A decade's experience with a preceptorship. A model for gastroenterologic education

I have conducted an experiment in medical subspecialty education during the last 10 years in the division of gastroenterology of the Mount Sinai School of Medicine in the form of 3-month preceptorships during the second year of the fellowship. I recognized that our training program, along with other subspecialty training programs, was no longer a purely hospital affair, but its future lay as well in the outpatient setting. I wanted to have the fellows participate in the daily care of patients in the realistic setting of practice. I hoped to offer them the excitement, as well as the problems, of daily gastroenterology practice. By seeing new and established patients with gastrointestinal problems in four daily sessions, and caring for hospitalized patients, including those being operated on, the fellows were to participate in every aspect of a busy office. The flavor of reality was to be heightened by their exposure to the preceptor's uncensored discussions with the patient, the family, the radiologists, endoscopists, and referring physicians. Here I report what the fellows and I have learned from experience, and I address the problems we all must face in the era of managed care, with the ongoing reduction in the number of specialists. I also consider who will do the teaching and who will pay them to protect the time they need.