.

This time-and-motion study was conducted in 1993 over two three-week periods (at the end of one academic year and at the beginning of another) in a family practice clinic affiliated with the University of Iowa College of Medicine. Observers recorded time spent by 14 faculty on teaching and non-teaching activities. Thirty-two residents were surveyed about their satisfaction with access to teaching.

Over 59 half-days, 2,644 faculty service events were recorded; 47% were teaching events (supervising care delivered by residents) and 53% were non-teaching events (providing care for other clinic patients). Mean teaching time was greater for first-year residents; they consulted faculty more frequently and required more teaching time per consultation. The most common non-teaching activities were telephone calls out, telephone calls in, and inquiries from nurses and office staff. Ten percent of non-teaching activities interrupted teaching, and 17% of the residents reported their teaching had been interrupted. Eighty percent of the residents were satisfied with their access to teaching, but 12% reported they had had to postpone discussing pressing patient problems. Resident dissatisfaction correlated with longer perceived waiting time, interruption of teaching, and faculty inaccessibility.

Faculty should plan to spend two to three times longer to teach lower-level residents than upper-level residents. By delegating some non-teaching activities to other personnel, faculty can reduce teaching costs and increase resident satisfaction.