Introducing ambulatory care during the medicine clerkship: impact on evaluation and attitudes

This article assesses student attitudes and the overall educational impact after a major curriculum change that implemented ambulatory care in an internal medicine clerkship. The study was cross-sectional with a historical comparison group and took place in a university teaching program with third-year students from three time periods. The 8-week clerkship was changed from 8 weeks of inpatient ward medicine to 4 weeks each of inpatient and ambulatory care in both primary care and subspecialty clinics. When students' responses before and after the curriculum change were compared, there was a significant improvement in evaluation of the clerkship experience (P = 0.001). Attitudes improved toward a general internal medicine career (P = 10(-5)) and there was improvement in evaluation of the inpatient experience (P = 0.01). Attitudes toward careers in subspecialty internal medicine and National Board examination scores were unchanged. The institution of ambulatory care into this internal medicine clerkship resulted in several significantly positive outcomes without a negative impact on the internal medicine knowledge base.